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ENRP Exam 1 > Benign Conditions Vulva And Vagina - Dr. Moulton > Flashcards

Benign Conditions Vulva And Vagina - Dr. Moulton Flashcards

1
Q

With ambiguous genitalia what should you do

A

PE , hormonal studies, karyotyping, us (usually with suboptimal or unsure genital structures the baby is assigned Female gender)

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2
Q

Female Pseudohermaphroditism

A

masculinization of female outside parts, Congenital adrenal hyperplasia, clitoromegaly, hypospadiac urethra meatus , malpositioned vaginal orifice

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3
Q

Male pseudohermaphroditism

A

Mosaicism + virulization and mullerian development, androgen insensitivity syndrome (feminization of a male external parts)

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4
Q

Androgen insensitivity is caused by

A

X androgen Rs, external F phenotype in male 46XY,

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5
Q

True hermaphroditism

A

Both female and male development externally and internally

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6
Q

Labial agglutination what and tx

A

Labia major as are stuck together, t4 with Estrogen cream and massage to separate the labias

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7
Q

Fox-Fordyce Disease what and from what

A

Severe itchy raised yellow cysts in axilla and labia majora/minora
= from keratin-plugged inflammation of apocrine glands

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8
Q

Inclusion cysts location and sx, tx

A

Under epidermis and mobile and nontender , slow growing , no tax required

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9
Q

Epidermal inclusion cysts , what, when, location

A
  1. Genital cysts most common,
  2. When hair follicles become obstructed
  3. Deep portion of follicle swells to accommodate the desquamated cells
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10
Q

Vulvar varicosities

A

Can become late during preg, blue color

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11
Q

Lentigo and nevi

A

Lentigo (freckles) and nevi (moles) make sure they are not melanoma

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12
Q

Urethral Caruncles

  1. Looks like
  2. Location
  3. Who and reason
A
  1. Small fleshy red outgrowth at distal edge of urethra
  2. Children = spontaneous prolapse of urethral epithelium

Post menopausal = hypoestrogen vaginal epithelium everting urethral epithelium

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13
Q

Vulvar Vestibulitis (Vestibular Adenitis) **

  1. What
  2. Sx
  3. Tx
A
  1. Infection of minor vestibular glands
  2. 1mm-4mm red dot lesions very tender + out of control PAIN, dyspareunia, vulvar pain
  3. Topical estrogen /hydrocortisone or surgery
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14
Q

Sebaceous cyst , location what, and looks like

A

Sebaceous gland inflammation , inner surface of labia minora and majora , cheesy material inside

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15
Q

Fibromas what, size,

A
  1. Most common benign solid tumor of vulva

2. Slow growing, 1cm -10cm (can get 250lb)

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16
Q

Lipoma what

A

Slow growing adipose tumor

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17
Q
  1. Hidradenoma
  2. Syringoma
  3. Neurofibromas
A
  1. Sweat gland of vulva lesion
  2. Eccrine gland tumor
  3. Von Recklinghausen disease
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18
Q

Angioma

A

many 2-3mm red lesion s usually 50yo,60yo women

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19
Q

Vulvar hematoma

A

Collection of bleed collect from trauma

= monitor and may have to do surgery so it does not bleed into peritoneal cavity

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20
Q

Atrophic Vaginitis how, sx, tx

A
  1. Low Estrogen (removed ovaries, menopause)
  2. Labia fuse together more and shrink , rugae of vagina lost (more smooth)
  3. give E topical or oral
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21
Q

Lichen Simplex Chronicus (Squamous Cell Hyperplasia)

  1. What
  2. Sx
  3. Histology **
  4. Tx
A
  1. Local thickening of epithelium from prolonged itching
  2. Itching + White, red thickened leathery raised surface (looks like psoriasis
  3. ELONGATED rete ridges + Hyperkeratosis of keratin layer **
  4. Steroid and antipruritic agent
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22
Q

Lichen Sclerosis

  1. What and who
  2. Sx + looks like
  3. Biopsy histology
  4. Tx
  5. Risk
A
  1. Menopause woman, on vulva
  2. Intense itching, dyspareunia, burning pain
    + Thin white inelastic skin, crinkled tissue paper like(onion skin, cigarette paper, parchment like)
  3. thin epithelium , LOSS of rete ridges**, inflammatory cells lining BM
  4. Clobetasol 0.05%
  5. SCC of vulva in 3% treated and 10% nontreated
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23
Q

Lichen Planus

  1. What
  2. Sx
  3. Syndrome it can form
  4. Tx
A
  1. Purple polygonal papules appear in erosive form
  2. Vulvar burning, severe insertional dyspareunia
  3. Vulvar-vaginal-gingival syndrome : lichen Planus of vulva vagina and mouth
  4. Topical and system steroids
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24
Q

Psoriasis

  1. Inheritance
  2. Looks like location
A
  1. AD

2. Velvety , no silvery scaly patches like on extremities, on vulva

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25
Q
  1. Pemphigus
  2. Bechets syndrome
  3. Crohn’s disease
A
  1. Autoimmune blistering disease on voluvovagina and conjunctiva
  2. Ulceration in genital, oral + uveitis
  3. Fistulations on vulva ulcerations
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26
Q
  1. Apthous ulcers
  2. Decubitus ulcers
  3. Acanthosis Nigricans
  4. Contact dermatitis
A
  1. Painful ulcers superficial (common in mouth)
  2. From chronic pressure (immobile elderly pts) or from wet tissue in urinalysis incontinence
  3. Brown pigment thickened skin, obesity, insulin resistance, benign or malignant conditions
  4. Soaps, perfumes , latex condoms, red, edema, ulceration,
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27
Q

Imperforate hymen

A

Bulging membrane like structure blocking vaginal opening , think dark bluish structure entrapping menstrual flow

28
Q

Transverse vaginal septum

A

Upper and middle 1/3 vagina , small sinus or perforation for menstrual flow , impede intercourse

29
Q

Midline, longitudinal vaginal septum what and associated with

A

Double vagina, can attach to lateral wall = blind vaginal pouch
= associated with duplication anomalies or uterine fundus

30
Q

Vaginal agenesis and associated with what

A
  1. Extreme anomaly, no vagina except distal part

2. Rokintansky Kuster Hauser Syndrome (Mullerian agenesis)= no uterus however Fallopian tubes present

31
Q

Adenosis what and who

A

Vagina wal has islands of columnar cells in the normal squamous epithelium
= women exposed to DES in uterus

32
Q

Gartners’s Duct Cyst

A
  1. From wolffian duct remnants (Mesonephric)
  2. 1cm-5cm on lateral wall of vagina
  3. Asymptomatic and no tx required
33
Q

Imperforate hymen
Microperforate
Cribiform
Septa the

A

Imperforate hymen = no vaginal opening
Microperforate = small vaginal opening
Cribiform = several small vaginal opening
Septa the = septa vaginal opening

34
Q

Urethral Diverticula

  1. What
  2. Can cause
  3. Tx
A
  1. Small 0.3-3.0cm sac like projections in anterior vagina along posterior urethra
  2. UTI, dysuria, urinary leakage
  3. Urethral dilation or excision (at urologist to avoid fistula formation)
35
Q

Inclusion cyst

  1. From what
  2. Location
  3. Associated with
A
  1. Infolding of vaginal epithelium
  2. Posterior lateral wall on lower 1/3 vagina
  3. Gyno surgery or laceration from childbirth
36
Q

Endometriosis characteristics of this

A

Can change in shape and pain with cycle

37
Q

Bartholin’s cyst

  1. What is it and type
  2. Sx and size
  3. What you see
  4. What do you do with this pt
A
  1. Most common vulvovaginal tumor
  2. Less then 3cm, asymptomatic
  3. Unilateral swelling
  4. Biopsy to rule out Bartholin’s carcinoma if over 40yo
38
Q

Bartholin’s Abscess

  1. SX
  2. From what
  3. TX
  4. Do what with this pt
A
  1. Painful**, inflammatory mass
  2. Blockage and accumulation of purulent material
  3. Word catheterization (leave in 4-6weeks to drain and glandular secretions = open up cyst and drain it
    + Marsupialization (creates a new ductal opening on vaginal wall for a new opening)
  4. Biopsy to rule out Bartholin’s carcinoma
39
Q
  1. Cystocele
  2. Rectocele
  3. Uterine prolapse
A
  1. Anterior vagina prolapse = bladder is pushing down on uterus and vagina (labia separate when standing)
  2. rectum pushed up pn uterus and vagina (push vagina to get stool out)
  3. Abnormal angle of vagina to uterus

= can happen from trauma or atrophy in elderly

40
Q

Fistula are from what abs causes

A
  1. Radiation, ob injuries, surgery complication (can also happen from atrophy in elderly)
  2. Rectum and vagina connected, urethra and vagina connected,
41
Q

Most vulvar vaginal malignant cancers are what and mean age and most common sx

A

SCC, 65yo postmenopausal , chronic vulvar pruritus

42
Q

VIN 1 and VIN 3

A

VIN 1 = vulvar mild dysplasia lower epidermis

VIN 3 = vulvar SCC

43
Q

VIN 3 usual type

A

Vulvar intraepithelial neoplasia : carcinogen HPV 16, smoking and immunocompromised reasons it happens

44
Q

VIN 3 differentiated type

A

Not associated with smoking of HPV, associated with dermatological conditions like Lichen Sclerosus

45
Q

VIN 3 SX

A

Pruritis

Elevated any color lesion , some are even warty

46
Q

VIN 3 managements

A
  1. Surgical incision with 5mm margins
  2. Skinning vulvectomy (remove vulvar skin = rarely done
  3. Laser therapy (small lesions on clitoris, labia minora, perianal)
47
Q

Paget’s disease

  1. Who
  2. What you should think of + do
  3. Sx
  4. Tx
A
  1. Postmenopausal white females (can also happen on nipples)
  2. Breast or colon carcinoma can also be present + do biopsy to see pagets cells
  3. Itching, tenderness, demarcated eczematoid fiery red with white plaque lesions
  4. Superficial excision 5-10mm margins to also exclude invasion
48
Q

SCC vulvar carcinoma

  1. Sx
  2. Who
  3. Spreads where
A
  1. Vulvar lump, itchy, raised, ulcerated, pigmented, warty, labia majora
    = do bx
  2. Postmenopausal 70yo-80yo
  3. Urethra, anus, vagina, bone/lung/liver
49
Q

VIN type 1
VIN type 2
(Age, cervical neoplasia association, preexisting lesion, cofactors)

A

VIN1 = high association, age + immune status + viral HPV, VIN preexisting lesion
VIN 2 = low association, vulvar atypia, lichen sclerosis + vulvar inflammation + Squamous cell hyperplasia preexisting lesions

50
Q

SCC vulvar carcinoma

  1. TX
  2. 5 year Prognosis stage 1+ 2 ,3,4
A
  1. Radial vulvectomy + LADectomy, excise tumor, usually only remove same side LN if stage 1
  2. 1 + 2 = 60%-80%, 3 = 45%, 4 = 15%
51
Q

Malignant Melanoma

  1. Who + location
  2. How common
  3. Tx and prognosis
A
  1. Postmenopausal white, labia minora and clitoris
  2. 2nd most common
    3 excision wide, 30% compared to non genital melanomas
52
Q

Verrucous carcinoma **

  1. Type
  2. Looks like and can be confused with
  3. TX
A
  1. Variant of SCC, usually no metastasis
  2. Cauliflower looking , can be confused with condyloma* from HVP*
  3. NO radiation = can induce anaplasitic transformation
53
Q

Bartholin’s Glands Carcinoma

  1. Sx
  2. Who
  3. Tx
  4. Prognosis 5 year
A

1 painless vulvar mass (dark color)

  1. 40yo and over have bx of any gland mass to Exclude
  2. Radical vulvectomy + bilateral LADetomy + postop radiation
  3. 85%, recurrence is common
54
Q

BCC of vulva looks like and tx

A

Rolled edge ulceration, roden like ulcer,

Local excision is fine (usually does not metastasize)

55
Q

VAIN (preinvasive Disease of vagina = Vagina Intraepithelial Neoplsia)

  1. How and what
  2. SX
  3. TX
A
  1. HPV virus , usually associated with pts with past cervical or vulvar cancer
  2. Asymptomatic abnormal pap post hyperectomy, no cervical lesions + do Colposcopic directed vaginal biopsy
  3. Excision if lesion on vault, many lesions = laser tx or topical 5-fluorouracil , vaginectomy
56
Q

Carcinoma of vagina

  1. Who
  2. Most common
  3. Sx
  4. Dx
A
  1. Over 60yo
  2. SCC
  3. Bleeding, discharge, hematuria , ulcer, growths
  4. Punch bx
57
Q

Carcinoma of vagina

  1. TX for upper and lower vagina
  2. Prognosis 5 years
A

Radiation and chemo
1. Upper = surgery + LADEctomy
LOWER = groin nodes removed if not excluded
2. 50%

58
Q 
Adenocarcioma of vagina 
1 goes where
2 clear cell from what 
3. Tx
4. Prognosis
A
  1. Cervix,, ovary, endometrium
    2 DES
  2. Hysterectomy, vaginectomy, radiation
  3. 80%
59
Q

Malignant MElanoma of vagina

  1. Who
  2. Locations
  3. Prognosis
A
  1. 55yo
  2. Distal anterior wall vagina
  3. 5%-10%
60
Q

Sarcoma Botryoides **

  1. Looks like + location
  2. Histo
  3. Who
  4. Tx
A
  1. Grape like polyps protruding from introitus
  2. Embryonal rhabdomyosarcoma
  3. 2yo-3yo
  4. Surgical resection, chemo, radiation
61
Q

Vagina normal epithelium

  1. Ph of vagina and what keeps the vagina at that
  2. . things that disrupt vagina ph
A
  1. Nonkeratinized stratified squamous epithelium
  2. 3.8-4.2, Lactic acid, H2O2 made by lactobacilli, + protects against STIs,
  3. ABs, Douching, sex, foreign body tampon
62
Q

How to test vaginal discharge *

A

Look at color, amount, texture

  1. Sample discharge at POSTERIOR FORNIX and put on Nitrazine paper
  2. Determines ph
  3. Then look at microscope (BV, Yeast, or Trichomonasis)
63
Q

Most common vaginal infection

64
Q

BV **

  1. Most common microorganism
  2. Risk
  3. Sx
  4. Dx how
  5. Tx
A
  1. Gardenerella Vaginalis
  2. Many sex partners, smoking, IUD, douching
  3. Asymptomatic, think milky discharge, fishy smell, esp after sex
  4. CLUE CELLS (saline wet mount), Amine odor (10% KOH + whiff test), Ph = over 4.5
  5. Metronidazole 500mg BID 7 days
65
Q

Vulvovaginal Candidiasis **

  1. Most common organism
  2. Risks
  3. Sx
  4. Dx how
  5. Tx
A

2nd most common vaginal infection
1. Candida albicans
2. High E levels (OCP, preg) DM, ABs, steroids, immunosuppressed pts
3. Vulvar itchy burning irritated dyspareunia, little white clumpy cottage cheese discharge
4. 10% KOH wet prep + = budding yeast (psudohyphea), ph under 4.5
5. Diflucan 150mg 1 time
OR Imidazole (miconazole, teraconazole = topical applications)

66
Q

Trichomonasis **

  1. Usually caused by
  2. Risks
  3. Sx
  4. Dx
  5. Tx
A
  1. Trichomonasis Vaginalis flagellated protozoan
  2. Unprotected sex
  3. Asymptomatic*, dyspareunia, vulvovaginal irritation, dysuria, GREEN-yellow frothy discharge
  4. Motile trichomonads (saline wet mount) + ph over 4.5 + STRAWBERRY cervix
  5. Metronidazole 2g single dose (test pt for STIs) + evaluate partners

ENRP Exam 1 (13 decks)

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