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Cervical/Vulval Disorders Flashcards

1
Q

Cervical ectropion

A

columnar epithelium of the endocervix (the canal of the cervix) has extended out to the ectocervix (the outer area of the cervix)

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2
Q

Ectocervix epithlium

A

Stratified Squamous

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3
Q

Cervix func

A
  • mucus plug to protect the fetus
  • prevent infection
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4
Q

Cervical polyps

A

Common benign neoplasm protruding from the inner surface of the cervix

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5
Q

Large Cervical polyp Mx

A
  • Surgical D&C
  • electrosurgical excision
  • hysterocopic polypectomy
  • Sent for Histology
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6
Q

Cervical ectropion Risk factors

A
  • COCP
  • Pregnancy
  • Adolescence

oestrogen dependent

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7
Q

Cervical Ectropion Mx for asymptomatic ectropion

A
  • NO Tx for asymptomatic ectropion
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8
Q

Nabothian Cyst

A

Fluid filled cyst located commonly at the CIJ

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9
Q

Lichen Sclerosus Sx

A
  • Pruritis
  • Pain
  • Superficial dyspareunia
  • Skin tightness
  • Fissures
  • Erosions
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10
Q

Lichen Sclerosus clinical findings

A
  • Erythema
  • White patches
  • Crinkly/fine wrinkling of skin
  • Atrophy: fusion of labias, clitoris hood,
  • ‘Figure of eight’ vulval-perianal extension
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11
Q

Define Lichen simplex

A

Chronic inflammation, irritation and lichenification of the skin from persistent scratching

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12
Q

Lichen simplex Sx

A
  • Pruritis
  • Plaques
  • Erythema
  • Scaling
  • Excoriations
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13
Q

Lichen simplex Mx

A
  • Topical steroid clobetasol 2/52
  • emollient / as a soap substitute
  • Avoid soap, shower gel or bubble baths
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14
Q

Define Lichen Planus

A

autoimmune condition that causes localised chronic inflammation with shiny, purplish, flat-topped raised areas

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15
Q

Define Bartholin cyst

A

The swelling of the Bartholin’s glands

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16
Q

Bartholin’s small/asymptomatic cyst Mx

A
  • Analgesics
  • Good hygiene
  • can use warm baths to encourage spontaneous rupture
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17
Q

Cervical ectropion causes

A

assoc with higher oestrogen levels

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18
Q

Cervical ectropion risk factors

A
  • Pregnancy
  • COCP
  • Younger women
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19
Q

Cervical ectropion Sx

A
  • Asymptomatic
  • Post-coital bleeding
  • Dyspareunia
  • Abnormal vaginal discharge
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20
Q

Cervical ectropion transformation zone

A

Squamocolumnar junction: the border between the columnar epithelium of the endocervix (the canal), and the stratified squamous epithelium of the ectocervix (the outer area of the cervix visible on speculum examination)

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21
Q

Cervical ectropion examination findings

A
  • Well-demarcated border = Transformation zone
  • Red (columnar) / pale pink (squamous)
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22
Q

Cervical ectropion further Ix

A
  • Ask about smear
  • can refer for colposcopy
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23
Q

Cervical ectropion Mx for problematic bleeding

A
  • Thermal cautery w/ silver nitrate
  • Cryotherapy (freezing) during colposcopy
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24
Q

Bartholin’s glands location

A

Both side of the post. vagina introitus (vaginal opening)

approx. 4/8 o’clock of the vaginal orifice

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25
Bartholin's cyst aetiology
- Blocked ducts of the Bartholin's glands
26
Bartholin's cyst complications
Bartholin’s abscess
27
Bartholin’s abscess Sx
- Swelling - Hot - Tenderness - Erythema - pus discharge - Lymphadenophathy - systemically unwell
28
Bartholin’s cyst Sx
- Unilateral - Swelling - Tenderness - filled w/ fluid
29
# 3 organisms Bartholin's abscess common infective organisms
1. E. coli 2. Chlamydia / gonorrhoea 3. MRSA
30
Bartholin's cyst **Ix** for women >40 years
A bx of the cyst to exclude **vulval carcinoma** | Histology
31
Bartholin’s abscess Mx
1. Abx 2. **Surgically**: - Bartholin's ballon: catheter to keep abscess open and hole forming after healing - Marsupialisation: suturing the sides of abscess open to allow drainage
32
Bartholin's glands functions
Secreting lubricant during sexual arousal
33
Define Lichen Sclerosus
an inflammatory skin condition that predominantly affects the **anogenital** area in women
34
Lichen Sclerosus complications
1. **Infections**: candida albicans, Staph. aureus, HSV 2. **SCC**: up to 5% of patitients
35
Cervical Polyps Pathophysiology
Focal hyperplasia of the **columnar epithelium** of the **endocervix**
36
Cervical Polyps aetiology
- Chronic inflammation - Abnormal response to **high** oestrogen (cervical polyps are associated with endometrial hyperplasia) - Localised congestion of the cervical vasculature
37
Cervical polyp Risk factors
- women 40-50 years - **multigravidae**
38
Cervical polyps Sx
- often **asymptomatic** - **Abnormal vaginal bleeding**: menorrhagia, intermenstrual, post-coital, post-menopausal - Increased vaginal discharge
39
Small Cervical polyps Mx
Twisting the polyp off with polypectomy forceps
40
Cervical Screening Timeline
1. 24.5yrs invite 2. 25-49 years 3 yearly 3. 50-64years 5 yearly *>65years (if recent smear = abnormal, OR if not had smear since age 50)
41
Define Nabothian Cysts
fluid-filled cysts often seen on the surface of the cervix
42
Usual size of nabothian cyst
Up to **1cm**
43
Nabothian Cysts Pathophysiology
When the **squamous epithelium** of the **ectocervix** slightly covers the **mucus-secreting columnar epithelium** of the **endocervix**, the mucus becomes trapped and forms a cyst
44
Nabothian Cysts Risk factors
- common in adult cervix - Post childbirth - minor trauma to the cervix - cervicitis
45
Nabothian cysts clinical findings
- smooth rounded bumps on the cervix - near to the cervical os - white or yellow in appearance
46
Nabothian cysts Mx
- Usually **NO Tx** required - Large cyst: cautery or cryotherapy
47
Define Cervicitis
Inflammation of the cervix characterised by a purulent **endocervical exudate** and/or easily induced endocervical bleeding caused by manipulation with an atraumatic instrument such as a cotton swab
48
Cervicitis common causative organisms
1. Chlamydia 2. Gonorrhoea
49
Cervicitis complications
- Pelvic Inflammatory Disease - Infertility **secondary to PID** - Chronic pelvic pain **secondary to PID** - Ectopic pregnancy **secondary to PID**
50
Cervicitis Risk Factors
- Women age 15-24 - Inconsistent condom use - multiple/new sexual partners - Prev STIs - Bacterial vaginosis
51
Cervicitis Common Sx
- Purulent vaginal OR cervical discharge - IMB/Post-coital bleeding - Dysuria - Increased urinary freq. - Easily induced cervical bleeding (e.g. cotton bud on examination) - **Systemically unwell** if progressed to **PID**
52
Cervicitis Uncommon Sx
- Dyspareunia - Strawberry cervix
53
Cervicitis Mx for **non-pregnant women**
- **Chlamydia** 1st: Doxycycline 100mg BD 7/7 2nd: Azithromycin 1g stat, 500mg OD 2/7 - **Gonorrhoea** 1st: single dose IM ceftriaxone - **Trichomoniasis** 1st: Metronidazole and tinidazole - **BV** 1st: Oral/Vaginal Metronidazole, OR intravaginal clindamycin cream - **HSV** 1st: Aciclovir
54
Cervicitis Mx for **pregnant women**
- **Chlamydia** 1st: Azithromycin 1g stat, 500mg OD 2/7 - **Gonorrhoea** 1st: single dose IM ceftriaxone - **Trichomoniasis** 1st: Metronidazole and tinidazole - **BV** 1st: Oral/Vaginal Metronidazole, OR intravaginal clindamycin cream - **HSV** 1st: Aciclovir/Valaciclovir
55
Cervicitis Ix
STIs: chlamydia, gonorrhoea, syphilis, HIV, hepatitis
56
Chlamydia/Gonorrhoea screening method
CT NG NAAT: nucleic acid amplification test
57
Lichen Sclerosus Risk Factors
- Female - FMHx of LS
58
Lichen Sclerosus aetiology
- Autoimmune conditions - Trauma/infections - Genetic
59
Lichen Sclerosus Pathophysiology
T-cell mediated inflammatory disorder affecting the skin and mucosa, with a predilection for the vulvar and perianal area
60
# Tapering off method Lichen sclerosus Mx
**1st**: Topical clobetasol for 3/12. OD for 1/12, then alternate days for 1/12 and then twice weekly for 1/12 - with **emollients** **2nd**: Avoid irritant and fragranced products **3rd:** Use **cotton underwears** Avoid tight underwear causing frictions --> **Koebner phenomenon**
61
Steroid FTUs for genitalia
0.5 FTU
62
# P for purple Lichen Planus clinical findings
- Pruritis - Purple - Shiny flat topped papules - Wickham's striae (white lines)
63
Lichen Planus Sx
- Extreme pruritis - Painful ulcer / erosion - Can overlapp with **Lichen Sclerosus**
64
Lichen planus Risk factors
- Usually occur in women age >40
65
Lichen planus Mx
- Topical potent steroid: clobetasol - Referral to derm
66
Pruritus vulvae infection differentials
- Candida albican (thrush) - Scabies - Threadworm - **STI:** Trichomoniasis
67
Pruritus vulvae inflammatory differentials
- Lichen sclerosus - Lichen planus - Lichen simplex - Contact dermatitis - Psoriasis
68
Pruritus vulvae non-infectious/non-inflammatory differentials
- Oestrogen dificiency (Post-menopausal) - Regrowth of pubic hair after shaving - Psychological and sexual disorders - Malignancies
69
Cervical Smear contraindications
- Is menstruating. - Is <12 weeks post-partum - Is < 12 weeks after a termination of pregnancy, or miscarriage. - Is pregnant - Has a vaginal discharge or pelvic infection
70
Negative for high-risk HPV (hrHPV) smear recall
3 years
71
hrHPV positive and negative cytology smear Mx
1. Repeat smear in 12months - HPV test **negative at 12 months**, return to routine recall - HPV test **remains positive at 12 months**, repeat HPV test in a further 12 months - If HPV testing is **negative at 24 months**, return to **routine recall**.
72
Positive for hrHPV and abnormal cytology smear MX
Refer to colposcopy 2ww VS 6 week
73
Inadquate cervix cell smear Mx
Repeat smear in 3/12 for cells to regrow
74
When to refer for colposcopy
- If HPV testing remains **positive at 24 months, refer to colposcopy** - If 2 consecutive unavailable HPV or inadequate cytology - Positive for hrHPV and abnormal cytology
75
Cervical smear cytology results
- Borderline changes in squamous or endocervical cells. - Low-grade dyskaryosis. Up to 18/52 - High-grade dyskaryosis (moderate). 2ww - High-grade dyskaryosis (severe). 2ww - Invasive squamous cell carcinoma. - Glandular neoplasia.
76
Define Cervicitis
An inflammation of the cervix
77
Cervicitis causes
- Chlamydia - Gonorrhoea - Trichomonas - Herpes: HSV 6 / 11 - Bacteria vaginosis
78
Cervicitis Sx
- Intermenstrual bleeding - Post-coital bleeding - Vaginal discharge - Dysuria
79
Cervicitis Ix
- CT / NG NAAT - Endocervical swab
80

Obs & Gynae (21 decks)

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