[CLMD] Benign and Malignant Conditions of the Vulva and Vagina [Moulton] Flashcards

1
Q

Androgen insensitivity syndrome (46,XY) is most commonly inherited how?

A

X-linked recessive

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2
Q

Which disease is characterized by severe pruritic raised yellow retention cysts in the axilla and labia majora and minor resulting from keratin-plugged inflammation of apocrine glands?

A

Fox-Fordyce disease

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3
Q

What is the most common type of genital cyst?

A

Epidermal inclusion cyst = mobile, nontender, spherical, and slow growing

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4
Q

Sebaceous cysts of the vulva are most commonly found where and contain what?

A
  • Inner surface of labia minora and majora
  • Contain a cheesy sebaceous material
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5
Q

What is the most common benign solid tumor of the vulva; what are its growth characteristics?

A
  • Fibromas
  • Slow growing, most range from 1-10cm
  • CAN become gigantic (250 lbs!!!!)
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6
Q

Which condition of the vulva is assoc. w/ 1-4mm erythematous dots that are extremely tender and is characterized by severe introital dyspareunia and occasional vulvar pain?

A

Vulvar vestibulitis (vestibular adenitis)

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7
Q

What is the treatment for labial agglutination?

A

Estrogen cream and massagetoseparatethelabia majora

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8
Q

Vuvlvar hematomas most often arise following what; how are they managed?

A
  • Arise following trauma i.e., bike injuries (straddle injury), birth trauma or sexual assault
  • Close observation and occasional surgical exploration may be warranted
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9
Q

Atrophic vaginitis is due to what; managed how?

A
  • Due to loss of estrogen
  • Tx w/ topical estrogen and may consider oral estrogen to prevent recurrence
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10
Q

Treatment for lichen simplex chronicus?

A

Moderate strength steroid ointments w/ anti-pruritic agents

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11
Q

Biopsy of lichen sclerosis will show what 2 major characteristics?

A
  • THIN epithelium
  • Loss of rete ridges and inflammatory cells lining the BM
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12
Q

What is seen with lichen planus and what are the sx’s?

A
  • Purplish, polygonal papules that may appear in an erosive form
  • Sx’s: vulvar burning, severe insertional dyspareunia
  • Tx: topical and systemic steroids
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13
Q

Transverse vaginal septums are most commonly found where in the vagina and may only become apparent when?

A
  • Upper and middle thirds of the vagina
  • May only become apparent when intercourse is impeded
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14
Q

Mullerian agenesis characterizd by absence of the uterus but sparing of the fallopian tubes is known as what?

A

Rokintansky-Kuster-Hauser Syndrome

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15
Q

What is the most common vulvovaginal tumor?

A

Bartholin’s Cyst

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16
Q

Bartholin’s cysts are typically (uni-/bilateral); how does size dictate symptoms and when must you biopsy?

A
  • Typically unilateral swelling
  • <3cm is usually asymptomatic
  • Need to biopsy in women 40+ y/o to rule out a Bartholin’s carcinoma!
17
Q

What are 2 treatment options for bartholin’s gland abscess?

A
  • Word catheterization: left in for 4-6 wks which promotes an epithelialized tract for drainage of glandular secretions
  • Marsupialization: creates a new duct opening by everting the cyst wall onto the epithelial surface where it is sutured w/ interrupted absorbable sutures
18
Q

What is the most frequently reported symptom of vuvlar cancer?

A

Long history of chronic vulvar pruritus

19
Q

What is VIN III usual-type vs. differentiated-type?

A
  • Usual-type: assoc w/ HPV (16/18), smoking, and immunocompromised states; younger (35-65 y/o)
  • Differentiated-type: is NOT assoc. w/ HPV or smoking –> more commonly w/ vuvlar dermatologic conditions, such as Lichen Sclerosus; older (55-85 y/o)
20
Q

Paget’s disease of the vuvla is most common in whom and what are the signs/sx’s?

A
  • Postmenopausal white females
  • Itching and tenderness are common —> well-demarcated and eczematoid in appearance w/ fiery red background w/ white plaque-like lesions
21
Q

How is VIN type III managed clinically?

A
  • Local superficial surgical excision is mainstay of tx; 5mm margins are typically adequate
  • Can do skinning vulvectomy
  • Laser therapy is useful for small lesions on clit, labia minora or perianal areas
22
Q

What is the management for SCC of the vulva?

A
  • Radical vulvectomy and regional lymphadenectomy

or

  • Wide local excision of the 1’ tumor w/ inguinal LN dissection +/- pre-op radiation, chemo, or both
23
Q

What do the lesions of verrucous carcinoma of the vuvla look like; what kind of tx is contraindicated?

A
  • Lesions are cauliflower-like and can be confused w/ condyloma
  • Radiation = contraindicated because it may induce anaplastic transformation
24
Q

What is tx for Batholin’s gland carcinoma?

A

Radical vulvectomy and bilateral lymphadenectomy w/ post-op radiation

25
Q

When is the diagnosis of vaginal intraepithelial neoplasia (VAIN) usually considered?

A

When an abnormal pap in a woman who is status post-hysterectomy or has no demonstrable cervical lesion

26
Q

What is the main method of treatment for carcinoma of the vagina?

A

Radiation or chemoradiation

27
Q

When collecting sample for investigation of vaginal discharge where do you take the sample from?

A

Sample discharge from posterior fornix and place on slide

28
Q

Diagnosis of Gardnerella vaginalis as cause of vaginitis can be made with what 3 findings?

A
  • Saline wet mount reveals presence of “clue cells”
  • 10% KOH-positive whiff test
  • Vaginal pH >4.5
29
Q

What is treatment for Gardnerella vaginalis?

A

Metronidazole BID x 7 days

30
Q

Sx’s and characteristics of the discharge assoc. w/ vuvlovaginal candidiasis?

A
  • Vulvar itching, burning, irritation/dyspareunia
  • Often little to no discharge, but if present is white adherent and clumpy (cottage cheese-like)
31
Q

Diagnosis of vuvlovaginal candidiasis made via what 2 findings?

A
  • 10% KOH wet prep-positive for budding yeast
  • Vaginal pH <4.5
32
Q

Treatment for vulvovaginal candidiasis?

A
  • Diflucan
  • Vaginal application w/ synthetic imidazoles (miconazole, terconazole, etc.)
33
Q

What is the vaginal discharge like w/ symptomatic T. vaginalis?

A

Green-yellow “frothy” discharge

34
Q

How is diagnosis of T. vaginalis made?

A
  • Saline wet mount reveals motile trichomonads
  • pH >4.5
  • Strawberry cervix
35
Q

What is the treatment for T. vaginalis; must also evaluate for what?

A
  • Metronidazole
  • Is an STD, so test pt for STI’s and have partners evaluated too!