Derm / vulva

Question 1

Molluscum contagiosum is a

a. Adenovirus
b. Herpesvirus
c. Pox virus
d. Myxoma virus

Answer 1

c. Pox virus

Question 2

Which of the following is NOT TRUE of Paget disease of the vulva

a. Typically there are red raised lesions
b. It tends to recur despite free excisional margins
c. Co-existent cancer is present in ¼ of cases
d. Immunocytochemistry suggests an eccrine gland origin of the cells

Answer 2

d. Immunocytochemistry suggests an eccrine gland origin of the cells

Examination:

• Lesions may appear as eczematoid with a scaly surface but vague margins
• Or may be sharply bordered with a red and velvety texture with areas and islands of hyperkeratosis

Paget’s disease of the vulva

• Intraepithelial adenocarcinoma
• Vulval adenocarcinoma may be present in 4-8%

Histology - Classically large round atypical cells with oval nuclei and pale cytoplasm singly or within clusters among basal cells of the epidermis

Question 3

A cystic structure is found at the fouchette in the midline. Which is the MOST LIKELY diagnosis?

a. Epidermoid cyst
b. Sebaceous cyst
c. Skene’s gland cyst
d. Gartner’s duct cyst

Answer 3

a. Epidermoid cyst

benign cyst derived from the infundibulum or upper portion of a hair follicle, encapsulated in a thin layer of epidermis-like epithelium

Question 4

Paget disease of the vulva is best treated by

a. Radiation therapy
b. Simple vulvectomy
c. Topical 5 flurouracil cream
d. Local excision

Answer 4

d. Local excision

Question 5

A 37yo woman has three white patches on her vulva. Biopsies of all sites show VIN3. The MOST APPROPRIATE treatment is

a. Wide local excision of all abnormal areas
b. Simple vulvectomy
c. Laser ablation of all abnormal areas
d. Repeat examination in three months

Answer 5

a. Wide local excision of all abnormal areas

Question 6

Lichen sclerosus is best diagnosed by

a. Basal cell antibodies
b. Skin mycology, microscopy and culture
c. Parietal cell antibodies
d. Skin biopsy and histology

Answer 6

d. Skin biopsy and histology

Question 7

Approximately what percentage of patients with VIN are age 40 or less?

a. 0%
b. 10%
c. 20%
d. 50%
e. 90%

Answer 7

d. 50%

Typically occurs in young women (35-40y)

Question 8

Which is LEAST true of vulval melanoma

a. Occurs more frequently on the labia majora than minora
b. 5 year survival with subcutaneous penetration is approximately 20%
c. A majority of melanoma cases are post menopausal
d. Melanoma represents approximately 2 percent of all vulval malignancies

Answer 8

a. Occurs more frequently on the labia majora than minora

Question 9

Which of the following is TRUE regarding lichen planus

a. It forms white lesions on mucosal surfaces and causes an erosive vaginitis
b. There are multiple purple scaly papules present
c. It favours extensor surfaces
d. Topical corticosteroids are ineffective

Answer 9

a. It forms white lesions on mucosal surfaces and causes an erosive vaginitis

Question 10

Lichen sclerosus is MOST effectively treated with

a. Oestrogen
b. Testosterone
c. Corticosteroids
d. Excisional surgery

Answer 10

c. Corticosteroids