Derm / vulva / FGM Flashcards
To which viral class does Molluscum contagiosum belong?
a. Adenovirus
b. Herpes virus
c. Pox virus
d. Papillomavirus
c. Pox virus
O
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
d. Immunocytochemistry suggests an eccrine gland origin of the cells
O
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
A cystic structure is found at the fourchette 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
e. Crohn’s disease
a. Epidermoid cyst
O
benign cyst derived from the infundibulum or upper portion of a hair follicle, encapsulated in a thin layer of epidermis-like epithelium
Paget disease of the vulva is best treated by
a. Radiation therapy
b. Simple vulvectomy
c. Topical 5 flurouracil cream
d. Local excision
e. Laser vaporisation
d. Local excision
O
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
a. Wide local excision of all abnormal areas
O
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
d. Skin biopsy and histology
O
Approximately what percentage of patients with vulvar intraepithelial neoplasia (VIN) are 40 years of age or younger?
A. None B. 10% C. 20% D. 50% E. 90%
D. 50%
O
Typically occurs in young women (35-40y)
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
a. Occurs more frequently on the labia majora than minora
O
Most common on the labia minora
Majority are in postmenopausal women
Although vulvar melanomas account for less than 1 percent of all melanomas, they represent 2-10 percent of all malignant tumors involving the vulva
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
a. It forms white lesions on mucosal surfaces and causes an erosive vaginitis
O
Lichen sclerosus is MOST effectively treated with
a. Oestrogen
b. Testosterone
c. Corticosteroids
d. Excisional surgery
c. Corticosteroids
O
Epidermal atrophy, subepidermal hyalinization, lichenoid mononuclear infiltrate in dermis
Mrs Brown is a 67yo who presents with a long history of vulval irritation which has been extensively treated for thrush. On examination, there are thickened white areas associated with labial resorption. The most likely diagnosis is:
a) Chronic keratinised candida
b) Epidermyolysis Bullae
c) Lichen Sclerosis
d) Lichen Simplex Chronicus
c) Lichen Sclerosis
O
Lichen planus, incorrect option
a) purple scaly patches
b) white mucosal lesions
c) flexor surfaces
d) erosive vaginitis
e) saw tooth rete pegs
f) corticosteroids effective
a) ??
J says c) but from what I can see flexors surfaces are effected…
A 22-year-old primigravid woman presents to your birthing suite. She has had limited antenatal care in Nigeria. She is at term and contracting 4:10. On vaginal examination she has grade 3 Female Genital Mutilation.
What is the most appropriate management?
a. Immediate LSCS
b. An anterior episiotomy and re-infibulate after delivery
c. An anterior episiotomy and control of bleeding only
d. A right mediolateral episiotomy
c. An anterior episiotomy and control of bleeding only
Type 3 - Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora +/- excision of the clitoris
As per RANZCOG document- Reinfibulation is against the law!
A woman presents at 6 weeks gestation and on examination has a type 3 female genital mutilation (circumcision). What is the OPTIMAL TIME to undergo deinfindibulation during pregnancy in order to minimize the maternal and fetal risk?
A. During the first trimester
B. During the second trimester
C. During the third trimester
D. Intrapartum
B. During the second trimester
O
May be done in labour but challenge is arranging somebody suitable hence why 2nd trim is preferable.
Of the following vulva lesions which is LEAST likely to be pigmented?
A. lentigo B. melanosis C. acrohordon D. nevus E. seborrhoeic keratosis
C. acrohordon
= skin tags
O
