Disorders of the Vulva, Vagina, and Cervix- Seibert

Question 1

When in doubt what should you do?

Answer 1

Refer for bx

Question 2

A patient presents with intense vulvur pruritis in a >60 year old woman. Her vulvar skin is thin and wrinkled and has a “cigarette appearance” with areas of linchenification and hyperkeratosis. What is the most likely diagnosis?

Answer 2

Lichen sclerosis

*Seibert referred to it as “simple itch”

Question 3

What is the tx for lichen sclerosis?

Answer 3

*need bx w/ gyno
Stop the its scratch cycle
-antihistamine @ night and high potency topical steroid (Clobetasol)

Question 4

Those with Lichen Sclerosis are at higher risk for what type of cancer?

Answer 4

LIchen scleroris = simple itch = squamous cell CA

Question 5

A patient presents with a thickened, leathery appearance on her labia majora. She states she has been itching and rubbing the area and that it has become very irritated. What is the most likely dx?

Answer 5

Lichen Simplex Chronicus

Question 6

Treatment for Lichen Simplex Chronicus?

Answer 6

*need bx w/ gyno

Oral antihistamines and medium potency steroid like triamicolone or betamethasone

Question 7

A patient presents with sharply marginated, flat topped papules on skin and less sharply marginated white plaques that are itchy and burning. What is the most likely dx?

Answer 7

Lichen planus

*has a propensity for mucous membranes

Question 8

Treatment for lichen planus?

Answer 8

• need bx w/ gyno

- topical with hydrocortisone foam for vagina

Question 9

The triad of reccurent oral ulcers, recurrent genital aphthae or painful ulcerations, uveitis is in what condition?

Answer 9

Behcet’s Syndrome

Question 10

This is associated with the HLA-B51?

Answer 10

Behcet’s Syndrome (autoimmune)

Question 11

Treatment for Behcet’s Syndrome?

Answer 11

topical and systemic corticosteroids

Question 12

A patient presents with intense pubic and anogenital itching. Physical exam shows pale brown insects or ova may be seen on hair shafts. What is the most likely dx?

Answer 12

Pediculosis pubis (crabs)

Question 13

What is the treatment for Pediculosis pubis (crabs)?

Answer 13

Permethrin cream or lindane shampoo

*MUST TREAT ALL CONTACTS and STERILIZE CLOTHING

Question 14

A patient presents with asymptomatic papillary growths on the vulva. What could be the cause of this?

Answer 14

Condyloma Acuminatum caused by HPV

Question 15

What is the tx for Condyloma Acuminatum?

Answer 15

Imiquimod

Question 16

A patient presents with vesicles and painful ulcers on the genitals. WHat is the most likely dx?

Answer 16

HSV

Question 17

What is the tx for HSV?

Answer 17

Acyclovir for all

Question 18

On physical exam, a patient presents with pearly, dome-shaped papules with dimpled center. What is the tx?

Answer 18

-Reassurance bc goes away on own or you can do Imiquimod

Question 19

A patient complains with a 2 day hx of pain, tenderness, difficulty walking and painful sex. She states there is swelling and pain around her vagina area. On examination you notice a pea size cyst at 5 o’clock. What is the most likely dx and what is the tx?

Answer 19

Batholin duct and abscess

Tx: I&D, catheter placement and abx

Question 20

A post-menopausal woman complains of vaginal dryness, itching and burning. Physical exam shows thin vaginal epithelium and loss of elasticity. What could be the cause of this?

Answer 20

Atrophic vaginitis

Question 21

Tx for Atrophic vaginitis?

Answer 21

Supplemental estrogen therapy

-Premetharin vaginal cream

Question 22

What type of cancer is mc for vulvar malignancy?

Answer 22

Squamous cell carcinoma

Question 23

A patient presents with a hx of vulvar irritation, pruritis, local discomfort and bloody discharge. It looks like she may have an ulcer on her vulva. What are the next steps? What is the most likely dx?

Answer 23

Refer for bx - vulvar malignancy

Question 24

Treatment for vulvar malignancy?

Answer 24

Surgery

Question 25

A patient presents with itchy, red, crusted lesions usually on labia majora and may have superficial white coating "cake icing." What is the most likely dx and what is the next step?

Answer 25

Paget disease of the vulva and refer to gyn for bx

Question 26

What is the normal pH of the vagina?

Answer 26

3.8-4.5

Question 27

What are the three most common causes of vulvovaginitis?

Answer 27

Bacterial vaginosis, candidiasis, trichomoniasis

Question 28

T/F: vulvovaginal candidiasis is an STD

Answer 28

False- its not an STD

Question 29

What is the GS for diagnosis of vulvovaginal candidiasis?

Answer 29

vaginal culture

Question 30

A patient presents with a 1-week hx of itching, white vaginal discharge and burning following urination. What is the most likely organism and cause?

Answer 30

Vulvovaginal candidiasis and Candidia albicans

Question 31

spachetti and meatballs on wet prep? or budding hyphae?

Answer 31

Candidiasis

Question 32

Treatment for Vulvovaginal candidiasis?

Answer 32

"Azoles" Fluconazole

Question 33

What is the Amsel Criteria?

Answer 33

A criteria used to dx BV. Must have 3 of the following 4 criteria: 1. Abnormal gray d/c 2. pH >4.5 3. + whiff test 4. Presence of clue cells

Question 34

clue cells and ground glass appearance

Answer 34

BV

Question 35

What organism causes BV?

Answer 35

gardnerlla vaginitis

Question 36

Tx for BV?

Answer 36

Metronidazole

Question 37

strawberry cervix

Answer 37

Trichomonas vaginitis

Question 38

Pt complains of foul odorous and frothy green d/c x 3 days. On physical exam you notice a strawberry cervix. what is the most likely dx?

Answer 38

Trichomonas

Question 39

Wet mount of this condition shows motile flagellates?

Answer 39

Trichomonas

Question 40

Treatment for Trichomonas?

Answer 40

Metronidazole with partner prophylaxis

Question 41

Thick, frothy, foul flagellates

Answer 41

Trichomonas

Question 42

Grey, pH, whiff, clue

Answer 42

BV

Question 43

itchy, white, adherent, no odor

Answer 43

Candidiasis/yeast

Question 44

Toxic shock releases what toxin?

Answer 44

Staph exotoxin

Question 45

A menstruating women presents with sudden onset of febrile illness. What should we tx her for?

Answer 45

Toxic shock

Question 46

Tx for toxic shock?

Answer 46

- Remove tampon - irrigation - B lactamase resistant PCN or vanco IMMEDIATELY

Question 47

This disease is caused by N. gonorrhoeae +/- trachomatis which can cause subtle signs like myalgias, aches, I don't feel good

Answer 47

PID

Question 48

What are some risk factors for PID?

Answer 48

- younger than 25 - previous PID - untreated STI - multiple sexual partners - uses douche - IUD

Question 49

What is the minimum criteria for PID?

Answer 49

cervical motion tenderness OR uterine motion tenderness OR adnexal tenderness PLUS fever, cervical discharge, elevated ESR, elevated CRP, documented cervical infection

Question 50

Treatment for PID?

Answer 50

Ceftriaxone + Metro +/- doxy

Question 51

Most vaginal cancers are what type?

Answer 51

Squamous cell carcinoma

Question 52

What is the word for eversion of columnar epithelium onto ectocervix where the cervix appears red, granular and inflammed?

Answer 52

Ectropion

Question 53

This is when there is a translucent-yellow mucus filled cyst on the surface of the cervix

Answer 53

Nabothian cyst

Question 54

This commonly occurs after menopause and is where the the passageway through the cervix (from the vagina to the main body of the uterus) is narrow or completely closed.

Answer 54

cervical stenosis

Question 55

How is the dx for cervical stenosis made?

Answer 55

Diagnosis made when you are unable to pass a sound or dilator through the cervical opening

Question 56

If you suspect a cervical bx, what should you do?

Answer 56

Biopsy and refer!

Question 57

Occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy.

Answer 57

Incomptent cervix

Question 58

Treatment for Incomptent cervix?

Answer 58

Cerclage and progesterone