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Clin Med Final Material- Semester 2 > Disorders of the Vulva Vagina & Cervix: Seibert > Flashcards

Disorders of the Vulva Vagina & Cervix: Seibert Flashcards

1
Q

Vulva is covered by skin that includes:

A

eccrine glands and hair

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2
Q

Dermatologic diseases seen elsewhere on skin can occur in the vulvar area such as:

A

psoriasis, eczema, allergic dermatitis, and variety of infectious diseases

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3
Q

3 Commonly seen conditions of the vulva are:

A
  • Lichen Sclerosis
  • Lichen Simplex Chronicus
  • Lichen Planus
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4
Q

What is the MC non-neoplastic vulvur epithelial disorder?

A

Lichen Sclerosis

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5
Q

Lichen Sclerosis:

-characterized by:

A

intense vulvar pruritis, usually in women >60yo

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6
Q

Lichen Sclerosis:

-**Key characteristic vulvur skin appearance=

A

Vulvar skin is thin and wrinkled “cigarette paper appearance” with areas of lichenification and hyperkeratosis

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7
Q

Lichen Sclerosis:

-Tx?

A

-**stop the itch-scratch cycle, usually with antihistamine at night and high potency topical steroid
Ex. Clobetasol propionate ointment 0.05% Sig: apply to vulva bid x 2 weeks, then qd x 2 weeks, then twice weekly x 2 weeks, then prn Disp: 30 gms

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8
Q

Lichen Sclerosis:

-tx in extreme cases=

A

-Oral steroid

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9
Q

Lichen Sclerosis has a greater than expected risk of ______

A
  • subsequent squamous cell carcinoma of the vulva

- Refer to OB-GYN for further eval, needs biopsy to confirm dx and R/O cancer

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10
Q

Lichen Simplex Chronicus= benign _______

A

epithelial thickening and hyperkeratosis resulting from chronic irritation

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11
Q

Lichen Simplex Chronicus is a non-specific reactive condition from _______

A
  • constant irritation or rubbing

- May be from infection, chemical exposure, or allergic causes

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12
Q

Lichen Simplex Chronicus:

  • pigmentation?
  • appearance?
A
  • Hyperpigmented or hypopigmented

- Results in thickened, leathery appearance

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13
Q

Lichen Simplex Chronicus:

-Pruritus? Specifically which area*

A
  • Extreme pruritis (itch-scratch cycle)

- **Usually on labia majora

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14
Q

Lichen Simplex Chronicus:

  • referral?
  • Tx?
A
  • to OB-GYN for further evaluation, needs biopsy to confirm diagnosis and R/O cancer
  • Tx – Oral antihistamines and topical medium potency steroid like betamethasone or triamcinolone twice daily
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15
Q

Lichen Planus= an inflammatory _______

A

autoimmune disorder

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16
Q

Lichen Planus:

-can affect vulva and vagina, and may also have _____

A

-oral lesions (propensity for mucous membranes)

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17
Q

Lichen Planus: rarely affects _____

A

vulva

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18
Q

Lichen Planus: characterized by _______

A

**sharply marginated flat topped papules on skin and less sharply marginated white plaques on oral and genital mucous membranes

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19
Q

Lichen Planus:

-S/Sx

A
  • itching, burning, postcoital bleeding, dyspareunia, and pain
  • +/- erosions or ulcerations and more likely to involve vagina
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20
Q

Lichen Planus:

  • referral?
  • Tx?
A
  • Refer to OB-GYN for further evaluation, needs biopsy to confirm diagnosis and R/O cancer
  • Careful and frequent examination of vagina for formation of adhesions

**tx= mainly topical, starting with hydrocortisone foam for vagina (Colifoam) and more potent topical steroids may be tried externally

“planus”=think plane=flat

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21
Q

Behcet’s Syndrome=

A

Rare inflammatory disorder characterized by classic triad

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22
Q

Behcet’s Syndrome:

-Classic triad=

A
  • Recurrent oral ulcers
  • Recurrent genital aphthae or ulcerations (painful)
  • Uveitis
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23
Q

Behcet’s Syndrome:

-Susceptibility associated with _____

A

HLA-B51 allele

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24
Q

Behcet’s Syndrome

  • etiology ?
  • Tx?
A
  • Etiology unknown, may be autoimmune

- tx: topical and systemic corticosteroids

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25
Q

Pediculosis Pubis=

A

Crab louse(=crabs) (Phthirus pubis) transmitted through sexual contact or shared infected bedding or clothing

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26
Q

Pediculosis Pubis:

-describe how infection spreads (hint: eggs)

A
  • Eggs laid at base of hair shaft

- Eggs hatch in 7-9 days

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27
Q

Pediculosis Pubis:

  • Sx: ?
  • PE finding?
A
  • **Intense pubic and anogenital itching

- PE: Pale brown insects or ova may be seen on hair shafts

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28
Q

Pediculosis Pubis:

tx?

A
  • –Permethrin 1% cream, lindane 1% shampoo (not for pregnant or lactating women).
  • *Treat all contacts and sterilize clothing/bedding
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29
Q

Condyloma Acuminatum= a sexually transmitted disease that has distinctly ______

A

verrucous lesions

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30
Q

Condyloma Acuminatum:

  • Asymptomatic ______ growths
  • Affects ____ areas
A
  • papillary

- Affects vulva, vagina, and cervix, and in perineal, perianal, and oropharyngeal areas in both sexes

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31
Q

Condyloma Acuminatum:

  • caused by ____
  • Prevention=
A
  • **HPV
  • HPV Vaccines recommend for 11-12 yo girls and boys
  • Test for other sexually transmitted diseases
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32
Q

Condyloma Acuminatum:

tx:

A

=Trichloroacetic acid, podophyllin, cryosurgery, electrosurgery, simple surgical excision, laser, **imiquimod 5% cream apply topically

-Biopsy may be needed to rule out neoplasia

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33
Q

Herpes Simplex Virus (HSV)=

Vesicles develop but erode rapidly resulting in ______

A

painful ulcer

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34
Q

HSV:

  • each erosion is surrounded by _____
  • Frequently preceded by prodrome=
A
  • **red halo

- **prodrome=burning, itching, and flu-like symptoms

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35
Q

HSV-1 is usually _____, HSV-2 usually _____

A

**HSV-1 is usually oropharyngeal, HSV-2 usually genital mucosa (now mixed)

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36
Q

HSV:

lesions heal ______

A

spontaneously, reoccurrence common

-Main complication is HSV transmission to neonate during birth

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37
Q

HSV: dx?

A

Viral culture, PCR, Tzanck smear

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38
Q

HSV:

-First episode: tx?

A

** Acyclovir 400mg po q 8 hours x 7-10 days.

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39
Q

HSV: Recurrent episodes–> tx?

A

Acyclovir 400mg po q 8 hrs. x 5 days (treat at onset of prodromal symptoms)

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40
Q

HSV: prophylaxis?

A

Acyclovir 400mg po BID

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41
Q

Molluscum Contagiosum= benign, epithelial poxvirus are _____

-demographic?

A
  • *dome shaped with a typical umbilicus

- Common in young children but in adults molluscum is usually sexually transmitted

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42
Q

Molluscum Contagiosum:
-affects genital, lower abd, buttocks, and _____

-dx based on characteristic _______

A

inner thighs

-**pearly, domed shaped papules with dimpled center, skin scraping, or biopsy to confirm – under microscope appear as numerous inclusion bodies (molluscum bodies) in cytoplasm of cell

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43
Q

Molluscum Contagiosum: tx?

A
  • may resolve on its own,

- cryotherapy, curettage, and topical therapy (imiquimod)

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44
Q

Bartholin Duct Cyst and Abscess

A

=Obstruction of main duct of Bartholin gland

  • -Pea sized glands at 5 and 7 o’clock
  • fx of the glands are to provide moisture for the vulva
  • **Duct obstruction causes cyst and abscess formation
  • *Fluctuant tender mass usually palpable
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45
Q

Bartholin Duct Cyst and Abscess:

-acute Sx: (list)

A

Pain
Tenderness
Dyspareunia
Difficult walking

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46
Q

Bartholin Duct Cyst and Abscess: tx?

A
  • **I&D, catheter placement, and marsupialization.
  • For catheter, an elliptical incision is made along the vaginal mucosa with expression of pus
  • Insert a Word catheter deep into the cavity, inflate the catheter balloon with saline
  • If a Word catheter is not available, gauze can be used to pack the cavity
  • Antibiotics should be administered if considerable inflammation develops
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47
Q

A Bartholin duct cyst in > ___yo should be biopsied to r/o bartholins gland carcinoma!!!!

A

40

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48
Q

Atrophic vaginitis= atrophy due to diminished ____

-MC in _____

A

estrogen levels

  • **post-menopausal women
  • Can be observed in prepubertal and lactating women as well due to lack of estrogen
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49
Q

Atrophic vaginitis:

  • pH of the vagina=
  • vaginal epithelium is______
A
  • pH= abnormally high

- thinned and more susceptible to infection and trauma

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50
Q

Atrophic vaginitis:

Common Complaints=

A 
Vaginal dryness
Itching
Burning
Dyspareunia
Spotting
Discharge
Urinary symptoms – urgency, frequency, recurrent UTI, incontinence
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51
Q 
Atrophic vaginitis:
clinical findings (4 things)
A
  • Low estrogen
  • Thin vaginal epithelium as woman ages
  • **pH elevated (5-7)
  • Loss of elasticity causes shortening and narrowing of the vagina
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52
Q

Atrophic vaginitis:

tx?

A
  • **Supplemental estrogen therapy
  • Oral/Systemic if no contraindications
  • Topical (1/3 of vaginal estrogen absorbed systemically, so contraindicated in women with hx of breast or endometrial cancer):
  • -Premarin vaginal cream – 0.5 grams per vagina qd x 3 weeks, off x 1 week, then repeat as needed
  • -Estrace vaginal cream – 1 gram per vagina 1-3x/week , start 2-4 grams PV qd x 2 weeks, then taper dose gradually over 1-2 weeks
  • -Vagifem tablets (10µg) – 1 tablet intravaginally daily x 2 weeks, then twice weekly x 3-6 months
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53
Q

Vulvar Malignancy:

T/F: carcinoma of the vulva is uncommon

A

true
-90% are squamous cell carcinoma

-More common in postmenopausal women (60-70 yo)

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54
Q

Vulvar Malignancy:

  • hx of vulvar irritation, pruritis, ______
  • **lesion?
A

local discomfort, and bloody discharge

-+/- ulcer or **large cauliflower lesion

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55
Q

Vulvar Malignancy:

  • risk factors?
  • dx?
A
  • cigarette smoking, HPV, immunodeficiency, hx of cervical carcinoma, chronic vulvar irritation
  • **Biopsy necessary for diagnosis
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56
Q

Vulvar Malignancy:

-tx

A

Staging and treatment are surgical

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57
Q

Paget Disease of the Vulva= extramammary ________

-describe

A

paget disease

-In situ adenocarcinoma in the epithelium of vulva and perianal regions

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58
Q

Paget Disease of the Vulva:

-Sx?

A

Itchy, red, crusted lesions usually on labia majora, may have superficial white coating **“cake icing”

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59
Q

Unlike mammary Paget’s disease,

A

20%

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60
Q

Paget Disease of the Vulva:
tx?
-recurrence rate?

A

Refer to GYN, biopsy needed

Tendency for recurrence

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61
Q

In the presence of ______ the vaginal epithelium thickens leading to the accumulation of glycogen in the epithelial cells

A

estrogen

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62
Q

in the vagina:

Intraepithelial glycogen metabolizes to _____ ____

A

lactic acid

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63
Q

Describe the vaginal pH

A
  • Intraepithelial glycogen metabolizes to lactic acid
  • **Results in lowering of pH to 3.5-4.0 which promotes the growth of normal vaginal flora, mainly lactobacilli and acidogenic corynebacteria
64
Q

T/F: Asymptomatic Candida organisms may be present in small quantities in the vagina (normal)

A

true

65
Q

MC reason for Pt visits to gyno?

A

Vulvovaginitis**

66
Q

Vulvovaginitis:

  • Sx?
  • successful tx?
A
  • Sx= acute or sub-acute and range in intensity from mild to severe
  • Has a broad DDx
  • Successful treatment depends on identification of offending organism
67
Q

Vulvovaginitis:

-list MC causes

A
  • Bacterial vaginosis
  • Candidiasis
  • Trichomoniasis
  • Can be signs of sexually transmitted infections

-Can be associated with conditions such as:
Atrophic vaginitis
Vulvar dermatologic conditions
Vulvodynia

68
Q

Vulvovaginitis:

Hx of Pt (includes)

A 
Location of symptoms
Duration
Relationship to menses
Response to prior treatment 
-Self treatment, douching, and sexual history
69
Q

Vulvovaginitis:

Lab tests

A
  • Vaginal pH (normal= 3.8-4.2)
  • Amine “whiff” test
  • Potassium hydroxide (KOH) microscopy
  • Saline (wet prep)

-DNA of Gardnerella vaginalis, Trichomonas vaginalis

70
Q

Case:
A 23 year old female patient, G0P0, comes to the office concerned about vaginal discharge
(what ?’s do you want to ask her?)

Lab: obtain vaginal sections for pH and wet prep – FIND **Clue Cells

tx?

A

-using pH paper: pH of vagina is 5.5,
- minimal d/c with fishy odor - PE: no erythema, or edema.
Lab: obtain vaginal sections for pH and wet prep – FIND **Clue Cells

tx= Metronidazole, Clinidamycin orally or topically

vs
–lab test you see budding hyphae= candidiasis
Tx: intervaginal treatments (syringes with antifungal tx’s)= clean, easy and simple

71
Q

A 23 year old virginal woman presents to the office with a 2-day history of thick white discharge, redness of her “bottom”, and intense vaginal itching.
She had a course of oral antibiotics the prior week for sinusitis.
She denies ever having anything like this in the past.
Her symptoms are confirmed on physical exam.

dx=

A

Vulvovaginal candidiasis

72
Q

Vulvovaginal Candidiasis:

  • 90% caused by _____
  • remaining 10%=
A

candida albicans
-Remaining 10%: Candida glabrata, Candida tropicalis,or Torulopsis glabrata

-Generally don’t co-exist with other infections – not an STI

73
Q

Vulvovaginal Candidiasis:

-more likely to occur in women who are:

A

pregnant, diabetic, obese, immunosuppressed, on medications such as: corticosteroids, OCPs, or antibiotics

  • Increased in those who wear tight clothing, habitual use of panty liners
  • *Must keep vulva and vaginal area dry
74
Q

Vulvovaginal Candidiasis:

-common complaints=

A 
Itching (may be intense)
-**White vaginal discharge (thick, curd like)
Vulvar erythema
Asymptomatic
Burning following urination
75
Q

Vulvovaginal candidiasis:

-clinical findings

A
  • Vulva and vaginal tissue bright red
  • Excoriated external vaginal tissue possible
  • **Thick, adherent “cottage cheese” discharge
  • **pH of 4.5 or greater
  • Odorless
76
Q

Vulvovaginal candidiasis:

-gold standard for dx=

A

**Vaginal culture

77
Q

Candidiasis (cells show?)

A
  • Branching pseudohyphae and spores

* *“spaghetti and meatballs”

78
Q

Vulvovaginal candidiasis:

-treatments:

A
  • available as topical creams, vaginal suppositories, and oral agents
  • -Fluconazole 150mg oral 1 tablet po x 1 single dose
  • -Clotrimazole 1% cream 5 g intravaginally x 7 -14 days
  • -Miconazole 2 % cream 5 g intravaginally x 7 days
  • -Nystatin 100,000 unit vaginal tablet, 1 tablet x 14 days

-Keep area clean and dry!

  • May also use boric acid
  • Prolonged treatment may be necessary in complicated cases
  • **Recurrent disease common

Note: dont memorize tx’s JUST KNOW azoles**

79
Q

The patient’s presentation strongly suggests candida vulvovaginitis

  • -The course of broad-spectrum antibiotics is a likely predisposing factor.
  • -The KOH prep confirms the dx, and the normal saline prep is negative for bacterial vaginosis and trichomoniasis
  • -A culture is not necessary in relatively straightforward cases, as this one appears to be, and surveillance for STDs is not needed because she denies sexual activity.
  • **A single dose of _____
A

**oral Diflucan successfully treats this patient’s Sx

80
Q

Bacterial Vaginosis (BV):
-organism
-Discharge?
-

A
  • Gardnerella vaginitis
  • **Thin gray-white to yellow discharge
  • Discharge mildly adherent to vaginal wall
81
Q

Bacterial Vaginosis (BV):

  • Mild vulvar irritation in ___% of cases
  • pH=
A

25%

->4.5

82
Q 
Bacterial Vaginosis (BV):
-Wet prep shows:
A

**shows WBC, clumps of bacteria, loss of normal lactobacilli and characteristic “clue cells” (more than 20% of epithelial cells)

83
Q 
Bacterial Vaginosis (BV):
dx defined by **amsel criteria--any 3 of the following 4 criteria:
A

1) Abnormal gray discharge
2) pH > 4.5
3) + whiff test
4) presence of clue cells

84
Q

Treatment of BV:

A

(**metronidazole or clindamycin )

Metronidazole oral- 500mg orally twice daily x 7 days or

Metronidazole gel - 0.75% 1 full applicator (5g) intravaginally, once a day x 5 days

Clindamycin cream – 2%, 1 full applicator (5g) intravaginally at bedtime x 7 days

Clindamycin oral – 300mg orally twice a day x 7 days

**Treatment in Pregnant patients – Metronidazole 250mg orally 3x daily x 7 days (may increase risk of preterm delivery)

85
Q

Trichomonas Vaginitis:

  • organism?
  • Flagellate protozoan lives in vagina, skene ducts and ____
A
  • Trichmonas vaginalis

- male or female urethra

86
Q

Trichomonas Vaginitis:

  • how common?
  • Associated with:
A
  • **MC non-viral sexually transmitted disease in US

- perinatal complications including preterm birth and increased incidence in transmission of HIV

87
Q

Trichomonas Vaginitis:

-often coexists with _____

A

other STDs, so offer testing to Pts

88
Q

Trichomonas Vaginitis:

-common complaints?

A

Vulvar itching, burning, copious discharge with odor, dysuria, and dyspareunia
-May be asymptomatic

89
Q

Trichomonas Vaginitis:
-Clinical Findings:
discharge?
pH?

A
  • **Thin, “frothy” discharge, foul smelling
  • Yellow-green
  • pH > 5
  • Vaginal erythema
  • **Multiple petechiae (strawberry spots) in vagina or cervix
  • Many are asymptomatic
90
Q

Trichomonas Vaginitis:

-wet mount findings=

A

**increased number of polymorpho-nuclear cells and motile flagellates

91
Q

strawberry spots=

A

**trich

92
Q

Trichomonas Vaginitis:

-Dx?

A
  • Confirmed by microscopic examination of vaginal secretions in wet-mount prep (sensitivity 60-70%)
  • Other tests include culture, immunochromatographic capillary flow dipstick technology and nucleic acid test (NAAT)
  • Test for other STD’s if patient has Trichomonas
93
Q

Trichomonas Vaginitis Treatment

A
  • **Systemic tx with metronidazole=1st line
  • -Metronidazole oral – 2 grams orally given in a single dose
  • -Tinidazole oral – 2 grams orally given in a single dose
  • Treat sexual partners
  • Avoid unprotected intercourse during treatment

-**Pregnancy concerns:
Associated with preterm delivery and increased incidence of HIV

94
Q

Thin, frothy, foul flagellates=

A

**trichomonas

95
Q

Grey, pH, whiff, clue cells=

A

**BV

96
Q

Itchy, white, adherent, no odor=

A

**Candidiasis/Yeast

97
Q

Foreign bodies (list MC ex’s)

A 
Paper
Cotton
Other material
Retained tampon
Contraceptive device
Pessary
98
Q

Foreign bodies:

  • common complains
  • sx usually 2/2:
A
  • Abnormal malodorous vaginal discharge
  • Intramenstrual spotting

-2/2: drying of the vaginal epithelium and micro-ulcerations

99
Q

Foreign Bodies:

clinical findings of retained tampon

A
  • *Ulcerative lesions typical of retained tampon

- Typically located in the vaginal fornices and have rolled, irregular edges with a red granulation tissue base

100
Q

Foreign Bodies:

-how quickly do lesions heal once tampon is discontinued?

A

lesions heal spontaneously!

–If retained for a long period of time, may erode into bladder or colon.

101
Q

Foreign Bodies: tx?

A

-Removal foreign object

  • Antibiotics not usually needed
  • -Do treat with antibiotics if: cellulitis or systemic symptoms like fever
102
Q

_______ is the most serious complication associated with tampon use
–Linked to ____ vaginal infection in healthy women

A
  • *Toxic shock

- staphylococcal

103
Q

Toxic Shock syndrome: Sx are 2/2 release of _____

A

**staph exotoxins

104
Q

Toxic Shock syndrome:

-Sx:

A 
High fever (> 38.9oC, 102o F)
Severe headache		
Sore throat
Myalgia
Vomiting
Diarrhea
  • Skin rash – disappears after 24-48 hours
  • Desquamation of palms and soles follows in 2-3 weeks
  • Hypotension leading to shock levels within 48 hours
  • **Multi-organ system failure may occur
105
Q

Any menstruating women presenting with sudden onset of febrile illness should be evaluated and treated for _____

A

*toxic shock

106
Q

Toxic shock syndrome:

-tx?

A
  • Remove tampon
  • Vaginal cultures taken
  • Copious irrigation of saline to decrease organism inoculation
  • B-lactamase-resistant penicillin or Vancomycin
107
Q

T/F: a Pt with toxic shock should NEVER use a tampon again

A

true!!

108
Q

PID (Pelvic Inflammatory Disease)= an inflammatory disorder of the ______

-often caused by:

A
  • upper genital tract
  • ** N. gonorrhoeae +/- C. trachomatis
  • Also caused by anaerobes, other microbes of GU tract
109
Q

PID (Pelvic Inflammatory Disease):
-morbidity?
-

A
  • *Serious cause of morbility, mortality, and infertility
  • Often undiagnosed
  • Subtle S/Sx
  • Can be confused with other disorders such as toxic shock syndrome, acute appendicitis, etc.
110
Q

PID continued: Risk Factors

A 
-**Younger than 25
Previous PID
Untreated STI
Multiple sexual partners
-Uses douche
-IUD (slight increased risk in first 3 weeks after implantation)
111
Q

PID continued: Sx?

A 
Abdominal pain
Fever
Vaginal/cervical discharge
Pain or bleeding with intercourse
Dysuria
Irregular vaginal bleeding
Sexually active
112
Q

PID continued: Dx

-Minimum criteria=

A 
Minimum criteria:
Cervical motion tenderness
OR
Uterine motion tenderness
OR
Adnexal tenderness

PLUS:
Fever, cervical discharge, elevated ESR, elevated CRP, documented cervical infection

**must do pelvic exam to assess for Cervical motion tenderness

113
Q

PID Tx:
1 in ___ women will have infertility issues; increased risk of ectopic pregnancy
-Test ALL patients for HIV, Gonorrhea, & ______

-ALL tx protocols must treat:

A
  • 1 in 8
  • Chlamydia
  • **Gonorrhea and Chlamydia
  • Avoid intercourse for entire treatment course
  • Treat all recent sexual partners (within 60 days)
  • *Common tx: Ceftriaxone IM plus Doxycycline +/- Metronidazole
114
Q

Malignant Disease of the Vagina:

  • how common?
  • Metastatic or vaginal involvement via ______
A
  • Rare, primary carcinoma of vagina (0.3%) of all gyn. cancers
    • direct extension from cervix is much more common
115
Q

Malignant Disease of the Vagina:

  • ___% are squamous cell cancers
  • Sx?
A
  • 85%
  • May be asymptomatic, early disease may have painless bleeding from ulcerated tumor, late disease with bleeding, pain, weight loss, and swelling
116
Q

Malignant Disease of the Vagina:

-association b/w **clear cell adenocarcinoma of vagina in young women whose mothers were treated with ____

A

**DES during pregnancy

117
Q

Malignant Disease of the Vagina:

  • dx?
  • tx
A
  • Biopsy

- tx= may be surgical, radiotherapy, and in some cases chemotherapy

118
Q

DES=

-DES daughters at increased risk of ______

A

=Diethylstilbestrol (DES), a synthetic nonsteroidal estrogen was used between 1940-1971 in US to prevent premature birth, miscarriages, and other OB complications

  • DES crosses the placenta and affects reproductive cell tract differentiation
  • ***DES daughters – increased risk vaginal clear cell carcinoma and other GU tract abnormalities, possible increase risk of breast cancer
119
Q

Vaginal Prolapse:

Cystocele=

A

bladder prolapse

120
Q

Vaginal prolapse:
-describe. the anterior vaginal wall

-Cystourethrocele=

A

-Prolapse of the anterior (front) vaginal wall
-Falls towards the vagina and creates bulge
-**Common for bladder and urethra to prolapse together,
=Called *cystourethrocele

121
Q

Rectocele=

A

prolapse of rectum or large bowel

122
Q

The cervix is the lower portion of the uterus and is divided into:
endocervix=
&
Ectocervix=

A

Endocervix= Portion of cervix extending into the uterus, opens through internal os, columnar epithelium

Ectocervix= Portion of cervix extending into the vagina, opens through external os, squamous epithelium
SCJ – Squamous columnar junction

123
Q

Ectropion= eversion of ____

A

columnar epithelium onto ectocervix

124
Q

Ectropion:

  • cervix appears _____
  • malignant or benign?
  • associated with:
A
  • red, granular, and inflammed
  • Benign but must do further testing to R/O cervical cancer
  • hormone changes – pregnancy and puberty
125
Q

Cystic abnormalities of cervix:
Nabothian Cysts=

-cause?

A
  • **Very common, typically asymptomatic, is a translucent-yellow mucous-filled cyst on the surface of the cervix, vary in size
  • They are most often caused when stratified squamous epithelium of the ectocervix grows over the simple columnar epithelium of the endocervix trapping cervical mucous inside the crypts
126
Q

Cervicitis=

A

Cervix in direct contact with vagina and therefore exposed to viral, bacterial, fungal, and parasitic agents

-Annually 3 million women diagnosed with cervicitis

127
Q

Cervicitis:

-List ex’s of viral, bacterial, fungal, and parasitic agents

A 
Chlamydia and Gonorrhea 
Herpes
HPV
Trichomoniasis
Bacterial vaginosis
Mycoplasma
  • If left untreated can lead to higher risk for infertility, ectopic pregnancy, and chronic pelvic pain
  • Cervicitis often asymptomatic, or sx similar to vaginitis
128
Q

Acute cervicitis:

______ vaginal discharge is primary sign of acute cervicitis

A

**purulent

129
Q

Acute Cervicitis:

Thick creamy purulent discharge in ______ infection

A

Thick creamy purulent discharge in GC

130
Q

Acute Cervicitis:

Greenish-white and foamy in ________ infection

A

trich

**In Trichomonas, cervix may look like a strawberry

131
Q

Acute Cervicitis:

-Discharge is Thin and gray in _______ infection

A

bacterial vaginosis

132
Q

Acute Cervicitis:

Other Sx

A

-Cervix inflamed, edematous
-Vulvar burning and itching
Urethritis, dysuria, and urgency
-Cervical friability
-Postcoital bleeding or intermenstrual spotting

133
Q

Chronic Cervicitis:

_______ is chief Sx

A

**Leukorrhea (not usually as profuse as acute cervicitis)

134
Q

Chronic Cervicitis:

other sx

A 
May cause vulvar irritation
Thick or mucous like discharge
Patchy erythema
Lower abdominal pain
Lumbosacral backaches
Dysmenorrhea
Dyspareunia
Urinary urgency, frequency, or dysuria
Postcoital bleeding
135
Q

Cervicitis: lab findings
-Wet Prep –
Presence of flagellated organism=

A

Trichomonas

136
Q

Cervicitis: lab findings
-Wet Prep –
Presence of speckled periphery to the epithelial cell (clue cell) hallmark of _______

A

**bacterial vaginosis

137
Q

Cervicitis: lab findings

-KOH Prep – presence of distinctive hyphae seen with:

A

Candidia

138
Q

Cervicitis:

-when should you get vaginal cultures?

A

Culture – G/C, HSV

139
Q

Cervicitis:

-CBC shows ______

A

White count may be normal or leukocyte slightly elevated – not typically part of lab order for cervicitis

140
Q

Cervical infections:

-complications?

A

Salpingitis/PID
Infertility
Ectopic pregnancy
Chronic pelvic pain

141
Q

Cervical infections:

  • prevention?
  • tx?
A
  • No unprotected sexual contact
  • Avoid infected partners
  • Barrier method contraception

tx:
Depends on patient - desire for maintaining fertility, pregnant, or breastfeeding, severity of cervical infection, and presence or absence of complicating factors

142
Q

Cervical Injury:

-lacerations=

A
  • Common complication of vaginal delivery, most common site lateral aspect
  • Very common with operative deliveries (forceps or vacuum)
  • Occurs with some Gyn surgical procedures or instruments
143
Q

Cervical Injury:

-perforations=

A
  • Seen with self induced abortion using a sharp object

- Inadvertently during uterine sounding, cervical dilation, or cervical cone

144
Q

Cervical Injury:

-ulcerations=

A

Pressure necrosis due to vaginal pessary or when uterine prolapse protrudes through the vaginal introitus

145
Q

Cervical Stenosis:

-occurs at the level of the ______

A

**internal cervical OS

146
Q

Cervical stenosis:

  • may lead to ____
  • Caused by:
A
  • May lead to amenorrhea and pelvic pain
  • May contribute to infertility

-Caused by Cone biopsy, LEEP, ablative techniques for treatment of dysplasia

147
Q

Cervical Stenosis:

  • dx?
  • tx?
A
  • dx made when you are unable to pass a sound or dilator through the cervical opening
  • tx=dilators CAREFULLY
148
Q

Cervical Polyp=
-describe
-size=
how common?

A

=A soft, red, pedunculated protrusion from the cervical canal at external os

  • Size: few mm to 2-3 cm
  • Common
149
Q

Cervical Polyp:

-arise as a result of _____

A

focal hyperplasia of endocervix

150
Q

Cervical Polyp:

  • attached to ____
  • dx?
A

endocervical mucosa near the external os

-**Biopsy!
Microscopic examination confirms the diagnosis

151
Q 
Cervical Polyp
.  Clinical Findings:
-S/Sx=
-Imaging=
-Labs=
A
  • S/sx: intermenstrual or postcoital bleeding
  • Imaging: Hysterosalpingogram or saline infusion sonohysterography

Labs: Biopsy!

152
Q

Cervical Polyp:

-DDx=

A
  • Adenocarcinoma
  • Endometrial sarcoma
  • Submucosal pedunculated myoma or endometrial polyp
153
Q

Cervical polyp:

tx?

A

Polypectomy may be done in office (grasp pedicle close to base with polyp forcep, twisting it until the growth is avulsed.
–If large, may require removal under anesthesia – send specimen to pathology

154
Q

Incompetent Cervix= condition that occurs when ______

A

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

155
Q

Incompetent cervix:

-risk factors?

A

Congenital
Cervical trauma
D&C
History of pre-term delivery

156
Q

Incompetent cervix:

-tx?

A

Cervical Cerclage
Bed Rest
Frequent Ultrasounds

-Progesterone - progesterone keeps a woman’s cervix long and closed, and her uterine muscles from contracting. A drop in progesterone shortens and opens the cervix and causes the uterine muscles to contract

157
Q

Cervical Summary

A

THINK infection, TREAT infection, SAVE fertility

For all of the previous content: when in doubt, refer!!

PID is more systemic inflammatory Sx vs cervicitis can be isolated to just the cervix

Clin Med Final Material- Semester 2 (22 decks)

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