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OB/GYN > EXAM #1: VULVAR & VAGINAL DISEASE > Flashcards

EXAM #1: VULVAR & VAGINAL DISEASE Flashcards

1
Q

What is the differential diagnosis for vulvovaginitis?

A

1) Bacterial vaginosis
2) Candida
3) Trichomoniasis
4) Atrophic vaginitis (elderly)

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2
Q

What two causes of vulvovaginitis will cause an increase in vaginal pH?

A

1) Bacterial vaginosis

2) Trichomoniasis

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3
Q

What is the wet mount finding that is pathognomonic for Bacterial Vaginosis?

A

Clue cells

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4
Q

What are the findings that are diagnositc for Bacterial vaginosis?

A

1) Gray discharge
2) pH greater than 4.5
3) Positive whiff test
4) Clue cells on wet mount

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5
Q

How is Bacterial vaginosis treated?

A

1) Oral metronidazole

2) Topical Clindamycin

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6
Q

Why is Candidiasis more common in younger women?

A

Infection requires estrogen

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7
Q

How will wet mount appear in Candidiasis?

A

Blastosphores or pseudohyphae

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8
Q

What are the classic findings in Candidiasis?

A

1) Odorless cottage-cheese like discharge

2) pH between 4-5 (normal)

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9
Q

What is the treatment for Candidiasis?

A

1) Vaginal application of an imidazole
2) Oral dose of fluconazole
3) Nystatin can be used in PREGNANCY

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10
Q

How does a yeast infection that is positive for T. glabrata alter the treatment regimen?

A
  • Resistant to all azoles; must treat with:
    1) Boric acid
    2) Gentian violet
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11
Q

What are the clinical manifestations of Trichomoniasis?

A

1) Foul-smelling green-yellow discharge
2) pH greater than 4.5
3) “Strawberry cervix”

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12
Q

How is Trichomoniasis identified on wet mount?

A

Mobile flagellates on wet mount

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13
Q

If you are going to diagnose a patient with Trichomoniasis, what else do you need to screen them for?

A

STIs i.e. Chlamydia and N. gonorrhea

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14
Q

How is Trichomoniasis treated?

A

Oral metronidazole (treat partner as well)

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15
Q

What is atrophic vaginitis?

A

Atrophy of the vagina in elderly women due to decreased estrogen

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16
Q

How is atrophic vaginitis treated?

A

Topical or oral estrogen

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17
Q

What is Linchen Sclerosis? What is the classic presentation of Linchen Sclerosis?

A
  • Thinning of the epidermis and fibrosis of the dermis of the vulva
  • Presents with leukoplakia and “parchment-like” vulvar skin
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18
Q

How is Linchen Sclerosis treated?

A

1) Biopsy to rule out neoplasia*
2) Treat any secondary infections (yeast)

*Long-standing linchen sclerosis can lead to vulvar carcinoma in elderly women

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19
Q

What are the general care measures for Linchen Sclerosis?

A

1) Cotton underwear
2) No tight/occlussive clothing
3) No soap to vulva

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20
Q

What is the initial pharmacologic treatment for Linchen Sclerosis?

A

1) Superpotent steroid ointment taper

2) Oral steroids

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21
Q

What is Lichen Simplex Chronicus (LSC)? How does LSC classically present?

A
  • This is hyperplasia of the vulvar squamous epithelium
  • Presents with thick leathery vulvar skin
  • Associated with chronic irritation and itching/ scratching
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22
Q

How is LSC treated?

A

1) Discontinue any irritants
2) Oral antipruritic med (diphenhydramine) w/ moderate strength steroid cream
3) Trial of oral anti-depressant

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23
Q

If LSC does NOT improve, what do you need to do?

A

Vulvar biopsy to rule out neoplasia

24
Q

What is Lichen Planus?

A

Cell-mediated immune response of unknown origin that causes a desquamative lesion of the vagina

25
Q

Aside from itching, what else is Lichen Planus associated with?

A

1) Insertion pain

2) Profuse vaginal discharge

26
Q

How is Lichen Planus diagnosed?

A

Biopsy

27
Q

How is Lichen Planus treated?

A

1) Topical steroid cream

2) Intravaginal hydrocortisone/ suppository

28
Q

What is Psoriasis?

A

Excessive keratinocyte proliferation causing salmon-color plaques with silver scale

*Autosomal dominant

29
Q

When Psoriasis is suspected in the vagina, what is the clinical clue to the diagnosis?

A

Psoriasis in other areas

30
Q

How is Psoriasis treated?

A

1) Topical coal tar followed by UV light

2) Topical steroid “Betamethasone”*

31
Q

What are the two types of eczema?

A

1) Exogenous= irritant and contact dermatitis

2) Endogenous= atopic dermatitis

32
Q

How is exogenous eczema treated?

A

Remove the offending agent

33
Q

What is Seborrheic Dermatitis?

A

Chronic inflammation of the sabecous glands in the vagina

34
Q

How does Seborrheic Dermatitis present?

A
  • Pale red to yellow-pink

- Oily appearing and scaly crust

35
Q

How is vulvar dermatitis treated?

A

1) Remove offending agent
2) Good perineal hygiene
3) Aluminum acetate solution
4) Topical corticosteroids
5) Oral antipruritic agents

36
Q

What are sebaceous cysts?

A
  • Blockage of the sebaceous gland duct resulting in a cysts
  • Small nodular mass with a cheesy sebaceous material inside

*Treatment is excision

37
Q

What is a cyst of the Canal of Nuck?

A

Hydrocele i.e. fluid collection in the round ligament of the uterus that inserts into the labia majora

*Treatment is excision

38
Q

What are the premalignant conditions of the vulva?

A

1) Pagets Disease

2) Vulvar Intraepithelial Neoplasia (VIN)

39
Q

What are the clinical manifestations of Paget’s Disease?

A

Erythematous, pruritic, ulcerated vulvar skin

*More common in women over 60

40
Q

How is Paget’s Disease diagnosed?

A

Biopsy

41
Q

How is Paget’s Disease treated?

A

Wide local excision

42
Q

What is VIN?

A

Vulvar Intraepithelial Neoplasia

  • Precursor to vulvar carcinoma
  • Often high-risk HPV related
43
Q

How is VIN diagnosed? What major diagnoses are you trying to differentiate between?

A

Colposcopy and biopsy

*Need to rule out melanoma

44
Q

How is VIN treated?

A

1) Laser excision
2) Wide local excision
3) Follow-up frequently b/c of high recurrence rate

Colposcopy every 6 months until disease free for 2 years; then annual

45
Q

What is the most common cell-type of vulvar cancer?

A

Squamous cell carcinoma (85-90%)

46
Q

Where is vulvar cancer typically found?

A

Labia major

47
Q

What are the risk factors for Vulvar Cancer?

A

1) Post-menopausal
2) CIN, VIN, HPV
3) Smoking
4) Immunosuppression
5) Hx. of cervical cancer

48
Q

How is vulvar cancer diagnosed?

A

Biopsy

49
Q

How is vulvar cancer treated?

A

1) Wide local excision plus ipsilateral inguinal lymph node dissection
2) Pelvic radiation if positive mets to nodes

50
Q

What is VAIN?

A

Vaginal Intraepithelial Neoplasia

*This is the precursor to vaginal carcinoma

51
Q

How is VAIN diagnosed?

A

1) PAP smear
2) Colposcopy
3) Biopsy

52
Q

What is the treatment for VAIN?

A

1) Local resection
2) Laser ablation (no sample for pathology)
3) 5-FU (chemotherapy cream w/ a lot of adverse effects)

53
Q

What is the proper follow-up for VAIN?

A

Colposcopy every 6 months until disease free for 2 years; then annual

54
Q

What is the most common type of vaginal cancer?

A

SCC

*Associated with extension from the cervix

55
Q

What is clear cell adenocarcinoma associated with?

A

In utero exposure to DES

56
Q

What is the treatment for Stage I or II vaginal cancer?

A

Surgical resection

57
Q

What is the treatment for Stage III or IV vaginal cancer?

A

Radiation

OB/GYN (19 decks)

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