GYN- Lower GU

Question 1

cause of labial fusion

Answer 1

excess androgens (Tx is d/c andogrens)
can be due to 21-hydroxylase def (Tx is cortisol in this condition) 

** can get reconstructive surgery

Question 2

How to diagnose imperforate hymen vs transverse vaginal septum

Answer 2

imperforate hymen = presents as primary amenorrhea + cyclical abd pain with mucocolpos/hematocolpos

TVS = presents as primary amenorrhea + cyclical abd pain + short vagina that ends in blind pouch
**presence of hymenal ring indicates TVS

Question 3

vaginal atresia vs vaginal agenesis

Answer 3

atresia = failure of lower vaginal to develop

agenesis = absence of vagina w/partial uterus and tubes (aka MRKH syndrome)

Question 4

vaginal thinning and atrophy in postmenopausal women + Tx?

Answer 4

lichen sclerosis = topical steroids

**10% assc with cancer

Question 5

chronic vulvar/vaginal irritation –> puritis –> hyperkeratotic changes + Tx?

Answer 5

atopic eczema = topical steroids

Question 6

chronic vulvar/vaginal irritation –> puritis –> reactive changes + Tx?

Answer 6

lichen simplex chronicus = topical steroids

Question 7

shiny purple papules +/- vaginal adhesions + Tx?

Answer 7

lichen planus = steroid suppository + surgery for adhesions

Question 8

silver scaly plaques + auspitz sign (bleeding when plaqes are removed) + Tx

Answer 8

vulvar psoriasis = topical steroids + UV light

Question 9

red spots/patches in upper 1/3 vagina due to DES exposure in utero + Tx

Answer 9

vaginal adenosis = close f/u bc is precursor to clear cell adenocarcinoma

Question 10

vaginal dryness +/- bleeding in postmenopausal women + Tx?

Answer 10

atrophic vaginitis = topical estrogen

Question 11

MC vulvar cyst

Answer 11

epidermal inclusion cyst = 2/2 to blocked hair follicle | Tx = I&D or excsion if infected

Question 12

multiple asymptomatic vuvlar cysts is most likely

Answer 12

sebacous cyst

Question 13

cysts that are only found in the groin and axillary region

Answer 13

apocrine cysts

Question 14

cyst that appears at 12 o’clock position in vulva

Answer 14

skene cyst

Question 15

cyst that appears at 4 and 8 o’clock position in vulva + management

Answer 15

bartholin cyst/abcess

usually self resolve but if > 40 need to Bx to r/o cancer
if large or symptomatic, Bx to r/o cancer

Question 16

cysts located in the anterolateral wall of the proximal (superior) portion of the vagina

Answer 16

Gartner duct cyst which are remnants of mesonephric (Wolffian ducts)

Tx is excision

Question 17

DES associated anomalies

Answer 17

vaginal adenosis
clear cell carcinoma
other cervival and uterine anomalies(?)

Question 18

occurs when ectocervix (SSC) overgrows endocervix (SCC)

Answer 18

Nabothian cyst (benign)

Question 19

treatment for cervical polyps

Answer 19

remove if symptomatic

Question 20

treatment for cervical fibroids

Answer 20

remove is symptomatic