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Reproductive > Lec 3 Vulvovaginal > Flashcards

Lec 3 Vulvovaginal Flashcards

1
Q

What type of genital ulcer is associated with dysuria in a US patient?

A

herpes –> cause urethritis

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2
Q

What type of genital ulcer is associated with patients from 3rd world countries?

A

hemophilus ducreyi = chancroid

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3
Q

What kind of tissue line vagina?

A

stratified squamous mucosa with overlying muscular wall and outer adventitia

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4
Q

What is outer labia?

A

made of skin

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5
Q

What is role of glycogen in vagina?

A

synthesized by vaginal epithelium –> thickens epithelium and is main nutrient for normal vaginal flora [lactobacilli]

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6
Q

What is normal vaginal pH?

A

3.8-4.2

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7
Q

What should you think if mucopurulent discharge with bleeding?

A

vaginal cancer

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8
Q

What are causes of chemical vaginitis?

A
  • sanitary supplies
  • feminine hygiene supplies
  • excessive sexual ativity
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9
Q

What is most common cause of bacterial vaginitis?

A

gardnerella vaginalis

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10
Q

What is morphology of gardnerella vaginalis?

A

facultative gram variable anaerobe

normally comprises small percent of vaginal flora

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11
Q

What are symptoms of gardnerella vaginosis?

A

itching and burning

scant grayish to milky white, fishy discharge

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12
Q

What do you see on histology in gardnerella?

A
  • on saline wet mount of secretions see clue cells = epithelial cells w/ bacteria studding the surface
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13
Q

What bug is associated wtih clue cells?

A

gardnerella vaginosis

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14
Q

What test can you do to diagnose gardnerella?

A

amine test = add KOH to discharge and reaction will release fishy odor

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15
Q

What is pH of gardnerella discharge?

A

higher [alkaline] = 5.0 - 5.5 [normal 3.8 - 4.2]

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16
Q

What is treatment for gardnerella vaginosis?

A

metronidazole or clindamycin

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17
Q

What are clinical symptoms of candida vanigitis?

A
  • erythematous skin, normal cervix
  • dysuria = burning w/ urination
  • thick cheesy discharge
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18
Q

When do you get candida vanititis?

A

when you have systemic disorder, pregnancy, use of antibiotics/oral contraceptives

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19
Q

What do you see on histology in candida vaginitis?

A

fungal hyphae in discharge on silver, methylene blue, or PAS stain
wet mount + KOT –> can see hyphae

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20
Q

What are clinical symptoms of trichomonas vaginalis?

A
  • profuse froth green smelly discharge

- cervical-vaginal petechial lesions = strawberry cervix

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21
Q

What is treatment for trichomoniasis?

A

metronidazole + TREAT PARTNER

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22
Q

What is pH of vagina in trichomoniasis?

A

pH > 4.5 ~ 6

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23
Q

What is morphology of trichomonas?

A

uniflagellar protozoans

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24
Q

What do you see on wet mount wtih trichomoniasis?

A

pear shaped motile organisms = can see them darting back and forth

25
Q

What bug causes anogenital warts?

A

HPV

26
Q

What 2 types of infections cause mucopurulent endocervicitis?

A
  • neisseria gonorrhea

- chlamydia trachomatis D-K

27
Q

What is clinical presentation of gonorrhea?

A

can be asymptomatic
can cause urethritis w/ copious pus-like discharge = more visible in males than females
inflammation, redness, dysuria, burning in urination

28
Q

What is a potential adverse effect of untreated gonorrhea in females?

A

can ascend and cause pelvic inflammatory disease leading to infertility [from scarring of fallopian tubes]

29
Q

What is pathogenesis of gonorrhea?

A

produces IgA protease that promotes virulence

30
Q

What test to diagnose gonorrhea?

A

gram stain shows gram negative diplocci

culture or DNA test

31
Q

What is treatment for gonorrhea?

A

ceftriaxone or cephalosporins

32
Q

What two diseases associated with chlamydia?

A

chlamydia D-K: mucopurulent cervicitis, PID

chlamydia L1-L3: lymphogranuloma venereum = painless papule followed by inguinal lymphadenopathy

33
Q

What is lymphogranuloma venereum?

A

small painless ulcers on genitals from chlamydia L1-L3 –> leads to swollen painful inguinal lymph nodes that ulcerate

34
Q

What is morphology of chlamydia trachomatis?

A

obligate intracellular bacteria

35
Q

What is effect of neonatal chlamydia infection?

A

trachoma [eye infection] and pneumonia –> can lead to blindness

36
Q

What are some complications of untreated chlamydial infection?

A

can lead to PID –> fallopian tube scarring, increased risk ectopic pregnancy, adhesion formation

37
Q

What are some complications of untreated lymphogranuloma venereum?

A

ulceration and hypertrophy of genitalia, fistula formation

38
Q

What is primary lesion in syphillis?

A

painless chancre

39
Q

How does secondary syphilis prsent?

A

diffuse rash of trunk + palms of hands and soles of feet; conyloma latum = broad whiteish wart like lesion

w/in 4-10 weeks of primary infection

40
Q

How does tertiary syphilis present?

A

gummas, neuro, or cardiac signs [aortic aneurysm formation]

41
Q

How do you test for syphilis?

A

non-treponemal test [VDRL] and RPR

42
Q

What is treatment for syphilis?

A

intramuscular penicillin

43
Q

What are clinical symptoms of chancroid?

A

painful papule that ulcerates
inguinal lymph nodes may swell and break through skin = buboes

usually occurs in 3rd world country

44
Q

What does chancroid look like on histology?

A

school of fish appearance

45
Q

What is morphology of hemophilus ducreyi?

A

gram negative streptobacillus

46
Q

What is granuloma inguinale?

A

donovanosis = chronic bacterial infection see in tropics and subtropics
due to klebsiella granulomatous infection

47
Q

Who is more likely to get granuloma inguinale?

A

same sex oriented men

48
Q

What is clinical presentation of granuloma inguinale?

A

painless gentical nodules that may ulcerate

no inguinal lymphadenopathy

49
Q

What is test to diagnose granuloma inguinale?

A

biopsy with wright-giemsa stain = gold standard

see macropahges that contain intracellulra red bacilli = donovan bodies

50
Q

What is the most common cause of genital ulcers in the US?

A

HSV-2

51
Q

How do you diagnoses HSV?

A

scrape lesion and do tzanck stain –> see multinucleated giant cells

52
Q

What is clinical presentation of herpes?

A

painful penile, vulvar, or cervical vesicles or ulcers

can have systemic symptoms – fever, malaise, headache, myalgia

53
Q

What are the low risk vs high risk types of HPV?

A

low risk = 6, 11

high risk = 16, 18 –> integrate into host DNA

54
Q

What two viral genes get disrupted when HPV integrates into host genome? effect?

A

E6 –> degrades p53

E7 –> interferes w/ cyclin A and p105 RB = regulators of cell cycle progression

55
Q

What do you see on histology with HPV?

A

koilocytes = perinuclear cytoplasmic clearing [halo] with raisinoid nucleus

56
Q

What do you see clinically with HPV?

A

condylomata acuminata = cauliflowerlike lesions

57
Q

What is lichen sclerosus?

A

type of vulvular dystrophy –> itchy patchy white, thin skin = parchement paper

58
Q

What is treatment for lichen sclerosus?

A

corticosteroids for symptom relief

59
Q

What does vulvar/vaginal dysplasia suggest?

A

suggests HPV infection

Reproductive (14 decks)

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