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Women's Health > Lecture 15: Vulvovaginal Disorders > Flashcards

Lecture 15: Vulvovaginal Disorders Flashcards

1
Q

The MC type of bacteria in the vagina is

A

Anaerobes

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2
Q

The MC specific bacteria seen in normal vaginal flora is

A

Lactobacillus

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3
Q

T/F: Normal vaginal pH is more acidic than post-menopausal vaginal pH

A

True! Normal is 4-4.5

Postmenopausal is 6.5-7.0

Glycogen in vaginal mucosal secretions is converted to lactic acid

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4
Q

The younger you are, the ?? lactobacillus you have in your vagina

A

More

Less estrogen as u age = less lactobacillus ty viv

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5
Q

What kind of foods are the WORST for altering vaginal flora

A

Sugary foods

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6
Q

The MC organism of candidal vulvovaginitis is…

A

Candida albicans

90% of all cases

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7
Q

The MC systemic disorder that presdisposes you to candidal vulvovaginitis is…

A

DM

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8
Q

Candidal Vulvovaginitis is characterized by these S/S: (4)

A
  • Intense itching
  • Thick, white, cottage cheese discharge
  • Minimal odor
  • Erythema and possible edema

Might also burn after ya pee

Cheesy Candida

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9
Q

If you did a saline prep of suspected candidal vulvovaginitis, you would expect to see (2)

A
  • Branching filaments/budding yeast
  • Pseudohyphae
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10
Q

If you did a KOH prep of suspected candidal vulvovaginitis, you would expect to see (1)

A

Fungal mycelia

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11
Q

The gold standard for diagnosing candidal vulvovaginitis is…

A

Culture

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12
Q

The pharm tx options for simple candidal vulvovaginitis are: (4)

A
  • Topical azole creams for 1-3 days
  • Single dose of fluconazole 150mg PO
  • Boric acid
  • Gentian violet
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13
Q

What makes candidal vulvovaginitis complicated?

A
  • 4+ eps/year
  • Severe symptoms
  • Non-albicans
  • Uncontrolled DM
  • HIV
  • Steroid use
  • Pregnant
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14
Q

What is the management and tx protocol for complicated candidal vulvovaginitis? (3)

A
  • 1-2 weeks of topical azoles or 2 PO doses of fluconazole
  • Culture to confirm
  • Consider Boric acid
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15
Q

The two primary cons of using oral antifungals for tx of candidal vulvovaginitis are

A
  • Rx only
  • Higher risk of systemic SE
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16
Q

The OTC therapy that is absolutely contraindicated in pregnancy for tx of candidal vulvovaginitis is…

A

Boric acid intravaginal

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17
Q

Generally, you want to avoid combining fluconazole/ketoconazole with () drugs and (-toxicity drugs)

A
  • QT-prolongation drugs
  • Hepatotoxic drugs
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18
Q

The MOA for both topical and oral antifungals is primarily

A

Inhibiting the enzyme that synthesizes cell walls.

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19
Q

Why is ibrexafungerp better than azoles for candidal vulvovaginitis?

A

Preventing long-term recurrence

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20
Q

The main use of boric acid intravaginal is that it can treat…

A

Non-candidial vulvovaginitis

Interferes with fungal metabolism

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21
Q

The main/iconic SE of gentian violet is…

A

Discoloration of clothing and skin

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22
Q

For recurrent cases of candidal vulvovaginitis, you can use prophylactic antifungals for up to…

A

6 months

Azoles PO 1x/wk or PV 1-2x/wk

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23
Q

You should recommend a patient wear …. undergarments to prevent candidal vulvovaginitis

A

Absorbent so it stays dry down there

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24
Q

The MC bacteria present in bacterial vaginosis is…

A

Gardnerella vaginalis

A Garden of bacteria

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25
Q

T/F: Bacterial vaginosis is common in both sexually active and non-sexually active patients

A

False, rare in nonsexual

But it is NOT AN STI

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26
Q

Bacterial vaginosis is characterized by (1) discharge, smells (2), and has a lack of (3)

A
  1. Milky, homogenous, malodorous vaginal discharge
  2. Fishy smell
  3. Lack of vaginal mucosal inflammation
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27
Q

Bacterial vaginosis increases the risk of () in pregnant patients

A

Preterm delivery

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28
Q

Buzz Words for Bacterial vaginosis (3)

A
  • Clue cells on saline prep
  • Fishy odor via whiff test on KOH prep
  • Milky, homogenous discharge
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29
Q

The two preferred medications to treat bacterial vaginosis in pregnant patients are…

A
  • Metronidazole PO/Vaginal
  • Clindamycin PO/vaginal/vaginal cream

all for 1 week, except only 3 days for clinda ovules PV

If pregnant, you want to use the PO version of these!

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30
Q

The 2nd line tx for bacterial vaginosis patients who are NOT pregnant are…

A
  • Tinidazole oral
  • Secnidazole oral

Both are higher cost, but secnidazole is a single dose

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31
Q

The MOA of the nitroimidazole is…

A

Binding and deactivating enzymes

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32
Q

Pt counseling for usage of metronidazole includes… (2)

A
  • Don’t drink alcohol 3 days after
  • Don’t use disulfiram +/- 2 weeks
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33
Q

Generally, all the pharm tx for the vagina seem to interact with…

A

Anticoagulants

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34
Q

The MOA of clindamycin is…

A

Binding to ribosomes to block protein synthesis

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35
Q

The primary SE of taking oral clindamycin is…

A

C diff

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36
Q

The MC non-viral STD in the US is…

A

Trichomonal vaginitis

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37
Q

Trichomonas is characterized by a (color) & (odor) vaginal discharge and a (appearance) cervix

A
  • Frothy green
  • Foul-smelling
  • Strawberry

A Trip to the strawberry farm to see the green ones

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38
Q

Saline prep of trichomonas should show…

A

Actively motile trichomonads

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39
Q

The most sensitive and specific method for dxing trichomonas is

A

Culture

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40
Q

First-line tx of trichomonas is

A

Metronidazole 2g PO x 1 dose or 500mg BID x 7 days (less SE)

Can also use the other nitroimidazoles

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41
Q

For more resistant trichomonas, the preferred tx is…

A

Tinidazole 500mg PO TID x 7d

Tough Trichomonas needs Tinidazole

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42
Q

T/F: A partner of someone with trichomonas also needs tx

A

True

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43
Q

Generally, the MC S/S of gonorrheal vulvovaginitis is…

A

Asymptomatic 80%+

the other 20% get PID

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44
Q

Gonorrheal vulvovaginitis is diagnosed with a () and should show ()

A

Nucleic acid probe/culture showing G- diplococci within leukocytes

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45
Q

The tx for gonorrheal vulvovaginitis is…

A

Rocephin + Doxy/azithryomycin (chlamydia)

Also tx partner

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46
Q

The preferred tx for chlamydial vulvovaginitis is…

A

Doxycycline 100mg PO BID x 7 days

Also treat gonorrhea with rocephin

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47
Q

Generally, the mainstay of tx for noninfectious vaginitis is…

A

Identifying and removing the underlying cause

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48
Q

Tx of noninfectious vaginitis w/ atrophy includes (4)

A
  • Lubricants
  • Moisturizers
  • HRT
  • Ospemifene (SERM)
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49
Q

The characteristic presentation of herpes genitalis is…

A

Vesicles becoming painful erosions/ulcer + erythematous halo

I also think theyre grouped

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50
Q

The tx for herpes genitalis is…

A

7-10 days of the antivirals (val, fam, a)

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51
Q

Recurrent herpes genitalis is treated with…

A

1-5 days of antivirals

Can take a giant dose or steady doses

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52
Q

The two MC types of HPV that result in condyloma acuminatum are…

A

HPV 6 & 11

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53
Q

The S/S of condyloma acuminatum are…

A
  • White exophytic/papillomatous growth
  • Tend to coalesce
  • Can also be flat

Can also spread

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54
Q

Prior to treating condyloma acuminatum, you should… (2)

A
  • Pap smear
  • Colposcopy

Might even need a biopsy

55
Q

The tx options done by a provider for condyloma acuminatum include… (5)

A
  • Topical application of bichloroacetic acid, Trichloroacetic acid, or podophyllin
  • Cryotherapy
  • Electrosurgery
  • Simple excision
  • Laser
56
Q

What should you remember to let patients know after tx of condyloma acuminatum?

A

Recurrence is common

57
Q

The underlying cause of molluscum contagiosum is…

58
Q

Microscopy of molluscum contagiosum should show…

A

Inclusion bodies (molluscum bodies) in the cytoplasm

59
Q

Tx of molluscum contagiosum includes… (5)

A
  • Desiccation
  • Freezing
  • Curettage
  • Chemical cauterization
  • Topical imiquimod

May cause scarring, so you can just observe if ya want

60
Q

Primary syphilis is characterized by 2 things:

A
  • Lone painless ulcer (CHANCRE)
  • +/- LAD
61
Q

Secondary syphilis is characterized by 3 things:

A
  • Generalized rash
  • Malaise
  • Fever
62
Q

The causative organism for syphilis is

A

Treponema Pallidum

63
Q

First line tx for syphilis

A

Penicillin (Benzathine penicillin)

64
Q

Tx for a pregnant woman allergic to penicillin

A

Desensitize and give penicillin

65
Q

For PCN allergic and non-pregnant women, the TOC for syphilis is

A

Doxycycline x 2 weeks

increase to 4 weeks if 1+ years of latent, tertiary, or cardio involved

66
Q

Generally, bartholin glands get obstructed because of…

67
Q

What might suggest a patient has a bartholin gland cyst?

A
  • Pain, tenderness, dyspareunia
  • Duck waddling gait
  • Fluctuant, tender mass
  • No pain/discomfort if solely cystic
68
Q

The first-line tx of bartholin gland disease is (2)

A
  • Marsupialization
  • Insertion of Word catheter

Drain and then do above^

69
Q

When is excision indicated in bartholin gland disease?

A
  • Recurrent
  • Post-menopausal
70
Q

The MC non-neoplastic epithelial vulvar disorder is…

A

Lichen Sclerosus

71
Q

Lichen sclerosus is primarily seen in these populations: (3)

A
  • Vit A deficiency
  • Women > 60
  • Autoimmune dz
72
Q

The MC presenting S/S of Lichen Sclerosus is…

A

Pruiritis

Can see vulvar pain, dyspareunia, or asymptomatic white lesions

73
Q

Acute Lichen Sclerosus follows a general pattern: (4)

A
  • Plaques develop
  • You keep itching it
  • You get telangiectasias and hemorrhages
  • You get erosions/ulcerations/fissuring
74
Q

Chronic lichen sclerosus describes the skin as…

A

Cigarette-paper

Thin, wrinkled, and white

Chronic Lichen Sclerosus = Cigarette-Like Skin

75
Q

What secondary conditions can occur in chronic lichen sclerosus?

A
  • Phimosis
  • Introital stenosis
  • Perianal involvement
76
Q

The main concern with Lichen sclerosus is…

A

High rate of SCC development

Biopsy all new lesions!

77
Q

Besides stopping the itchy cycle, the 3 patient recommendations to help with Lichen Sclerosus are…

A
  • Avoid tight underwear
  • Daily cleansing with mild soap
  • Drying skin with hair dryer

Improvement of vulvar hygiene

78
Q

The first-line tx for Lichen Sclerosus is…

A

Clobetasol propionate 0.05% topical

HIGH potency steroid

79
Q

Surgery is indicated for Lichen Sclerosus in (2)

A
  • Introital narrowing due to dyspareunia
  • Invasive squamous cell neoplasia
80
Q

What should you NOT USE in Lichen Sclerosus?

A
  • Topical testosterone cream
  • Topical progesterone cream
  • Intralesional alcohol injection
  • Vulvectomy
81
Q

Chronic lichen sclerosus will recur when…

A

You stop tx :(

82
Q

What the main differentiating factor between Lichen Simplex chronicus vs Sclerosus?

A

Simplex has a simple explanation

Obvious cause for it i think is what she said

83
Q

Generally, the main cause of Lichen Simplex Chronicus is…

A

Chronic irritation (pads, infection, cancer)

84
Q

The S/S of Lichen Simplex Chronicus include… (3)

A
  • Lichenified, scaly, localized plaque (itchy!!!)
  • Red papules that coalesce
  • Pigmentation
85
Q

The dx of Lichen Simplex Chronicus is via..

A

Biopsy of lesion

Must rule out CIN or invasive CA

86
Q

Lack of what differentiates Lichen Simplex Chronicus from Sclerosus?

87
Q

The pharmacological tx for Lichen simplex Chronicus includes… (2)

A
  • Oral antihistamines
  • Topical med-pot CS (Fluocinolone, triamcinolone)
88
Q

For intractable cases of Lichen Simplex Chronicus, the two tx options are:

A
  • Intralesional SQ steroid injections
  • Oral antidepressants (TCAs like amitriptyline)
89
Q

Lichen Planus, a mucocutaneous dermatosis, is () sharply marginated on skin and () sharply marginated on mucous membranes

Either More or less

A
  • More on skin
  • Less on mucuous membranes

Rarely on the vulva

90
Q

The initial tx for Lichen Planus on the vagina is

A

Topical hydrocortisone foam (Colifoam)

91
Q

Secondary tx for Lichen Planus is…

A
  • Higher potency topical steroids
  • Topical tacrolimus
92
Q

If Lichen planus ends up with introital stenosis or adhesions, we tx with (2)

A
  • Vaginal dilators
  • Surgical release
93
Q

What are the more common dark vulvar lesions?

A
  • Melanosis/lentigo (looks like melanoma)
  • Vulvar melanoma (actual cancer but v rare)
  • Capillary hemangiomas (Childhood = red, senile = dark blue)
94
Q

Varicose veins in the vulva are rare outside of what condition?

A

Pregnancy

Normal could signify underlying vascular dz or pelvic tumor

95
Q

What is the recommended tx for vulvar varicosities?

A

Supportive compression undergarments if preggo

Otherwise, rarely need to tx!

96
Q

What is the tx for vulvar varicosities that persist postpartum?

A

Sclerosing agent

97
Q

A patient with vulvar intraepithelial neoplasia (VIN) most likely has () lower genital tract disease

A

Multifocal

98
Q

What age range is most likely to have VIN?

A

Younger women

99
Q

The MC factor seen in VIN is…

A

HPV

Smoking increases risk of it being high-grade

100
Q

The MC presentation of VIN and MC symptom is…

A
  • MC Presentation: White, hyperkeratotic papules
  • MC symptom: Pruiritis (60%)
101
Q

The gold standard for Dxing VIN is…

A

Colposcopy + Biopsy of suspicious lesions

102
Q

The follow-up protocol for VIN is…

A
  • Colposcopy Q3months until disease free for 2 years
  • Pelvic exam Q6m after those 2 years are good.
103
Q

Extramammary Paget’s disease is MC in…

A

White women 60-70

104
Q

What exactly is Extramammary Paget’s disease?

A

Intraepithelial neoplasia/adenocarcinoma in situ

Almost always confined to the EPITHELIAL layer

105
Q

The two MC symptoms of extramammary Paget’s disease + hallmark appearance is…

put on your privacy screen and spit out your food

A
  • Pruiritis
  • Vulvar soreness
  • Red velvet cake
106
Q

The Dx of extramammary paget’s disease is…

A

Vulvar biopsy

107
Q

The tx for extramammary paget’s disease is…

A

Wide local excision

108
Q

What suggests a good prognosis for extramammary paget’s disease?

A

No lymph node metastases

lymph node metastases = almost always fatal

109
Q

90% of vulvar cancers are (cell type)

A

SCC

2nd MC is malignant melanoma

110
Q

Gyn cancers are rare overall, but the MC RFs for them are (2)

A
  • Poor
  • Elderly
111
Q

The MCC of vulvar cancer in young women is…

112
Q

The MCC of vulvar cancer in older women is…

A

Chronic inflammation

113
Q

Generally, vulvar cancer presents with (2)

A
  • Pruiritis
  • Mass
114
Q

Generally, most SCC vulvar cancers originate from the (anatomical structure)

115
Q

Between exophytic/endophytic vulvar lesions, which one is more likely to become large, necrotic, and infected?

A

Exophytic lesions

Cauliflower one

116
Q

Overall, the mainstay of tx for vulvar cancer is…

A

Remove all tumor wherever possible! (Wide local excision with inguinal lymph node excision)

If lymph metastases, add radiation

117
Q

When is pelvic exenteration indicated with vulvar cancer?

A
  • Anus
  • Rectum
  • Rectovaginal septum
  • Proximal urethra
  • Bladder

Any involved

118
Q

Once someone has vulvar cancer treated, how often do they followup?

A

Q3 months for 2 years, then Q6months

80% recurrence in first two years

119
Q

Where do vaginal intraepithelial neoplasias (VAIN) tend to appear in the vagina?

A

Upper 1/3 of vagina

Same RFs as CIN/VIN (HPV, smoking)

120
Q

What kind of appearance description of preinvasive vaginal disease is usually associated with dysplasia?

A

Condylomatous

Spicules

121
Q

The Dx of Preinvasive vaginal disease/VAIN is via…

A

Colposcopy + biopsy

122
Q

Tx of VAIN 1 is with…

A

Nothing, usually regresses

123
Q

Tx of VAIN 2/3 is…

A
  • Surgical excision
  • CO2 laser
  • Topical 5-FU
124
Q

How often do you followup post VAIN excision/tx?

A

Q4-6months

Might need multiple tx

125
Q

85% of all vaginal cancers are (cell type)

126
Q

What is the MC form of vaginal malignancy?

A

Extension of cervical cancer

127
Q

Define primary vaginal cancer

A

Minimal to no cervix involvement

128
Q

The MC primary vaginal cancer in young patients specifically is (cell type)

A

Adenocarcinomas

129
Q

A highly aggressive, polypoid, edematous, grape-like vaginal cancer is most likely a (cell type)

Prepare yourself

130
Q

MC symptom of primary vaginal cancer

A

Postmenopausal or postcoital bleeding

131
Q

Dx of primary vaginal cancer is via…

A

Colposcopy + biopsy

132
Q

Tx of primary vaginal cancer is via…

A
  • Hysterectomy
  • Vaginectomy
  • Lymphadenectomy

If locally invasive, gotta do pelvic exenteration

133
Q

The worst prognosis cell type of primary vaginal cancer is…

A

Melanoma

Extremely rare tho

Women's Health (15 decks)

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