Seibert - Disorders of the Vulva, Vagina, Cervix Flashcards
1
Q
commonly seen conditions of the vulva
A
lichen sclerosis
lichen simplex chronicus
lichen planus
2
Q
mc non-neoplastic vulvar epithelial d.o
A
lichen sclerosus
3
Q
intense vulvar pruritis usually in women > 60 yo
A
lichen sclerosus
4
Q
what is this
A
lichen sclerosus
5
Q
benign epithelial thickening and hyperkeratosis resulting from chronic irritation
A
lichen simplex chronicus
6
Q
which type of lichen needs bx to r.o cancer
A
lichen simplex chronicus
7
Q
what is this
A
lichen simplex chronicus
8
Q
inflammatory AI lichen
A
lichen planus
9
Q
tx for the lichens
A
steroids
10
Q
what do you think when you see: recurrent oral ulcers, recurrent genital aphthae/ulcerations, and uveitis
A
bechet’s syndrome triad
11
Q
what is this
A
bachet’s
12
Q
sexually transmitted conditions
A
pediculosis pubis
condyloma acuminatum
HSV
molluscum contagiosum
13
Q
crab louse transmitted through sexual contact or shared infected bedding or clothing
A
pediculosis pubis
14
Q
std that has distinctly verrucous lesions and involves asymptomatic papillary growths
A
condyloma acuminatum
15
Q
condyloma acuminatum is caused by
A
HPV
16
Q
what do you think when you see vesicles that erode rapidly resulting in painful ulcer, surrounded by red halo
A
HSV
17
Q
main complication of HSV
A
transmission to neonate during birth
18
Q
prodrome of HSV mimics
A
flu
(covid)
19
Q
benign epithelial poxvirus that is dome shaped w. a typical umbilicus; typically not itchy
A
molluscum contagiosum
20
Q
molluscum contagiosum is usually seen in __
but can also be __
A
kids
sexually transmitted
21
Q
what is this
A
molluscum contagiousum
fleshy warts
22
Q
in adults, molluscum contagiosum is considered
A
STI
23
Q
obstruction of main duct of bartholin gland
A
bartholin duct cyst and abscess
24
Q
fxn of bartholin gland
A
moisturize vulva/vagina → obstruction causes cyst/abscess
25
sx of bartholin cyst/abscess
pain
tendernes
dyspareunia
difficult walking
26
what is this
bartholin gland cyst
27
tx for bartholin gland cyst
I&D
catheter placement
marsupialization
28
atrophy 2/2 diminished estrogen levels; mc in post-menopausal women; pH of vagina abnormally high
atrophic vaginitis
29
tx for atrophic vaginitis
supplemental estrogen therapy
*if no contraindications*
30
topical estrogens
premarin
estrace
vagifem
31
90% of vulvar malignancy is
squamous cell carcinoma
32
what might you see on the hx of a pt w. vulvar malignancy
lichen sclerosis
Bachet's
33
rf for vulvar malignancy
smoking cigs
HPV
immunodeficiency
hx cervical carcinoma
chronic vulvar irritation
34
vulvar malignancy is sensitive to
chemo
35
in situ adenocarcinoma in epithelium of vulva and perianal regions
paget dz of the vulva
36
itchy, red crusted lesions usually on labia majora; +/- superficial white coating, “cake icing”
paget dz of vulva
37
tx for paget dz of the vulva
refer to gyn
bx
38
normal vaginal environment is
acidic
lots of vaginal flora
39
how should the vagina be cleaned
it is a self cleaning system!!
40
mc reason for pt visits to gynecology offices
vulvovaginitis
41
mc causes of vulvovaginitis
bacterial vaginosis (BV)
trichomoniasis
candidiasis
*can be associated w. all 3*
42
which of the 3 causes of vulvovaginitis is considered an STI
trichomoniasis
43
bv is caused by
gardnerella vaginalis
44
vaginal candidiasis is caused by
c albicans
45
what promotes c. albicans infxn (4)
systemic abx
DM
pregnancy
OCP
46
what do you think when you see: motile, pear-shaped flagellated cells and strawberry cervix
trichomoniasis vulvovaginitis
47
5 tests for vulvovaginosis
vaginal pH
amine whiff test
KOH
saline (wet prep)
DNA of gardnerella vaginalis, trichomonas vaginalis
48
if a non sexually active pt presents w. a yeast infxn that you determine to be candidiasis, do you need to test for chlamydia/gonorrhea
no!
candidiasis is not an STI
49
90% of vulvovaginal candidiasis is caused by
candidia albicans
50
what do you think when you see: itching, white vaginal discharge, vulvar erythema, high pH, odorless
vulvogainal candidiasis
51
gold standard dx for vulvovaginal candidiasis
vaginal culture
52
branching pseudohyphae and spores; spaghetti and meatballs
KOH finding for vulvovaginal candidiasis
53
tx for vaginal candidiasis
creams, suppositories, oral:
fluconazole
clotrimazole
miconazole
nystatin
54
for dx of BV you need 3 out of what 4 criteria
abnormal gray discharge
pH \> 4.5
(+) whiff test
presence of clue cells
55
thin gray-white to yellow discharge
gardnerella vaginitis
56
ground glass appearance
clue cells → BV
57
tx for bv
metronidazole
clindamycin
58
tx for pregnant pt w. BV
metronidazole
59
flagellate protozoan that lives in vagina, skene ducts, and male or female urethra
trichomonas vaginitis
60
what do you think when you see: vulvar itching, burning, copious discharge w. odor, dysuria, dyspareunia
trichomonas vaginitis
61
thin, frothy discharge, foul smelling, yellow-green, pH \> 5, strawberry cervix
trichomonas vaginitis
62
dx for trichomonas vaginitis
wet-mount prep
63
tx for trichomonas vaginitis
systemic metronidazole
64
thick, frothy, foul flagellates
trichomonas
65
grey, pH, whiff, clue
BV
66
itchy, white, adherent, no odor
candidiasis/yeast
67
what do you think when you see: abnormal malodorous vaginal discharge, intramenstrual bleeding
foreign bodies
68
retained tampons usually cause
ulcerative lesions
69
toxic shock syndrome is caused by what pathogen
staph vaginal infxn
70
when would you use abx for foreign body
cellulitis
systemic sx → fever
71
recommendation for tampons
least absorption for the least amount of time
72
sx of TSS are similar to flu, how do you differentiate
menstruating woman who uses tampons
BP changes
rash
73
any menstruating woman presenting w. sudden onset of febrile illness should be evaluated and treated for
TSS
74
tx for TSS
remove tampon
vaginal cultures
copious irrigation
b-lactamase resistant PCN or vano
75
can patients who have had TSS use tampons again
no! → high risk to get it again
76
inflammatory disorder of the upper genital tract that is a serious cause of morbility, mortality, and infertility
PID
77
PID is often caused by
n. gonorrhea
78
PID can also be caused by
c trachomatis
anaerobes
79
PID can easily be confused with
TSS
acute appendicitis
80
6 rf for PID
\< 25 yo
previous PID
untreated STI
multiple sex partners
douching
IUD
81
what can be a unique sx of PID (2)
irregular vaginal bleeding
cervical motion tenderness
82
vague sx of PID
abd pain
fever
vaginal/cervical d.c
pain or bleeding w. intercourse
83
minimum criteria for PID dx
cervical motion tenderness
OR
uterine motion tenderness
OR
adnexal tenderness
PLUS
fever, cervical d.c, elevated ESR/CRP, documented cervical infxn
84
should you wait confirm PID dx before treating it to
no!
85
tx for PID
ceftriaxone IM PLUS doxycycline
+/- metronidazole
86
all tx protocols for PID must treat
gonorrhea
chlamydia
87
education regarding sexual intercourse during PID tx
avoid intercourse for entire tx course
88
you must do a __ on all patients w. suspected PID
pelvic exam
89
85% of malignant diseases of the vagina are
squamous cell cancers
90
what is DES
diethylstilbestrol → synthetic nonsteroidal estrogen
increases risk for vaginal clear cell carcinoma and other GU tract abnormalities in utero
91
what is a cystocele
bladder prolapse
92
what is a cystourethrocele
bladder and urethra prolapse together
93
eversion of columnar epithelium onto ectocervix; cervix appears red, granular, inflamed
ectropion
94
ectropion is benign and associated w. __ (2)
but needs \_\_
hormone changes → pregnancy/puberty
cervical ca work up
95
very common, typically asymptomatic translucent-yellow mucous-filled cyst on the surface of the cervix
nabothian cyst
96
cervicitis indicates
spread of vaginal infxn
97
major concern w. cervicitis
infxn will spread and cause PID
98
2 major sign of cervicitis
cervical friability →
spotting
post coital bleeding
99
major sx of chronic cervicitis
leukorrhea
100
major cause of amenorrhea
cervical stenosis
101
condition that occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy
incompetent cervix
102
tx for incompetent cervix
**cervical cerclage**
progesterone
103
if you ever have a doubt about a diagnosis, you should
refer!
104
think \_\_
treat \_\_
save \_\_
infection
infection
fertility
