Surgery Halo-halo

Question 1

What’s VIN?

Answer 1

Vulvar intraepithelial neoplasia

Question 2

Most common histologic type of vulvar cancer

Answer 2

Vulvar SCC

Question 3

Behavior of Vulvar SCC

Answer 3

Lymphatic spread: inguinal -> pelvic —> iliac —> peri-aortic
Hematogenous spread:
Lungs, liver, etc

Question 4

HPV-related VSCC

Answer 4

Incidence: 30%
Pathogenesis: high-risk HPV infection
Age: 60y/o
Histo: basoloid, warty
Precursor lesion: Classic VIN

Question 5

Non-HPV related VSCC

Answer 5

Incidence: 70%
Pathogenesis: chronic epithelial irritation
Age: 75y/o
Histo: keratinizing
Precursor lesion: differentiated VIN

Question 6

Sequelae of caustic injury to esophagus

Answer 6

Stricture
60% in 1 month
80% in 2 months
Perforation
-CXR: gas shadw in mediastinum: esophageal perforaiton
-CXR: gas under diaphragm: gastric perforation
SCC

Question 7

Phases of esophageal caustic injry

Answer 7

1st phase: acute necrotic phase
-1-4 days
2nd phase: ulceration and granulaion phase
(3-5 days)
-disappearance of symptoms
-period when esophagus is WEAKEST
3RD PHASE: cicatrization and scarring 
(3rd week)
-reappearance of dysphagia due to stricture formation

Question 8

Endoscopy in esophageal caustic injury

Answer 8

Early endoscopy
Done within 24 hours of ingestion
Mid-esophagus: m/c site of perforation

Question 9

Diagnostics for esophageal perforatiotn

Answer 9

Water soluble contrast esophagogram (Gastrografin)

Question 10

Treatment of esophageal perforatiotn

Answer 10

Closure within 24 hours: 90% surival

Question 11

Classification for esophgeal caustic injury

Answer 11

Zargar’s classification
(Endoscopic)
Grade:
0: normal
1: superficial mucosal edema and erythema
2: mucosal and submucosal ulceration
2A: superficial ulceration, erosion, exudate
2B: deep discrete or circumferential ulcer
3: transmural ulceration with necrosis
3A: focal necrosis
3B: Extensive necrosis (esophaogastric resection)
4: perforation (kita na to sa PE tho, so no need endoscopy, matik EX LAP)
E-U-N-P

Question 12

Most common cause of vulvar leukoplakias

Answer 12

Lichen sclerosis

Question 13

3 causes of vulvar leukoplakia

Answer 13

Lichen sclerosus
Lichen planus
Lichen simplex chronicus

Question 14

Remarks on lichen sclerosus

Answer 14

Figure-of-eight pattern of white epithelium around the anus and vulva resulting in variable scarring and itching, and less comonly pain
5% risk of malignant transformation to vulvar SCC

Question 15

Cut-off for biopsies in bartholin’s cysts

Answer 15

40 y/o

Question 16

Treatment of chancroid

Answer 16

Azithromycin 1g PO
Or
Ceftriaxonw 250mg IM x 1
OR
Ciprofloxacin 500 mg pO BID x 3 days

Erythromycin base 500 mg pO TID x 7 days