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Gynae > The vagina and vulva > Flashcards

The vagina and vulva Flashcards

1
Q

What epithelium lines the vagina?

A

Squamos

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2
Q

What is found posterior to the vagina?

A

upper 1/3 is the pouch of douglas and lower 2/3s is the rectum

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3
Q

What is the lymph drainage from the vagina?

A

inguinal lymph nodes - femoral - external iliac- mets spread

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4
Q

What symptoms are linked to the vulva?

A

Pruritis, soreness, burning, superficical dyspareunia

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5
Q

Which infections can occur at the vulva?

A

Candidiasis +/- vaginal discharge, diabetes, systemic disease. Vulval warts- condylomata acuminate. pubic lice, scabies, HSV, syphillis, donovanosis

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6
Q

What is donovanosis?

A

Bacterial infection with klebsiella granulomatis causing ulcerative genital lesions.

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7
Q

Which derm diseases are seen at the vulva?

A

Eczema and psoriasis

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8
Q

Which condition is thickening of the skin of the vulva with scaling that arises secondary to repetitive scratching or rubbing seen?

A

Lichen simplex

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9
Q

What treatment can be given to relieve lichen simplex?

A

Emollients, steroid creams, antihistamines and pt advised to avoid soap contact.

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10
Q

In which condition is erythematous, inflammed, scaly, well-demarcated, lichenified, firm, rough plaques, exaggerated skin lines with hyperpigmentation and maybe a cutaneous horn seen?

A

Lichen simplex

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11
Q

In which condition is white thickening of the skin of the vulva seen?

A

Lichen sclerosis

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12
Q

Which condition presents with thin vulval epithelium (due to loss of collagen) with lesions that appear small, flat and of a white/ivory colour?

A

Lichen sclerosis

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13
Q

In which condition is the affected vulva skin unbearably itchy (pruritis vulvae) and/ or vulvodynia (sore) sometimes with bruises, blood blisters and ulcers appear after scratching or on their own?

A

Lichen sclerosis

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14
Q

Which conditions are associated with lichen sclerosis?

A

Autoimmune disease, thyroid disease and vitiligo

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15
Q

Which vulval disease is associated with a lack of collagen?

A

Lichen sclerosis

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16
Q

What percent of patients are at risk of developing vulvar carcinoma which presents with a slowly-growing lump or sore that doesn’t heal?

A

5%

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17
Q

Which rash of the vulva is chronically recurrent and is due to inflammation?

A

Lichen planus

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18
Q

Which disease of the vulva is characterised by small, flat- topped, many sided (polygonal) bumps/papules- purplish in colour that can grow together into rough scaly plaques on the skin.

A

Lichen planus

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19
Q

Which condition of the vulva has flat topped lilac or violet spots a few millimeters in diameter on the skin?

A

Lichen planus

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20
Q

Apart from the vulva, what else can lichen planus affect?

A

Hair, nails, mucous membranes

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21
Q

Where is donovanosis commonly found?

A

It is an STI commonly found in tropical, and subtropical areas such as Southeast India, Guyana and New Guinea

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22
Q

How is candidiasis commonly seen in?

A

Patients with diabetes, pregnant women, women using antibiotics and those with compromised immunity.

23
Q

What are bartholins glands and what is their function?

A

2 glands behind the labia minora which secrete lubricating mucus for coitus.

24
Q

What infection is commonly seen when the ducts of bartholins glands become blocked and form cysts/abscesses?

A

Staph a and e.coli

25
Q

How are bartholins cysts treated?

A

Incision, drainage and marsupialization

26
Q

What is marsupialization?

A

Surgical technique of cutting into a cyst and suturing the edges of the slit to form a continuour surface from the exterior to the interior of the cyst, the cyst remains open and can drain freely. This is used to treat a cyst that a single draining would not be effective for and complete removal of the surrounding structure would be undesirable.

27
Q

What is the name of the surgery which can treat an introital tear?

A

Fentons procedure

28
Q

What causes introital damage?

A

Over tightening due to incorrect perineal repair or extensive scar tissue. Commonly follows childbirth

29
Q

What are the symptoms of VIN?

A

Puritis, pain and change in appearance of the skin- popular, white areas

30
Q

What type of VIN is most usually seen?

A

HPV 16-18.

31
Q

What type of lesion is seen in VIN, hpv 16-18?

A

A warty, basaloid lesion

32
Q

The other type of VIN- the differentiated type, commonly develops more often in women with what condition?

A

Lichen sclerosis. It is also keratinizing.

33
Q

Which type of VIN is the major cause of vulval cancer in women over 45?

A

Differentiated type

34
Q

How do you treat VIN?

A

Alleviate the pain and itching and with high grade VIN: local incision, laser therapy, topical immunomodulators such as imiquimod (also used to treat genital warts and acitinic keratinosis)

35
Q

What is the pathology of 95% of vulval carcinomas?

A

squamous cell carcinomas

36
Q

What is the pathology of 5% of vulval carcinomas?

A

Melanomas, BCC, adenocarcinomas, sarcomas

37
Q

What are the causes of vulval carcinoma?

A

VIN, de novo, lichen sclerosis, immunosuppression, smoking and pagets

38
Q

What are the clinical features of vulva cancer?

A

Pruritis, bleeding, discharge and a mass

39
Q

On examination of a vulval carcinoma, what is likely found?

A

Ulcer/mass/hard enlarged immobile inguinal nodes

40
Q

How does vulval cancer spread via lymph?

A

superficial inguinal nodes to deep inguinal nodes to femoral- externam iliac

41
Q

How is stage 1 vulval cancer described?

A

Its a tumour less than 2cm with no nodal involvement
1a- stromal invasion -<1mm
1b- stromal invasion >1mm

42
Q

How is stage 2 vulval cancer described?

A

Tumour more then 2cm with no nodes

43
Q

How is stage 3 vulval cancer described?

A

Spread beyond vulva, periuneum to urethra, vagina, anus. Nodes only affected unilaterally

44
Q

How is stage 4 vulval cancer described?

A

Tumour is in rectum, bladder, bone or distant mets. Nodes are affected bilaterally

45
Q

What is the treatment for vulval cancer?

A

Stage 1a- wide local excision, no lymphadenectomy
Other stages- wide local excision and groin lymphadenectomy
Radiotherapy is used on large tumours to shrink down

46
Q

Which carcinoma of the vagina is commonly seen is late teenage years and is related to children of women who were given DES during pregnancy in the 1950s?

A

Clear cell adenocarcinoma

47
Q

What are the symptoms of primary vaginal carcinoma and who is it seen in?

A

Older women and its squamous with bleeding, discharge, a mass and maybe an ulcer common symptoms.

48
Q

What is the treatment for primary vaginal carcinoma?

A

Vaginal radiotherapy. radical surgery.

49
Q

Where does secondary vaginal cancer usually originate?

A

Cervix, endometrium and vulva

50
Q

What type of discharge is commonly associated with TV?

A

Offensive, yellow/green, frothy discharge
Vulvovaginitis
Strawberry cervix

51
Q

What type of discharge is associated with BV?

A

Offensive, thin, white/grey, ‘fishy’ discharge

Next question

52
Q

What type of discharge is associated with candida?

A

‘Cottage cheese’ discharge
Vulvitis
Itch

53
Q

In which two conditions is cervical excitation found?

A

Ectopic and PID

Gynae (15 decks)

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