Trigger - Vulvovaginal Flashcards
Saline prep shows branching filaments and budding yeast
suspected candidal vulvovaginitis
pseudohyphae
If an uncontrolled diabetic pt has candidial vulvovaginitis how would you treat them?
remember our complicated case indicators!!!
* 4+ episodes/yr
* severe symptoms
* non-albicans
* uncontrolled DM
* HIV
* Steroids
* pregnancy
what is the CI for use of Boric Acid as a tx for candidial vulvovaginitis
pregnancy!
you want to avoid mixing these drugs with QT prolonging drugs and hepatotoxic drugs!
also with clopidogrel and warfarin!!
fluconazole/ketoconazole/itraconazole
MOA - inhibits enzyme for cell membrane synthesis
fluconazole/ketoconazole/itraconazole
this medication not only treats candidial vulvovaginitis but also prevents long-term recurrence!
ibrexafungerp
is there mucosal inflammation in bacteral vaginosis
NOOOOOOOOO
keep forgetting this
Clue cells on saline prep suggest what
bacterial vaginosis
if a pregnant patient has bacterial vaginosis what is the treatment
PO!!!!!!!!
metro or clinda :)
PO!!!!!!! Not vaginal
What can you NOT use in the treatment of bacterial vaginosis in a pregnanty patient
Tinidazole
Secnidazole
VAGINAL CREAMS
only treat pregnant w PO:)
MOA for this drug class is that it binds and deactivates enzymes
Nitroimidazoles
metro, tinidazole, secnidazole
Do not drink alcohol or use disulfiram with these medications
nitroimidazoles
(alchohol w/i 3 days, disulfiram w/i2 weeks)
metro, tinidazole, secnidazole
MOA- Binding to ribosomes to block protein synthesis
clindamycin
Tx for trichomonas
metronidazole (or other nitroimidazole)
if you give metronidazole to a patient to treat their strawberry cervix w green discharge and they come back a week later and its STILL not better….. what do you give them…?
tinidazole!!!
tought trich needs tinidazole!
Nucleic acid probe/culture showing G- diplococci within leukocytes
what is it and how to tx it?
gonorrheal vulvovaginitis
tx with rocephin + Doxy or azithromycin!
what are potential causes of noninfectious vaginitis
- topical irritants
- allergens
- atrophy
- excessive sexual activity
- poor hygiene/stress/sweat/heat
what cause of noninfectious vaginitis would warrant the tx of lubricants/moisturizers, HRT, or ospemifene
atrophy!!!
What are the CAM treatments for noninfectious vaginitis?
also probiotics!!!!
HPV 6 and 11 are the causes of what
condyloma acuminatum
Before treating this condition you should def do a pap and colposcopy (and maybe a biopsy) to r/o neoplassia!
condyloma acuminata
what vulvuvaginal problem is caused by poxvirus?
molluscum contagiosum
microscopy of this disease shows inclusion bodies in the cytoplasm
molluscum contagiosum
if a pt presents with a lone PAINLESS ulcer on the genitalia +/- LAD is suggestive of what
PRIMARY syphilis
rash, malaise and fever are associated with which condition
secondary syphilis
a patient with positive serology of syphilis but no symptoms is what kind
latent syphilis
when would you use PCN IM for 3 weeks
Syphilis that is……
* >1 yr latency
* tertiary
* systemic involvement (cardiac)
A patient presents with a duck waddling gait and pain/tenderness to the groin area. On exam you see a flutuant, tender mass located near the vaginal orifice.
what is this diagnosis? what would change about your diagnosis if this patient was post menopausal? what is tx?
- bartholian gland cyst
- If this pt is postmenopausal it may reflect cancer so consider biopsy!
- Tx - marsupilization w word catheter! abx if significant inflammation. Excision if recurrent or postmenopausal
idk may be a question
MC in women>60 w autoimmune dz or vit A deficiency
lichen sclerosis
A patient has erythema and edema of the vulva w white plaques and intense pruritus. She reports shes been scratching it alot and you assume thats why she now has telangectasis and subepithelial hemorrages in her vulvar area.
what is her dx?
what is her tx?
- acute lichen sclerosis
- clobetasol propionate 0.05% first line!
- Biopsy all new lesions!
A patient presents to your office with complaints of itching of the vaginal area. On exam you see thin, wrinkled, white skin.
what is this
how do you treat
Dx: chronic lichen sclerosis
tx: Clobetasol propionate. If refractory use intralesional injection, oral acitretin (retinoid) or methotrexate or laser.
surgery if introital narrowing!!!
this lichen diagnosis does not have dermal inflammatory infiltrates and is diagnosed with ……. and is treated w …….
lichen simplex chronicus
biopsy!
tx w oral antihistamines and topical fluocinolone or triamcinolone
intractable = IL steroid injections, TCAs (amitriptyline)
is lichen planus more sharply marginated on skin or mucosa
skin
what do you treat with a sclerosing agent
vulvar varicosities that persist postpartum
what is the tx for vulvar intraepithelial neoplasia
This is a Intraepithelial neoplasia/adenocarcinoma in situ
exramammary pagets disease
red velvet cake, pruritus and vulvar soreness
extramamarry pagets disease hallmark appearance
eventually causes developement of white plaques!
when do you use this
pagets disease
the main concern with …… is that it has a high rate of SCC developement
this is probably multiple things so plz lemme know
lichen sclerosus
when do we use clobetasol propionate
lichen sclerosus
when do you use a vulvar biopsy
extrammamary pagets disease
