Trigger - Vulvovaginal

Question 1

Saline prep shows branching filaments and budding yeast

Answer 1

suspected candidal vulvovaginitis

pseudohyphae

Question 2

If an uncontrolled diabetic pt has candidial vulvovaginitis how would you treat them?

Answer 2

remember our complicated case indicators!!!
* 4+ episodes/yr
* severe symptoms
* non-albicans
* uncontrolled DM
* HIV
* Steroids
* pregnancy

Question 3

what is the CI for use of Boric Acid as a tx for candidial vulvovaginitis

Answer 3

pregnancy!

Question 4

you want to avoid mixing these drugs with QT prolonging drugs and hepatotoxic drugs!

also with clopidogrel and warfarin!!

Answer 4

fluconazole/ketoconazole/itraconazole

Question 5

MOA - inhibits enzyme for cell membrane synthesis

Answer 5

fluconazole/ketoconazole/itraconazole

Question 6

this medication not only treats candidial vulvovaginitis but also prevents long-term recurrence!

Answer 6

ibrexafungerp

Question 7

is there mucosal inflammation in bacteral vaginosis

Answer 7

NOOOOOOOOO

keep forgetting this

Question 8

Clue cells on saline prep suggest what

Answer 8

bacterial vaginosis

Question 9

if a pregnant patient has bacterial vaginosis what is the treatment

Answer 9

PO!!!!!!!!

metro or clinda :)

PO!!!!!!! Not vaginal

Question 10

What can you NOT use in the treatment of bacterial vaginosis in a pregnanty patient

Answer 10

Tinidazole
Secnidazole
VAGINAL CREAMS

only treat pregnant w PO:)

Question 11

MOA for this drug class is that it binds and deactivates enzymes

Answer 11

Nitroimidazoles

metro, tinidazole, secnidazole

Question 12

Do not drink alcohol or use disulfiram with these medications

Answer 12

nitroimidazoles

(alchohol w/i 3 days, disulfiram w/i2 weeks)

metro, tinidazole, secnidazole

Question 13

MOA- Binding to ribosomes to block protein synthesis

Answer 13

clindamycin

Question 14

Tx for trichomonas

Answer 14

metronidazole (or other nitroimidazole)

Question 15

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…?

Answer 15

tinidazole!!!

tought trich needs tinidazole!

Question 16

Nucleic acid probe/culture showing G- diplococci within leukocytes

what is it and how to tx it?

Answer 16

gonorrheal vulvovaginitis

tx with rocephin + Doxy or azithromycin!

Question 17

what are potential causes of noninfectious vaginitis

Answer 17

• topical irritants
• allergens
• atrophy
• excessive sexual activity
• poor hygiene/stress/sweat/heat

Question 18

what cause of noninfectious vaginitis would warrant the tx of lubricants/moisturizers, HRT, or ospemifene

Answer 18

atrophy!!!

Question 19

What are the CAM treatments for noninfectious vaginitis?

Answer 19

also probiotics!!!!

Question 20

HPV 6 and 11 are the causes of what

Answer 20

condyloma acuminatum

Question 21

Before treating this condition you should def do a pap and colposcopy (and maybe a biopsy) to r/o neoplassia!

Answer 21

condyloma acuminata

Question 22

what vulvuvaginal problem is caused by poxvirus?

Answer 22

molluscum contagiosum

Question 23

microscopy of this disease shows inclusion bodies in the cytoplasm

Answer 23

molluscum contagiosum

Question 24

if a pt presents with a lone PAINLESS ulcer on the genitalia +/- LAD is suggestive of what

Answer 24

PRIMARY syphilis

Question 25

rash, malaise and fever are associated with which condition

Answer 25

secondary syphilis

Question 26

a patient with positive serology of syphilis but no symptoms is what kind

Answer 26

latent syphilis

Question 27

when would you use PCN IM for 3 weeks

Answer 27

Syphilis that is……
* >1 yr latency
* tertiary
* systemic involvement (cardiac)

Question 28

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?

Answer 28

• 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

Question 29

MC in women>60 w autoimmune dz or vit A deficiency

Answer 29

lichen sclerosis

Question 30

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?

Answer 30

• acute lichen sclerosis
• clobetasol propionate 0.05% first line!
• Biopsy all new lesions!

Question 31

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

Answer 31

Dx: chronic lichen sclerosis
tx: Clobetasol propionate. If refractory use intralesional injection, oral acitretin (retinoid) or methotrexate or laser.

surgery if introital narrowing!!!

Question 32

this lichen diagnosis does not have dermal inflammatory infiltrates and is diagnosed with ……. and is treated w …….

Answer 32

lichen simplex chronicus
biopsy!
tx w oral antihistamines and topical fluocinolone or triamcinolone

intractable = IL steroid injections, TCAs (amitriptyline)

Question 33

is lichen planus more sharply marginated on skin or mucosa

Answer 33

skin

Question 34

what do you treat with a sclerosing agent

Answer 34

vulvar varicosities that persist postpartum

Question 35

what is the tx for vulvar intraepithelial neoplasia

Answer 35

Question 36

This is a Intraepithelial neoplasia/adenocarcinoma in situ

Answer 36

exramammary pagets disease

Question 37

red velvet cake, pruritus and vulvar soreness

Answer 37

extramamarry pagets disease hallmark appearance

eventually causes developement of white plaques!

Question 38

when do you use this

Answer 38

pagets disease

Question 39

the main concern with …… is that it has a high rate of SCC developement

this is probably multiple things so plz lemme know

Answer 39

lichen sclerosus

Question 40

when do we use clobetasol propionate

Answer 40

lichen sclerosus

Question 41

when do you use a vulvar biopsy

Answer 41

extrammamary pagets disease