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Clin med sem 2 > Vagina > Flashcards

Vagina Flashcards

1
Q

Lichen Sclerosis- pathophysiology

A

Most common non-neoplastic

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2
Q

Lichen Sclerosis- epidemiology

A

> 60

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3
Q

Lichen Sclerosis- S/S & PE

A

Intense vulvar pruritis
Vulvar skin - thin/wrinkled ““cigarette paper appearance””
- lichenification, hyperkeratosis, erosions, fissures, subepithelial hemorrhages, ulcerations

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4
Q

Lichen Sclerosis- treatment

A

Stop Itch Cycle!!
Antihistamine @ night + high dose topical steroid
- Clobetasol propionate ointment
PO steroids - severe

Refer to OB -> BIOPSY

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5
Q

Lichen Sclerosis- prognosis

A

RISK - squamous cell carcinoma of vulva

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6
Q

Lichen Simplex Chronicus- pathophysiology

A

Benign epithelial thickening and hyperkeratosis

non-specific reactive condition from constant irritation or rubbing

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7
Q

Lichen Simplex Chronicus- cause

A

Chronic irritation

Chemical, infection, allergic

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8
Q

Lichen Simplex Chronicus- S/S & PE

A

Hyper or hypopigmented
Thickened, leathery appearance
Extreme prurutis - labia majora

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9
Q

Lichen Simplex Chronicus- treatment

A

Refer to OB -> BIOPSY

PO antihistamines + topical med steroid
- betamethasone or tiamcinolone

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10
Q

Lichen Simplex Chronicus- prognosis

A

Not associated w/ cancer risk

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11
Q

Lichen Planus- pathophysiology

A

Inflammatory autoimmune disorder

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12
Q

Lichen Planus- S/S & PE

A

Flat topped papules - white plaques
- on vulva, vagina, oral
Ulceration or erosions - usually on vagina
Itching, burning, postcoital bleeding, dyspareunia, pain

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13
Q

Lichen Planus- treatment

A

Refer to OB -> BIOPSY
Frequent exam for formation of adhesions

Topical hydrocortisone foam
- Colifoam
High dose topical can be tried externally

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14
Q

Lichen Planus- prognosis

A

Very Rare

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15
Q

Behcet’s Syndrome- pathophysiology

A

Rare inflammatory disorder

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16
Q

Behcet’s Syndrome- cause

A

HLA-B51

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17
Q

Behcet’s Syndrome- S/S & PE

A

Triad - oral ulcers, genial apthae/ulcerations, uveitis

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18
Q

Behcet’s Syndrome- treatment

A

Topical and Systemic corticosteroids

Refer to OB -> Biopsy

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19
Q

Bartholin Duct Cyst/abscess- pathophysiology

A

Obstruction of main duct of Bartholin gland

Barholin gland - 5 and 7 o’clock
- provide moisture

Obstruction -> cycsts or abscess

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20
Q

Bartholin Duct Cyst/abscess- S/S & PE

A

Fluctuant tender mass - palpable

Pain, tenderness, dyspareunia, difficult walking

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21
Q

Bartholin Duct Cyst/abscess- treatment

A 
I&D
Catheter placement - elliptical incision along vaginal mucosa w/ expression of pus 
- insert word cath deep in cavity 
- can use gauze to pack cavity 
Marsupialization

abx - if inflammation

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22
Q

Atrophic vaginitis- pathophysiology

A

atrophy

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23
Q

Atrophic vaginitis- cause

A

Dec Estrogen levels

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24
Q

Atrophic vaginitis- epidemiology

A

Postmenopausal
Prepubertal
Lactating women

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25
Q

Atrophic vaginitis- S/S & PE

A

pH of vag high 5-7
Epithelium thinned
- more susceptible to infection/trauma
Los of elasticity - shortening/narrowing of vag

Vaginal dryness, itching, burning, dyspareunia, spotting, discharge, urinary symptoms - urgency, frequency, UTI, incontinence

Low estrogen

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26
Q

Atrophic vaginitis- treatment

A 
Estrogen Therapy 
- PO or systemic - contra 
- topical - 1/3 will be absorbed systemic - don't give to hx or breast or endometrial cancer
Premarin vaginal cream
Estrace vaginal cream
Vagifem tablets
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27
Q

Vulvar Malignancy- pathophysiology

A

Carcinoma of Vulva

- v rare

28
Q

Vulvar Malignancy- epidemiology

A 
Postmenopausal 
Smoking
HPV
Immunodeficiency 
hx cervical carcinoma
Chronic vulvar irritation
29
Q

Vulvar Malignancy- S/S & PE

A

Hx - vulvar irritation, pruritis, discomfort, bloody discharge

Ulcer or large cauliflower lesion

30
Q

Vulvar Malignancy- treatment

A

Surgery - stage/treat

31
Q

Paget Disease- pathophysiology

A

Extramammary Paget dis

In situ adenocarcinoma in epithelium of vulva and perianal regions

32
Q

Paget Disease- S/S & PE

A

Itchy, red, crusted lesion - labia major

White coating - caking icing

33
Q

Paget Disease- treatment

A

Refer to OB -> biopsy

34
Q

Paget Disease- prognosis

35
Q

Foreign bodies- cause

A 
Paper
Cotton
Retained tampon
Contraceptive
Pessary
36
Q

Foreign bodies- S/S & PE

A

Malodorous vaginal discharge
Intramenstrual spotting

2nd to - vaginal epithelium drying and microculcerations

Ulcerative lesions - vaginal fornices
- rolled, irregular edges w/ red granulation tissue base

37
Q

Foreign bodies- treatment

A

Remove foreign object
Abx - not usually needed
- yes if - cellulitis, systemic symptoms

38
Q

Toxic Shock Syndrome- pathophysiology

A

Tampon usage

39
Q

Toxic Shock Syndrome- cause

A

Staph exotoxins

40
Q

Toxic Shock Syndrome- S/S & PE

A 
High fever
Severe HA
Sore throat
Myalgia 
V/diarrhea
Skin rash - gone after 24/48hrs
Desquamation of palms and soles - 2-3w post
Hypotension -> shock - w/in 48 
Multiorgan failure
41
Q

Toxic Shock Syndrome- treatment

A 
Remove tampon
Vaginal cultures
Copious irrigation of saline 
Penicillin or Vanco
DON’T USE TAMPONS AGAIN
42
Q

Malignant Disease of Vagina- pathophysiology

A

Rare - primary

Met or vaginal involvement via directly from cervix - more common

43
Q

Malignant Disease of Vagina- cause

A

Clear cell adenocarcinoma

-> mom was treated w/ DES during pregnancy

44
Q

Malignant Disease of Vagina- S/S & PE

A

Asymptomatic
Early - painless bleeding, ulcerated tumor
Late - bleeding, pain, weight loss, swelling

45
Q

Malignant Disease of Vagina- labs & imaging

46
Q

Malignant Disease of Vagina- treatment

A

Surgery
Radiology
Chemo

47
Q

Pelvic Organ Prolapse- S/S & PE

A 
Cystocele - bladder prolapse
- anterior front vaginal wall
- falls towards vagains -> bulge
- difficulty getting urine started or completely out
Cystourethrocele - bladder and urethra
Rectocele - rectum or large bowel 
- posterior back vaginal wall
- diff to pass stool, more mechanical
48
Q

Ectropion- pathophysiology

A

Eversion of columnar epithelium into ectocervix

Ectocervix - vagina - squamous epithelium
Endocervix - uterus - columnar epithelium

49
Q

Ectropion- epidemiology

A

Pregnancy

Puberty

50
Q

Ectropion- S/S & PE

A

Cervix - red, granular, inflamed

Benign - biopsy to r/o cancer

51
Q

Nabothian Cysts- pathophysiology

A

Very common

52
Q

Nabothian Cysts- cause

A

Squamous epithelium of ectocervix grows over simple columna of endocervix

53
Q

Nabothian Cysts- S/S & PE

A

asymptomatic

Translucent - yellow mucous filled cysts on surface of cervix

54
Q

Cervical stenosis- pathophysiology

A

Internal OS

55
Q

Cervical stenosis- cause

A

Cone biopsy
LEEP
Ablative techniques

56
Q

Cervical stenosis- S/S & PE

A

Amenorrhea
Pelvic pain
Infertility

57
Q

Cervical stenosis- diagnosis

A

Can’t pass sound or dilator through Os

58
Q

Cervical stenosis- treatment

59
Q

Cervical Polyp- pathophysiology

A

Common

External Os

60
Q

Cervical Polyp- cause

A

Focal hyperplasia of endocervix

61
Q

Cervical Polyp- S/S & PE

A

Soft, red, pedunculated protrusion from cervical canal
1mm- 2-3cm

intermenstrual or postcoital bleeding

62
Q

Cervical Polyp- labs & imaging

A

Biopsy

Imaging - hysterosalpingogram, saline infusion sonohysterography

63
Q

Cervical Polyp- treatment

A

Polypectomy

64
Q

Incompetent Cervix- pathophysiology

A

Weak cervical tissue -> premature birth or loss of prego

65
Q

Incompetent Cervix- treatment

A

Cervical cerclage
bed rest
Progesterone

Clin med sem 2 (30 decks)

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