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Senoir 21-2 > Vaginal And Vulvar Disorders > Flashcards

Vaginal And Vulvar Disorders Flashcards

1
Q

What is the most common cause of vaginal Dc

A

BV

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2
Q

What are the Amsels criteria for BV

A

Requires 3 of the following 4 (“Amsel’s”) criteria:

  • Homogeneous discharge
  • pH >4.5
  • Positive “whiff” test
  • Clue cells on wet prep
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3
Q

What are the recommended Rx for BV

A

Metronidazole 500mg BID x 7 days

Or Gel
Or Clindamycin Cream x 7 days

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4
Q

What are the bad outcomes of BV

A

Premature rupture of membranes
Postpartum fever
Post-abortion infection/sepsis

Increased Risk of STI

Persistence of HPV (CANCER)

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5
Q

What is the treatment for a pt with BV x 3 in the last 12 months

A

Metrogel or PO nitroimidazole x 7-10d, then metrogel 2 x weekly for 4-6m

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6
Q

A pt presents with Vaginal burning/itching, irritation, post-voiding dysuria, odorless thick white “cottage cheese” discharge
With a ph less than 4.5

Think

A

Candida infection

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7
Q

What are the tx approaches to candida infections

A

-azoles

Fungal infections

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8
Q

Define recurrent candida

A

4+ episodes a year

Think

  • oral contraceptives ?
  • DM?
  • Pregnant?
  • tight clothing?
  • Candida Glabrata?
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9
Q

What is the tx approach to recurrent Candida Infections

A

Acute recurrent infection treatment:
-Local intravaginal therapy for 7-14 ds

-Oral fluconazole (200mg*) 1 pill every 72 hrs x 3 doses → days 1, 4, & 7

Suppressive treatment:
-Oral fluconazole 100 - 200mg wkly for 6 mos

Start suppressive treatment after completing acute treatment first

May need to continue indefinitely if symptoms recur when stopping txt!

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10
Q

If a pt has recurrent candida infections that is NOT Albicans

What is the tx?

A

Fluconazole 150-200 mg PO every 72 hrs x 3-4 doses
-50% cure rate

Boric acid 600 mg capsule PV qd for 2 wks:
-60% cure rate

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11
Q

A pt presents with frothy green yellow dc
With frothy dc and a strawberrry cervix

Ph > 4.5

Think

A

Trichomoniasis

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12
Q

What is the gold standard to test of r Trichomoniasis

A

NAAT

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13
Q

What is the tx approach for Trichomoniasis

A

Metronidazole 2g orally or 500 mg BID for 2 weeks

Followed by Test of Cure at 1 and 6 months

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14
Q

What is the one fact about lichen sclerosus

A

increased risk of squamous cell carcinoma

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15
Q

A pt presents with early pruritus, irritation, and vulvar thickening
With dysparunia, and introital stenosis

With cellophane paper/ tissue paper appearance on genital stretching of the skin

Often involving the perianal region

Think

A

Lichen Sclerosus

Get a Bx and re-eval in 1 year

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16
Q

A pt with a itch-scratch-cycle of the valvular area think

A

Lichen-simplex-chronicus

Nocturnal itching

17
Q

What is the tx approach to lichen simplex chronicus

A

Eliminate trigger

And lubricate with petroleum jelly

Sits bath

Oral antihistamine

And nocturnal gloves at night

+/- topical steroids

18
Q

When would you get a Bx for Lichen Simplex Chronicus

A

If not resolved in 1-3 weeks

19
Q

How does psoriasis presents on the vulva

A

Koebnerization! Trauma leading to psoriasis

Instead of the silver fine scales, presents as a fine red scale on the vulva

20
Q

What is the underlying etiology of psoriasis

A

Autoimmune

21
Q

Tx approach to psoriasis of the vulva

A

Treatment: emollients, steroids

Dovonex (calcipotriene) after control obtained

22
Q

What is lichen PLANUS?

A

Autoimmune d/o t-cells affecting both males and females
Drug induced

red erosions with white border!

Chronic vaginal discharge w/ intense vulvovaginal pruritus, burning pain, dyspareunia, & postcoital bleeding

23
Q

What are the “P”s of Lichen Planus

A

Purple, pruritic, polygonal, papules & plaques

24
Q

What is the tx approach to Lichen planus

A

Topical steroids (clobetasol)
Vaginal hydrocortisone
Suppository

25
Q

What are the tx for Intertrigo

A

Drying agents: corn starch, etc.

Inflammation: mild topical steroid

Infection: treat cause

Fungal: nystatin, clotrimazole

Encourage weight loss if obese
Wear light-weight, loose-fitting clothing (natural materials)

26
Q

What is the most common cause of vaginal irritation after menopause

A

Strophic vaginitis

27
Q

What is the tx for strophic vaginitis

A

Topical estrogen (low dose)

Treat concomitant infection

If uterus still present, caution w/ unopposed estrogen! (short term)

28
Q

Bartholin Cyst in a pt over 40

Think

A

CA>?

29
Q

Women with bartholins abcesses need what screening?

A

Screen for gonorrhea and chlamydia

30
Q

2 failed word catheters in a bartholian abcess

Then what?

A

marsupination with ABX

31
Q

A pt presents with fever, malaise, diarrhea, with a red rash, and HOTN

Post a recent menses

Think

A

Toxic shock syndrome

Treat emergency with ABX, fluids

32
Q

What is the most common vulvar cancer

A

SCC

33
Q

WHat is the major risk for smokers with HPV

A

Vulvar cancer

Senoir 21-2 (77 decks)

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