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GK F3E5 > Vaginal Disorders > Flashcards

Vaginal Disorders Flashcards

1
Q

causative organism for vulvovaginal candidiasis (VVC)

A

Usu. Candida albicans

Can be caused by other Candida sp. or yeasts: Candida glabrata, Candida tropicalis, or Torulopsis glabrata

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2
Q

Vulvar pruritis, external dysuria, burning, dyspareunia, swelling, redness, excoriation

Thick, curd-like vaginal discharge

Normal vaginal pH <4.5

what dz?

A

VVC

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3
Q

risk factors of VVC

A

abx

immunocompromised

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4
Q

dx of VVC

A

consistent clinical px

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5
Q

VVC testing

A

Wet prep (saline & 10% KOH) with microscope visualization of budding yeast and hyphae

Candida culture

Normal vaginal pH (<4.5)

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6
Q

uncomplicated VVC tx

A

Short course (1-3 days) of topical (vaginal) azole, eg. clotrimazole (OTC)

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7
Q

what characterizes complicated VVC?

A

Recurrent (> 4 episodes in 1 yr),

OR

Severe, Non-albicans, Patient has uncontrolled DM or immune compromise

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8
Q

complicated VCC tx

A

7-14 days topical azole or oral fluconazole

If Non-albicans, avoid fluconazole

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9
Q

VVC during pregnancy tx

A

topical azole x 7 days

OR

single dose fluconazole

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10
Q

does the male partner need tx if pt has VVC?

A

Male partner doesn’t need treatment unless he has balanitis (inflammation of the skin covering the glans of the penis)

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11
Q

for what do you evaluate pts who have recurrent VVC or are difficult to tx?

A

DM
HIV

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12
Q

bacterial vaginosis causative organism

A

polymicrobial - often assoc. with Gardnerella vaginalis & Mobiluncus sp (gram variable anaerobes)

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13
Q

Vaginal irritation, thin white or gray discharge with strong fishy odor

clinical px of what?

A

bacterial vaginosis

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14
Q

risk factors for bacterial vaginosis

A

New or multiple sex partners

Douche

Rarely affects women who have never been sexually active

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15
Q

bacterial vaginosis dx

A

3/4 Amsel’s criteria must be present

  1. Thin white homogenous discharge that smoothly coats vaginal walls
  2. Clue cells on microscopy
  3. Vaginal fluid pH > 4.5
  4. Release of fishy odor when adding KOH solution (+ whiff test)

Gram stain: Shows anaerobes known to cause BV & lack of Lactobacilli

Gold standard but not generally used clinically

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16
Q

bacterial vaginosis tx

A

Treat all pts with symptoms*

Metronidazole x 7 days*

Metronidazole gel intravaginally for 5 days

Clindamycin orally or intravaginally

Pregnant patients: Use oral medication

Sex partners: Routine treatment of male partners not recommended

May spread between female sex partners

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17
Q

what should you avoid when taking metronidazole?

A

alcohol

18
Q

complications of bacterial vaginosis

A

Increases risk of acquiring & transmitting HIV

Increases risk of acquiring herpes, gonorrhea (GC) & chlamydia

Association with PID (?independent risk factor)

Persistent or recurrent BV is common

19
Q

žLoss of estrogen causes epithelial thinning involving the vulva, vagina and bladder

Symptoms of dryness

žLoss of elasticity in connective tissue

Vagina shortening/narrowing

Pathophys of what condition?

A

atrophic vaginitis

20
Q

žDyspareunia

žPost-coital bleeding

žLeukorrhea

žBurning, raw, dry sensation

“feels like a yeast infection”

žUrinary symptoms

clinical px of what?

A

Atrophoic vaginitis

21
Q

physical exam of atrophic vaginitis

A

žVagina has loss of rugae

žPale – red coloring, petechiae

žPurulent vaginal discharge, fissures or erosions

žWet mount: parabasal cells, decreased/absent lactobacilli

ž

žpH > 5

22
Q

atrophic vaginitis tx

A

žOTC vaginal moisturizer: Replens, etc, Contraindications to estrogen

žMechanical treatment

žVaginal Estrogens: Premarin or Estrace vaginal cream, Vagifem 10mcg twice weekly, Estring q 90 days

žVaginal prasterone (DHEA)

žOspemifene (Osphena) 60mg daily: SERM (Potential for thrombotic events)

23
Q

Risk Factors of vaginal intraepihelial nepplasia (VAIN)

A

Same as CIN: Smoking, multiple sexual partners and early onset of sexual activity

History of CIN III: Unclear how CIN migrates to vagina

24
Q

T/F: žSome women with primary vaginal cancer have NO history of CIN III or cervical cancer

A

TRUE

25
Q

HPV exposure

Development of VaIN following HPV exposure requires greater period of time

Frequency of VaIN is not as high as CIN since vaginal epithelium is different than cervical

VaIN progression to invasive cancer is lower than CIN to cervical cancer

Most lesions are located in the upper 1/3 of vagina

Patho of what?

A

VAIN

26
Q

VAIN classification

A

benign viral proliferation

27
Q

VAIN 2 classification

A

intermediate risk

28
Q

VAIN 3 classification

A

true precursor to vaginal cancer

29
Q

VAIN Dx

A

pap smear (cytology) for detection

colposcopy

30
Q

VAIN 1 mgmt

A

Observation is justified in younger women

Cytology/HPV/Colposcopy Q 6 months

31
Q

VAIN 2/3 mgmt

A

Surgical intervention vs. Topical chemotherapy

32
Q

when is vaginectomy preferred for VAIN

A

Invasion suspected, women > 40ys, cytology and colposcopy differ and if extended sampling needed

Removes upper 1/3 of vagina

S/E’s: vaginal shortening, blood loss, need for skin graft and adverse sexual functioning

90% success rate

33
Q

disadvantages of laser vaporization for VAIN

A

Inability to access lesions extending into vault or lesions within surgical scar from TAH and operator-dependent

34
Q

VAIN mgmt

A

žžTopical chemotherapy / 5FU: Insert 2g PV x 5-7 nights: Apply zinc oxide in AM at introitus and vulva prior to application

Causes sloughing of vaginal epithelium

35
Q

side effects of topical chemotherapy/5FU

A

S/E’s:

Dyspareunia, vaginal burning/ulceration/irritation

¡Only used if other treatment options are not feasible

¡Not FDA approved for this indication

36
Q

what is the MCC of invasive vagina CA?

A

metastasis from endometrium, ovary or cervix

37
Q

FIGO definition of vaginal CA

A

FIGO states only when the primary site of growth is from the vagina can it be called vaginal cancer

38
Q

T/F: Squamous cell is the most common type of vaginal CA

A

True

39
Q

Asymptomatic

Leukorrhea

Vaginal odor

Post-coital bleeding

Abnormal Pap smear

Colposcopy demonstrates acetowhite changes, punctation or mosaicism

Clinical px of what?

A

vaginal cancer

40
Q

vaginal CA tx

A

Combination of vaginectomy and radiation

41
Q
A

GK F3E5 (19 decks)

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