Vaginal/Vulvar dz Flashcards
Vaginitis mc sx
vaginal secretions are usually ___ and result from ___ and sec from accessory ___
may contain contributions from ___
vaginal discharge
non-odorous, cervical mucous, vaginal glands
normal vaginal flora
Vulvovaginal candidiasis
Caused by ___ usually __
RF include P D I O R W
candia, candida albicans
Preg DM Immunosuppression Obesity Recent ab (kills off normal flora that inhibits yeats) Wearing tight clothing
Sx of vulvovaginal candidiasis
P
V__ often thick, ___ and ___, ___, described as ___, pH of
Vaginal/vulvar tissues may be
___ possible
DX take vaginal swab and create
Apply ___ to discharge to observe cells
KOH test - apply to ___
Hallamrk of yeast infection is visualization of ____ on KOH prep
Pruritis
Vaginal discharge, adherent and white, odorless, “cottage cheese”, 4-5
erythematous
excoriation
wet mount
normal saline
lyse cells
buds/hyphae
TX vulvovaginal candidiasis
T
__ preferred by pt (even ___ effective)
___ may provide instant relief if __ involved
Topical/oral antifungals
Oral, single dose
Topical, vulva
Bacterial vaginosis
Overgrowth of normal vaginal flora including ___ and ___
Sx
Dx
On wet prep __ often present
___ w numerous coccoid bacteria on surface
on KOH prep- KOH liberates ___ that cause the fishy odor (aka wwhiff test)
tx w
Gardnerella vaginalis, anaerobes
thin grey-white discharge
fishy odor
vaginal/vulvar irritation
cells
Vaginal epithelial cells
amines
metronidazole
Trichomonas vaginitis
Caused by
has ___
Sx include B, C, O, D
Discharge described as
Can have ___ cervix from inflamm
Dx w visualization of ___ on wet prep
Tx w
Protozoa trichimonas vaginalis
flagella
Burning/pruritis, copious discharge, odor, dyspareunia
frothy
bright red, strawberry
mobile protazoa
metronidazole
Candidiasis and __ considered not ___
Vaginal dysplasia- similar path/dx/behavior to
termed
Often related to
More likely in women having gone ___ for CIN3 (need continued ___)
Dx confirmed w
Tx dysplastic lesions w
E
L
T
Bacterial vaginosis
cervical dysplasia
Vaginal intraepithelial neoplasia (VIN)
HPV
hysterectomy, pap surveillance
vaginoscopy/biopsy
Excision
Laser ablation
Topical chemo (5FU)
Vaginal cancer
MC
Tx w __ or __
Rare cancers include ___
Vaginal adenocarcinoma ___ assc w ___ exposure
DES also associated w
Children can have ___ embryonal rhabdomyosarcoma
Mass of grape like tissue at
__ discharge
Arises from ___ of anterior vaginal wall
SCC
Surgery (if early), radiation
Melanoma
clear cell cacner
DES
t shaped uterus
sarcoma botryoides
introitus
bloody
undiff mesenchyme
Bartholins gland abscess
Results in __ and ___
Tx w ___ and ___ w/wo __ to keep gland open/draining
Can be assc w __ of batholins gland in ___
Gartners duct cyst ___ remnant
Oft ___ on the __ or __ vaginal wall
Urethral diverticulum can be mistaken for
Atrophy occurs in __
Lack of ___ leads to tissue that can be ___
Tx w
pain, erythema/induration
incision/drainage, word catheter
adenocarcinoma, older women
wolffian
asx cyst, lateral/posterior
anterior vaginal wall cyst
postmenopausal pt
estrogen
vaginal estrogen cream
Lichen sclerosis
__ disease
___ ___ condition
Marked ___ and __ of epithelium
Most common in ____
Intensely ___
Skin usually ___
W advanced dz. lose ___ w loss of ___
Dx by ___
difficult to differentiate from ___ or ___ lesions
tx w
vulvar dz
chronic, progressive
inflam/thinning
older, postmen owmen
pruritic
whitened/waxy
vulvar arch, distinct labia majora
biopsy
precancerous/cancerous
high potency topical steroid
Lichen simplex chronicus
Defined as skin ___ w ___
Skin is ___ and ___ result from
Assc w
Tx focuses on ___
___ is useful
changes/plaques, hyperkeratosis
thick, excoriated, scratching
intense pruritis
breaking itch/scratch cycle
steroids
Vulvar cancer commonly presents at age
types in order
RF include M P G P S H L and is not
70-80
SCC, melanoma, basal cell
multiple partners prior abnormal paps genital condyloma poor SES smoking HPV lichen sclerosis, HPV related
Vulvar cancer precursor lesion
Similar to ___, develops ___
Termed
classified as ___
High grade lesions tx w ___ to avoid progression to cancer
New lesions commonly ___ as underlying patho still exists (ie ___)
cervical/vaginal, intraepithelial squamous dysplasia
vulvar intraepithelial neoplasia
VIN 1 or high grade vulvar dysplasia
excision/destruction
form/recur, HPV/lichen sclerosis
Sx of vulvar cancer
P m p B U
comps occur bc
Tx is ___ of primary lesion w/wo
Adjuvant ___ depending on results
Primary ___ can be used for ___
pruritis mass pain bleeding ulceration
pt delay medical care, docs delay biopsy
surgical excision, LN dissection
radiation
radation, unresectable lesions
Extra mammary Paget’s dz
Similar to ___
__ appearance w ___
Often __ and ___ common
On vulva, see ___
may be ___
can have synchronous malig of
Tx w
Paget dz of breast
eczematoid, reddened plaques
multifocal, pruritis
intraepithelial lesion
invasive
breast, UT, rectum, cervix, ovary
excision
