Vulva and Vagina Disorders

Question 1

Normal vaginal pH

Answer 1

4.0-4.5

Question 2

What would you suspect if you saw erythema, lesions or fissures on the vulva?

Answer 2

dermatitis

Question 3

pH range for trichomoniasis vaginal infection

Answer 3

5.0-6.0

Question 4

pH range for candidial infection

Answer 4

4.0-4.5

Question 5

Not helpful in evaluation of vaginosis

Answer 5

bacterial cultures

Question 6

Most common cause of discharge of women of childbearing age

Answer 6

bacterial vaginosis

Question 7

Pathophysiology of bacterial vaginosis

Answer 7

Decrease in hydrogen-peroxidase lactobacilli. Increase in primarily gram negative rods

Question 8

Exam findings may include: fishy odor, clue cells, and thin, white/gray discharge

Answer 8

bacterial vaginosis

Question 9

Preferred treatment for bacterial vaginosis

Answer 9

Metronidazole: Oral 500mg BID for 7 days

Question 10

How does bacterial vaginosis affect pregnancy?

Answer 10

associated with preterm birth

Question 11

Primary etiologic agent for vulvovaginal candidiasis

Answer 11

Candida albicans

Question 12

On speculum exam: Thick, white, sometimes “cottage cheese”, discharge. In severe cases a gray membrane

Answer 12

Vulvovaginal Candidiasis

Question 13

Prescription treatment vulvovaginal candidiasis

Answer 13

Fluconazole (Diflucan)

Question 14

Most common STI WORLD wide. Flagellated protozoan

Answer 14

Trichomonas vaginalis

Question 15

On speculum exam may seen green, malodorous, frothy discharge

Answer 15

trichomonas vaginitis

Question 16

Characteristic look of cervix with a trichomonas infection due to irritation of protozoan

Answer 16

“strawberry” cervix

Question 17

Treatment for trichomonas for both partners in addition to abstaining from sex until tx is completed

Answer 17

Tinadazole (Tindamax) or metronidazole (Flagyl)

1 time dose of 2 grams

Question 18

Presenting symptoms include painful genital ulcers, itching, dysuria, tender inguinal lymphadenopathy

Answer 18

genital herpes

Question 19

What would you expect to see on physical exam with a patient who has genital herpes?

Answer 19

multiple vesicles on erythematous base

Question 20

How do you confirm diagnosis of genital herpes?

Answer 20

viral cell culture or PCR

Question 21

What is the treatment for primary infection of genital herpes?

Answer 21

acyclovir (Zovirax), famcyclovir (Famvir), or valocyclovir (Valtrex) for 7-10 days

Question 22

Length of duration for recurrent genital herpes treatment

Answer 22

1-3 days

Question 23

MOST common viral sexually transmitted disease in the U.S. Etiologic agent is often HPV serotypes

Answer 23

Codylomata acuminata (anogenital warts)

Question 24

Clinical manifestations include pruritis, burning, pain that can interfere with defecation and coitus

Answer 24

Codylomata acuminata (anogenital warts)

Question 25

Chemical treatment of Codylomata acuminata (anogenital warts) for pregnant women

Answer 25

Trichloroacetic acid

Question 26

Multiple, 1-2 mm raised, painless lesions. Dome-shaped with central dimple. Contain cheesy-white material

Answer 26

Mulloscum Contagiosum

Question 27

Can occur in women of any age who experience a decrease in estrogenic stimulation of urogenital tissue

Answer 27

Atrophic Vaginitis

Question 28

Clinical presentation includes: 2 yrs since natural menopause, loss of labial/vulvar fullness, pallor of urethral/vaginal epithelium, narrow introitus, minimal vaginal moisture

Answer 28

atrophic vagnitis

Question 29

Most effective therapy for Atrophic Vaginitis

Answer 29

vaginal estrogen therapy

Question 30

Caused by intense inflammatory reaction. Diagnosed by biopsy.

Answer 30

lichen sclerosis

Question 31

Symptom that is a hallmark for lichen sclerosis

Answer 31

vulvar pruritis that is so intense it interferes with sleep

Question 32

PE findings include well-demarcated white, finely wrinkled, atrophic patches

Answer 32

lichen sclerosis

Question 33

Treatment for lichen sclerosis

Answer 33

clobetasol propionate 0.05% cream for 6-12 weeks (topical steroids)

Question 34

Most common large cyst of the vulva—average 1-3 cm size. Tx not necessary in asymptomatic women < 40 yrs

Answer 34

Bartholin Duct Cyst

Question 35

Clinical manifestations include exquisite pain, erythematous, warm, tenderness of swollen Bartholin gland

Answer 35

Bartholin Duct Abscess

Question 36

Intraepithelial adenocarcinoma. Lesions are brick red, scaly, velvety eczematoid plaque with sharp border

Answer 36

Paget's Disease

Question 37

Treatment for Paget's disease of genitalia

Answer 37

excision with > 3 mm border from visible margin

Question 38

Risk factors include HPV infection, cigarette smoking, lichen sclerosis, northern european ancestory

Answer 38

vulvar cancer

Question 39

What are the clinical manifestations of vulvar cancer?

Answer 39

Unifocal vulvar plaque, ulcer or mass

Question 40

Most common histological cell type of vulvar cancer

Answer 40

squamous cell

Question 41

Why should we continue pap smears after hysterectomy?

Answer 41

risk of vaginal Intraepithelial Neoplasia