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vulva/vaginal dz Flashcards

1
Q

what lesions are white lesions

A

lichen sclerous

lichen simplex chronicus

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2
Q

what are red lesions

A

psorasis

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3
Q

what are dark lesions

A

melanosis or lentigo

melanoma

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4
Q

what are ulcerative lesions

A

Herpes genitalis

bechets

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5
Q

what are small tumors

A

chondyloma acuminatum

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6
Q

what are large tumors

A

bartholin’s duct cyst and abscess

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7
Q

lichen sclerosis

A

MC benign epithelial vulvar d/0

chronic inflammatory process

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8
Q

Lichen sclerosis is MC in which women

A

postmenopausal women >60

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9
Q

what are signs and symptoms of lichen sclerosis

A

erythema/edema of vulvar skin
white plaques, intense pruritis
subepithelial hemorrhages from scratching
erosions/fissures and ulcerations

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10
Q

what will lichen sclerosis look like in chronic dz

A

thin wrinkled and white skin that is fused together, perianal involvement

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11
Q

what is the Tx for lichen sclerosis

A 
control pruritis to minimize inflammation
good hygeine
antihistamine
topical steroids
topical steroids
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12
Q

what is lichen simplex chronicus

A

benign thickening and hyperkeratosis secondary to chronic irritation
dermal layer is spared

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13
Q

S/S of lichen simples chronicus

A

pruritis, rubbing scratching, thickening of epithelium

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14
Q

how is vulvar lichen simplex chronicus dx’d

A

biopsy

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15
Q

what is the tx for lichen simplex chronicus

A

good hygiene, lubricats, sits bath, antihistamines

topical sterods

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16
Q

what are red lesions secondary to

A

thinning epidermis revealing capillary vessels

vasodilation associated w/ inflammation

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17
Q

what is the tx for a red lesion

A

topical steroid and tx any underlying process

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18
Q

what are dark lesions caused by

A

secondary to increased quantity of concentration of melanin or hemosiderin pigments or trauma

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19
Q

what do all dark lesions require

A

biopsy

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20
Q

what is melanosis

A

benign pigmented flat lesion

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21
Q

what is a melanoma

A

uncommon but aggressive may arise from pigment nevi

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22
Q

what are types of ulcerative lesions

A 
Genital herpes
Bechet's
Syphilis
Chancroid
Lymphogranuloma venereum
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23
Q

which types of herpes affect the vagina

A

type 1&2

60% are due to type 2

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24
Q

how is herpes transmitted

A

through sexual contact

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25
what is the incubation time for HSV
2-7days with periods of viral shedding which can result in transmission to a sexual partner
26
how to precent HSV
avoid direct contact with active lesions condom use supression therapy
27
what are S/S of HSV
tingling, burning, itching, fever, malaise, myalgias | ulceration w/painful symptoms
28
what will HSV look like of PE
erosions/ulcerations surrounded by a red halo in a sperentine like fashion bilateral lymphadenopathy
29
what is the gold standard in Tx for HSV
viral culture you can also do serologic testing
30
what is the Tx for HSV
lesions are self limiting and heal on their own unless you develop secondary infection symptomatic tx: good hygiene, loose clothes, cool compresses oral analgesics Antiviral Tx
31
what should you do with pregnant women
screen all pts for HSV | all women with recurrent herps should deliver by c-section
32
what is bechets dz | what is the triad
Oral ulcers, Genital ulcers, Uveitis | immune mediated systemic vasculitis, may result in thrombophlebitis, erytherma nodosum, involves joints and CNS
33
what is the Tx for bechets
colchicine, topical systemic steroids
34
what is condyloma acuminatum
genital warts caused by HPV 6,11 sexually transmitted
35
what are the signs/symptoms of genital warts
usually painless | white, exophytic, papillomatous growth that tend to coalesce and for cauliflower like masses
36
what are complications of genital warts
can be sexually transmitted and given to a newborn | can become large and result in pain
37
what is the Tx for condyloma acuminatum
``` Tx'd by provider: Trichlorocetic acid podophyllin cyrosurgery, electrocautery Tx by pt: podofilox Imiquidmod ```
38
what is bartholin gland cyst/abscess
gland located in the posterior third of each labia into the vestibules at 4 and 8 o'clock position Obstruction of the duct leads to retention of secretion and dilation of the cyst
39
what are the signs and symptoms of bartholin gland cyst
pain, tenderness, palpable mass dypareunia pain w/walking
40
what will you see on PE with bartholin cyst
palpable tender fluctuant mass | surrounding edema and inflammation
41
what is the tx for bartholin gland abscess
drain infected cyst/abscess: Marsupialization word catheter Abx if infx present to cover e.coli and staph
42
Vulvar cancer is mostly what type
90% squamous cell carcinoma
43
when does vulvar cancer most commonly occur
60-70 years of age d/t vulvar dystrophy and chronic inflammation
44
what are RF for vulvar cancer
``` Tobacco use HIV Hx of cervical carcinoma HPV infx chronic vulvar irritation secondary to DM ```
45
what are signs/symptoms of vulvar cancer
vulvar pruritis, vulvar mass, bleeding, vulvar pain
46
what will PE for vulvar cancer look like
large califlower lesions to small ulcer craters
47
what is the Tx for vulvar cancer
surgery | degree and extent depends on the staging tumor size, lymph node involvement
48
what is the most important factor in prognosis of vulvar cancer
lymphnode involvement
49
what is the normal vaginal pH
3.8-4.2
50
what factors affect the vaginal environment?
``` feminine hygiene products contracetive hormones vaginal meds Abx STD Intercourse Stress Medical Dz ```
51
what tools are used to evaluate vaginitis
saline wet mount KOH prep Whiff Cultures
52
how is a saline wet mount used
vaginal discharge is placed on a slide with 1-2 drops of 0.9% isotonic sodium chloride and examined under high power microscope
53
KOH prep works
vaginal discharge is placed on a slide with 10% KOH solution and examined under a microscope
54
how does a whiff test work
release of fishy odor after addition of 10% KOH to discharge
55
how do cultures work
little use in evaluating acute vaginitis b/c results are not readily available
56
Candidiasis
candida albicans is the most common species | infection depends on growth and colonization
57
what systemic disorders are associated with yeast infection
DM,HIV, Pregnancy, Med (abx, OCP, roids) frequent intercourse
58
what are the signs/symptoms of candidiasis
White cottage cheese discharge Vulvar erytherma/pruritis burning sensation following urination
59
what will candidiasis look like on PE
eryhterma swelling of labia and vulva thick cottage cheese discharge no cervical involvement
60
what is the golf standard for candida; diagnosis
vaginal culture vaginal pH ≤ 4.5 Wet mount will show hyphae and budding yeast form are noted
61
what is the Tx for candidiasis
Imidazole Fluconazole (topical, suppositories, oral) No need to treat partner unless uncircumcised or inflammation of the glans of the penis
62
what is recurrent candidiasis and how is it Tx'd
≥4 episodes in 1 year consider underlying systemic illness wear cotton or microfiber underwear eat yogurt
63
what is the most common cause of symptomatic bacterial infection in reproductive aged women
Bacterial vaginosis
64
what causes bacterial vaginosis
alterations in normal vaginal flora resulting in overgrowth of Gardnerella, Mobiluncus, anaerobic gm neg, Peptostreptococcus
65
what are signs and symptoms of bacterial vaginosis
fish vaginal discharge, noticeable after intercourse | White to gray discharge
66
what will BV look like on PE
D/C is frothy and white/grey in color that is thin and homogenous and can adhere to vaginal mucousa
67
how is BV diagnosed
``` 3 of 4 needs to be met -Homogenous white/gray adherent discharge -Vaginal pH >4.5 -(+) whiff test Clue cells on wet mount ```
68
what is the treatment for BV
Metronidazole or CLINDAMYCIN | avoid alcohol with metronidazole
69
Trichomonas
most prevelant non-viral STD | identified in 80% male partners
70
what are RF for Trichomonas
Tobacco use, IUD and unprotected intercourse
71
what are signs and symtpoms of trichomonas
purulent malodorous discharge Green frothy and foul smelling postcoital bleeding
72
what will PE for Trichomonas look like
erythermatous and edematous vulva | petechiae on cervix (strawberry spots)
73
how is trichomonas dx'd
vaginal pH >5 Saline wet mount will show oval shaped protozoa, large # of WBC Whiff test may be positive
74
what is the Tx for trichomonas
metronidazole Tinidazole TREAT ANY AND ALL PARTNERS abstain from unprotected intercourse for 10days
75
vaginal neoplasims
85% are squamous cell carcinoma
76
what are the RF for vaginal neoplasm
``` Tobacco HPV mult sex partners Hx of lower genital tract neoplasia Inutero DES ```
77
what is the Tx for pelvic organ prolapse
pessary pelvic floor exercises (kegal) estrogen therapy Surgery

womens health (6 decks)

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