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womens health > vulva/vaginal dz > Flashcards

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
Q

what is the incubation time for HSV

A

2-7days with periods of viral shedding which can result in transmission to a sexual partner

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26
Q

how to precent HSV

A

avoid direct contact with active lesions
condom use
supression therapy

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27
Q

what are S/S of HSV

A

tingling, burning, itching, fever, malaise, myalgias

ulceration w/painful symptoms

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28
Q

what will HSV look like of PE

A

erosions/ulcerations surrounded by a red halo in a sperentine like fashion
bilateral lymphadenopathy

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29
Q

what is the gold standard in Tx for HSV

A

viral culture

you can also do serologic testing

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30
Q

what is the Tx for HSV

A

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

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31
Q

what should you do with pregnant women

A

screen all pts for HSV

all women with recurrent herps should deliver by c-section

32
Q

what is bechets dz

what is the triad

A

Oral ulcers, Genital ulcers, Uveitis

immune mediated systemic vasculitis, may result in thrombophlebitis, erytherma nodosum, involves joints and CNS

33
Q

what is the Tx for bechets

A

colchicine, topical systemic steroids

34
Q

what is condyloma acuminatum

A

genital warts
caused by HPV 6,11
sexually transmitted

35
Q

what are the signs/symptoms of genital warts

A

usually painless

white, exophytic, papillomatous growth that tend to coalesce and for cauliflower like masses

36
Q

what are complications of genital warts

A

can be sexually transmitted and given to a newborn

can become large and result in pain

37
Q

what is the Tx for condyloma acuminatum

A 
Tx'd by provider:
Trichlorocetic acid
podophyllin
cyrosurgery, electrocautery
Tx by pt:
podofilox
Imiquidmod
38
Q

what is bartholin gland cyst/abscess

A

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
Q

what are the signs and symptoms of bartholin gland cyst

A

pain, tenderness, palpable mass
dypareunia
pain w/walking

40
Q

what will you see on PE with bartholin cyst

A

palpable tender fluctuant mass

surrounding edema and inflammation

41
Q

what is the tx for bartholin gland abscess

A

drain infected cyst/abscess:
Marsupialization
word catheter
Abx if infx present to cover e.coli and staph

42
Q

Vulvar cancer is mostly what type

A

90% squamous cell carcinoma

43
Q

when does vulvar cancer most commonly occur

A

60-70 years of age d/t vulvar dystrophy and chronic inflammation

44
Q

what are RF for vulvar cancer

A 
Tobacco use
HIV
Hx of cervical carcinoma
HPV infx
chronic vulvar irritation secondary to DM
45
Q

what are signs/symptoms of vulvar cancer

A

vulvar pruritis, vulvar mass, bleeding, vulvar pain

46
Q

what will PE for vulvar cancer look like

A

large califlower lesions to small ulcer craters

47
Q

what is the Tx for vulvar cancer

A

surgery

degree and extent depends on the staging tumor size, lymph node involvement

48
Q

what is the most important factor in prognosis of vulvar cancer

A

lymphnode involvement

49
Q

what is the normal vaginal pH

A

3.8-4.2

50
Q

what factors affect the vaginal environment?

A 
feminine hygiene products
contracetive hormones
vaginal meds
Abx
STD
Intercourse
Stress
Medical Dz
51
Q

what tools are used to evaluate vaginitis

A

saline wet mount
KOH prep
Whiff
Cultures

52
Q

how is a saline wet mount used

A

vaginal discharge is placed on a slide with 1-2 drops of 0.9% isotonic sodium chloride and examined under high power microscope

53
Q

KOH prep works

A

vaginal discharge is placed on a slide with 10% KOH solution and examined under a microscope

54
Q

how does a whiff test work

A

release of fishy odor after addition of 10% KOH to discharge

55
Q

how do cultures work

A

little use in evaluating acute vaginitis b/c results are not readily available

56
Q

Candidiasis

A

candida albicans is the most common species

infection depends on growth and colonization

57
Q

what systemic disorders are associated with yeast infection

A

DM,HIV, Pregnancy, Med (abx, OCP, roids) frequent intercourse

58
Q

what are the signs/symptoms of candidiasis

A

White cottage cheese discharge
Vulvar erytherma/pruritis
burning sensation following urination

59
Q

what will candidiasis look like on PE

A

eryhterma
swelling of labia and vulva
thick cottage cheese discharge
no cervical involvement

60
Q

what is the golf standard for candida; diagnosis

A

vaginal culture
vaginal pH ≤ 4.5

61
Q

what is the Tx for candidiasis

A

Imidazole
Fluconazole
(topical, suppositories, oral)
No need to treat partner unless uncircumcised or inflammation of the glans of the penis

62
Q

what is recurrent candidiasis and how is it Tx’d

A

≥4 episodes in 1 year

63
Q

what is the most common cause of symptomatic bacterial infection in reproductive aged women

A

Bacterial vaginosis

64
Q

what causes bacterial vaginosis

A

alterations in normal vaginal flora resulting in overgrowth of Gardnerella, Mobiluncus, anaerobic gm neg, Peptostreptococcus

65
Q

what are signs and symptoms of bacterial vaginosis

A

fish vaginal discharge, noticeable after intercourse

White to gray discharge

66
Q

what will BV look like on PE

A

D/C is frothy and white/grey in color that is thin and homogenous and can adhere to vaginal mucousa

67
Q

how is BV diagnosed

A 
3 of 4 needs to be met
-Homogenous white/gray adherent discharge
-Vaginal pH >4.5
 -(+) whiff test
Clue cells on wet mount
68
Q

what is the treatment for BV

A

Metronidazole or CLINDAMYCIN

avoid alcohol with metronidazole

69
Q

Trichomonas

A

most prevelant non-viral STD

identified in 80% male partners

70
Q

what are RF for Trichomonas

A

Tobacco use, IUD and unprotected intercourse

71
Q

what are signs and symtpoms of trichomonas

A

purulent malodorous discharge
Green frothy and foul smelling
postcoital bleeding

72
Q

what will PE for Trichomonas look like

A

erythermatous and edematous vulva

petechiae on cervix (strawberry spots)

73
Q

how is trichomonas dx’d

A

vaginal pH >5
Saline wet mount will show oval shaped protozoa, large # of WBC
Whiff test may be positive

74
Q

what is the Tx for trichomonas

A

metronidazole
Tinidazole
TREAT ANY AND ALL PARTNERS
abstain from unprotected intercourse for 10days

75
Q

vaginal neoplasims

A

85% are squamous cell carcinoma

76
Q

what are the RF for vaginal neoplasm

A 
Tobacco
HPV
mult sex partners
Hx of lower genital tract neoplasia
Inutero DES
77
Q

what is the Tx for pelvic organ prolapse

A

pessary
pelvic floor exercises (kegal)
estrogen therapy
Surgery

womens health (6 decks)

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