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Year 2 OBGYN > Vulvar disease > Flashcards

Vulvar disease Flashcards

1
Q

what are the ddx for vulvovaginitis?

A
  • bacterial vaginosis
  • candidiasis
  • trichomoniasis
  • atrophic vaginitis
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2
Q

what makes up the majority of the discharge in vulvovaginitis? what color is it?

A

cervical mucous

white to off-white

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3
Q

what is bacterial vaginosis?

A

polymicrobial infection characterized by a lack of normal H2O2 lactobacilli and an overgrowth of anaerobes

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4
Q

what color is discharge from BV?

A

thin gray-white / yellow

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5
Q

what is the pH in BV?

A

over 4.5

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6
Q

what is seen under the microscope in BV?

A
  • increase in WBCs
  • clumps of bacteria
  • loss of normal lactobacilli
  • CLUE CELLS
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7
Q

what are clue cells? what condition is it seen in?

A

epithelial cells with cocci bacteria attached to their surfaces so that borders appear indistinct and cytoplasm looks like “ground glass”

BV

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8
Q

what does candida require?

A

estrogenized tissue

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9
Q

what is the gold standard stain for BV?

A

gram

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10
Q

how is diagnosis usually made for BV?

A

3 out of 4 of:

  • abnormally gray discharge
  • pH over 4.5
    • whiff test
    • clue cells
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11
Q

what is the treatment for BV?

A
  • oral or topical metronidazole

- topical clindamycin

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12
Q

in candida infection what color are the tissues?

A

bright red

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13
Q

what is the discharge appearance in candida?

A

thick, odorless, adherent “cottage cheese”

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14
Q

what is the pH in candida?

A

pH 4-5

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15
Q

what is required for candida diagnosis?

A

visualization of blastospores or pseudohyphae on saline of 10% KOH microscopy or a positive culture

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16
Q

what is the treatment for candida?

A
  • vaginal application of an imidazole - miconazole, clotrimazole, terconazole
  • single dose oral fluconazole
  • nystatin in pregnancy
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17
Q

what causative organism of candida is resistant to all azoles?

A

T. glabrata

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18
Q

what is the discharge appearance in trichomoniasis?

A

copious “frothy” discharge with rancid odor - yellow green / gray

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19
Q

which condition is associated with a “strawberry cervix”?

A

trichomoniasis

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20
Q

how is trichomoniasis diagnosed?

A

direct visualization on microscopy

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21
Q

what is the treatment for trichomoniasis?

A
  • oral metronidazole or tinidazole

- treat sexual partners

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22
Q

what is atrophic vaginalis? what happens to the epithelium?

A
  • atrophy of vaginal epithelium due to decreased estrogen levels
  • vaginal epithelium is thinned, pH elevated to 4.7+
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23
Q

what is the pH in atrophic vaginalis?

A

4.7+

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24
Q

what is the treatment for atrophic vaginalis?

A
  • local water based moisturizing applications

- topical or oral estrogen therapy

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25
Q

what is lichen sclerosus? what are the clinical symptoms, what is the most common symptom?

A

common chronic inflammatory vulvar disease

  • keyhole vagina
  • most common symptom is pruritis
26
Q

what is the treatment regimen for lichen sclerosus?

A
  • general care measures (emollients, 100% cotton underwear, no soaps)
  • high potency steroid ointment
27
Q

what is lichen simplex chronicus (LSC)? how does it develop?

A
  • an “itch that rashes”

- usually develops secondary to an irritant dermatitis, which progresses to LSC

28
Q

what is the physical exam appearance of lichen simplex chronicus?

A

labia majora and minora and perineal body diffusely reddened with occasional hyperplastic or hyperpigmented plaques of red to red/brown

29
Q

what is lichen planus? in what two ways can it present?

A
  • rare inflammatory skin condition
  • presents as a desquamative lesion of the vagina; can develop lesions on inner labia minora and vulvar vestibule
  • can also present with whitish, lacy bands (wickham striae) of keratosis near the reddish ulcerated-like lesions
30
Q

what is necessary to confirm diagnosis of lichen planus? what is seen?

A
  • biopsy
  • vaginal discharge shows large numbers of acute inflammatory cells without significant numbers of bacteria
  • histology: thinning epithelium, loss of rete ridges, lymphocytic infiltrate
31
Q

what is the treatment for lichen planus?

A
  • topical steroid cream

- intravaginal 1% hydrocortisone douches or vaginal suppositories

32
Q

what is the inheritance of psoriasis?

A

autosomal dominant

33
Q

what are the two types of eczema?

A

exogenous and endogenous

  • exogenous: irritants, contact dermatitis
  • endogenous: atopic dermatitis
34
Q

what is vulvar seborrheic dermatitis? what is the appearance?

A
  • chronic inflammation of sebaceous glands

- pale, red to yellow-pink and may be covered by oily appearing scaly crust

35
Q

what is the treatment for vulvar dermatitis?

A
  • 5% aluminum acetate several times

- topical corticosteroids

36
Q

what is vulvodynia?

A

involves acute and chronic inflammation of vestibular glands

37
Q
  • new onset insertional dyspareunia
  • worsening over 3-4 months
  • pain with tampon insertion, sitting, bathing perineal area
A

vulvodynia

38
Q
  • small, smooth nodular masses
  • contain cheesy material
  • may be excised
A

sebaceous gland cyst

39
Q
  • round ligament insertion into labia majora
  • peritoneal fluid collects within
  • excision may be needed
A

cyst of canal of Nuck (hydrocele)

40
Q

fibromas arise from what tissue?

A

connective tissue

41
Q

what is hidradenitis suppurativa?

A
  • chronic skin condition
  • area of high density sweat glands
  • indurated occluded follicles
42
Q

where are the bartholin glands located? what type of secretion? where do they open?

A
  • 4:00 and 8:00 on posterolateral aspect of introitus
  • mucous secreting glands
  • open into external hymenal ring
43
Q

if there is a bartholin gland growth in a woman over 40, what should you do? why?

A
  • biopsy

- suspect rare bartholin gland carcinoma

44
Q

what are the important premalignant conditions of the vulva?

A
  • pagets disease

- vulvar intraepithelial neoplasia (VIN)

45
Q

what is the clinical presentation for pagets disease of the vulva?

A
  • chronic prutitis

- velvety-red lesions become eczematous and scar into white plaques

46
Q

how is pagets disease of the vulva treated?

A

local excision (without local metastases)

47
Q

one must assume that vulvar intraepithelial neoplasia will proceed to what?

A

vulvar carcinoma

48
Q

what is a colposcope? what is it used for?

A

microscope on wheels

used for VIN, vulvar cancer

49
Q

WHAT IS THE MOST COMMON VULVAR CANCER?

A

SQUAMOUS CELL CARCINOMA (85-90%)

50
Q

vulvar cancer is is usually found in what region, anatomically? what is the appearance?

A

labia majora

cauliflower-like masses to hard indurated ulcers

51
Q

what is important in the diagnosis of vulvar cancer?

A
  • annual exam
  • signs and symptoms
  • biopsy
52
Q

what is the treatment for vulvar cancer?

A
  • wide local excision with inguinal lymph node dissection

- pelvic radiation of + mets to nodes

53
Q

what is VaIN?

A

vaginal intraepithelial neoplasia

54
Q

how is diagnosis of VaIN made?

A
  • usually found on PAP
  • colposcopy
  • biopsy
55
Q

what is the treatment for VaIN?

A
  • local resection
  • laser ablation
  • 5-FU
56
Q

what is the most common type of vaginal cancer?

A

squamous cell carcinoma

57
Q

what are the signs / symptoms of vaginal cancer?

A
  • water, blood tinged vaginal discharge
  • postmenopausal bleeding
  • vaginal pruritis
58
Q

what is the treatment for stage I and II vaginal cancer?

A

surgical resection

59
Q

what is the treatment for stage III and IV vaginal cancer?

A

radiation

60
Q

what type of cancer is associated with in utero exposure to DES (1970s)?

A

clear cell adenocarcinoma

Year 2 OBGYN (33 decks)

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