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Foundations-Women's Health > vulvar disorders > Flashcards

vulvar disorders Flashcards

1
Q

Lichen Sclerosus etiology

A
  1. Autoimmune
  2. Genetics
  3. Environmental
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2
Q

Who does lichen sclerosis MCly occur in?

A

Postmenopausal women

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3
Q

MC sx in lichen sclerosis

A

Pruritus

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4
Q

Other sx’s in lichen sclerosis

A
  1. Dysuria
  2. Dyspareunia
  3. Anal discomfort
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5
Q

lichen sclerosis PEx findings

A
  1. Sharply, well-demarcated white plaques: “Cellophane paper”
  2. Fragility/thin skin: Hallmark
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6
Q

What risk/condition is associated with lichen sclerosis? Who is more likely to develop this?

A

Squamous cell carcinoma

Elderly, hyperkeratotic lesion

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7
Q

What autoimmune disorder is highly associated with lichen sclerosis?

A

Hypothyroidism

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8
Q

lichen sclerosis diagnosis

A

Punch biopsy

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9
Q

lichen sclerosis treatment

A

Topical high potency steroid OINTMENT: Clobetasol 0.05% ointment

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10
Q

Clobetasol SE’s

A
  1. Atrophy
  2. Dermatitis
  3. Rosacea
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11
Q

Lichen Simplex si/sx

A
  1. Vulvar pruritus and/or burning (wks-mos): “itch that rashes”.
  2. Anxiety/depression association
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12
Q

Lichen Simplex physical exam findings

A

Eczematous process:

Poorly marginated, red, scaling plaques

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13
Q

What are the initial signs in lichen simplex

A
  1. Weeping
  2. Excoriations
  3. Crusting
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14
Q

What are the chronic signs in lichen simplex

A
  1. Lichenification

2. Hypopigmentation with moisture

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15
Q

What is the definitive dx in lichen simplex

A

Vulvar punch biopsy

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16
Q

Lichen Simplex pharm treatment

A
  1. Topical steroid cream: Lower dose potency
    - Hydrocortisone 1-2%
    - Triamcinolone acetonide
    - Betamethasone valerate
  2. Antihistamines
  3. SSRI: if h/o anxiety/depression
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17
Q

Lichen planus clinical presentation

A
  1. Introital irritation
  2. Burning (less commonly pruritus)
  3. Vaginal discharge
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18
Q

Non-erosive disease in lichen planus

A

Lacy, white epithelium (fern-like appearance)

White striae

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19
Q

erosive disease in lichen planus

A

Deep vaginal redness
vulvar erosions
purulent vaginal secretions

20
Q

1st line treatment in lichen planus

A

Topical steroid cream:

Hydrocortisone acetate 25mg suppository QHS

21
Q

2nd treatment in lichen planus

A
  1. Topical Tacrolimus 0.1% ointment QOD - BID

2. Systemic corticosteroids

22
Q

What is Vulvar Intraepithelial Neoplasia (VIN) U associated with?

A

HPV: 16, 18, 31

23
Q

VINU risk factors

A
  1. Smoking: 50-80%
  2. Immunosuppression
  3. Multiple sex partners
24
Q

VINU presentation

A

Burning and itching=50%

25
Q

What is VINU highly associated with?

A

High grade CIN

26
Q

VINU diagnostic procedure

A

Vulvar Colposcopy:
3-5% acetic acid
Sit for 3-5 minutes
Lesions gray-white-red/black

27
Q

What is the standard of care in VINU?

A

Surgical treatment:

  1. CO2 laser vaporization-do not perform if invasion suspected
  2. Local wide excision
  3. Vulvectomy
28
Q

What is the post-treatment recurrence rate in VINU?

A

30-50%

29
Q

What population does VIND mainly effect?

A

Older population: >70

30
Q

What is VIND associated with?

A

Squamous cell hyperplasia

lichen sclerosis that likely went untx

31
Q

VIND prevention and treatment

A

Prevention: Proper tx of underling condition
Tx: Surgical excision

32
Q

What is the ACOG/ASCCP position statement for VINU and VIND

A

Vaccination with Gardasil

33
Q

What is the post-tx f/u in VINU/D?

A

Colposcopic vulvar inspection:
6 and 12 months
Annually thereafter

34
Q

Vulvar CA common comorbidities

A
  1. Type 2 DM
  2. Obese
  3. HTN
35
Q

What is the MC age in Vulvar CA?

A

Bimodal:

  1. 20-40yrs: HPV related (VINu)
  2. 60-70yrs: d/t chronic irritation
36
Q

80% of women with vulvar CA have what untreated long-lasting conditions?

A
  1. lichen sclerosus

2. lichen simplex chronicus 3. squamous cell hyperplasia

37
Q

Vulvar CA clinical presentation

A
  1. ASYMPTOMATIC
  2. Pruritus: MC sx
  3. Vulvar bleeding/pain
38
Q

Vulvar CA treatment

A
  1. Complete surgical removal w/ inguinal node dissection

2. Radiation: indicated w/ lymph node spread

39
Q

Behcets clinical presentation

A
  1. Oral ulcerations
  2. Urogenital lesions
  3. Skin lesions
  4. Ocular dz
40
Q

Behcets diagnostic criteria

A

Recurrent oral aphthae at least 3 times in 1 year plus 2 of the following:

  1. Recurrent genital ulcers
  2. Uveitis
  3. Skin lesions
  4. (+) Pathergy test: 2mm papule at injection site within 48h
41
Q

Behcets treatment

A
  1. Temovate 0.05% ointment
  2. Intralesional Triamcinolone: 5 – 10mg/mL
  3. Systemic corticosteroids for refractory cases
42
Q

Bartholin cyst/abscess treatment

A
  1. I&D w/ insertion of word catheter
  2. Culture purulent material:
    Polymicrobial, E. coli, MRSA, STI
  3. +/- empirical antibiotic therapy: Bactrim, Augmentin
43
Q

Severe or recurring Bartholin cyst treatment

A

Marsupialization

44
Q

Vulvodynia clinical presentation

A
  1. Vulvar “burning”*
  2. Absent clinical findings: Everything looks nl
  3. Introital pain with intercourse
45
Q

Vulvodynia pharmacologic treatment

A
  1. Topical lidocaine ointment
  2. Topical vaginal estrogen w/ testosterone
  3. Amitriptyline or nortriptyline
  4. SNRIs
  5. Gabapentin

Foundations-Women's Health (8 decks)

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