Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SG F3 E5 > Vulvar disorders > Flashcards

Vulvar disorders Flashcards

1
Q

What is Lichen Sclerosis

A

autoimmune disease where autoAbs attack extracellular matrix and basement membrane, affecting all levels of the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lichen sclerosis is associated with

A 
thyroid disorders (esp. hypothyroid) 
HLA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The two predicted etiologies of lichen sclerosis are

A

Genetic (22% have positive FHx)

Environmental (incontinence, infx, contact dermatitis, trauma- koebner phenomenon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What age women does Lichen Sclerosis affect

A

mostly POST-menopausal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the MC symptoms of lichen sclerosis

A

**Pruritis!

Dysuria, dyspareunia, anal discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does lichen sclerosis look like oh physical exam

A

Sharp, well demarcated white plaques (cellophane paper*) that start around the clitoral area and spread to the perineum
Can look waxy, or hyperkeratotic
Classic: white figure 8 sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the hallmark of lichen sclerosis

A

purpura
erosions
fissures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bad cases of lichen sclerosis can present like this

A

loss (or fusion) of normal anatomical landmarks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is lichen sclerosis associated with cancer

A

5% of cases progress to squamous cell carcinoma- RF are elderly and hyperkeratotic lesions
A few cases of atypical nevi and melanoma have been reported (take pigmented lesions SERIOUSLY)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you diagnose lichen sclerosis

A

Full thickness vulvar punch biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you treat lichen sclerosis

A

Topical VERY HIGH potency steroid OINTMENT- Clobetasol 0.5%, apply BID until nl texture, then 1-3x week to maintian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ADE of clobetasol high potency (lichen sclerosis) are

A

atrophy
dermatitis
rosacea
-SO, when applying make sure it is only to the affected area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Can you cure lichen sclerosis

A

No, it is autoimmune so it does not go away
need long term follow up!
Squamous cell carcinoma visit after 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes lichen simplex chronicus

A

unknown!
environmental trigger (sweating, excessive hygiene, panty ilners, topical meds, tight clothing)
Emotional tensions induce pruritis
Hx of atopy (eczema) are more prone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What cycle is associated with lichen simplex chronicus

A

itch-scratch cycle!

itch= scratch= irritate= epidural thickening= inflammatory cells increase sensitivity= itch and REPEAT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does lichen simplex chronicus present

A

vulvar pruritis/ BURNING, relieved when scratching

“the itch that rashes”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Patients with lichen simplex chronicus often have underlying

A

depression or anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

On physical exam, lichen simplex chronicus presents as

A

poorly marginated, red, scaling papules and plaques

initial: weeping, excoriations, crusting
chronic: lichenification, hypopigmentation w/ moisture (anogenital macerated look)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you diagnose lichen simplex chronicus

A

clinically (PE)

can also do a confirmation vulvar punch biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you treat lichen simplex chronicus

A

Remove underlying trigger (wear loose clothing, no panty liners, less aggressive hygiene, decrease stree)
Bath tub soaks
lubricant
low potency steroid cream (hydrocortisone 1-2%, triamcinalone acetonide, betamethasone valerate)
Anti-histamine QHS to Tx pruritis
SSRI daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is lichen planus

A

autoimmune d/o more common in extra-genital areas that occurs mostly in women 50-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Lichen planus presents with

A 
introital irritation (SF dyspareunia) 
burning 
vaginal discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

On PE for lichen planus you note

A

Disruption of vulvar anatomy (agglutination of labia minora, introital narrowing) on mucosal or keratinized surface
Non-erosive: lacy, white epithelium (fern like), white striae
Erosive: deep vaginal redness, vulvar erosions, purulent vaginal secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you treat lichen planus

A

Low potency topical steroids (like simplex chronicus)- hydrocortisone acetate 25mg suppository QHS
2 line: topical tacrolimus ointment BID, or systemic corticosteroids
vaginal estrogens
vaginal dilators (if you have narrowing of introitus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Is lichen planus curable

A

It responds well to Tx, but has a high rate of recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is vulvar intraepithelial neoplasia

A

neoplastic cells confined to squamous epithelium

classified as VIN 1, 2, or 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are each classification of VIN associated with

A

VIN1: genital warts

VIN2-3: true precursor to cancer

28
Q

VIN 2-3 are further classified as

A

VINu: usual, high risk for HPV
VINd: differentiated

29
Q

VINu is associated with

A

HPV 16, 18, 31

younger women

30
Q

RF for VINu include

A

smoking*
immunosuppression
multiple sex partners

31
Q

How does VINu present

A

ASx

vulvar burning and pruritis

32
Q

How do you diagnose VINu

A

colposcopy/ pap smear (bc it is associated w/ high grade CIN)
must biopsy ALL pigmented lesions

33
Q

How do you do a vulvar colposcopy

A

stain w/ 3-5% acetic acid, let sit 3-5 min (tissue turns white over lesions)
-DO NOT use acetic acid over inflamed or broken skin
lesions can be raised or flat, turn gray/white or even red/black

34
Q

How do you treat VINu

A

No gauranteed cure, but you can try these OFF-label meds (30-50% recurrence rate):
5FU (Efudex) cream
Interferon (Intron A)
Imiquimod (Aldara) 5% cream

35
Q

Standard of care treatment for VINu is

A

surgery;
CO2 laser vaporization (destroy entire thickness)
local wide excision (must for VIN3)
vulvectomy

36
Q

do NOT preform CO2 laser vaporization to Tx VINu if

A

invasion is suspected

37
Q

VINd occurs in

A

older women (>70)
LOWER 1/3 of vagina (upper 2/3 have no abn cells)
-unrelated to HPV

38
Q

VINd is associated with

A

squamous cell hyperplasia (Lichen Sclerosis)
unidentified carcinogens + chronic irritated skin
-many have associated untreated lichen sclerosis, lichen simplex chronicus, or squamous hyperplasia

39
Q

How can you prevent VINd

A

treat underlying condition!

if lichen sclerosus, high potency Clobetasol ointment

40
Q

How do you treat VINd

A

surgical excision

41
Q

ACOG/ASCCP recommend

A

Vaccinate (Gardasil)

F/u post Tx w/ colposcopic vulvar inspection at 6-12 months, and annually after that

42
Q

ACOG/ASCCP state

A

women with a Hx of VIN are considered at risk for recurrence throughout their lifetime

43
Q

What is the 4th MC malignancy of the female genital tract

A

vulvar cancer!

Occurs more in women w/ T2DM, obese, or hypertensive

44
Q

What is the incidence of vulvar cancer

A

bimodal peaks;
VINu in women 20-40 (HPV related)
VINd in women 60-70 (chronic irritation)

45
Q

How does vulvar cancer present

A

ASx!! so always inspect the vulva!
*Pruritis
vulvar bleeding and pain

46
Q

On PE what are different findings associated with vulvar cancer

A

SCC: large, cauliflower lesion - small, ulcerative lesion w/ surrounding hyperkeratosis
Malignant melanoma: raised, dark lesion MC at labia majora and clitoris
BCC: raised lesion w/ ulcerated center and rolled border

47
Q

What is vulvar cancer staging based on

A

FIGO

48
Q

How do you treat vulvar cancer

A

Primary: complete surgical removal w/ inguinal node resection
Radiotherapy if w/ lymph node spread

49
Q

What is Behcet’s disease

A

Autoimmune d/o triggered by exposure in susceptible individuals (bacterial/viral antigens, heavy metals, chemicals)

50
Q

How does Behcet’s disease present

A
  • Oral ulcers (aphthous ulcers)
  • Urogenital lesions (ulcers)
  • Skin lesions (erythema nodosum, SF thrombophlebitis, palpable purpura, papulopustular lesions
  • Ocular disease (uveitis)
51
Q

What is the criteria needed to Dx Behcet’s disease

A

recurrent aphthous ulcers 3x in 1 year PLUS 2 of following:
recurrent genital ulcers
uveitis
skin lesions
+ pathergy test (2mm papule at injection site w/in 48 hrs)

52
Q

How do you treat Behcet’s disease

A

Temovate (clobetasol) 0.05% ointment (high potency)
Intralesional triamcinolone
systemic corticosteroids if refractory

53
Q

Where are bartholin glands found and what do they do

A

at 4 and 8 o’clock position w/in labia minora
they open into vestibule adjacent to introitus
they secrete mucus like material to maintain moisture of vaginal mucosa

54
Q

What is a bartholin cyst

A

ductal obstruction 2/2 trauma or non-specific inflammation
1-3cm large
can develop an abscess from an infected cyst or primary gland infection (STI)

55
Q

How do bartholin cysts present

A

acute, painful unilateral labial swelling (less pain if only a cyst)
dyspareunia
pain with sitting or walking
drainage

56
Q

On PE, a bartholin cyst will look like

A

tender, fluctuant labial mass w/ surrounding erythema and edema
cellulitis
abscess formation
fever

57
Q

How do you treat a bartholin cyst

A

I%D w/ wood catheter to occupy space and prevent recurrence
Culture purulent material
+/- Abx (bactrim, augmentin, 2/3 gen Ceph+Doxy)
Sitz bath 2-3 days 2/p I&D
No intercourse until catheter is removed

58
Q

What bacterial likely will be found on bartholin cyst culture

A

polymicrobial; E. coli, MRSA, or STI

59
Q

In order to prevent recurrence, what can you do for a bartholin cyst

A

Marsupialization after draining!

60
Q

What is Vulvodynia

A

Unexplaines pain and burning in the vulvar area

61
Q

What causes Vulvodynia

A 
unknown! Suspected causes include: 
Drop in estrogen (menopause) 
pelvic floor dysfunction 
Mood/anxiety d/o (4x more likely) 
poor allostasis 
Neuro sensitization 2/2 chronic inflammation (increased epithelial nerve endings and SF blood flow= more sensitive)
62
Q

How does vulvodynia present

A

Burning
stinging, irritated, sore, raw, or stabbing
absent clinical findings
no underlying pathology
Introital pain w/ intercourse (avoid coitus!)

63
Q

What are categories of vulvodynia

A

generalized vs localized
provoked vs non-provoked
non-sexual, sexual, or both

64
Q

On PE for vulvodynia you will find

A

pain limited to vestibule (use Q-tip to palpate vestiule, labia majora, perineum, and interlabial folds)
spasm or ttp on single digit exam
non-specific vestibular erythema

65
Q

How do you treat vulvodynia (non-pharm)

A

avoid scented products, tight clothes, vigorous exercise, panty liners
Sitz baths BID w/ thin film of petroleum jelly
couples counseling
pelvic floor PT

66
Q

How do you Tx vulvodynia (pharm)

A

topical lidocaine ointment
topical vaginal estrogen w/ testosterone
Amitriptyline/Nortriptyline QHS (start at 10mg, titrate to 50)
SNRI
Gabapentin TID (start at 100, titrate to 1200)

SG F3 E5 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions