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OBGYN > Vulvar Disorders/Dysplasia/CA > Flashcards

Vulvar Disorders/Dysplasia/CA Flashcards

1
Q

vulvular dystrophies are characterized by what two key features?

A

pruritus and white lesions of the vulva

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2
Q

t or f: vulvuar lesions must be biopsied to rule out malignancy

A

TRUE

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3
Q

t or f: an increased risk of vulvar carcinoma is associated with lichen plans and lichen sclerosus.

A

TRUE

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4
Q

t or f: paget disease of the vulva is frequently associated with cancers

A

TRUE (these pts are at increased risk of cancer)

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5
Q

t or f: recurrence of paget disease of the vulva is fairly uncommon

A

FALSE (its actually very common and requires yearly screening)

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6
Q

pruritic, erythematous, eczematoid lesions of the vulva are indicator of what?

A

paget of the vulva

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7
Q

t or f: paget of the vulva is more common in women in their 20s to 30s

A

FALSE; post menopausal women (white)

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8
Q

paget of the vulva is associated with which two carcinomas?

A

adenocarcinoma of the GI tract or breast

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9
Q

how is the diagnosis of paget of the vulva made?

A

direct bx which reveals paget’s cells

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10
Q

what is the treatment of a solitary paget lesion without malignancy?

A

wide excision to subq fat

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11
Q

what three exams/tests need to be performed annually in pts with paget disease?

A

breast exam, screening for GI disease, and cytology of cervix and vulva

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12
Q

this vulvar disorder is a hypertrophic dystrophy caused by chronic irritation resulting in raised, white, thickened lesions

A

lichen simplex chornicus

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13
Q

what are the two main complaints (in terms of symptoms) associated with lichen simplex chronicus?

A

itching and scratching

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14
Q

These are fine white lacy lesions commonly associated with lichen planus

A

Wickham striae (often found on the papules).

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15
Q

microscopic examination of lichen simplex chornicus will reveal which two things?

A

acanthosis and hyperkeratosis

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16
Q

this vulvar dystrophy is characterized by a paper like appearance of the vulva on both sides and epidermal contractures

A

lichen sclerosis

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17
Q

what does microscopic examination of lichen sclerosis reveal?

A

epithelial thinning with a layer of homogenization below and inflammatory cells

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18
Q

what are some commons signs that help reveal lichen planus?

A

purple (shiny purple lesions), polygonal, planar pruritic

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19
Q

how is the diagnosis of lichen planus made?

A

3 to 5 mm punch biopsy

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20
Q

what is the medical management of lichen planus? (pharma)

A

steroid creams (testosterone, clobetasol/temovate); oral steroid in severe cases; remember you can also use uv light for continued scratching

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21
Q

which vulvar dystrophy is characterized by red plaques covered by silver scales?

A

psoriasis

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22
Q

what is the pharma treatment for psoriasis of the vulva?

A

steroid creams and vitamin d

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23
Q

t or f: vestibulitis is associated w/insertional dyspareunia and post coital pain

A

TRUE

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24
Q

what does the colposcopic examination of the lesion of vestibulitis reveal?

A

acetic acid turns the affected area white, BUT these lesions are NOT dysplastic

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25
Q

t or f: TCA application is a treatment option for vestibulitis

A

true; vestibulectomy is a drastic option

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26
Q

vestibulitis diagnosis can be made how?

A

cotton tipped applicator application produces pain

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27
Q

vestibular glands (bartholin) are located where in the vestibule?

A

at 5 and 7 o’clock

28
Q

t or f: bartholin gland cysts tend to be bilateral

A

FALSE - unilateral

29
Q

t or f: bartholin gland cysts can rupture on their own w/in a few days of development

A

TRUE

30
Q

what are the bartholin glands analogous to in the male?

A

Cowper’s gland

31
Q

what is the function of the bartholin glands?

A

to secret thick, alkaline fluid during coitus

32
Q

t or f: bartholin gland cysts often produce severe unilateral pain

A

FALSE; often not painful

33
Q

t or f: a normal bartholin gland is not palpated

A

TRUE

34
Q

what is the MCC of bartholin gland abscess?

A

infection causing main duct draining the gland to become occluded

35
Q

what is the mainstay of treatment for bartholin gland abscess?

A

i&d followed by marsupialization

36
Q

what is the alternative to marsupialization when treating bartholin gland abscess?

A

placement of ward catheter

37
Q

what is the most common vulvar cyst?

A

sebaceous cyst (epidermoid)

38
Q

is an epidermoid cyst more common on the labia minora or majora?

A

majora; (remember, this is where the hair - cysts form when the pilosebaceous ducts become occluded)

39
Q

t o f: most epidermoid cysts do NOT require treatment

A

TRUE

40
Q

hidradenitis suppurativa is commonly found where?

A

in intertriginous areas of the body

41
Q

t or f: women are more likely to develop hidradenitis suppurativa than men

A

true

42
Q

this condition is a chronic infection of the apocrine glands

A

hidradenitis suppurativa - as the infection grows over time, scaring and pits can form

43
Q

how is the diagnosis of hidradenitis suppurativa made?

A

biopsy

44
Q

what is the treatment of hidradenitis suppurativa?

A

topic steroid creams and oral antibiotics

45
Q

what is the most common complaint in vulvar cancer?

A

itching and burning of the vulva (with raised white lesions)

46
Q

what are the two high and low risk strains of HPV we vaccinate against with Guardasil?

A

6 11 (low) 16 18 (high)

47
Q

lower numbered strains of HPV are typically responsible for what pathology? higher strains?

A

condylomas/vulvar warts; dysplasia and CA

48
Q

t or f: vulvar cancer risk factors include HPV (16, 18, 31, 33)

A

TRUE

49
Q

what are the precancerous lesions of the vulva called?

A

VIN (vulvar untraepithelia neoplasia)

50
Q

t or f: a hx of vulvar skin dz is a risk factor for VIN

A

TRUE

51
Q

what are the two mainstay procedures for diagnosis of VIN?

A

colposcopy and biopsy

52
Q

at what staging level of VIN is it considered carcinoma-in-situ?

A

VIN III

53
Q

in general, the bigger the VIN lesion what are the treatment options?

A

small lesions can get wide local excision while larger lesions require lasers and vulvectomy

54
Q

t or f: vulvar intraepithelial lesions are just as likely as cervical intraepithelial lesions to become high grade or cancers

A

FALSE - LESS LIKELY

55
Q

what is the most common type of vulvar CA?

A

squamous cell (90%)

56
Q

post menopausal or premenopausal women more at risk for vulvar CA?

A

post

57
Q

how is the diagnosis of vulvar CA made?

A

bx

58
Q

what is the MCC of vulvar dysplasia>

A

labia majora

59
Q

what is the difference between the condyloma acuminata and lata?

A

acuminata is associated with HPV (pearly, and plaque-like or cauliflower appearance); lata associated with secondary syphilis (non-painful, raised, grayish-white lesions)

60
Q

what type of vaginal CA is associated with in utero DES exposure?

A

clear cell adenocarcinoma

61
Q

what is the general treatment and staging of vulvar cancer?

A

as the stage increases in number, the more invasive the cancer; as the cancer becomes more invasive you have to surgically removes more involved organs

62
Q

vaginal CA présents typically in which age group?

A

post menopausal women

63
Q

what is the most common type of vaginal CA (cell type)?

A

squamous cell carcinoma

64
Q

t or f: having VIN and/or CIN is a risk factor for vaginal CA

A

TRUE

65
Q

as the stage increases with vaginal CA how does the tx change?

A

with an increase in stage you move away from surgery and move towards radiation only

66
Q

how is vulvar CA staged?

A

surgical

67
Q

how is vaginal CA staged?

A

clinical

OBGYN (21 decks)

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