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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
t or f: TCA application is a treatment option for vestibulitis
true; vestibulectomy is a drastic option
26
vestibulitis diagnosis can be made how?
cotton tipped applicator application produces pain
27
vestibular glands (bartholin) are located where in the vestibule?
at 5 and 7 o'clock
28
t or f: bartholin gland cysts tend to be bilateral
FALSE - unilateral
29
t or f: bartholin gland cysts can rupture on their own w/in a few days of development
TRUE
30
what are the bartholin glands analogous to in the male?
Cowper's gland
31
what is the function of the bartholin glands?
to secret thick, alkaline fluid during coitus
32
t or f: bartholin gland cysts often produce severe unilateral pain
FALSE; often not painful
33
t or f: a normal bartholin gland is not palpated
TRUE
34
what is the MCC of bartholin gland abscess?
infection causing main duct draining the gland to become occluded
35
what is the mainstay of treatment for bartholin gland abscess?
i&d followed by marsupialization
36
what is the alternative to marsupialization when treating bartholin gland abscess?
placement of ward catheter
37
what is the most common vulvar cyst?
sebaceous cyst (epidermoid)
38
is an epidermoid cyst more common on the labia minora or majora?
majora; (remember, this is where the hair - cysts form when the pilosebaceous ducts become occluded)
39
t o f: most epidermoid cysts do NOT require treatment
TRUE
40
hidradenitis suppurativa is commonly found where?
in intertriginous areas of the body
41
t or f: women are more likely to develop hidradenitis suppurativa than men
true
42
this condition is a chronic infection of the apocrine glands
hidradenitis suppurativa - as the infection grows over time, scaring and pits can form
43
how is the diagnosis of hidradenitis suppurativa made?
biopsy
44
what is the treatment of hidradenitis suppurativa?
topic steroid creams and oral antibiotics
45
what is the most common complaint in vulvar cancer?
itching and burning of the vulva (with raised white lesions)
46
what are the two high and low risk strains of HPV we vaccinate against with Guardasil?
6 11 (low) 16 18 (high)
47
lower numbered strains of HPV are typically responsible for what pathology? higher strains?
condylomas/vulvar warts; dysplasia and CA
48
t or f: vulvar cancer risk factors include HPV (16, 18, 31, 33)
TRUE
49
what are the precancerous lesions of the vulva called?
VIN (vulvar untraepithelia neoplasia)
50
t or f: a hx of vulvar skin dz is a risk factor for VIN
TRUE
51
what are the two mainstay procedures for diagnosis of VIN?
colposcopy and biopsy
52
at what staging level of VIN is it considered carcinoma-in-situ?
VIN III
53
in general, the bigger the VIN lesion what are the treatment options?
small lesions can get wide local excision while larger lesions require lasers and vulvectomy
54
t or f: vulvar intraepithelial lesions are just as likely as cervical intraepithelial lesions to become high grade or cancers
FALSE - LESS LIKELY
55
what is the most common type of vulvar CA?
squamous cell (90%)
56
post menopausal or premenopausal women more at risk for vulvar CA?
post
57
how is the diagnosis of vulvar CA made?
bx
58
what is the MCC of vulvar dysplasia>
labia majora
59
what is the difference between the condyloma acuminata and lata?
acuminata is associated with HPV (pearly, and plaque-like or cauliflower appearance); lata associated with secondary syphilis (non-painful, raised, grayish-white lesions)
60
what type of vaginal CA is associated with in utero DES exposure?
clear cell adenocarcinoma
61
what is the general treatment and staging of vulvar cancer?
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
vaginal CA présents typically in which age group?
post menopausal women
63
what is the most common type of vaginal CA (cell type)?
squamous cell carcinoma
64
t or f: having VIN and/or CIN is a risk factor for vaginal CA
TRUE
65
as the stage increases with vaginal CA how does the tx change?
with an increase in stage you move away from surgery and move towards radiation only
66
how is vulvar CA staged?
surgical
67
how is vaginal CA staged?
clinical

OBGYN (21 decks)

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