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Women's Health > Vulvar D.O  > Flashcards

Vulvar D.O  Flashcards

1
Q

Lichen Sclerosis etiology

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

Lichen Sclerosis Clinical Presentation

A

3 P’s:

  1. Postmenopausal women
  2. Pruritus
  3. Pain: Dysuria, dyspareunia, anal discomfort
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3
Q

Lichen Sclerosis PEx findings

A
  1. Cellaphone paper
  2. Fragility
  3. Diffuse involvement of vulva
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4
Q

Lichen Sclerosis Diagnosis

A

Vulvar biopsy

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5
Q

Lichen Sclerosis Treatment

A

Topical SUPER HIGH potency steroid OINTMENT: Clobetasol ointment (0.05%)

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6
Q

Why does Lichen Sclerosis require long term follow-up?

A

Risk of developing squamous cell carcinoma

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7
Q

What is the main RF for squamous cell carcinoma in Lichen Sclerosis?

A

Hyperkeratotic lesions

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8
Q

Lichen Simplex Chronicus etiology

A
  1. Idiopathic: Atropy more prone
  2. Emotional: assoc. with anxiety & depression
  3. Environmental triggers: Sweating, excessive hygiene, panty liners, tight clothes
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9
Q

Lichen Simplex Chronicus presentation

A
  1. Itch-Scratch Cycle

2. Anxiety/Depression

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10
Q

Lichen Simplex Chronicus PEx findings

A

Eczematous process:

  1. Initial: Weeping, excoriations, crusting
  2. Chronic Signs: lichenification, hypopigmentation with moisture
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11
Q

Lichen Simplex Chronicus definitive diagnosis

A

Vulvar punch biopsy

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12
Q

Lichen Simplex Chronicus treatment

A
  1. Identify underlying cause
  2. Topical Steroids: Hydrocortisone, bethamethasone
  3. Antihistamine QHS
  4. SSRI: if depression/anxiety
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13
Q

Lichen Planus etiology

A

Autoimmune

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14
Q

Lichen Planus clinical presentation

A
  1. Women age 50-60
  2. Introital irritation: SF dyspareunia
  3. Burning
  4. Vaginal discharge
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15
Q

Lichen planus PEx findings

A
  1. Disruption of vulvar anatomy: agglutination of labia minor, introital narrowing, fusion of vestibule
  2. Non-erosive dz: lacy white epithelium=Fern like appearance
  3. Erosive dz: Deep vaginal redness, vulvar erosion, purulent vaginal secretions
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16
Q

Lichen Planus 1st line Treatment

A

Topical steroid cream: Hydrocortisone acetate 25 mg suppository QHS

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17
Q

Lichen Planus 2nd line Treatment

A
  1. Topical Tacrolimus 0.1% ointments
  2. Systemic Corticosteroids
  3. Vaginal Estrogens
  4. Vaginal Dilators
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18
Q

Define Vulvar Intraepithelial Neoplasia (VIN)

A

Neoplastic cells confined to squamous epithelium

19
Q

VINU (Usual) etiology

A

HPV: 16, 18, 31

20
Q

What age population does VINU MCly occur in?

A

Young women

21
Q

VINU RF’s

A
  1. Smoking
  2. Immunosuppression
  3. Multiple sex partners
22
Q

VINU clinical presentation

A
  1. Asx
  2. Vulvar Burning/Pain=50%
  3. High association with high grade CIN= Must get colposcopy/Pap smear
23
Q

VINU diagnosis

A

Vulvar colposcopy

24
Q

What is the standard care for VINU

A

Surgical Treatment:

  1. CO2 laser vaporization
  2. Local wide excision
  3. Vulvectomy
25
Q

What is the caveat to medical treatment in VINU?

A

OFF-LABE USE

Non provide guaranteed cure

26
Q

What is post-treatment recurrence rate in VINU

A

30-50%

27
Q

VIND (differentiated) pathogenesis

A

Squamous Cell Hyperplasia: Lichen Sclerosis

UNRELATED to HPV

28
Q

What age population does VIND MCly occur in?

A

Older women: >70

29
Q

VIND treatment

A

surgical excision

30
Q

ACOG/ASCOP position statement in VINU/IVIND f/u

A
  1. Vaccination with Gardasil (VINU)

2. Post-treatment follow-up: Colposcopic inspection @ 6 & 12 mos., then annually

31
Q

RF’s for vulvar CA

A
  1. Obese
  2. HTN
  3. Type 2 DM
32
Q

What is the main etiology of vulvar CA?

A

Untreated long lasting:

  1. Lichen slcerosus
  2. Lichen chronicus
  3. Squamous cell hyperplasia
33
Q

Vulvar CA presentation

A
  1. Asx: INSPECT VULVA!
  2. Pruritis= MC sx
  3. Vulvar bleeding and pain
34
Q

Vulvar CA treatment

A

Surgical removal of tumor w/ inguinal node dissection

35
Q

Bechets diagnostic criteria

A

Recurrent oral apthae @ least 3x in 1 year + 2 of the following:

  1. Recurrent genital ulcers
  2. Uveitis
  3. Skin lesions
    • Pathergy test: 2 mm papule injection site w/in 48 hrs
36
Q

Bechets treatment

A
  1. Temovate 0.05%
  2. Intralesional triamcinolone 5-10 mg/mL
  3. Systemic corticosteroids for refractory cases
37
Q

Bartholin cyst presentation

A
  1. Acute, painful, unilateral labial swelling
  2. Dyspareunia
  3. Pain with sitting/walking
  4. Drainage
38
Q

Bartholin cyst treatment

A
  1. I & D w/ insertion of word Cath
  2. Culture
  3. +/- empiric abx: Bactrim, Augmentin
  4. Sitz bath
39
Q

What age does vulvodynia typically present? Reasoning?

A

Menopause: Estrogen concentration?

40
Q

Who is 4x more likely to develop vulvodynia?

A

Pt’s with mood/anxiety disorders

41
Q

vulvodynia clinical presentation

A
  1. Vulvar “Burning”: w/ absent clinical findings and no underlying vulvar/vaginal pathology
  2. Introital pain w/ intercourse
42
Q

Vulvodynia PEx findings

A
  1. Pain limited to vestibule with Q-tip exam

2. Erythema

43
Q

vulvodynia pharm tx

A
  1. Topical lidocaine ontiment
  2. Topical vaginal estrogen with testosterone
  3. Amitriptyline
  4. SNRI’s
  5. Gabapentin

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