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Special Pops Exam 1 > Vulvar & Vaginal Disease -> > Flashcards

Vulvar & Vaginal Disease -> Flashcards

1
Q

Which vulvar disorders have white lesions?

A

Lichen sclerosus & Lichen simplex chronicus

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2
Q

Which vulvar disorders have dark lesions?

A

Melanosis or Lentigo & Melanoma

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3
Q

What are the pelvic floor muscle disorders?

A

Cystocele (bladder), Rectocele (rectum), Enterocele (small bowel), Uterine prolapse

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4
Q

What is the most common benign epithelial vulvar disorder?

A

Lichen Sclerosis

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5
Q

Who is lichen sclerosis most common in?

A

Postmenopausal women >60

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6
Q

How is lichen sclerosis characterized?

A

Marked inflammation, epithelial thinning, distinctive dermal changes

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7
Q

Cause of lichen sclerosis?

A

Chronic inflammatory process: unknown etiology but possibly autoimmune, genetic, hormonal, HPV, trauma

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8
Q

S/sx of lichen sclerosis?

A

Vulvar pain, dyspareunia (pain w sex), and/or asx white lesions

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9
Q

Characteristics of acute lichen sclerosis?

A

erythema/edema of vulva, white plaques (lichenification/keratosis), intense itching causing telangiectasia/hemorrhages, erosions, fissures, ulceration

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10
Q

Characteristics of chronic lichen sclerosis?

A

Thin, wrinkled, white skin
Anterior labia minora fuse
Stenosis of introitus (vaginal opening)
Perianal involvement (leads to dyspareunia)

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11
Q

Possible complications of lichen sclerosis?

A

3-5% inc. risk SCC of vulva

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12
Q

How to diagnose lichen sclerosis?

A

Biopsy (4mm vulvar punch)

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13
Q

Treatment goal of lichen sclerosis?

A

Control pruritus

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14
Q

How to control pruritus w/ lichen sclerosis?

A

General hygiene, oral antihistamines, topical steroids (taper until improved, then PRN), education

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15
Q

Prognosis of lichen sclerosis?

A

Chronic: will recur if tx stopped

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16
Q

Interchangeable terms for vulvar lichen simplex chronicus?

A

Hyperplastic dystrophy, squamous cell hyperplasia, atopic eczema, neurodermatitis

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17
Q

How is vulvar lichen simplex chronicus characterized?

A

Benign d/o caused by persistent itching of the skin creating thickened epithelial layer w/ hyperkeratosis (dermal layer is spared)

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18
Q

Causes of vulvar lichen simplex chronicus itching?

A

Perfumed pad use, chronic vulvovaginal infections

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19
Q

S/sx of vulvar lichen simplex chronicus?

A

Pruritus, thickened epithelium, maceration (d/t humidity), raised white lesion

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20
Q

How to diagnose vulvar lichen simplex chronicus?

A

Biopsy to r/o malignancy

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21
Q

Treatment of vulvar lichen simplex chronicus?

A

Hygiene, lubricants, sitz baths, antihistamines, topical steroids

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22
Q

How long does vulvar lichen simplex chronicus typically take to heal?

A

6 weeks

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23
Q

What do dark lesions of the vulva result from?

A

Inc. # of concentration of melanin or hemosiderin pigment, possible trauma, nevus or melanoma (if persistent), Kaposi’s sarcoma, dermatofibroma, seborrheic keratosis

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24
Q

Do all dark lesions require biopsy?

A

YES

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25
Q

Appearance of melanosis?

A

Benign pigmented flat lesion

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26
Q

What does vulvar melanoma arise from? Is melanoma of the vulva common?

A

Pigmented nevi (uncommon but aggressive)

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27
Q

Bartholin gland location?

A

Deep in posterior 1/3 of each labia majora

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28
Q

Where is the duct opening for bartholin glands?

A

Open into vestibule at 4 o’clock & 8 o’clock position

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29
Q

What causes bartholin cyst/infection/abscess?

A

Obstruction of the bartholin gland ducts

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30
Q

S/sx of bartholin cyst?

A

Pain, tender, palpable mass, dyspareunia, pain w/ walking

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31
Q

PE for bartholin cyst?

A

Palpable, tender, fluctuant mass
If infected: edema/inflammation

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32
Q

Tx of bartholin cyst?

A

I&D w/ packing or catheter placement if large
If infected: Abx to cover E.coli/Staph

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33
Q

Solution for recurrent bartholin cysts?

A

Gland excision

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34
Q

If bartholin gland/cyst enlargement occurs in a postmenopausal female, what should be done?

A

Bx (r/o malignancy)

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35
Q

Where may vulvar cancer arise from?

A

Skin, subcutaneous tissue, or glandular elements of vulva

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36
Q

90% of vulvar cancers are what type?

A

SCC

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37
Q

Other types of vulvar cancer (other than SCC)?

A

BCC, melanoma, carcinoma of bartholin gland

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38
Q

Is vulvar cancer common or uncommon?

A

Uncommon, <5%

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39
Q

Peak incidence (age) of vulvar cancer?

A

60-70 yet inc. in women <50 d/t HPV

40
Q

RF for vulvar cancer?

A

Tobacco, HIV, hx of cervical cancer/dysplasia, HPV, chronic vulvar irritation

41
Q

S/s of vulvar cancer?

A

Pruritus, possible mass, bleeding, pain
*20% are asx

42
Q

PE for vulvar cancer?

A

SCC appearance range: large/cauliflower lesions —-> small/ulcerative lesions

43
Q

How to diagnose vulvar cancer?

A

Bx

44
Q

Tx for vulvar cancer?

A

Complete excision of all tumor if possible

45
Q

Prognosis of vulvar cancer WITHOUT lymph node involvement?

A

90%

46
Q

Prognosis of vulvar cancer WITH lymph node involvement?

A

40%

47
Q

Key for good prognosis of vulvar cancer?

A

Early dx & tx

48
Q

Top 3 causes of vaginitis? Others?

A

Candidiasis, BV, Trichomonas
(others: chemical, allergy, reactive, STD, atrophic)

49
Q

Normal vaginal pH in mostmenarchal and premenopasual women?

A

3.8-4.2

50
Q

Factors that alter vaginal environment?

A

Hygiene products, hormones/contraceptives, vaginal meds, Abx, STIs, sex, stress, medical diseases

51
Q

Hx for evaluation of vaginitis?

A

Discharge (quantity, duration, color, consistency, odor), prior episodes, STDs, sexual activity, contraceptive method, last menses, douching practices

52
Q

What is a saline wet mount for vaginitis eval?

A

Swab of discharge on slide w/ 1-2 drops of 0.9% isotonic NaCl (under microscope)

53
Q

What is a potassium hydroxide prep for vaginitis eval?

A

Swab of discharge on slide w/ 10% KOH solution (under microscope)

54
Q

What is a whiff test for vaginitis eval?

A

Release of fishy odor after 10% KOH added to discharge (d/t release of amines)

55
Q

Purpose of cultures for vaginitis?

A

Not as useful for vaginitis (results not immediately available)
*useful to test for co-existing STDs

56
Q

Most common species of yeast infection?

A

Candidia albicans

57
Q

RF of candidiasis?

A

DM, HIV, obesity, pregnancy, meds (abx, steroids, OCPs), frequent sex, chronic debilitation

58
Q

S/sx of candidiasis?

A

Vulvar pruritus/erythema, white/cheesy discharge, possible burning after urination

59
Q

PE for candidiasis?

A

Erythema, +/- swelling of labia/vulva, satellite lesions (discrete/pustulopapular), cottage cheese like discharge

60
Q

How to diagnose candidiasis?

A

Vaginal culture, pH <4.5*, wet mount slide

*helps differentiate between trich & BV

61
Q

Wet mount slide for candidiasis would reveal what?

A

Hyphae and budding yeast

62
Q

Whiff test for candidiasis (+ or -)?

A

Negative

63
Q

Tx of candidiasis?

A

Antifungal/imidazole meds: topical, suppository, oral, many OTC

64
Q

OTC meds for candidiasis?

A

Fluconazole, Miconazole, Nystatin, Clotrimazole

65
Q

What is the most common cause of symptomatic bacterial infection in reproductive-aged women?

A

BV

66
Q

BV happens due to an overgrowth of which organisms?

A

Gardnerella vaginalis, Mobiluncus spp, anaerobic gram neg. rods, Peptostrep spp

67
Q

Is BV related to sexual activity?

A

Uncommon in non-sexually active women, not an STI - no counterinfection in men

68
Q

S/sx of BV?

A

“fishy”/white-grey discharge, pruritus, 50% asx

69
Q

PE for BV?

A

Frothy, thin, homogenous, white/grey discharge that is adherent to vaginal wall

70
Q

How to diagnose BV?

A

3/4 need to be met:
-homogenous white/grey, adherent discharge
-pH >4.5
-positive whiff test
-clue cells on wet mount

71
Q

What are clue cells?

A

Vaginal epithelial cells covered w/ many vaginal rods & cocci

72
Q

Possible complications of BV?

A

Inc. risk of preterm labor, premature rupture of membranes, abnormal paps needing repeat, infections of cervix w/ procedures

73
Q

Tx for BV?

A

Metronidazole PO/gel or Clindamycin cream/PO/suppositories

74
Q

85% of vaginal neoplasms are what type?

A

SCC (ulcerative or exophytic)

75
Q

Are vaginal neoplasms common?

A

No, rare (<1%)

76
Q

Other types of vaginal neoplasms (other than SCC)?

A

Adenocarcinoma, sarcomas, melanomas (rare but aggressive)

77
Q

What is the most common cause of malignancy involving the vagina?

A

Secondary carcinoma: extension of cervical cancer

78
Q

RF for vaginal neoplasms?

A

Tobacco, HPV, multiple partners, hx of lower genital tract neoplasia, in utero DES (synthetic estrogen) exposure

79
Q

In utero DES exposure causes what type of vaginal neoplasm & at what age?

A

Adenocarcinoma, mean age 19

80
Q

Most common location of vaginal SCC? What can it invade directly?

A

Posterior wall of upper 1/3 of vagina, can directly invade bladder/rectum

81
Q

S/sx of vaginal neoplasms?

A

Often asx, postmenopausal/postcoital bleeding MC, discharge, mass, urinary sx

82
Q

How to diagnose vaginal neoplasms?

A

Bx

83
Q

Staging of vaginal neoplasms is based on what?

A

Clinical findings only: lesion depth/spread

84
Q

Treatment for vaginal neoplasms?

A

Radiation, Chemo, +/- Surgery depending on stage

85
Q

Prognosis of vaginal neoplasms depends on what?

A

Size/stage of disease at time of dx

86
Q

Stage I vaginal neoplasm? 5 year survival rate?

A

Limited to mucosa, 77% survival

87
Q

Stage II vaginal neoplasm? 5 year survival rate?

A

Involves subvaginal tissue (but not pelvic wall), 52% survival

88
Q

Stage III vaginal neoplasm? 5 year survival rate?

A

Involves pelvic wall, 42% survival

89
Q

Stage IV vaginal neoplasm? 5 year survival rate?

A

Beyond pelvis –> other organs, 18% survival

90
Q

Pelvic organ prolapse includes what organs?

A

Anterior vaginal, posterior vaginal, uterine, enteroceles

91
Q

Pelvic organ prolapse is more common in ______ women.

A

Postmenopausal/older *prevalence inc. w/ age

92
Q

Cause of pelvic organ prolapse?

A

Defects in pelvic supporting structures –> relaxation abnormalities

93
Q

RF for pelvic organ prolapse?

A

Age, inc. parity, obesity, hx of pelvic surgery, chronic cough, chronic constipation, heavy lifting, vaginal deliveries, physical debilitation, neurologic decline

94
Q

S/sx of pelvic organ prolapse?

A

Asx to severe, fullness/pressure/heaviness, bulging mass, sx worse with bearing down, back/pelvic pain, urinary/bowel sx, dyspareunia, coital laxity/looseness

95
Q

PE for pelvic organ prolapse?

A

Examine in supine for obvious prolapse, have pt. strain, if unable to produce in supine –> standing position w knees slightly bent/ask to bear down

96
Q

Tx for pelvic organ prolapse?

A

Conservative: pessary to support uterus/vaginal walls, kegels/PT, local estrogen therapy
Or surgery

97
Q

Side effects of pessary for pelvic organ prolapse?

A

Infections, fistulas if neglected (need changing q2-3 mos)

Special Pops Exam 1 (8 decks)

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