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Women's Health - GYN > Vulvar, Vaginal, & Ovarian Disease > Flashcards

Vulvar, Vaginal, & Ovarian Disease Flashcards

1
Q

dyspareunia =

A

painful intercourse

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2
Q

Most common cause of dyspareunia in women under 50?

A

vestibulodynia

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3
Q

Signs of vestibulodynia vs vulvodynia

A

Both have pain that is burning, stinging, sore in nature that can be generalised around vulva or localized; not typically itchy

vestibulodynia - provoked pain with light touch (e.g. tampon or sex) and asx at other times

vulvodynia - unprovoked, spontaneous pain

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4
Q

Most common cause of dyspareunia in postmenopausal women.

A

vulvovaginal atrophy (aka atrophic vaginitis)

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5
Q

Causes of inadequate lubrication

A

Estrogen deficiency in menopause
Decreased arousal
Medications

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6
Q

Appearance/signs of Vulvar Lichen Sclerosus

A

small white, atrophic patches or plaques; tissue thickens and may fissure
labia and clitoris may disappear d/t scarring

pruritis and pain

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7
Q

Hallmark of Vulvar Lichen Sclerosus

A

extreme pruritis, vulvar pain and burning

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8
Q

Two peaks of onset of Vulvar Lichen Sclerosus

A

prepubertal and peri/post-menopausal

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9
Q

Why is taking patient off intravaginal therapy for 2 weeks helpful in dx?

A

Eliminates adverse reactions to meds from the differential diagnosis

Allows adequate eval of vaginal secretions, cultures will be reliable

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10
Q

How is Vulvar Lichen Sclerosus confirmed?

A

vulvar biopsy

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11
Q

Vulvar Lichen Sclerosus treatment

A

Preventative education

Topical corticosteroids (Dermovate)

Clobetasol or halobetasol propionate 0.05% ointment daily at night

F/U within 3 months

If no improvement, refer to GYN

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12
Q

Vulvar Intraepithelial Neoplasia associated with ______ infection.

A

HPV

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13
Q

Vulvar Intraepithelial Neoplasia signs/sx’s? Similar to what other disease?

A

ITCHING
vulvar lesion that are raised and/or veracious and white plaques (sometimes red or brown)

presents like vulvar cancer

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14
Q

Vulvar Intraepithelial Neoplasia diagnosis

A

turn white with vinegar wash

biopsy to r/o cancer

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15
Q

Vulvar Intraepithelial Neoplasia treatment

A

surgical excision because pre-cancerous

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16
Q

common cause of sudden onset vulvar pruritus

A

contact dermatitis (soaps, new clothes, spermicides, condoms, etc.)

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17
Q

Treatment of contact dermatitis on vulva

A

Antihistamines
Topical steroids (only 7-10 days)
Cool compress, baking soda, Aveeno baths

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18
Q

Vulvar Paget’s Disease signs/sx’s

A

Usually red, velvety areas with white island of tissue
May appear pink
Moist oozing ulceration that bleed easily
50% complain of itching

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19
Q

flesh-colored papule or nodule on vulva that appears fluid filled

A

sebaceous or inclusion cysts

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20
Q

Bartholin Gland Abscess treatment

A

drain and insert catheter or marsupialize (incision over center of cyst to dissect from mucosa)

abx if surrounding cellulitis

may excise if reforms

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21
Q

Woman has small smooth flesh-colored bumps with central umbilication on vulva. Likely dx? tx?

A

molluscum contagiosum

tx: cryosurgery, topical Retin A, topical benzoyl peroxide

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22
Q

Cauliflower-like warty lesions on vulva and perineum.

A

HPV (condyloma acuminatum)

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23
Q

Patient comes in with groin rash that looks like cystic acne. Likely dx? tx?

A

Hidradenitis suppurativa

tx: refer to derm, abx, intralesional steroids

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24
Q

What is a urethral caruncle?

A

benign fleshy outgrowths at urethral meatus, occurring primarily in post-menapausal women

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25
Pathophysiology of atrophic vaginitis
decreased circulating estrogen
26
signs/sx's of atrophic vaginitis
Vaginal dryness and dyspareunia PE: tissues thin, friable, and pale
27
Treatment of atrophic vaginitis
Vaginal moisturizers (Vagisil, Replens, K-Y SILK-E) and lubricants (KY jelly, Astroglide) Estrogen preparations - Topical cream (Premerin, Estrace) - Vaginal tablet (Vagifem) - Vaginal ring (Estring)
28
Characteristics of normal vaginal discharge
White or transparent, thick, odorless Quantity increases with ovulation, pregnancy, and oral contraceptives
29
Normal flora of vagina
Lactobacillus
30
Predisposing factors to getting vaginal yeast infection
``` Recent antibiotics Diabetes Increased estrogen Pregnancy, oral contraceptives, estrogen therapy Immunocompromised Vaginal or vulvar irritants ```
31
Thick cottage cheese vaginal discharge =
Candida vulvovaginitis
32
How is yeast dx'd in lab?
KOH wet mount shows budding yeast with hyphae
33
Candida vulvovaginitis treatment
Single dose oral fluconazole 150 mg Intravaginal antifungal Longer tx regimens for recurrent disease, diabetes and immunosuppression
34
Woman comes in for recurrent candidas +4 episodes per year. What should be ruled out?
Diabetes and HIV * treat these before yeast infection
35
Normal pH of vagina
4.0 - 4.5
36
Physiological changes of vagina in bacterial vaginosis
Reduction in vaginal flora pH rises overgrowth of vaginal anaerobes
37
Fishy odor, off-white thin discharge =
bacterial vaginosis
38
Wet mount of bacterial vaginosis
pH > 4.5 fishy odor with KOH (+ whiff test) Clue cells = epithelial cells coated with bacteria
39
Bacterial vaginosis treatment
Topical Metrogel BID X 5 days or Cleocin Gel hs X 7 days OR Oral Metronidazole 500 BID X 7 Days (avoid alcohol)
40
What is added to treatment of yeast or bacterial vaginal infections if recurrent (> 3-4 episodes per year)?
Intravaginal Boric Acid 600 mg
41
copious greenish frothy vaginal discharge =
Trichomonas vaginalis
42
Treatment for Trichomonas vaginalis
Metronidazole 500 mg x 1 dose | No EtoH for 24 hrs
43
Typical presentation of vaginal cancer
60 yo woman with post menopausal bleeding * same as uterine cancer
44
Most common cause of vaginal cancer
metastatic cancer
45
What is not found in lower UTI that is found in kidney infection?
Fever | CVA tenderness
46
UA results of lower UTI
> trace leuks | nitrites
47
Treatment of uncomplicated UTI
3-day regimen of TMP-SMX or Fluoroquinolone * Macrobid 100 mg BID x 3-7 days has less chance of yeast infections from abx
48
What is complicated UTI? Treatment?
- DM, elderly, immunocomp'd, catheter, h/o recurrance - Proteus, Klebsiella, Pseudomonas, Serratia Tx: Fluoroquinolone x 7-14 days
49
DDX of female dysuria
``` Lower UTI Interstitial cystitis Acute pyelonephritis Chlamydia or GC urethritis Trichomonas, Candidas, or bacterial vaginosis Herpes Simplex ```
50
Follicular vs corpus luteum cyst causes
Follicular cyst - Follicle fails to rupture, no ovulation occurred, or didn't resolve after ovulation - Can enlarge with each cycle or be reabsorbed Corpus luteum cyst - Occur when corpus luteum doesn't involute after ovulation but instead continues to enlarge
51
Define adnexa
Area between the lateral pelvic wall and the uterus consists of ovaries, fallopian tubes and upper portion of the broad ligament
52
How to dx ovarian cyst?
U/S will confirm
53
Treatment of ovarian cysts
Most resolve spontaneously in a couple weeks May need oral contraceptives or surgery
54
Most common cause of androgen excess and hirsutism
Polycystic Ovarian Syndrome
55
Signs of Polycystic Ovarian Syndrome
Effects of androgen excess - hirsutism, acne, male pattern balding Effects of ovulatory dysfunction - oligomenorrhea or amenorrhea, menstrual irregularities, infertility
56
Patient with polycystic ovary syndrome likely has what other conditions?
obesity DM metabolic syndrome hyperinsulinemia
57
Women c/o amenorrhea and excessive hair growth that are at risk for Type II DM.
Polycystic Ovarian Syndrome
58
PCOS treatment
Hirsutism: oral contraceptives, Spirolactone Endometrium thinning: oral contraceptives Infertility: WEIGHT LOSS, Clomid (clomiphene) Insulin resistance: Metformin
59
What is an ectopic pregnancy?
blastocyst implants anywhere other than endometrial lining of uterus (98% in tubes)
60
Risk factors of ectopic pregnancy
``` previous ectopic current IUD use tubal surgeries history of PID prior infertility ```
61
When is transvaginal U/S not useful in eval of pregnant woman?
4-6 weeks after gestation; won't see anything
62
Clinical features of ovarian neoplasms
History: pelvic pain, dysmenorrhea, dyspareunia Eval: enlarged ovary, complex mass on U/S
63
How is risk for ovarian cancer assessed based on history?
FHX!!! (10%) | Decreased risk with h/o pregnancy, use of OC, breastfeeding, tubal ligation or hysterectomy
64
Genetic testing for ovarian cancer?
Annual CA-125 screen (poor predictive value, used to assess cancer progression) BRCA1 and 2 gene mutation
65
While evaluating a female for suspected ectopic pregnancy, the transvaginal U/S finds echogenic fluid in the Pouch of Douglas. What does this suggest?
Hemoperitoneum following the rupture of an ectopic pregnancy

Women's Health - GYN (12 decks)

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