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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
Q

Pathophysiology of atrophic vaginitis

A

decreased circulating estrogen

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26
Q

signs/sx’s of atrophic vaginitis

A

Vaginal dryness and dyspareunia

PE: tissues thin, friable, and pale

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27
Q

Treatment of atrophic vaginitis

A

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
Q

Characteristics of normal vaginal discharge

A

White or transparent, thick, odorless

Quantity increases with ovulation, pregnancy, and oral contraceptives

29
Q

Normal flora of vagina

A

Lactobacillus

30
Q

Predisposing factors to getting vaginal yeast infection

A 
Recent antibiotics
Diabetes 
Increased estrogen
Pregnancy, oral contraceptives, estrogen therapy
Immunocompromised 
Vaginal or vulvar irritants
31
Q

Thick cottage cheese vaginal discharge =

A

Candida vulvovaginitis

32
Q

How is yeast dx’d in lab?

A

KOH wet mount shows budding yeast with hyphae

33
Q

Candida vulvovaginitis treatment

A

Single dose oral fluconazole 150 mg
Intravaginal antifungal

Longer tx regimens for recurrent disease, diabetes and immunosuppression

34
Q

Woman comes in for recurrent candidas +4 episodes per year. What should be ruled out?

A

Diabetes and HIV

  • treat these before yeast infection
35
Q

Normal pH of vagina

A

4.0 - 4.5

36
Q

Physiological changes of vagina in bacterial vaginosis

A

Reduction in vaginal flora
pH rises
overgrowth of vaginal anaerobes

37
Q

Fishy odor, off-white thin discharge =

A

bacterial vaginosis

38
Q

Wet mount of bacterial vaginosis

A

pH > 4.5
fishy odor with KOH (+ whiff test)
Clue cells = epithelial cells coated with bacteria

39
Q

Bacterial vaginosis treatment

A

Topical Metrogel BID X 5 days or Cleocin Gel hs X 7 days OR

Oral Metronidazole 500 BID X 7 Days (avoid alcohol)

40
Q

What is added to treatment of yeast or bacterial vaginal infections if recurrent (> 3-4 episodes per year)?

A

Intravaginal Boric Acid 600 mg

41
Q

copious greenish frothy vaginal discharge =

A

Trichomonas vaginalis

42
Q

Treatment for Trichomonas vaginalis

A

Metronidazole 500 mg x 1 dose

No EtoH for 24 hrs

43
Q

Typical presentation of vaginal cancer

A

60 yo woman with post menopausal bleeding

  • same as uterine cancer
44
Q

Most common cause of vaginal cancer

A

metastatic cancer

45
Q

What is not found in lower UTI that is found in kidney infection?

A

Fever

CVA tenderness

46
Q

UA results of lower UTI

A

> trace leuks

nitrites

47
Q

Treatment of uncomplicated UTI

A

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
Q

What is complicated UTI? Treatment?

A
  • DM, elderly, immunocomp’d, catheter, h/o recurrance
  • Proteus, Klebsiella, Pseudomonas, Serratia

Tx: Fluoroquinolone x 7-14 days

49
Q

DDX of female dysuria

A 
Lower UTI
Interstitial cystitis
Acute pyelonephritis
Chlamydia or GC urethritis
Trichomonas, Candidas, or bacterial vaginosis
Herpes Simplex
50
Q

Follicular vs corpus luteum cyst causes

A

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
Q

Define adnexa

A

Area between the lateral pelvic wall and the uterus

consists of ovaries, fallopian tubes and upper portion of the broad ligament

52
Q

How to dx ovarian cyst?

A

U/S will confirm

53
Q

Treatment of ovarian cysts

A

Most resolve spontaneously in a couple weeks

May need oral contraceptives or surgery

54
Q

Most common cause of androgen excess and hirsutism

A

Polycystic Ovarian Syndrome

55
Q

Signs of Polycystic Ovarian Syndrome

A

Effects of androgen excess - hirsutism, acne, male pattern balding

Effects of ovulatory dysfunction - oligomenorrhea or amenorrhea, menstrual irregularities, infertility

56
Q

Patient with polycystic ovary syndrome likely has what other conditions?

A

obesity
DM
metabolic syndrome
hyperinsulinemia

57
Q

Women c/o amenorrhea and excessive hair growth that are at risk for Type II DM.

A

Polycystic Ovarian Syndrome

58
Q

PCOS treatment

A

Hirsutism: oral contraceptives, Spirolactone

Endometrium thinning: oral contraceptives

Infertility: WEIGHT LOSS, Clomid (clomiphene)

Insulin resistance: Metformin

59
Q

What is an ectopic pregnancy?

A

blastocyst implants anywhere other than endometrial lining of uterus (98% in tubes)

60
Q

Risk factors of ectopic pregnancy

A 
previous ectopic
current IUD use
tubal surgeries
history of PID
prior infertility
61
Q

When is transvaginal U/S not useful in eval of pregnant woman?

A

4-6 weeks after gestation; won’t see anything

62
Q

Clinical features of ovarian neoplasms

A

History: pelvic pain, dysmenorrhea, dyspareunia

Eval: enlarged ovary, complex mass on U/S

63
Q

How is risk for ovarian cancer assessed based on history?

A

FHX!!! (10%)

Decreased risk with h/o pregnancy, use of OC, breastfeeding, tubal ligation or hysterectomy

64
Q

Genetic testing for ovarian cancer?

A

Annual CA-125 screen (poor predictive value, used to assess cancer progression)

BRCA1 and 2 gene mutation

65
Q

While evaluating a female for suspected ectopic pregnancy, the transvaginal U/S finds echogenic fluid in the Pouch of Douglas. What does this suggest?

A

Hemoperitoneum following the rupture of an ectopic pregnancy

Women's Health - GYN (12 decks)

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