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passmed incorrect > vulvovaginal > Flashcards

vulvovaginal Flashcards

1
Q

what general advice can be given to pts with vulval conditions?

A

avoid contact with chemical irritants - soaps, lubricants
avoid tight fitting garments

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2
Q

lichen sclerosis aetiolgoy

A

autoantibodies to ECM protein 1
immunopathogenic mechanisms involved

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3
Q

features of lichen sclerosus

A

ithcy
sore
dyspareunia
dysuria
constipation - if perianal invovlement

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4
Q

what areas does lichen sclerosis affect?

A

labia majora/minora
clitoral hood
perianal skin

extragenital lesions in 10%

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5
Q

signs o/e in lichen sclerosis

A

allow
purpura
loss of architecture
erosions
lichenifcation, hyperkeratosis

figure of 8 distribution

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6
Q

complications of lichen sclerosus

A

SCC
clitroal pseudo-cyst
sexual dysfunction
urinary symptoms
vulvodynia
reactivation of latent HSV or HPV

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7
Q

how do you diagnose lichen sclerosus?

A

clinical
biopsy (younger women)

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8
Q

when is biopsy needed in lichen scelrosus

A

dx uncertain
atypical features
suspicion of VIN or SCC
failure to respond to first line tx
atypical pigmented areas

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9
Q

what is seen histologically in lichen sclerosu

A

epidermal atrophy
sub-epidermal hyalinisation of collagen
lymphocytic dermal infiltrate

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10
Q

tx lichen sclerosus

A

emollients
dermovate - clobetasone steroid with tapering regime
steroid + anti fungal
topical calcineurin inhibitors eg tacrolimus
oral retinoids in severe hyperkeratotic disease
UVA

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11
Q

how does lichen scelrosus affect pregnancy + breastfeeding?

A

improves in pregancy
no CI to vaginal delivery
steroids safe
tacrolimus CI
oral retinoids CI during breastfeeding + pregnancy, and for 2 yrs before

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12
Q

lichen planus aetiology

A

probably immunological response by activated T cells
weak circulating basement membrane antibodies present

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13
Q

what is lichen planus

A

inflammatory disorder of skin, oral and genital mucosa
may involve hair + nails, causing scarring alopecia + nail dystrophy

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14
Q

symptoms lichen planus

A

itch - hypertrophic
sore
dyspareunia
urinary symptoms
vaginal discharge

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15
Q

types of lichen planus

A

classic
hypertrophic
erosive

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16
Q

what is classical lichen planus

A

papule found on keratinised anogenital skin /- striae on inner vulva
hyperpigmentation following resolution, esp in darker skin

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17
Q

what is hypertrophic lichen planus

A

perineum + perianal area
thickened warty plaques
may become ulcerated, infected + painful

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18
Q

what is erosive lichen planus?

A

mucosal surfaces eroded with pale lilac lace network (Wickham’s striae)

consist of friable telangectasia with patchy erythema

cause post coital bleeding, dyspareunia, serosanguinus discharge
seen in oral mucosa

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19
Q

what is vulvo-vaginal gingival syndrome + symptoms

A

erosive disease n three sites

symptoms inc soreness, dyspareunia, blood-stained vaginal discharge

20
Q

complications of lichen planus

A

scarring, vulval + vaginal adhesions
SCC in hypertrophic

21
Q

how do you ix lichen planus

A

biopsy - if dx uncertain
autoimmune disease eg TFTs
skin swab
patch testing
Hep C

22
Q

tx of lichen planus

A

dermovate - clobetasol steroid
topical calcineruin inhibitors eg tacrlimus

systemic eg oral sprednisolone, methotrexate, hydroxycholoriquine, mycophenolate

biologics in oral + cutaneous disease eg basiliximab

photodynamic therapy
sugary for severe adhesions

23
Q

aetiology of vulval atopic eczema?

A

gene ,mutation in strucutral epidermal protein filaggrin leading to disturbance of the normal epidermal barrier function and increased epidermal susceptibility to allergens and microbes, resulting in chronic inflammation

24
Q

what can cause irritation of genital skin?

A

urine, faeces, sweat
fragrances, preservatives
spices, peppermint
spermicides, lubricants
overzealous cleaning of genital skim, friction from exercise, tight synethetic underwear

25
Q

what can be seen in vulval seborrhoea eczema?

A

mildly pink, glazed appearance, poorly defined patches with slight greasy scale

can affect pubic region, groin flexures + natal cleft, vulva

26
Q

hisptolgical finding for vulval eczema?

A

spongiosis

27
Q

what is VIN

A

vulvar intraepithelial neoplasia
premalignant lesion of vulval skin

28
Q

aetiology of VIN

A

caused by HPV, usually 16
higher risk in smokers + immunocompromised

29
Q

symptoms of VIN

A

burning itch/irritation
pain/soreness
lump or thickening

30
Q

signs of VIn

A

white, erythematous or pigmented plaques
warty in appearance
hyperkeratotic, erosive or ulcerated
appear at clotpris, labia minor, vaginal introitus, inner labia majora

31
Q

complications of VIn

A

SCC
multifocal disease
recurrent
psychosexual issues

32
Q

diagnosis of VIN

findings?

A

biopsy

histology:
high nuclear-cytoplasmic ratios
hyperchromasia
pleomorphism
cytological atypia + motises

P16 in HSIL and p53 in dVIN

33
Q

tx of VIN

A

dVIN = surgical excision eg partial vulvectomy

HSIL = local excision, imoquimod cream
maybe cidofivir 1% gel, ablative laser

34
Q

who is usually affected by dVIN and HSIL

A

dVIN =post meonpausal
HSIL = 35-49yo

35
Q

can you use imiquimod + cidofovir in pregnancy or breastfeeding

A

NO

36
Q

what causes acute ulcers?

A

sexually acquired = HSV, syphilis, MPox, tropical STIs

non sexually acquired = Lipschultz

37
Q

how can you diagnose acute vulval ulcers?

A
38
Q

how can you diagnose chronic vulval ulcers?

A
39
Q

what is Lipschultz ulcer aetiology

A

assoc with EBV, CMV, COVID 19

40
Q

features of lipschultz

A

painful ulcers affecting labia minor and majora
assoc with flu symptoms
deep, well demarcated borders
superficial fibrinous coating
kissing ulcers
<20yo with little sexual history

41
Q

ix for lipschultz

A

PCR for HSV and syphilis
syphilis serology
screening for gonorrhoea and chla,mydisa
Mpox testing
bacterial culture
serology for EBV, CMV, mycoplasma, toxoplasmosis, flu, salmonella

42
Q

tx of lipschultx

A

topical local anaesthetic
NSAIDs for pain
acicilovir 400mg TDS 5 days
potent topical steroids - clobetasol

short course oral steroids if severe

43
Q

female genital pain classifications

A

provoked vulvodynia - pain at vestibule on penetration
unprovoked vulvodynia

44
Q

what causes vulvodynia?

A

maladaptive function of NS leading to a perpetuation of pain after inflammation or a triggering noxious stimulus has resolved

may be induced by exposure to acute phsyoica; +/- psychological events

45
Q

how is vulvodynia charatcerised

A

burning, stabbing +/- shooting pain
allodynia or hyperalgesia

46
Q

tx of provoked vulvodynia?

A

topical local anaesthetics
physiotherapy
psychosexual discussion

47
Q

tx for unprovoked vulvodynia

A

pain modifiers eg tricyclic antidepressants eg amitryptilline

passmed incorrect (7 decks)

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