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Women's Health > Vulvovaginal Disorders (Exam 1) > Flashcards

Vulvovaginal Disorders (Exam 1) Flashcards

1
Q

What is the most common Vulvar Disorder

A

Lichen Sclerosis

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2
Q

What are the symptoms of Lichen Sclerosis

A

Intense pruritus, Erosions, fissures, sub-epithelial hemorrhage, ulcerations caused by itching, white plaques, fissures, and bruising in perineal region

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3
Q

What is Lichen Sclerosis

A

Benign and chronic inflammatory condition of the vulva

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4
Q

what is The suspected Etiology of Lichen Sclerosis

A 
Vitamin A deficiency 
Autoimmunity 
Excess amounts of elastase 
           enzyme 
Decreased 5-alpha reductase      
           enzyme activity
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5
Q

What age pt’s are most likely to be experiencing Lichen sclerosis

A

Women greater than 60

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6
Q

Management of Lichen Sclerosis

A 
Avoid tight underwear
Clean area daily with mild 
     soap
dry vulvar skin with hair 
    dryer after bathing 
oral antihistamines at bed 
      time
Clobetasol dipropionate 0.05% (Dermovate)
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7
Q

Clinical features of chronic irritation, Benign epithelial thickening, hyperkeratosis are suggestive of

A

Vulvar Lichen Simplex Chronicus

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8
Q

Tx of Vulvar Lichen Simplex Chronicus

A 
Vulvar hygiene 
Sitz baths
Lubricants to restore 
      moisture 
Oral antihistamines
Medium-Potency Steroids
    BID to decrease inflammation and pruritis
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9
Q

Vulvar Psoriasis effects what areas

A

Scalp, extremities, body, trunk, and vulva… thus this version effects the vulva

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10
Q

What is they typical appearance of Vulvar Psoriasis

A

Erythematous, clearly defined, and can resemble yeast infections

*often crusts that are found on psoriasis on other areas of the body are not found on the vulva

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11
Q

Tx of Vulva psoriasis

A

Treated with topical steroids

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12
Q

What is Lentigo often mistaken for

A

Melanoma

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13
Q

What percentage of vulvular cancers is melanoma a part of

A

1-3%

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14
Q

what is Lentigo

A

Benign, dark pigmented nevi of the vulva. Nevus on the vulva can be flat, slightly elevated, papillomatous, dome-shaped, or pedunculated

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15
Q

What is Capillary Hemangioma

A

Multiple, small, dark blue, asymptomatic papules found incidentally during examination of older women.

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16
Q

Complete a excision biopsy of Capillary Hemangiomas only in what situation

A

If there is repeated bleeding that occurs

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17
Q

Childhood Hemangiomas typically ( remain or Regress )

A

Regress- typically by 18 months of age.

-Large lesions may require cryosurgery, argon laser therapy, or sclerosing solutions

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18
Q

What is the most common cause of vulvar ulcers

A

Genital Herpes

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19
Q

Genital Herpes Simplex virus is what type

A

Typically type II however it can also be type I

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20
Q

How is Genital Herpes Transferred

A

through sexual contact

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21
Q

Clinical Features of Genital Herpes

A

Burning, Itching, Flu-like symptoms, open lesions, closed pustules

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22
Q

Tx options for Genital Herpes

A

Initial - 400 mg TID for 10 days of Acyclovir

Recommended that Acyclovir be continued BID daily for 1 year post initial treatment.

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23
Q

What are Bartholin’s Cysts or Abscess

A

Obstructed Bartholin duct

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24
Q

Risk factors for Bartholin’s Cyst

A

Infection, mucus, congenitally narrowed duct

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25
Q

Clinical Features of Bartholin’s

A 
Unilateral cyst/ abscess 
pain
tenderness
Dyspareunia
Difficulty walking
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26
Q

Management of Bartholin Cyst or Abcess

A

Sitz baths 15-20 min TID and Self Draining
Moderate / large cyst
Lidocane injection
lance with scalpel (block with towel pressure )
Doxycycline 100mg PO BID X 14 days

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27
Q

What is a Cystocele

A

Weakened anterior vaginal wall that allows for herniation of bladder into the vagina

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28
Q

Risk factors for Cystocele include:

A 
Multiparous 
Aging
Hysterectomy
Genetics 
Obesity
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29
Q

Symptoms of Cystocele

A

Vaginal or pelvic pressure
sensation of something “falling out” of the vagina

Stress urinary incontinence
Difficulty voiding

30
Q

Evaluation and Diagnosis of Cystocele

A

Physical exam, Bladder tests, assesses ability to empty

31
Q

complications of Cystoceles

A

Incomplete Bowel/ bladder emptying
Repeat bladder infections
Discomfort with coughing / lifting
Bulge of tissue protruding from vagina

32
Q

What is a Rectocele

A

Herniation of the rectum through the posterior vaginal wall

33
Q

Etiology of Rectocele

A

Increased pelvic floor pressure with weakened pelvic floor support

34
Q

Risk Factors of Rectocele

A 
Constipation 
Chronic cough
repeated heavy-lifting 
Obesity 
Aging
Multiparous
Genetics
35
Q

Evaluation / Diagnosis of Rectocele

A

Physical Exam / Defecography

36
Q

management of Rectocele

A

Expectant management and observation
Pessary
Surgical Repair

37
Q

complications of Rectocele

A

Inability to empty bowel

Discomfort, Dyspareunia

38
Q

Vaginal / uterine Prolapse

A

Extrusion of the uterus or vagina through the vaginal opening
stretched or weakened pelvic floor muscles and ligaments often due to age or pregnancy

39
Q

Risk factors for Vaginal / Uterine prolapse

A

Aging, Multiparous, Genetics, Chronic straining, Caucasian / Hispanic

40
Q

Management of vaginal / Uterine prolapse

A

Pelvic floor exercise
vaginal pessary
Correctie surgery

What is a pessary - Must be fitted to the pt. provided support, left in for up to 3 months between cleanings

  • device to help support the vaginal wall
41
Q

what will disrupt environmental disruptions

A

Soap in the vagina, Douching, Intercourse, Lubricant, condoms, Spermicide, semen, infection, prolonged or unnecessary tampon use, Feminine deodorant spray

42
Q

What is Vulvovaginitis

A

Is inflammation of the vulva and vagina, it can cause discharge, itching, irritation, or pain

43
Q

Risk factors of Vulvovaginitis

A

Chemicals, Allergens, excessive sexual activity, lack of estrogen, pre-pubesant girls, lactating women, postmenopausal women, or unknown causes

44
Q

What are the clinical features of Vulvovaginitis

A

Vaginal and vulvar irritation/burning discharge
elevated pH
Discharge
Postmenopausal women may have vaginal dryness, spotting, watery discharge, dyspareunia, and decreased vaginal folds

45
Q

Most common causes of Cervicitis

A

Herpes simplex virus, Chlamydia, Ghonorrhea, HPV, Trichomonas, Cytomegalovirus, and Bacterial vaginosis

46
Q

How many people are diagnosed annually with Cervicitis

A

3 million women annually

47
Q

MCC causes of Cervicitis

A

Herpes simplex virus, Chlamydia, Gonorrhea, HPV, Trichomonas, Cytomegalovirus, and Bacterial vaginosis

48
Q

Risk Factors for Cervicitis

A 
Women 19-25
multiple sexual partners
Unprotected intercourse
high risk sexual partner
infected sexual partner 
Hx of STI's 
Current / prior drug use
49
Q

Clinical Features of Cervicitis

A 
Often Asymptomatic 
Change in vaginal discharge
     thick, runny, colored, 
     malodorous
Post-coital bleeding 
vulvar burning/itching
Dysuria, urgency > urination
Cervical Friability 
Lower abdominal pain 
Dysmenorrhea
Cervical motion tenderness
50
Q

management of Cervicitis

A

Treat the underlying cause per CDC guidelines

51
Q

Complications of Cervicitis

A

Cervical hemorrhage, leukorrhea, Cervical Stenosis, Salpingitis (inflammation of the fallopian tubes), PID, infertility, ectopic pregnancy, and chronic pain

52
Q

What type of infection is Vaginal Candidiasis

A

Yeast infection

75% of women will have a yeast infection during their lifetime

53
Q

What is the typical organism that is overgrown in yeast infections

A

Candida albicans

54
Q

What is the Organism that is overgrown in Bacterial Vaginosis

A

Gardnerella vaginalis

55
Q

Risk Factors For Bacterial Vaginosis

A

Sexual intercourse

Sharing sexual toys with infected individuals

56
Q

Clinical features of bacterial vaginosis

A

“Fishy” vaginal odor
vaginal itching
thin gray film

57
Q

Evaluation and Diagnosis of bacterial vaginosis

A

Wet mount (look for 20% clue cells)

pH 5.5 + whiff test

58
Q

What is the most frequently reported infectious disease in the U.S.

A

Vaginal Chlamydia

-85% are asymptomatic
-highest prevalence ≤ 24 y.o.
recommended screening in sexually active people less than 25 y.o.

59
Q

if not asymptomatic what are the clinical features

A

pelvic pain, white discharge, dysuria

60
Q

Management of Vaginal Chlamydia

A

Azithromycin 1g PO once
Abstain from sex 7 days post tx

Alt- Doxycycline 100mg PO BID 7 days

61
Q

Complications of Vaginal Chlamydia

A

PID, Ectopic pregnancy, Infertility,

62
Q

What is the second most commonly reported communicable disease in U.S

A

Vaginal Gonorrhea

63
Q

Clinical Features of Gonorrhea if not asymptomatic

A

Yellow Discharge,
Pelvic Pain
Dysuria

64
Q

Management of Gonorrhea

A

Azithromycin 1g PO once
Ceftriaxone 250mg IM one dose

Abstain from sex post tx for 7 days

65
Q

Pelvic inflammatory Diseases involves what organs in women

A

Uterus, Fallopian tubes, Ovaries

66
Q

Risk factors of PID

A

Undiagnosed infection, Multiple sexual partners, inconsistent condom use, High risk partner,
partner with hx of infection
85% result from STI’s

67
Q

Clinical Features of PID

A 
Pelvic Pain 
Cervical Motion Tenderness
Cervical DC f unknown cause
Cervical Friability
Oral Temperature >101 F
Abundant WBC's on wet mt
Elevated C-reactive protein
Elevated erythrocyte sed. 
           rate
68
Q

Management of PID

A

Ceftriaxone 150 mg IM
Plus Doxycycline 100 mg PO BID for 14 days

With or without metronidazole 500mg PO BID 14 days

Abstain from sexual intercourse during treatment

69
Q

Complications of PID

A

Yeast infection
GI upset
Adherence to medication

70
Q

What are the symptoms of a Retained Tampon

A

Foul odor

Toxic Shock develops rapidly

71
Q

S/S of Toxic Shock Syndrome

A

Hypotension, Abdominal pain, rash, diarrhea, confusion, irritability, HA, hallucinations

72
Q

Treatment of a retained tampon

A

Remove tampon
Watch for Toxic shock Syndrome
- admit for IV antibiotics

Women's Health (4 decks)

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