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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
Clinical Features of Bartholin's
``` Unilateral cyst/ abscess pain tenderness Dyspareunia Difficulty walking ```
26
Management of Bartholin Cyst or Abcess
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
27
What is a Cystocele
Weakened anterior vaginal wall that allows for herniation of bladder into the vagina
28
Risk factors for Cystocele include:
``` Multiparous Aging Hysterectomy Genetics Obesity ```
29
Symptoms of Cystocele
Vaginal or pelvic pressure sensation of something "falling out" of the vagina Stress urinary incontinence Difficulty voiding
30
Evaluation and Diagnosis of Cystocele
Physical exam, Bladder tests, assesses ability to empty
31
complications of Cystoceles
Incomplete Bowel/ bladder emptying Repeat bladder infections Discomfort with coughing / lifting Bulge of tissue protruding from vagina
32
What is a Rectocele
Herniation of the rectum through the posterior vaginal wall
33
Etiology of Rectocele
Increased pelvic floor pressure with weakened pelvic floor support
34
Risk Factors of Rectocele
``` Constipation Chronic cough repeated heavy-lifting Obesity Aging Multiparous Genetics ```
35
Evaluation / Diagnosis of Rectocele
Physical Exam / Defecography
36
management of Rectocele
Expectant management and observation Pessary Surgical Repair
37
complications of Rectocele
Inability to empty bowel | Discomfort, Dyspareunia
38
Vaginal / uterine Prolapse
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
Risk factors for Vaginal / Uterine prolapse
Aging, Multiparous, Genetics, Chronic straining, Caucasian / Hispanic
40
Management of vaginal / Uterine prolapse
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
what will disrupt environmental disruptions
Soap in the vagina, Douching, Intercourse, Lubricant, condoms, Spermicide, semen, infection, prolonged or unnecessary tampon use, Feminine deodorant spray
42
What is Vulvovaginitis
Is inflammation of the vulva and vagina, it can cause discharge, itching, irritation, or pain
43
Risk factors of Vulvovaginitis
Chemicals, Allergens, excessive sexual activity, lack of estrogen, pre-pubesant girls, lactating women, postmenopausal women, or unknown causes
44
What are the clinical features of Vulvovaginitis
Vaginal and vulvar irritation/burning discharge elevated pH Discharge Postmenopausal women may have vaginal dryness, spotting, watery discharge, dyspareunia, and decreased vaginal folds
45
Most common causes of Cervicitis
Herpes simplex virus, Chlamydia, Ghonorrhea, HPV, Trichomonas, Cytomegalovirus, and Bacterial vaginosis
46
How many people are diagnosed annually with Cervicitis
3 million women annually
47
MCC causes of Cervicitis
Herpes simplex virus, Chlamydia, Gonorrhea, HPV, Trichomonas, Cytomegalovirus, and Bacterial vaginosis
48
Risk Factors for Cervicitis
``` Women 19-25 multiple sexual partners Unprotected intercourse high risk sexual partner infected sexual partner Hx of STI's Current / prior drug use ```
49
Clinical Features of Cervicitis
``` 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
management of Cervicitis
Treat the underlying cause per CDC guidelines
51
Complications of Cervicitis
Cervical hemorrhage, leukorrhea, Cervical Stenosis, Salpingitis (inflammation of the fallopian tubes), PID, infertility, ectopic pregnancy, and chronic pain
52
What type of infection is Vaginal Candidiasis
Yeast infection 75% of women will have a yeast infection during their lifetime
53
What is the typical organism that is overgrown in yeast infections
Candida albicans
54
What is the Organism that is overgrown in Bacterial Vaginosis
Gardnerella vaginalis
55
Risk Factors For Bacterial Vaginosis
Sexual intercourse | Sharing sexual toys with infected individuals
56
Clinical features of bacterial vaginosis
"Fishy" vaginal odor vaginal itching thin gray film
57
Evaluation and Diagnosis of bacterial vaginosis
Wet mount (look for 20% clue cells) pH 5.5 + whiff test
58
What is the most frequently reported infectious disease in the U.S.
Vaginal Chlamydia -85% are asymptomatic -highest prevalence ≤ 24 y.o. recommended screening in sexually active people less than 25 y.o.
59
if not asymptomatic what are the clinical features
pelvic pain, white discharge, dysuria
60
Management of Vaginal Chlamydia
Azithromycin 1g PO once Abstain from sex 7 days post tx Alt- Doxycycline 100mg PO BID 7 days
61
Complications of Vaginal Chlamydia
PID, Ectopic pregnancy, Infertility,
62
What is the second most commonly reported communicable disease in U.S
Vaginal Gonorrhea
63
Clinical Features of Gonorrhea if not asymptomatic
Yellow Discharge, Pelvic Pain Dysuria
64
Management of Gonorrhea
Azithromycin 1g PO once Ceftriaxone 250mg IM one dose Abstain from sex post tx for 7 days
65
Pelvic inflammatory Diseases involves what organs in women
Uterus, Fallopian tubes, Ovaries
66
Risk factors of PID
Undiagnosed infection, Multiple sexual partners, inconsistent condom use, High risk partner, partner with hx of infection 85% result from STI's
67
Clinical Features of PID
``` 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
Management of PID
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
Complications of PID
Yeast infection GI upset Adherence to medication
70
What are the symptoms of a Retained Tampon
Foul odor | Toxic Shock develops rapidly
71
S/S of Toxic Shock Syndrome
Hypotension, Abdominal pain, rash, diarrhea, confusion, irritability, HA, hallucinations
72
Treatment of a retained tampon
Remove tampon Watch for Toxic shock Syndrome - admit for IV antibiotics

Women's Health (4 decks)

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