Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Women's Health > Vulvovaginal Health & Infections > Flashcards

Vulvovaginal Health & Infections Flashcards

1
Q

Why might menopause place one at a higher risk for UTIs?

A

Menopause is marked by a time of lower-potency estrogen (estrone - E1). Low estrogen levels lead to a thinner, less active vaginal epithelium with scant lactobacilli, increasing the pH (6-8). Increasing pH and relative lack of lactobacilli increase risk for infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Priority goal of vulvovaginal care

A

keep the vulva dry and free from irritants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Patient education regarding routine vulvovaginal care

A

wash with warm water; avoid douches, wipes, sprays, and powders; wear cotton underwear and avoid thongs; use unscented cotton menstrual hygiene products; avoid scented detergent, bubble baths, and scented oils; avoid shaving and waxing; wipe front to back after voiding and defecation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Normal appearance of the vaginal on physical exam

A

pink, rugaeted, moist vaginal muscosa (“well-estrogenized”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Normal vaginal pH

A

3.5-4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Normal vaginal discharge

A

clear to cloudy, white, flocculent (loosely clumped). Minimal to small in amount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Normal wet mount findings

A

numerous lactobacilli, normal squamous epithelial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Menstrual Cycle: vaginal discharge is egg white - clear, viscous

A

mid-cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Menstrual Cycle: vaginal discharge is thick, pasty, sometimes yellow-ish

A

luteal phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Estrogen promotes the growth of this bacteria as part of the healthy vaginal flora

A

lactobacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Alkaline pH of the vagina

A

> 4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

KOH stands for….

A

potassium hydroxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the purpose of having a separate KOH wet mount? (2)

A
  1. whiff/amine test for bacterial vaginosis

2. lyses the WBCs and trich making the candida easier to see

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

INTERPRET: Perineal laceration affecting the skin and subcutaneous tissue, with perineal muscles intact

A

1st degree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

INTERPRET: Perineal laceration extending into the fascia and muscles of the perineal body, with the anal sphincter intact

A

2nd degree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

INTERPRET: Perineal laceration extending through the fascia/musculature and some or all of the external anal or internal anal sphincters

A

3rd degree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

INTERPRET: Perineal laceration involving the perineal muscles, external and internal anal sphincters, and the rectal mucosa

A

4th degree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

1st degree perineal lacerations after vaginal childbirth can be expected to heal….

A

within a few weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

INTERPRET: FGM/C involving partial or total removal of the clitoris

A

Type 1 (clitordectomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

INTERPRET: FGM/C involving partial or total removal of the clitoris and labia minora, with or without the labia majora

A

Type 2 (excision)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

INTERPRET: FGM/C involving narrowing of the vagina with the creation of a covering seal by repositioning either labia, with or without excision of the clitoris

A

Type 3 (Infibulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Vaginitis vs. Vaginosis

A 
ITIS = inflammation
OSIS = abnormal increase or production of
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Generally, name for increased inflammation of the vagina with increased discharge and WBCs

A

vaginitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Generally, name for increased discharge from the vagina, without inflammation or WBCs

A

vaginosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

(3) most common causes of vulvovaginitis

A

bacterial vaginosis, candidal infections, trichomoniasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Causes of Bacterial Vaginosis (1)

A

An alkaline environment leading to the overgrowth of anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

DIAGNOSE: Pt presents with CC of vaginal itching and irritation. Endorses postcoital spotting, dyspareunia, and urinary discomfort. On speculum exam, you note a fishy odor and increased thin, gray-white milky discharge that is homogenous and adherent to the vaginal walls.

A

Bacterial vaginosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Amsel Criteria for Bacterial Vaginosis

A

3 out of the 4 must be present:

  • thin, white adherent vaginal discharge
  • pH >4.5
  • positive whiff or amine test
  • > 20% of epithelial cells must be clue cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

INTREPRET: You prepare a wet mount slide and conduct pH testing for cc of vaginal discharge. You note a positive whiff test on your KOH slide. pH is 4.5. On saline mount, >20% of epithelial cells are clue cells.

A

Bacterial vaginosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Priority patient education when prescribing metronidazole

A

NO alcohol during therapy and for 24 hours after completion of therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Drugs of choice for treatment of symptomatic BV (2)

A

metronidazole or clindamycin vaginal or oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Alternative therapies for BV

A

probiotics, boric acid, vinegar douches, tea tree oil, garlic suppositories

33
Q

Cause of Vulvovaginal Candidiasis (VVC)

A

Complex relationship between host immune function, estrogen, virulence of the candida strain, and increased vaginal pH

34
Q

DIAGNOSE: Pt presents with CC of vaginal and vulvar itching. Endorses dysuria. On speculum exam, found to have thick clumpy white discharge, a swollen red vagina, and white patches of discharge on the vaginal walls.

A

Vulvovaginal candidiasis (VVC)

35
Q

In patients with recurrent vulvovaginal candidiasis infections, consider underlying _____ (4) and get a yeast culture

A

HIV, DM, pregnancy, non-albicans strain of candida

36
Q

INTREPRET: You prepare a wet mount slide and conduct pH testing for cc of vaginal discharge. You note pseudohyphae on the wet mount. The vaginal pH is normal

A

Vulvovaginal candidiasis

37
Q

Pharmacologic treatment for VVC

A

OTC antifungal (‘-azole’) creams, suppositories, and oral agents

38
Q

Alternative therapies for VVC

A

gentian violet, white vinegar, probiotics, yogurt

39
Q

Only recommended treatment for VVC in pregnant clients

A

topical antifungal -azoles (EXCEPT FLUCONAZOLE, which may be teratogenic)

40
Q

New name for atrophic vaginitis

A

Genitourinary syndrome of menopause (GSM)

41
Q

Cause of Genitourinary Syndrome of Menopause (GSM)

A

Decreased estrogen production in perimenopause and menopause, or any medications that reduce estrogen production

42
Q

DIAGNOSE: Pt presents with CC of vaginal itching, burning, urinary frequency, pain, vaginal dryness, and dyspareunia. On physical exam, you note pale vaginal walls with decreased ruggae, and petechiae lining the walls, scant vaginal secretions. She reports her LMP was 8 months ago

A

Genitourinary syndrome of menopause (GSM)

43
Q

INTREPRET (2): You prepare a wet mount slide and conduct pH testing for cc of vaginal discharge. You note parabasal cells on wet mount, increased WBCs, reduced lactobacilli. The pH is increased (>5)

A

Genitourinary syndrome of menopause (GSM), Desquamative inflammatory vaginitis (DIV)

44
Q

Pharmacologic treatment for GSM

A

Start with OTC lubricants and moisturizers. May consider vaginal preparations of low dose estrogen. An FDA-approved option for treating vaginal dryness is ospemifene (SERM)

45
Q

Cause of Desquamative Inflammatory Vaginitis (DIV)

A

Non-infectious inflammation in perimenopausal and menopausal women leads to bacterial disruption whereby the lactobacilli are replaced with gram-positive coccobacilli (such as group b strep)

46
Q

DIAGNOSE: Pt presents with CC of vaginal irritation, burning, and dyspareunia. On speculum exam, you note profuse, purulent yellow/green vaginal discharge and vaginal/vestibular erythema. There is no loss of vulvovaginal architecture.

A

Desquamative inflammatory vaginitis (DIV)

47
Q

Pharmacologic management of DIV

A

Clindamycin cream 2-4 weeks. Reevaluate in 4 weeks. Consider adding a low dose estrogen if GSM is present, too.

48
Q

DIAGNOSE: Pt presents with CC of headache, vomiting, and new rash. On physical exam, found to have a high fever, rash appears generalized, erythematous, macular. You note non-pitting edema and erythema of the palms and soles, with desquamation of some fingers. On speculum exam, you note hyperemic vaginal mucosa, with vulvovaginal tenderness.

A

Toxic shock syndrome (TSS)

49
Q

Priority predisposing factors for TSS

A

within 5 days of onset of menses and recent tampon use

50
Q

(2) causative agents for TSS

A

staph aureus, strep pyogenes

51
Q

Priority patient education with h/o TSS

A

avoid barrier contraceptive methods and tampons

52
Q

Treatment for TSS

A

life threatening emergency, refer to the hospital

53
Q

Cause of Bartholin Gland Cysts

A

fluid and mucus build-up after obstruction of a duct

54
Q

Etiology of bartholin gland cysts vs. abscess

A 
cysts = non-infectious
abscess = infectious
55
Q

DIAGNOSE: Pt presents for routine well-woman exam, no CC. On pelvic exam, you note a visible round-oval mass at the vestibular entrance

A

Bartholin gland cyst

56
Q

Management of Bartholin Gland Cyst in pre-menopausal pt

A

If small and asymptomatic, does not require treatment. If large and symptomatic, managed similarly to abscess

57
Q

Management of Bartholin Gland Cyst in post-menopausal women

A

refer for cancer evaluation

58
Q

Causes of Bartholin Gland Abscess

A

infection of the bartholin fluid, most commonly by e coli found in the skin and vaginal flora. Rarely, can be caused by gonorrhea or chlamydia

59
Q

DIAGNOSE: Pt presents with CC of sudden onset vulvar pain, tenderness. Endorses difficulty sitting and walking, dyspareunia. On physical exam, you note a tender, flucuant mass at the vestible with erythema of the overlying skin, and labial edema

A

Bartholin gland abscess

60
Q

Management of Bartholin Gland Abscess (3)

A

I&D with packing; word catheter; or referral to specialist for marsupialization (CULTURE NOT INDICATED)

61
Q

Cause of Hidradenitis Suppirativa

A

Genetic and hormone defects in the base of the folliculophilosebaceous unit. The plugged hair follicles fill with keratin and sebum, causing rupture, inflammation, scarring, and draining sinus tracts

62
Q

DIAGNOSE: Pt presents with chief complaint of vulvar pain and inflamed hair follicles. She has been squeezing the hair follicle to pop it but it is making it worse. On physical exam, you note exquisitely painful nodules that were draining, and a few that had scarred. You examine the breasts and axilla, and there are no additional nodules

A

Hidradenitis suppurativa

63
Q

How do you make a diagnosis of Hidradenitis suppurativa

A

purely history and physical. You are looking for typical lesions in the typical locations with a relapsing, chronic pattern. No lab tests are needed to diagnose.

64
Q

This condition is often misdiagnosed as simple folliculitis in its early stages

A

Hidradenitis suppurativa

65
Q

Patient education for lifestyle management of Hidradenitis Suppurativa

A

avoid trauma (tight clothing, continuous moisture, squeezing), tobacco cessation, weight management, choose tampons over pads, (dairy?)

66
Q

Medical treatment options for hidradenitis suppurativa

A

topical and oral antibiotics, anti-androgens, immunosuppressants, humira, baratric surgery, wide excision for extensive disease

67
Q

cause of contact dermatitis

A

allergen or irritant

68
Q

DIAGNOSE: Pt presents with CC of vaginal itching. Speculum exam is generally normal, with mild vulvar erythema and evidence of excoriations from itching.

A

contact dermatitis

69
Q

Treatment recommendations for contact dermatitis

A

avoid irritant, topical corticosteroid ointment

70
Q

Cause of Lichen Sclerosus

A

chronic mucocutaneous disorder, that is likely autoimmune

71
Q

DIAGNOSE: Pt presents with CC of severe vulvar burning and itching. Endoses dyspareunia. States it initially started as dull, non-specific vulvar irritation. On physical exam, you note areas of hypopigmentation in a figure 8 pattern, thin pappery skin, and a loss of vaginal architecture

A

Lichen Sclerosus

72
Q

Treatment for Lichen Sclerosus

A

Defer a biopsy until 12 week treatment trial with high potency topical steroids with a 3 month taper.

73
Q

If you suspect Lichen Sclerosus, make sure to r/o….

A

thyroid disease

74
Q

Most debilitating of the Lichen conditions

A

Lichen planus

75
Q

DIAGNOSE: Pt presents with CC of severe vulvar burning and itching. Endoses dyspareunia. On physical exam, you note well-demarcated papular lesions/erosions on the vulva with white straie and a loss of genital architecture. You inspect the oropharynx, and note oral lesions as well

A

Lichen Planus

76
Q

Treatment for lichen planus

A

Super potent topical steroid x3 months and/or intralesions injection. Refer erosive disease to dermatology.

77
Q

Variant of atopic dermatitis - a vulvar disorder that causes pruritis

A

Lichen simplex chronicus

78
Q

DIAGNOSE: Pt presents CC of vaginal itching. States “I always get yeast infections and my provider calls in abx, but this one won’t go away”. States that the scratching and rubbing offer intense but temporary relief. The itching is worse at night

A

Lichen simplex chronicus

79
Q

Medication treatment for lichen simplex chronicus

A

Topical -caine to numb the area, oral antihistamine to reduce itching, potent topical steroid ointment tapered x3-4 months.

Women's Health (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions