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Foundations III > Vulvar disorders > Flashcards

Vulvar disorders Flashcards

1
Q

Lichen Sclerosus is associated with what?

A
  • Autoimmune (thought to be)
  • Hypothyroidism*
  • Koebner’s phenomenon: trauma makes it worse
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2
Q

Lichen sclerosus: clinical presentation

A
  • post menapausal women

- Pruritus**

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3
Q

Lichen sclerosus: physical exam

A

-sharp, well-demarcated white plaques “cellophane paper”

  • fragility is hallmark of disease
  • usually starts around the clitorus
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4
Q

Lichen sclerosus: Tx

A

Clobestasol ointment (super-high potency steroid)

-will need to use as maintenance 1-3x a week since lichen sclerosis does not go away :(

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5
Q

Lichen simplex chronicus: etiology

A
  • atopic patient
  • anxiety/depression may induce sensation of pruritis*
  • excessive hygiene
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6
Q

Lichen simplex chronicus: clinical presentation

A

‘itch that rashes’

-patient’s likely to have underlying anxiety/depression

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7
Q

Lichen simplex chronicus: physical exam

A
  • poorly marginated
  • red, scaling papules and plaques
  • weeping, excoriations, crusting
  • (chronic signs): lichenification, hypopigmentation
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8
Q

Lichen simplex chronicus: treatment

A
  1. Topical steroid (ex. hydrocortisone 1-2%, or triamcinolone)
  2. Antihistamine QHS
  3. SSRI
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9
Q

Lichen planus: etiology

A

autoimmune

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10
Q

Lichen planus: clinical presentation

A
  • women 50-60
  • Introital irritation
  • Burning**
  • Vaginal discharge
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11
Q

Lichen planus: physical exam

A

Non-erosive disease: lacy, white epithelium (fern-like appearance), white striae

Erosive disease: deep vaginal redness, vulvar erosions, purulent vaginal secretions

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12
Q

Lichen planus: tx

A

1st line: topical steroid - ex. hydrocortisone acetate 25mg suppository QHS

2nd line: Topical Tacrolimus (Protopic) 0.1% ointment

3rd line: oral steroid

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13
Q

VIN U (usual type) risk factors

A
  • HPV 16, 18, 31
  • Young women
  • Smoking
  • Multiple sex partners
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14
Q

VIN U presentation

A

-burning and pruritis (50% of cases)

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15
Q

VIN U: pigmented lesion

A

biopsy all pigmented lesions

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16
Q

VIN U: diagnosis

A

vulvar colposcopy with acetic acid (vinegar)

17
Q

VIN U: tx

A

ALL medical therapies are off-label:

  • 5FU cream
  • Interferon
  • Imiquiod (Aldara) cream

Surgery is standard of care****

18
Q

VIN D (differentiated type): etiology

A
  • NOT related to HPV
  • older women (70+)
  • Lower 1/3 of epithelium
19
Q

VIN D: pathogenesis

A

-association with squamous cell hyperplasia (so, also assoc with Lichen Sclerosis)

20
Q

VIN D: tx

A

surgical excision

21
Q

Vulvar cancer: etiology/background

A
  • Uncommon
  • Bimodal peak:
  • –20-40 is HPV related (VIN u)
  • –60-70 is due to chronic irritation (VIN d)
22
Q

Vulvar cancer: clinical presentation

A

Asymptomatic

-Pruritis* (MC symptom)

23
Q

Vulvar cancer: Tx

A

complete surgical removal + inguinal node dissection

radiation therapy if lymph node spread

24
Q

Behcet’s disease: clinical presentation

A
  1. oral ulcerations (aphthous ulcers)
  2. Urogenital lesions
  3. Skin lesions
  4. Uveitis
25
Q

Behcet’s disease: diagnosis

A

oral aphthae 3 or more times in the last year +:

  • recurrent genital ulcers
  • uveitis
  • skin lesions
  • (+) pathergy test: 2mm papule at injection site within 48 hrs.
26
Q

Behcet’s disease: tx

A

Clobetasol 0.05% ointment

27
Q

Bartholin cyst: clinical presentation

A
  • acute, painful unilateral labial swelling
  • dyspareunia
  • pain with sitting or walking
28
Q

Bartholin cyst: treatment

A
  1. Incision and drainage
  2. Placement of Word catheter
  3. Culture
  4. Empiric ABO treatment: Bactrim (TMP/SMX)
  5. Sitz bath 2-3 days after I&D
29
Q

What is the treatment if a bartholin cyst is severe or keeps happening?

A

marsupialization

30
Q

Vulvodynia: key points

A
  • onset around menopause
  • increased pain sensitivity***
  • mood and anxiety disorders
31
Q

Vulvodynia: most common presentation

A

vulvar burning

32
Q

Vulvodynia: tx non-pharmacologic

A
  • Sitz bath BID followed by thin petroleum jelly

- Pelvic floor PT for spasms

33
Q

Vulvodynia: tx

A
  1. topical lidocaine ointment
  2. Topical vaginal estrogen with testosterone
  3. Amitriptyline (or nortriptyline)*
  4. SNRIs
  5. Gabapentin 1200mg TID

Foundations III (34 decks)

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