Beaton benign malignant vulva Flashcards
(48 cards)
2 most common cause of PREpubertal vaginitis
Foreign body
How is the discharge of monilial vaginitis different from bacterial vaginosis?
candida is a thick white cottage cheese like discharge whereas bacterial vaginosis is homogenous, thin and whitish grey? and it smells like fish
How should the treatment regimen of bacterial vaginosis be adjusted in pregnancy?
They should be treated for a longer period of time
Tx for vulvar SCC?
radical vulvectomy; modified 3 incision approach has lower morbidity
Which type of organism most commonly overgrows in the vagina?
Bacterial vaginosis > monilial (yeast) vaginitis
List 6 predisposing factors to monilial vaginitis
Broad spectrum antibiotics, Corticosteroids, Oral contraceptives, Diabetes, Pregnancy and Tight fitting synthetic clothing
How is the etiology of prepubertal vaginitis different from post-menopausal vaginitis?
Prepubertal is usually an allergic rxn to bubble bath or foreign body; post-menopausal is an ATROPHIC vaginitis that is an age related change from ESTROGEN DEFICIENCY
What are the obstetric risks involved in bacterial vaginosis?
PROM, premature delivery, chorioamnionitis, and a 6x risk of post-cesarean endometritis in mothers who need c-section
When are you most likely to smell bacterial vaginosis in a patient and why? How does one of the diagnostic tests work on the same principle?
Usually smells the most around sex or menses due to a change in pH (relative alkalinzation). The KOH sniff/whiff test works on the same principle since hydroxide = base
3 pathological events that can happen to Bartholin’s glands
cysts, inflammation (bartholinitis), and abscess
Tx for Herpes genitalis
Valacyclovir or acyclovir; these activate thymidine kinase and become phosphorylated but lack 3’ OH so lead to chain termination of viral DNA replication
What is the second most common cause of floral overgrowth in the vagina?
Candidiasis aka monilial vaginitis
Which is more likely to cause a burning sensation on urination, bacterial vaginosis or monilial vaginitis?
monilial vaginitis, the vulvar surfaces become inflammed by overgrowth of yeast
1 most common cause of PREpubertal vaginitis
Allergic reaction to bubble baths
6 Tx for condylomata acuminata
Laser vaporization, Cryotherapy, topical 5-Fluorouracil, trichloroacetic acid, bichloroacetic acid, and 25% podophyllin
What is the most common cause of acute salpingitis?
Chlamydia trachomatis
What do you do if a woman is in labor and you notice that she has vesicular lesions on her vulva?
C section delivery; knowing them, the answer will be “low transverse” rather than vertical because it is so exquisitely board relevant
What does vulvar dystrophy usually look like, Tx?
thickened keratin response d/t acute insult; medium strenght corticosteroid
What is unique about fluconazole in the Tx of monilial vaginitis when compared to other azole options?
It is the simplest as it is an oral tablet vs. a cream, however it is only useful against 1 out of 3 of the causal Candida species
How is herpes genitalis usually contracted?
From a person with REACTIVATION of herpes as the first time is usually too painful that they usually wouldn?t want to have sex
How can you clinically differentiate between vulvar dystrophy, vulvar intraepithelial neoplasia, and vulvar SCC?
You can’t, you need a biopsy
How is the diagnosis of Trichomonas different from that of bacterial vaginosis and monilial vaginitis?
Trichomonas will show flagellated trichomonads on the smear, vaginosis will show clue cells and monilial vaginitis will show fungal hyphae after 10% KOH
Next best step if cultures for PREpubertal vaginitis return as positive for chlamydia, mycoplasma, or gonorrhea
Consider sexual abuse
How are the treatments for bacterial vaginosis and trichomonas vaginalis similar and different?
Both involve Tx with metronidazole. However, trichomonas only requires an oral treatment, not vaginal. Also, trichomonas requires TREATING THE PARTNER whereas this is usually not indicated in bacterial vaginosis unless recurrent
