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Hannah Endo/Repro year 2 > Benign and malignant condition of the vulva/ vagina > Flashcards

Benign and malignant condition of the vulva/ vagina Flashcards

1
Q

complication with vulvar varicosities

A

can enlarge and become painful in pregnancy

***characteristically blue in color

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2
Q

what do you not treat verrucounus carcinoma with

A

radiation bc risk if anapestic change

cauliflower like lesions on vulva

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3
Q

of the structural vaginal changes that can occur over time, what is the name for anterior vaginal prolapse and posterior vaginal prolapse ? and other structural ABNL that can occur over time

A

-anterior: cystocele (prolapsed bladder)
-posterior: rectocele (prolapsed rectum)
-others:
uterine prolapse
fistulas (from surgery/radiatoin) : rectovaginal, urethrerovagial , vesicovaginal

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4
Q

most frequently reported sx of (rare) vulvar cancer

A

long history of chronic vulvar pruritis (lichen sclerosis)

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5
Q

most common benign solid tumor of the vulva

A

fibroma

-slow growing solid mass, usually small but can be HUGE (250 lbs)

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6
Q

dx and tx of VIN III

A

dx: careful inspection of the vulva and biopsy
tx: local superficial surgical excision (MC)
can user laser therapy if on the clitoris, labia minora, or perianal area

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7
Q

most common type of genital cyst

A

inclusion cyst

  • mobile, nontender, spherical, slow growing, benign cysts below the epidermis
  • form from plugged hair follicles
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8
Q

what is the most common cause of vaginitis

A

bacterial vaginosis

gardnerella vaginalis

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9
Q

define an inclusion cyst of the VAGINA (not vulva)

A
  • caused by infolding of the vaginal epithelium
  • at posterior or lateral wall of lower 1/3 vagina
  • assoc with gyn surgery or labor lacerations
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10
Q

define imperforate hymen

A
  • after birth- BULDGING membrane at vaginal opening that blocks mucus outflow
  • if not dx till after menarche: appears thin, dark blue, bc entrapping mestrual flow
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11
Q

how to dx VAIN

A
  • usually ASX

- must do colposcopy with directed vaginal biopsy

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12
Q

what structural vulvar ABNL must be distinguished from melanoma

A

freckles (lentigo) and moles (nevi)

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13
Q

what describes well demarcated and eczematous in appearance with fiery red background and white plaque like lesions

A

Pagets DZ of the vulva

-tx: surgical excision

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14
Q

how to work up vaginal discharge

A

hx: color, amount, odor, texture
nitrazine paper: determine pH
microscope: sample discharge and place on slide under microscope

Ddx: bacterial vaginosis, candidiasis. STI

HNM

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15
Q

what is lichen sclerosis and how to tx

A

-MC on vulba of menopausal women
-assoc with autoimmune etiology
-thinning of the epidermis and sclerotic change (thickening) of the dermis
-PE: parchment like thinning of the vulvar skin, leukoplakia
-biopsy- thin epithelium, loss of retentions ridges, HYALINE ZONE in DERMIS, inflammatory infiltrate in BM
(hyperkeratinosis seen in both lichens)
-sx: intense pruritis, dyspareunia, burning pain
-tx: clobestasol
**if UNTX can increase risk of vulvar carcinoma

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16
Q

RF and SX of material vaginosis

A

RF: new or multiple sex partners, smoking, IUD, douching
Sx: many asx, profuse thin milky discharge, malodorous fishy amine odor (esp after sex)

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17
Q

major complications of lichen sclerosis

A

loss of labia minora
shrinking of labia majora
constriction of opening
inverted/trapped clitoris

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18
Q

how to tx VAIN

A
  • if lesion is in vault : surgical excision

* if multifocal: tx with laser therapy, topical 5-flurouracil, and if all fails may need vaginectomy

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19
Q

tx for labial agglutination

A

estrogen cream and massage

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20
Q

define sebaceous cyst (and what does it resemble)

*vulvar structural ABNL

A

-inflammation and blocking of sebaceous gland
-sx: small, red, smooth, nodular, mass on inner surface of labia major/minora
(similar to inclusion cyst but is only on inside surface of labia and is red)

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21
Q

define urethra caruncle

A

fleshy red growth on distal end of urthera

  • children caused by spontaneous prolapse of the urethral epithelium
  • post menopause due to contraction of hypoestrogenic vaginal epithelium and everting of the urtheral epithelium
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22
Q

what is lichen simplex chronicus and how to tx

A

aka “vulvar squamous cell hyperplasia”

  • thickening of the epidermis secondary to chronic itching
  • sx: prutitis
  • PE: leukoplakia, white/red thickened skin, leathery skin, (similar to psoriasis appearance)
  • biopsy: ,prominent granular layer, aconthosis, elongated rete ridges, inflammatory cells in dermis (hyperkeratinosis seen in both lichens)
  • tx: steroid cream and pruritic agents
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23
Q

RF and Sx of trichomoniasis

A

RF: unprotected sex
Sx: 50% asx , dyspareunia, vulvogainal irritation, occasion dysuria, green-yellow “frothy” discharge

24
Q

what is Fox-Fordyce Dz

A
  • yellow pruritic cysts in axilla and labia majora/minora

- from keratin plugged apocrine glands

25
define bartholin cyst
- inflammation and blocking of bartholin gland duct - unilateral ASX cyst at the lower vestibule adjacent to vaginal canal --> becomes painful when changes to abscess - common in reproductive age women (second the infections/STI) - tx: word catheterization (drainage) or marsupilzation (permanent opening)
26
define vaginal septum
1. transverse - usually upper 2/3 vagina - usually has small opening for menstrual flow - may only be noticeable with impeded intercourse 2. longitudinal ("double vagina") - can have blind end vagina - assoc with duplication ABNLs of the uterine fundus
27
how to dx SCC of the vagina
punch biopsy is required to confirm dx | staging is clinical
28
50-90% pts with VAIN will have coexistent or prior neoplasia or cancer of the __ and ___
cervix and vulva | *alll HPV related
29
what causes female psuedohermaphrotism
-masculinaztion in utero of external genitalia by hormones ABNL (clitoromegaly, hypospadias, malpositioned vaginal orifice) *internal genitalia is NL female
30
tx for vulvar SCC
radical vulvectomy and regional lymphadenectomy | -can add chemo and radiation
31
Dx and Tx of trichomoniasis
``` dx: wet mount reveals motile trichomonads pH > 4.5 strawberry cervix fishy odor possibly ``` tx: metronidazole STI therefore test patient and partner for other STIs
32
most common cause of vaginal trauma
sexual assault
33
most common X-linked recessive disorder
androgen insensitivity - male 46XY with little external genitalia growth - external female phenotype , internal male - undescneded testes - no mullein duct form therefore no uterus or fallopian tubes
34
define gartner duct cyst and tx
- common - from remnants of the wolfian (mesonephric) duct on lateral vaginal wall - 1-2 cm fluid filled cysts in submucosa - most ASX no tx
35
RF and SX of vulvovaginal candidiasis
``` RF: high estrogen levels (OCP, preganancy) DM abx use steroid use immunosuppression ``` Sx: vulvar pruritis, burning, irritation, dyspareunia, (no/little discharge, if + is cottage cheese like)
36
true hermaphroditism
have both male and female internal and external genitalia | -extent of mascuinization depends on amount of functioning testicular tissue
37
what is lichen planus and tx
"vulvar- vaginal- gingival" syndrome - purple papules (maybe erosive) on vulva, vagina, and mouth - sx: burning, and severe dyspareunia on insertion - tx: steroid cream or systemic
38
tx for SCC of the vagina
radiation or chemo is main tx - if lower 1/3 : remove groin nodes if spread - if upper 2/3: surgical removal of the area
39
when are angiomas of the vulva seen
40-50s yo | 2-3 mm red lesions on vulva
40
rokintansky kuster Hauser syndrome
-mullerian duct agenesis (vaginal agenesis) = no uterus, or upper 2/3 vagina -fallopian tubes and distal 1/3 vagina present
41
what vulvar dermatologic condition is associated with insulin resistance (DM) and obesity
aconthosis nigricans | -brown pigmented thickened layers of superficial skin
42
second most common cause of vaginal infections
vulvovaginal candidiasis | candida albicans
43
what results from secondary failure of the genital tubercles
clitoral agenesis
44
what is urethral diverticula and tx
- small sac like projections in the anterior vagina along the posterior urethra - can cause recurrent UTIs and urinary leaking - sx: dysuria - tx: urethral dilation or excision
45
risk factor for adenosis
(columnar cells in upper squamous epithelium of vagina; causes red area distinct from NL pink area) -DES exposure
46
congenital anomaly of the vulva: with ambiguous genitalia ___ is required
careful examination -PE, u/s, hormone study, karyotyping (exam genital, check u/s for inside genitalia, check male/female hormones levels, check genotype of male or female)
47
define vulvar vestibilitis (vestibular adenititis) | KNOW
- infection of 1+ minor vestibule glands - causes 1-4cm VERY TENDER erythematous dots, and dyspareunia - tx: estrogen cream or hydrocortisone cream
48
PE sign of SCC vulvar cancer
- pruritic lesions that is raised, ulcerated, pigmented, or warty in appearance - usually on the labia major
49
what is atrophic vaginitis and how to treat it
- atrophy of external genitalia (loss of vaginal rugae, minor regresses and major shrinks, constriction) - causes by loss of estrogen (menopause or surgical) - tx: estrogen cream , maybe oral estrogen to prevent reoccurrence
50
most common symptoms of VIN III
pruritus
51
dx and tx of bacterial vaginosis
dx: saline wet mount = "clue cells" -KOH + positive whiff test for odor -vaginal fluid pH > 4.5 tx: metronidazole (not an STI therefore don't need to tx partner)
52
cause of trichomoniasis
T. vaginallis
53
dx and tx for vulvovaginal candidiasis
dx: wet prep + for budding yeast vaginal pH < 4.5 (normal) tx: diflucan synthetic imidazoles
54
symptoms of SCC of the vagina
abnormal discharge or bleeding, hematuria (BLOOD IN URINE)
55
most common vulvovaginal tumor
bartholin cyst

Hannah Endo/Repro year 2 (11 decks)

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