Benign and Malignant Conditions of the Vagina and Vulva (Moulton) PART 2

Question 1

1) What is Urethral DIverticula?
2) Where is it location?
3) What are the symptoms?

Answer 1

1) Sac like projections
2) Anterior Vagina along posterior Urethra
3) Recurrent UTI, dysuria, urinary leakage

Question 2

1) Where are inclusion cysts located?
2) What are they associated with?
3) They result from what?

Answer 2

1) Posterior or lateral wall in lower third of vagina
2) Gynecologic surgery or lacerations from childbirth
3) Infolding of Vaginal epithelium

Question 3

Endometriosis is caused by implants seen in the vagina and they change in appearance with the?

Answer 3

Menstrual cycle

Question 4

What asymptomatic cyst usually presents as an unilateral swelling and is the most common vulvovaginal tumor?

Answer 4

Bartholin’s cyst

Question 5

1) What painful inflammatory mass arises from blockage and accumulation of purulent material?
2) What is the treatment?

Answer 5

1) Bartholin’s gland abscess

2) Word Catheterization and Marsupialization

Question 6

What is characterized by leaving in for 4-6 weeks which promotes an epithelialized tract for drainage of glandular secretions?

What is characterized by creating a new ductal opening by everting the cyst wall onto the epithelial surface where it is sutured with interrupted absorbable sutures?

Both of these treatments are used for?

Answer 6

1) Word catheterization
2) Marsupialization
3) Bartholin’s gland abscess

Question 7

What structural change is characterized by anterior vaginal prolapse?

What structural change is characterized by posterior vaginal prolapse?

Answer 7

1) Cystocele (bladder collapse into anterior vagina)

2) Rectocele (Rectum collapse into posterior vagina)

Question 8

Rectovaginal, urethrovaginal, and vesicovaginal ____ can result from What?

Answer 8

1) Fistulas

2) Radiation, OB injuries, Surgery complications

Question 9

The most common cause of vaginal trauma is?

Answer 9

Sexual assault

Question 10

1) What happens to the vagina after menopause?
2) What happens to the vaginal epithelium?
3) What happens to the vaginal pH?

Answer 10

1) Vaginal Ruggations flatten
2) Vaginal epithelium becomes thin, pale, inelastic
3) Rises

Question 11

The most common malignant tumors of the vulva are?

Answer 11

Squamous Cell Carcinomas

Question 12

Squamous Cell Carcinomas occur mainly in what population of women?

The most frequently reported symptom of vulvar cancer is long history of?

Answer 12

1) Postmenopausal

2) Chronic vulvar pruritis

Question 13

Vulvar intraepithelial (VIN) I-III are designated based upon the?

Which VIN aka as squamous cell carcinoma in situ has been linked to vulvar cancer?

Answer 13

1) Depth of epithelial involvement

2) VIN III

Question 14

1) What are they two subdivided VIN type III groups?
2) VIN type III is subdivided into two groups, the VIN usual type is associated with?
3) What preventative measure should cause a decrease the VIN usual type?
4) The differentiated type VIN is more commonly associated with vulvar dermatologic conditions, such as?

Answer 14

1) VIN usual-type and Differentiated type VIN
2) HPV 16, smoking, immunocompromised status, and STD history
3) Gardasil vaccine
4) Lichen sclerosis

Question 15

Paget’s Disease

1) What demographic?
2) Demarcated how?
3) What appearance
4) Background?
5) What kind of lesion
6) Where else can it occur?

Answer 15

1) Postmenopausal white female
2) Well Demarcated
3) Eczematoid appearance
4) Fiery red background
5) white plaque like lesion
6) Nipple

Question 16

1) How does Squamous Cell vulvar carcinoma present as?
2) Demographic?
3) Where?
4) What do you need for definitive diagnosis?

Answer 16

1) Pruritic, raised, ulcerated, pigmented or warty
2) Post menopausal female between 70-80
3) Labia Majora
4) Biopsy

Question 17

What are methods of spreading for Squamous cell vulvar carcinoma ?

Answer 17

1) Lymphatic embolization to regional LNs
2) Hematogenous spread to distant sites (lung, liver, bone)
3) Direct Extension to adjacent structures

Question 18

What is the second most common vulvar cancer (6% of vulvar cancer)?

And occurs in post-menopausal white woman with lesions on labia minora & Clitoris

Answer 18

Malignant melanoma

Question 19

1) What is a variant of squamous cell carcinoma and its lesions are cauliflower-like in nature can be confused with condyloma?

2) What is contraindicated?
3) Why?
4) Does metastasis occur?

Answer 19

1) Verrucous carcinoma
2) Radiation
3) Risk of anaplastic Transformation
4) No

Question 20

1) What does Bartholin Gland Carcinoma present as?

2) Women over the age of 40 should have what?

Answer 20

1) Painless vulvar mass

2) Biopsy to exclude malignancy

Question 21

1) What rare vulvar carcinoma appear as a rolled edge ulceration
2) Does it metastasize?

Answer 21

1) Basal cell carcinoma

2) NO

Question 22

What preventative measure should decease the incidence of vaginal intraepithelial neoplasia (VAIN) and vaginal cancers in the future?

Answer 22

Gardasil vaccine

Question 23

1) The most common vaginal cancer is?
2) How do you confirm diagnosis of vaginal cancer?
3) What is the main method of treatment for primary vaginal cancer?
4) What should happen if lower ⅓ of vagina is involved?

Answer 23

1) Squamous cell carcinoma
2) Punch Biopsy
3) Radiation
4) Groin Nodes treated or removed

Question 24

1) What is special about Adenocarcinoma?
2) What is the subtype of this cancer?
3) What causes this subtype to occur

Answer 24

1) Metz from Cervix, Endometrium, or Ovary
2) Clear cell adenocarcinomas
3) Exposure to Diethylstilbestrol (DES)

Question 25

1) When does Malignant Melanoma present?

2) Where does Malignant Melanoma present

Answer 25

1) 55 years

2) Distal Anterior Wall

Question 26

What presents in as a mass of grape-like polyps protruding from the introitus?

Histologically the tumor is?

Who does it present in

Answer 26

1) Sarcoma Botryoides
2) Embryonal rhabdomyosarcoma
3) Girls less than 4

Question 27

The vagina is lined by what type of epithelium?

Answer 27

Nonkeratinized stratified squamous

Question 28

Lactic acid & Hydrogen peroxide producing ____ predominate and result in keeping the vaginal pH at 3.8-4.2.

Answer 28

Lactobacilli

Question 29

What are factors that can alter the protective microflora?

Answer 29

1) Antibiotics
2) Douching
3) Intercourse
4) Foreign body

Question 30

What is the most common cause of vaginitis?

It is often polymicrobial but what is the most common organism?

Answer 30

1) Bacterial vaginosis

2) Gardnerella vaginalis

Question 31

Bacterial vaginosis can cause a profuse __1__ discharge.

Saline wet mount reveals presence of __2__.

10% KOH-positive whiff
test releases __3__ like odor.

Vaginal fluid pH is __4__.

What is the treatment for Bacterial Vaginosis?

Answer 31

1) Thin milky
2) Clue cells
3) Amine
4) Greater than 4.5
5) Metronidazole

Question 32

What is the second most common cause of vaginal infections?

The most common cause of this is?

Increased levels of what are a risk factor?

Answer 32

1) Vulvovaginal Candidiasis
2) Candida Albicans
3) Estrogen (high dose OCPs, pregnancy)

Question 33

For Vulvovaginal Candidiasis, the 10% KOH wet prep is positive for __1__.

The vaginal pH is __2__.

What is the treatment?

Answer 33

1) Budding yeast
2) Less than 4.5
3) Diflucan and imidazoles

Question 34

What is caused by the flagellated protozoan T. Vaginalis?

What kind of vaginal discharge will be seen?

Answer 34

1) Trichomoniasis

2) green-yellow “frothy” discharge

Question 35

In the diagnosis of trichomoniasis, the saline wet mount reveals __1__.

The pH is __2__.

And the cervix is describes as __3__ appearing.

Answer 35

1) Motile trichomonads
2) Greater than 4.5
3) Strawberry