Benign Disorders of the Lower Genital Tract Flashcards Preview

Obstetrics and Gynecology > Benign Disorders of the Lower Genital Tract > Flashcards

Flashcards in Benign Disorders of the Lower Genital Tract Deck (23):
1

Most common cause of labial fusion?

Exogenous androgen exposure

2

A neonate presents with ambiguous genitalia, hyperandrogenism, salt waisting, hyperkalemia, hypoglycemia, and hypotension.

1. Diagnosis?
2. What is the cause?
3. Diagnostic tests?
4. Treatments?

1. Congenital adrenal hyperplasia (CAH).
2. 21-hydroxylase deficiency.
3. Elevated 17 alpha hydroxyprogesterone levels.
4. Cortisol and reconstructive surgery (add fludrocortisone acetate if significant salt wasting).

3

A 15 year old girl presents with primary amenorrhea and cyclic pelvic pain. Physical exam reveals a tense bulging hymen.

1. Diagnosis?
2. Complications?
3. Treatments?

1. Imperforate hymen..
2. Hematocolpos/Mucocolpos in the vagina, hematometra in the uterus.
3. Surgical repair.

4

A 15 year old girl presents with primary amenorrhea and cyclic pelvic pain. Physical exam reveals a short vagina ending in a blind pouch.

1. Diagnosis?
2. Cause?
3. Treatments?

1. Transverse Vaginal Septum.
2. Incomplete canalization of the mullerian tubercle (where embryonic upper and lower vagina meet).
3. Surgical Repair

5

A 15 year old girl presents with primary amenorrhea and cyclic pelvic pain. Physical exam reveals a a lack of a vaginal introitus and the presence of a vaginal dimple.

1. Diagnosis?
2. Cause?
3. Complications?
4. Treatments?

1. Vaginal Atresia
2. Embryonic urogential sinus fails to contribute to forming the lower vagina.
3. Hematocolpos (seen on Ultrasound/MRI)
4. Surgical repair - Vaginal pull through.

6

On physical exam it is revealed that a patient has no vagina.

1. Diagnosis?
2. What reproductive structures are intact?
3. Karyotype?
4. Treatment?

1. Mayer-Rokitansky-Kuster-Huaser Syndrome (MRKH)
2. Ovaries! Uterus and tubes are typically underdeveloped. External genitalia and secondary sexual characteristics are intact.
3. 46XX - they are women,
4. McIndoe procedure - make a neovagina. Serial vaginal dilators.

7

A post menopasual woman presents with dyspareunia, and white thinned skin on her labia, perineum, and perianal regions. The labia minora appears shrunken and is undergoing fusion.

1. Diagnosis?
2. Tests?
3. Treatment?

1. Lichen sclerosus
2. Vulvar Biopsy
3. High potency topical steroids (clobetasol) for 6-12 weeks

8

A woman presents with chronic vulvar pruritis. On exam you note thickened vulvar skin and raised white lesions on the labia majora (hyperkeratotic changes).

1. Diagnosis?
2. Tests?
3. Treatment?

1. Squamous cell hyperplasia (atopic eczema)
2. Vulvar Biopsy
3. Medium potency topical steroids for 4-6 weeks

9

A 45 year old woman presents with vulvar pruritis. On exam you note many shiny purple papules with white striae on the labia minora, vagina, and vestibule.

1. Diagnosis?
2. Complications?
3. Causes?
4. Tests?
5. Treatment?

1. Lichen Planus
2. Vaginal adhesions that can develop into erosive vaginitis
3. Drug induced or spontaneous
4. Vulvar Biopsy
5. Vaginal hydrocortisone suppositories. Surgery for vaginal adhesions.

10

A woman presents with chronic vulvar pruritis. On exam you note thickened, unilateral, and circumscribed white epithelium (reactive changes).

1. Diagnosis?
2. Tests?
3. Treatment?

1. Lichen Simplex Chronicus
2. Vulvar Biopsy
3. Medium potency topical steroids for 4-6 weeks

11

A woman presents with red moist lesions on her vulva, that are also seen on her scalp, axilla, and groin.

1. Diagnosis?
2. Tests?
3. Treatment?

1. Vulvar psoriasis (suborrheic dermatitis)
2. Vulvar Biopsy
3. UV light or topical steroids

12

On a routine exam, you note a woman has palpable red spots and patches in the upper third of the anterior wall of her vagina.

1. Diagnosis?
2. Tests?
3. Cause?
4. Complications?
5. Treatment?

1. Vaginal Adenosis
2. Vulvar Biopsy.
3. 30-90% had exposure to diethylstilbestrol (DES) in utero
4. Adenocarcinomas can develop from these benign lesions
5. Serial exams.

13

Do topical estrogens or testosterone assist in the treatment of epithelial vulvar disorders?

No

14

Most common vulvar tumor?
Cause?

Epidermal inclusion cysts.
Blocked hair follicle.

15

What is the cause of Fox-Fordyce disease? Complications?
Treatment?

Occluded apocrine sweat glands in the mons pubis and labia majora.
Hidradenitis suppurativa.
Incision and Drainage.

16

What is the cause of Skene's gland cysts?

Chronic inflammation of the paraurethral glands.

17

A woman notes a large cyst at "4 o'clock (or 8)" on the posteriolateral aspect of the vaginal orifice.

1. Diagnosis?
2. Complications (rare and common)?
3. Treatments of more common complication (2)?
4. Warm sitz baths are recommended for pain relief, are antibiotics typically prescribed?

1. Bartholin duct cyst (obstruction of the mucus secreting duct).
2. In women over 40, rare possibility of bartholin gland carcinoma. More commonly - develop gland abscess
3. Word catheter placement to drain the abscess. Marsupialization of the abscess.
4. Only if coinfected with N. Gonorrhoeae or Staph Aureus.

18

A young woman expresses difficulty inserting her tampon. On exam, a cyst is found on the anterior lateral aspect of the upper vagina.

1. Diagnosis?
2. Cause?
3. Treatment and complications?

1. Gartner's Duct Cysts
2. Remnants of mesonephric ducts.
3. Surgical excision - risk for bleeding.

19

Management of lipomas, hemangiomas, or urethral caruncles of the vulva and the vagina?

Lesions are typically asymptomatic and resolve on their own. You can give them a short course of estrogens if they are bleeding - surgery if severe.

20

Most common cause of congenital cervical abnormalities? Most severe complications (2)?

In utero exposure to DES.
Cervical insufficiency in pregnancy and increased risk of clear cell adenocarcinoma.

21

Most common cervical cyst? Red colored cervical cysts?

Nabothian cysts (blockage of endocervical gland).
Endometriosis.

22

Why are cervical polyps typically removed?

So that they don't mask the bleeding caused by a more serious condition like cervical cancer, endometrial polyps, etc.

23

Most common treatment of cervical stenosis? Treatment for more severe cases?

Nothing - it typically doesn't affect menstruation or fertility.
Gentle dilation of the cervix.