Common Vaginal and Pelvic Problems

Question 1

What are the 4 common pathologies of the Vulva

Answer 1

• Vulvitis (candida)
• Bartholin’s Cyst
• Condyloma Accuminata
• Herpes Simplex

Question 2

What are four clinical features of Vulvitis

Answer 2

• Satellite Rash
• Microabscesses
• White discharge
• Pruritus

Question 3

What is the organism that commonly causes Vulvitis and how is it treated

Answer 3

Candida
(Topical Antifungal)

Question 4

What is the clinical manifestation of Bartholin’s Cyst

Answer 4

swelling of posterior 1/3rd of vulva

Question 5

Is a non-tender Bartholin gland sweeling a cyst or an abscess?

Answer 5

Cyst

Question 6

Is a tender Bartholin gland swelling a cyst or an abscess?

Answer 6

An Abscess

Question 7

Which organisms commonly cause Bartholin’s abscess

Answer 7

E.coli
Gonorrhea (less commonly)

Question 8

What is the treatment for Bartholin’s Cyst?

Answer 8

Incision and Drainage
Marsupialization
Word Catheter drain

Question 9

What is the clinical presentation of Condyloma Acuminata

Answer 9

Raised lesions
pruritus (often associated)

Question 10

What HPV serotypes commonly cause genital warts

Answer 10

HPV 6, 11 (low risk types)

Question 11

What are the three treatment option for genital warts

Answer 11

Podophylin (cytotoxin)
Cauterization (burn them off)
ALDARA (imiquimod)

Question 12

What is the clinical presentation of Herpes Simplex

Answer 12

Vessicles, Blisters followed by ulceration

Question 13

True or False
Herpes Simplex is self-limiting and recurrent

Answer 13

True

Question 14

What is the treatment for HSV (herpes Simplex Virus)

Answer 14

Antiviral (Acyclovir)

Question 15

List four factors that increase vaginal discharge

Answer 15

• pre mentruation
• at Ovulation
• use of OCPs
• Use of IUDs

Question 16

What are the components of a physiological vaginal discharge?

Answer 16

Cervical mucous
Bartholin gland secretion
Glycoprotein layer
Bacterial flora
Desquamated cells

Question 17

Normal Vaginal flora has was number of bacteria

Answer 17

10^8- 10^9 per gram of fluid

Question 18

Which bacteria makes up normal vaginal flora?

Answer 18

Lactobacilli

Question 19

Lactobacilli produce lactic acid maintaining the vaginal pH at what level

Answer 19

<4.5

Question 20

List 5 non-infective pathological causes of vaginal discharge

Answer 20

Ectropion (cervical cells extended to the outer cervix)
External devices: tampon, condom
Neoplasms
Polyps
Allergy/dermatitis

Question 21

List 7 details from the patient h/o that will assisted in diagnosing the cause of pathological discharge

Answer 21

• Duration
• irritation
• odour
• cyclical pattern
• recurrence
• sexual history
• partners symptoms

Question 22

What is the commonenst cause of pathological discharge from the vagnina

Answer 22

Bacterial Vaginosis

Question 23

Describe the discharge seen in Bacterial Vaginosis

Answer 23

Homogenous grey
Fishy odour
No inflammation

Question 24

Describe the discharge seen in Vaginitis (Candida)/ Monilia/ Yeast

Answer 24

Adherent curdy white discharge

Question 25

What are 3 clinical features of vaginitis

Answer 25

dyspareunia pruritus external dysuria

Question 26

Describe the discharge seen in Trichomoniasis

Answer 26

- Malodorous - frothy yellow-green

Question 27

What are the clinical features seen in Trichomoniasis

Answer 27

Strawberry cervix frothy yellow green discharge

Question 28

How is trichomoniasis treated

Answer 28

- Metronidazole 2 g po OD

Question 29

What type of discharge is seen in cervicitis

Answer 29

Mucopurulent

Question 30

What is the cause of cervicitis

Answer 30

Chlamydia Gonorrhea (less commonly)

Question 31

What is the recommended treatment for Bacterial Vaginosis?

Answer 31

Metronidazole 500mg bd x 7days

Question 32

What is the recommended treatment for Trichomoniasis?

Answer 32

Metronidazole 2g po od

Question 33

What is the recommended treatment regimen for Candidiasis?

Answer 33

Topical Azole drugs Clomitrazole (3 or 7 day regimen) Oral azole (1-5 days) Fluconazole, Itraconazole

Question 34

What is the recommended treatment for Cervicitis (Chlamydia)

Answer 34

Doxycyclin 100mg bd x7 days Azithromycin 1g po od

Question 35

What is the recommended treatment for Cervicitis (Gonorrhea)

Answer 35

Ceftriaxone 125mg IM single dose

Question 36

List the 5 types of Uterine fibroids

Answer 36

- Pedunculated - Intracavitary - Intramural - Submucous - Subserous