Disorders of the Vulva and Vagina

Question 1

Vulva may contain?

Answer 1

Breast tissue

Can become swollen after delivery

Question 2

Vaginitis

Answer 2

Inflammation or infection of the vagina.

Change of volume, color, odor of discharge

Question 3

Normal vaginal pH

Answer 3

3.5 - 4.5

Question 4

Trich infection pH

Answer 4

5.0 - 6.0

Question 5

Bacterial Vaginosis pH

Answer 5

> 4.5

Question 6

Candidial infxn pH

Answer 6

4.0 - 4.5

Question 7

Clue cells on saline wet mount

Answer 7

Bacterial Vaginosis

Question 8

KOH Prep

Answer 8

Reveals hyphae and budding of yeast

Question 9

Bacterial vaginosis usually only causes

Answer 9

Malodorous or copious discharge

Does not cause painful urination or inflammation

Question 10

BV Tx

Answer 10

Flagyl 500mg BID x 7 days

Question 11

BV Tx for pregnant and nursing

Answer 11

Clindamycin

Question 12

Candidiasis

Answer 12

Thick, white cottage cheese discharge
Usually colonize from anus
Rarly transmitted sexually

Question 13

Candidiasis prevention

Answer 13

Keep external area clean and dry
Avoid douches, irritating soaps
Change tampons frequently
Wear loose underwear

Question 14

uncomplicated yeast infxn tx

Answer 14

Fluconazole (Diflucan) 150mg x 1 dose

OTC intravaginal ointments

Question 15

Complicated infxn tx

Answer 15

Floconazole (diflucan) 150mg 2-3 doses 72 hrs apart.
Topical therapy
Intravaginal boric acid tablets for 2 wks
Flucytosine cream qHS for 2 wks

Question 16

Intravaginal boric acid is …

Answer 16

Fatal if swallowed

Question 17

Most common STI in the world

Answer 17

Trichomonas Vaginitis

Question 18

Trichomonas Vaginitis

Answer 18

Flagellated protozoan
Infects both males and females
Males generally asymptomatic

Question 19

Trich presentation

Answer 19

Malodorous, thin green/yellow d/c
Burning, dysuria, frequency
Pruritis, painful sex, post-coital bleeding

Question 20

Trich dx

Answer 20

pH 5-6
Mobile organisms on wet mount
Rapid antigen test
Strawberry cervix

Question 21

Trich tx

Answer 21

For everyone: 2 g flagyl one dose

For HIV: 7 day course BID

Question 22

Genital Herpes

Answer 22

Painful ulcers and itching
Dysuria
Tender inguinal lymphadenopathy
Constitutional sx

Question 23

Herpes Tx

Answer 23

Treat within 72 hrs

Acyclovir (zovirax) 400mg TID for 7-10 days

Question 24

Most common viral STD in the US

Answer 24

Condylomata Acuminata

Anogenital Warts

Question 25

Anogenital Warts

Answer 25

Condylomata Acuminata women 67% of pop HPV 6 and 11

Question 26

Warts tx

Answer 26

Chemical destruction Immunologic Surgery

Question 27

Molluscum Contagiosum

Answer 27

Painless domes | Can be sexually transmitted

Question 28

Atrophic vaginitis

Answer 28

Caused by decreased estrogen (menopause) Dryness, burning itching Decreased lubrication during sex Bleeding, discharge

Question 29

Atrophic vaginitis tx

Answer 29

Moisturizers, lubricants | Estrogen therapy

Question 30

Lichen sclerosis

Answer 30

Intense inflammatory rxn in non-child-bearing pop. | Painful pruritis and itching - may interfere w/ sleep

Question 31

Lichen sclerosis PE

Answer 31

Chronic inflammation Well demarcated white atrophic patches Labia minora shrinks and clitorous may be lost

Question 32

Lichen sclerosis tx

Answer 32

Clobetasol propionate .05% cream for 6-12 weeks then Maintenance therapy 1-3 x/wk

Question 33

Bartholin glands

Answer 33

``` 2-3% of women develop cysts or abscesses Most common large cyst of vulva Mostly asymptomatic Must exclude carcinoma in women over 40 No tx for women under 40 ```

Question 34

Bartholin abscess s/s

Answer 34

Swelling and exquisite pain Erythematous and warm Polymicrobial

Question 35

Bartholin abscess tx

Answer 35

I&D | Word catheter for 4 wks

Question 36

Cystocele

Answer 36

Bladder prolapse into vagina

Question 37

Pagets Dz

Answer 37

Intraepithelial carcinoma of genital, perianal and axillary areas. Red, scaly velvety esions Itching, burning and bleeding Excise.

Question 38

Vulvar CA

Answer 38

4th most common GYN CA Pruritis most common complaint Many pts are asymptomatic Mostly squamous cell

Question 39

Vaginal Intraepithelial Neoplasia (VAIN)

Answer 39

Caused by HPV 6 and 11