vaginal disorders

Question 1

vaginal cancer epidemiology?

Answer 1

Rare → 1% of gyn malignancies → Usually secondary to another cancer

Question 2

peak incidence of vag ca

Answer 2

60-65 yo

Question 3

types of vag ca

Answer 3

Squamous Cell → 95%
Clear cell if DES exposure in utero

DES (Diethylstilbestro: estrogen)

Question 4

s/sx of vag ca

Answer 4

Asymptomatic

Changes in menstrual period

Abnormal vaginal bleeding

Vaginal discharge

Question 5

tx of vag ca

Answer 5

radiation

Question 6

vulvar ca types

Answer 6

90% squamous

Question 7

rf for vulvar ca

Answer 7

HPV 16, 18, 31

linked to DES exposure

Question 8

when is peak incidence of vulvar cancer

Answer 8

50 yo

Question 9

s/sx of vulvar ca

Answer 9

Pruritus → Most Common Presentation → Vaginal itching, irritation

Asymptomatic (20%)

Post-coital bleeding

Vaginal discharge

Question 10

dx of vulvar ca

Answer 10

Red/White ulcerative, crusted lesions → Biopsy

Question 11

tx of vulvar ca

Answer 11

Surgical Excision, radiation therapy, chemotherapy (Ex: 5FU)

Question 12

types of infection vaginitis

Answer 12

Bacterial vaginosis, Trichomoniasis, Candida, Cytolytic

Question 13

types of atrophic vaginitis

Answer 13

postmenopausal, allergic rxn

Question 14

bacterial vaginosis PP

Answer 14

Decreased Lactobacillus acidophilus → Normally maintains vaginal pH → Overgrowth of normal flora such as GARDNERELLA VAGINALIS, anaerobes (Mobiluncus, Peptostreptococcus)

Question 15

Most Common cause of vaginitis

Answer 15

bacterial

Question 16

s/sx of bacterial vag

Answer 16

Vaginal odor worse after sex
+ Pruritus

> 50% asymptomat

Question 17

vag d/c in bacterial vag

Answer 17

Copious discharge
Thin, homogenous, watery
→ GREY-WHITE with “FISH ROTTEN” smell

Question 18

vag pH in bacter vag

Answer 18

> 5

Question 19

whiff test results in bac vag?

Answer 19

Positive → Fishy Odor

10% KOH Prep

Question 20

microscopic results ofBV

Answer 20

clue cells, few WBC, few lactobacili

Question 21

what are clue cells?

Answer 21

epithelial cells covered by bacteria

Question 22

tx of BV

Answer 22

METRONIDAZOLE (Flagyl) x 7 days → Gel or PO
Safe in pregnancy
CLINDAMYCIN → Gel or PO

Question 23

preventing BV

Answer 23

Avoid douching → Promotes loss of Lactobacilli

Treating partner unnecessary → Unclear if sexually transmitted but reduced recurrence if male uses condom

Question 24

complications of BV

Answer 24

Pregnancy → PROM, PTL, chorioamnionitis

Question 25

trichomoniasis PP?

Answer 25

TRICHOMONAS VAGINALIS → Pear shaped flagellated protozoa | Sexually transmitted

Question 26

s/ sx of trich

Answer 26

Vulvar pruritus, erythema, dysuria Dyspareunia

Question 27

trich d/c?

Answer 27

Copious malodorous discharge FROTHY YELLOW GREEN DISCHARGE Worse with menses

Question 28

what does the cervix look like in trich?

Answer 28

strawberry cervix!! cervical petechiae

Question 29

vag pH in trich?

Answer 29

>5

Question 30

whiff test in trich

Answer 30

+/- positive

Question 31

what would you see microscopically in a trch infxn?

Answer 31

mobile protozoa on wet mount wbc

Question 32

tx of ttrick

Answer 32

``` METRONIDAZOLE (Flagyl) 2g oral dose x 1 dose OR 500mg BID oral x 7 days Safe in pregnancy Oral preferred ```

Question 33

prevent trich

Answer 33

Spermicidal Agents → Ex: Nonoxynol 9 reduces transmission | MUST TREAT PARTNER

Question 34

complications of trich

Answer 34

Perinatal complications | ↑HIV transmission

Question 35

candida PP

Answer 35

Candida albicans overgrowth → Part of normal flora due to change in normal vaginal environment (ex: use of abx)

Question 36

what are RF for candida?

Answer 36

↑ with DM, steroid, pregnancy

Question 37

s/sx of candida

Answer 37

Vaginal & vulvar erythema, swelling, burning, pruritus, Burning when urine touches skin Dysuria Dyspareunia

Question 38

candida d/c?

Answer 38

THICK CURD-LIKE/COTTAGE CHEESE DISCHARGE

Question 39

vag pH in candida

Answer 39

normal (3.8-4.2)

Question 40

what will you see microscopically with candida?

Answer 40

hypae, yeast, and posrts on KOH wet prep

Question 41

tx of candida?

Answer 41

FLUCONAZOLE (PO x 1 dose)

Question 42

what are types of intravaginal antifungals

Answer 42

Clotrimazole, Nystatin Butoconazole Miconazole

Question 43

prevention of candida

Answer 43

Keep vagina dry, 100% cotton underwear, avoid tight-fitting clothes, avoid use of feminine deodorants & bubble baths

Question 44

what is cytolytic vaginitis

Answer 44

Overgrowth of LACTOBACILLI

Question 45

s/sx of vaginitis

Answer 45

Vaginal or vulvar pruritus & burning | Dysuria

Question 46

cytolyitc vaginitis d/c?

Answer 46

non-odorous d/x white to opaque

Question 47

cytolytic vaginitis ph?

Answer 47

normal

Question 48

what will you see microcoscopically in cytolytic vag?

Answer 48

copious lactobacili | large # of epithelial cells