Vulva and Vagina

Question 1

What causes Labial Fusion?

Answer 1

Excess androgens from either extraneous androgen administration or increased androgen production

Question 2

What is the most common cause of Labial Fusion?

Answer 2

21-B Hydroxylase deficiency

Question 3

When is it recommended to treat Labial Fusion?

Answer 3

only if other symptoms are present such as urinary dribbling or pain

Question 4

What is the primary treatment for labial Fusion?

Answer 4

Topical Estrogen Cream

Question 5

Where are Bartholin Gland cysts located?

Answer 5

On the lateral sides of the vulva

Question 6

What do bartholin gland Cysts do?

Answer 6

Secrete mucus and become obstructed: leading to cyst or abscess which causes pain, tenderness and dyspareunia

Question 7

What is seen on physical exam for Bartholin Gland Cysts?

Answer 7

edema and inflammation of the area with a deep fluctuant mass

Question 8

How do you treat Bartholin Gland Cysts?

Answer 8

Incision and Drainage (I&D)
Cx for STD

Question 9

What should you consider for management of recurrent Bartholin Gland Cysts?

Answer 9

Marsupializaiton: Form of I&D where the cyst is opened and the cyst walls are sutured to the vaginal mucosa

Question 10

What is Lichen Sclerosus?

Answer 10

Benign chronic condition of the vulvar epithelium that causes pruritus and pain

Question 11

How doe Lichen Sclerosus present?

Answer 11

White atrophic papules that coalesce into plaques

Question 12

How do you treat Lichen Sclerosus?

Answer 12

Topical Steroids

Question 13

What are the 3 major Epithelial Abnormalities?

Answer 13

Lichen Sclerosis
Squamous Cell hyperplasia
Lichen Planus

Question 14

What age group is commonly affected in Lichen Sclerosus?

Answer 14

Any age: increased risk of caner in postmenopausal patients

Question 15

How would you describe Lichen Sclerosus?

Answer 15

White, thin skin extending from labia to perianal area: can cause anatomic disfiguration if left untreated

Question 16

How do you treat Lichen Sclerosus?

Answer 16

Topical Steroids

Question 17

What age group does Squamous Cell Hyperplasia most commonly affect?

Answer 17

Any age: Patients who hav had chronic vulvar pruritus increased risk

Question 18

How would you describe Squamous Cell hyperplasia?

Answer 18

Patients with chronic irritation develop hyperkeratosis: raised white lesion

Question 19

How do you treat Squamous Cell Hyperplasia?

Answer 19

Sitz baths or lubricants: relieves pruritus

Question 20

What age group is most commonly affected with Lichen Planus?

Answer 20

30’s-60’s

Question 21

How would you describe Lichen Planus?

Answer 21

6 P’s: Pruritic, Polygonal, Planar, Purple, Papules and Plaques

Question 22

How do you treat Lichen Planus?

Answer 22

Topical Steroids

Question 23

What are common risk factors for Vaginitis?

Answer 23

anything that will increase the pH of the vagina including
-Antibiotic use: Lactobacillus normally keep pH <4.5
-Diabetes
-Overgrowth of normal flora

Question 24

What are common symptoms of Vaginitis?

Answer 24

Itching, pain, abnormal odor and discharge

Question 25

What pathogen causes Bacterial Vaginosis?

Answer 25

Gardnerella

Question 26

How does bacterial vaginosis present?

Answer 26

Vaginal discharge with fishy oder and gray/white color

Question 27

What is the diagnostic test for Bacterial Vaginosis?

Answer 27

Saline wet mount: shows clue cells: epithelial cells covered with bacteria

Question 28

How do you treat Bacterial Vaginosis?

Answer 28

Metronidazole or Clindamycin

Question 29

What pathogen causes Candidiasis Vaginitis?

Answer 29

Candida Albicans

Question 30

how does Candidiasis Vaginitis present?

Answer 30

White clumpy vaginal discharge

Question 31

What is the diagnostic test for Candiadiasis Vaginitis?

Answer 31

KOH Prep shows Pseudohyphae

Question 32

What is the treatment for Candiadiasis Vaginitis?

Answer 32

Miconazole, Clortimazole, Fluconazole or Nystatin

Question 33

What pathogen causes Trichomonas Vaginitis?

Answer 33

Trichomonas Vaginallis

Question 34

How does Trichomonas Vaginitis present?

Answer 34

Profuse gren, frothy vaginal discharge

Question 35

What is the most accurate test for Trichomonas vaginitis?

Answer 35

NAAT

Question 36

What other test can be used for Trichomonas Vaginitis?

Answer 36

Salien wet mount: showing Motile Flagellates

Question 37

How do you treat Trichomonas Vaginitis?

Answer 37

Treat both patient and partner with Metronidazole

Question 38

What is a chancroid?

Answer 38

Genital ulcer caused by gram (-) rod Haemphilus Ducreyi

Question 39

What pathogen causes Chancroid?

Answer 39

Gram (-) Rod Haemophilus Ducreyi

Question 40

How does a Chancroid present?

Answer 40

Painful genital ulcer with erythematous base and may have lymphadenopathy

Question 41

How do you treat Chancroid?

Answer 41

Azithromycin, Ceftriaxone or Ciprofloxacin

Question 42

What pathogen causes Syphillis?

Answer 42

Spirochete Treponema Pallidum

Question 43

How does Primary Syphilis present?

Answer 43

Painless chancre and lymphadenpathy

Question 44

How does secondary syphillis present?

Answer 44

Diffuse, symmetric macular or papular rash involving the trunk, extremities, palms and sole

Question 45

How does tertiary syphillis present?

Answer 45

Years later with Gummas (granulomas in skin an bones), Cardiac abnormalities or CNS abnormaliteis (Tabes Dorsalis)

Question 46

What is Paget Disease of the Vulva?

Answer 46

intraepithelial neoplasia most commonly in Postmenopausal Caucasion women

Question 47

How does Paget Disease of the Vulva Present?

Answer 47

Vulvar Soreness and pruritus appearing as a red lesion with superficial white coating

Question 48

What is needed to definitively diagnose Paget Disease of the Vulva?

Answer 48

Biopsy

Question 49

How do you treat Paget Disease of the Vulva?

Answer 49

Radical Vulvectomy if bilateral Modified Vulvectomy if unilateral

Question 50

What is the most common type of Vulvar Cancer?

Answer 50

Squamous Cell Carcinoma

Question 51

How does SCC of the Vulva present?

Answer 51

Pruritus, bloody vaginal discharge and postmenopausal bleeding

Question 52

What is seen on physical exam for SCC of the vulva?

Answer 52

Range from small ulcerated lesion to large cauliflower like lesion

Question 53

What is essential for diagnosing SCC of the vulva?

Answer 53

Biopsy

Question 54

When is SCC of the vulva stages?

Answer 54

During surgery

Question 55

How do you treat U/L SCC of the vulva without lymph node involvement?

Answer 55

Modified Radical Vulvectomy

Question 56

How do you treat bilateral SCC of the vulva?

Answer 56

Radical vulvectomy

Question 57

What is needed to treat SCC of the Vulva with node involvement?

Answer 57

Lymphadenectomy