Vulvar Disease

Question 1

What is the Clinical appearance of Bacterial Vaginosis? Treatment?

Answer 1

Musty/Fishy odor
Gray/White to yellow discharge
pH >4.5
KOH test +Amine odor
\+ whiff test
Clue Cells
Oral or topical metronidozol

Question 2

What are the S and S of Candidiasis?

Answer 2

Itching
External Dysuria
Cottage Cheese

Question 3

How is Candidiasis diagnosed??

Answer 3

Visualization of blastophores or pseudohyphae on saline or KOH

Question 4

What are the Treatments of Candidiasis?

Answer 4

Imidazole
Miconazole
Clotrimazole
Terconazole
Fluconazole in Preggo

Question 5

What are the S and S of Trichomoniasis?

Answer 5

Frothy discharge
Yellow-green discharge
Strawberry cervix
Edema, erethema of vulva

Question 6

How is Trich Diagnosed?

Answer 6

Microscopic Exam

Nucleic Acid Probe test

Question 7

How is Trich Treated?

Answer 7

Oral Metronidazole or Tinidazole

Tx partner too

Question 8

What is the cause of Atrophic Vaginitis?

Answer 8

Dryness and Decreased Vaginal Discharge 2/2 decreased estrogen from Menopause

Question 9

What is the Tx of Atrophic Vaginitis?

Answer 9

Moisturizing preparations

Topical or oral estrogen therapy

Question 10

What are examples of Benign Vulvar disease?

Answer 10

Lichen Sclerosis
Lichen Simplex Chronicus
Lichen Planus
Psoriasis
Dermatitis
Vulvar pain Syndrome
Vulvar Lesions

Question 11

What is the Presentation of Lichen Sclerosis?

Answer 11

Intense itching

Question 12

What is the Tx of Lichen Sclerosis?

Answer 12

Bland emollients
Cotton underwear
No soaps on vulva
Superpotent steroid ointment 2x daily for 1 mon then 1x day

Question 13

What is Lichen Simplex Chronicus?

Answer 13

“an itch that rashes”

2/2 an irritant dermatitis that progresses to LSC

Question 14

What is the Tx of Lichen Simplex Chronicus?

Answer 14

Stop irritant
Antipruritic: Diphenhydramine or hydroxyzine combined with steroid cream
Antidepressant

Question 15

What is Lichen Planus?

Answer 15

Rare inflammatory skin condition
Desquamative lesion of the vagina
Whitish lacy bands of keratosis near reddish ulcerated-like lesions

Question 16

What is the Treatment of Lichen Planus?

Answer 16

Topical Steroid Cream
Hydrocortisone cream
More likely to recurr

Question 17

What is the Tx of Vulvar Dermatitis?

Answer 17

Remove attending agent
Good perineal hygeine
Topical Corticosteroids
Oral antipruritics at bedtime

Question 18

What are the Tx of Psoriasis?

Answer 18

Coal tar followed by UV light

Topical Steroids more effective

Question 19

What is a Sebaceous Cyst?

Answer 19

Blockage of Sebaceous gland duct
Small, smooth nodular mass
Filled with cheesy sebaceous material

Question 20

What is the Cyst of the canal of Nuck?

Answer 20

Round Ligament inserts into labia majora
Peritoneal fluid collects within
Excision may be needed

Question 21

What is a Bartholin Gland Cyst?

Answer 21

Located at 4 and 8 on posterolateral aspect of Introitus
Mucus Secreting Gand
Cystic Dilation 2/2 obstruction of the duct

Question 22

What is the Tx of Bartholin cyst?

Answer 22

Incision and drainage if painful
Recurrent cyst may be marsupialized
Abtx if N. Gonnorhea
Cover S. Aureus if cellulitis occurrs

Question 23

What is seen in Paget’s disease of vulva?

Answer 23

Chronic Pruritis
Velvety red lesions scar into white plaques
Biopsy
Wide local incision
Fatal if it spreads to LN

Question 24

What is Vulvar Intraepithelial Neoplasm?

Answer 24

50% asymptomatic
Vulvar Pruritis
Do colposcopy and biopsy

Question 25

What is the Tx of VIN?

Answer 25

Assume it will progress to Vulvar CA Wide local excision Laser Excision

Question 26

What is the most common type of Vulvar Cancer?

Answer 26

Squamous cell CA

Question 27

What is the appearance of Vulvar Cancer?

Answer 27

Found on labia majora | -Cauliflower like mass

Question 28

What are the risk factors of Vulvar Cancer?

Answer 28

``` Manopausal Status CIN, VIN, HPV Cigarette smoking Immunosupression h/o cervical CA ```

Question 29

What is the Tx of Vulvar Cancer?

Answer 29

Wide local excision with inguinal LN dissection | Pelvic Rad of + mets to nodes

Question 30

What is Premalignant Disease of the Vagina?

Answer 30

``` Vaginal intraepithelial Neoplasia Similar to VIN and CIN Less common Diagnosed: on PAP Colposcopy Biopsy ```

Question 31

What is Tx and FU of VaIN?

Answer 31

Local Resection Laser Ablation 5-FU Colposcopy every 6 mon until disease free

Question 32

What predisposes someone to Clear Cell Adenocarcinoma?

Answer 32

in utero exposure to DES

Question 33

How is Vaginal Cancer Diagnosed?

Answer 33

``` Watery, blood tinged vaginal discharge Postmenopausal Bleeding Vaginal pruritis Found on PAP or Colposcopy Biopsy! ```

Question 34

What is the Tx of Vaginal Cancer?

Answer 34

Stage 1, 2 surgical resection | Stage 3, 4 radiation