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Vulvar Diseases Flashcards

(106 cards)

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1
Q

What is the cause of bacterial vaginosis?

A

Gardnerella Vaginalis

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2
Q

What are the three major infectious causes of vulvovaginitis?

A
  • BV
  • Candidiasis
  • Trichomoniasis
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3
Q

What is the vaginal pH associated with BV, trichomoniasis, and Candidiasis?

A
  • BV = More than 4.5
  • Candida = Normal
  • Trichomonas = More than 4/5
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4
Q

What is the discharge associated with BV?

A

Thin white

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5
Q

What is the discharge associated with candidiasis?

A

White curdy discharge

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6
Q

What is the discharge associated with trichomoniasis?

A

Yellow-green froth

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7
Q

What is the normal vaginal pH?

A

3.8-4.2

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8
Q

What is the KOH whiff test used to diagnose?

A

BV

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9
Q

What is the treatment for BV?

A

Metronidazole

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10
Q

What is the treatment for vaginal candidiasis?

A

Fluconazole

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11
Q

What is the treatment for trichomonas?

A

Metronidazole

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12
Q

What is the MOA of metronidazole?

A

inhibits nucleic acid synthesis by disrupting the DNA of microbial cells

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13
Q

What are the characteristics of physiologic vaginal discharge?

A
  • Mucus
  • White to off white color
  • Odorless
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14
Q

What comprises physiologic vaginal discharge?

A

Endometrial fluid

Cervical mucus

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15
Q

What is the definition of BV?

A

Polymicrobial infection characterized by a lack of normal H2O2 lactobacilli, and an overgrowth of anaerobes

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16
Q

Which vaginal infection has a fishy odor?

A

BV

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17
Q

What are clue cells, and what are they diagnostic of?

A

Epithelial cells with cocci bacteria attached to their surfaces, such that it looks like ground glass

BV

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18
Q

What is the gold standard test for diagnosing BV?

A

Gram stain

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19
Q

What are the 4 criteria to diagnose BV? How many are needed?

A
  • Abnormal gray discharge
  • pH more than 4.5
  • Whiff test
  • clue cells

3/4 needed

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20
Q

Why is treatment needed urgently for pregnant women?

A

High risk pregnancies there is an increased chance of PROM and pTD

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21
Q

Is vulvovaginal candidiasis an STI?

A

No, but partners can transmit it

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22
Q

Who is vulval candidiasis more likely to occur in?

A

Pregnant, obese, DM women

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23
Q

Why are vaginal candida infections more common in younger women?

A

Candida needs estrogenized tissue to colonize

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24
Q

What are the s/sx of candidiasis?

A
  • Itching
  • Burning
  • External dysuria
  • Dyspareunia
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25
What are the gross characteristics of vaginal candidiasis?
Bright red tissue with odorless cottage cheese discharge
26
What are the histological findings of candia?
Pseudohyphae
27
Germ tube = ?
Candida albicans
28
India ink stain = ?
Cryptococcus neoformans
29
What is the treatment for recurrent vaginal candidiasis?
Oral fluconazole x6 months
30
Pts with recurrent vaginal candidiasis should be evaluated for what diseases?
- DM | - Autoimmune diseases
31
What is the fungi that is resistant to all azoles? Treatment?
T. Glabrata | Intravaginal boric acid
32
Is trichomoniasis sexually transmitted?
Yes, but can also survive in swimming pools and hot tubs
33
What is the effect of trichomoniasis and HIV?
Trich increases the transmission of HIV
34
Strawberry cervix = ?
Trichomonas
35
How do you diagnose trichomonas?
Microscopic exam of vaginal secretions in saline
36
Do you treat the partner for trich? In pregnancy?
yes to both
37
What is atrophic vaginitis?
Atrophy of vaginal epithelium d/t decreased estrogen levels (usually in postmenopausal women)
38
What changes in the vagina with atrophic vaginitis?
Thinning of the epithelium, and pH elevated to more than 4.7
39
What are the s/sx of atrophic vaginitis?
- Decreased vaginal discharge - Dryness - itching - burning - dyspareunia
40
What is the treatment for atrophic vaginitis?
water based moisturizing preps Topical/oral estrogen therapy
41
What is lichen sclerosis?
a disease of unknown cause that results in white patches on the skin, which may cause scarring on and around genital or sometimes other skin
42
What are the s/sx of lichen sclerosus?
- *Intense Pruritus* - dysuria/dyspareunia - Pain with defecation
43
Keyhole lesions around the vagina = ?
Lichen sclerosus
44
How do you diagnose lichen sclerosus?
Clinically and/or Bx, and to r/o CA
45
What are the general care measures with lichen sclerosus?
- 100% cotton underwear - Avoid tight clothing - No soaps to the vulva
46
What is the pharmacotherapy for lichen sclerosus?
Superpotent steroid ointment BID x months
47
What is lichen simplex chronicus?
A skin disorder characterized by chronic itching and scratching 2/2 some irritant. The constant scratching causes thick, leathery, brownish skin, which itches more.
48
What are the exam findings of lichen simplex chronicus?
Labia majora and minora and perineal body are diffusely reddened with occasional hyperplastic or hyperpigmented plaques
49
What is the treatment for lichen simplex chronicus?
- D/c irritant - Antipruritic meds - Anti depressants
50
What is lichen planus?
Rare inflammatory skin condition that presents with desquamative lesion of the vagina, and can develop
51
What are the exam findings of lichen planus?
Whitish, lacy bands of keratosis near the reddish ulcerated-like lesions
52
What are the s/sx of lichen planus?
- Chronic vulvar burning / itching - Insertional dyspareunia - Profuse vaginal discharge
53
What should be done in the evaluation of lichen planus?
Bx to r/o cancer
54
What are the histological characteristics of lichen planus?
No atypia, but thinned, loss of rete ridges, and with lymphocytic infiltrate
55
What are the histological characteristics of the discharge with lichen planus?
Large numbers of acute inflammatory cells without significant numbers of bacteria
56
What is the treatment for lichen planus?
Topical steroids
57
Cigarette paper-like skin = ?
Lichen sclerosis
58
Erosive vaginitis with demarcated edges = ?
Lichen planus
59
Symmetric with variable pigmentation = ?
Lichen simplex chronicus
60
White, lacy network with flat topped lilac papules and plaques = ?
Lichen planus
61
Lichenified, hyperplastic plaques of red to reddish brown = ?
Lichen simplex chronicus
62
What is psoriasis?
AD, long-lasting autoimmune disease characterized by patches of abnormal skin. These skin patches are typically red, itchy, and scaly
63
What is the treatment generally for psoriasis? How about for the vagina?
Generally = topical coal tar and UV light Vagina = Topical steroids
64
What is eczema?
Dermatitis, also known as eczema, is inflammation of the skin. It is characterized by itchy, erythematous, vesicular, weeping, and crusting patches
65
What are the two types of dermatitis?
Eczema and seborrheic
66
What is seborrheic dermatitis?
an inflammatory skin disorder affecting the scalp, face, and torso. Typically, seborrheic dermatitis presents with scaly, flaky, itchy, and red skin. It particularly affects the sebaceous-gland-rich areas of skin
67
What are the characteristics of the lesions with seborrheic dermatitis?
Pale to yellow-pink and may be oily appearing
68
What is the general treatment for vulvar dermatitis?
Remove the offending agent and good perineal hygiene
69
What is the pharmacotherapy for vulvar dermatitis?
5% Solution of aluminum acetate several times a day Topical steroids
70
What are sebaceous cysts?
Blockage of sebaceous gland ducts, causing small, smooth nodular masses, and contain cheesy material
71
What are cysts of the canal of Nuck?
A hydrocele in the location where the round ligament inserts into the labia majora
72
What are the Bartholin glands?
Vestibular glands that secrete mucus
73
What is the treatment for Bartholin gland cysts?
I&D
74
What is marsupialization of a cyst?
Turning it inside out to prevent the refilling of the cavity
75
If a bartholin gland cyst presents in a woman over 40 yrs for the first time, what should be suspected?
Bx to r/o gland carcinoma
76
What is the only time abx are needed for Bartholin gland cysts?
If there is N. Gonorrhea present or cellulitis
77
What is Paget's disease of the vagina?
a rare, slow-growing, usually noninvasive intraepithelial (in the skin) adenocarcinoma
78
What are the s/sx of Paget's disease of the vagina?
Chronic pruritus with Velvety-red lesions that become eczematous and scar into white plaques
79
In whom is Paget's disease of the vagina more common?
Women over 60
80
What is the treatment for Paget's disease of the vagina?
Bx and wide, local excision
81
What is the recurrence rate for Paget's disease of the vagina?
High
82
What is the prognosis for Paget's disease of the vagina that spreads to the lymph nodes?
Invariably fatal
83
What is vulvar intraepithelial neoplasia (VIN)?
Cellular atypia contained within the epithelium
84
What percent of patients with VIN have concurrent CIN? What percent have HPV changes?
60% 80-90% with HPV changes
85
What is the most common presentation of VIN?
Asymptomatic but can present with vulvar pruritus or vulvodynia
86
What is the treatment for VIN?
Assume that it will progress to vulvar cancer, and perform a wide, local excision
87
What should be done to f/u VIN?
Colposcopy q 6 months until disease free for 2 years
88
What is the recurrence rate with VIN?
18-55%
89
What is the most common type of vulvar cancer?
Squamous cell carcinoma
90
Where is vulvar cancer usually found (anatomically)?
Labia majora
91
What are the gross characteristics of vulvar cancer?
Cauliflower-like masses to hard indurated ulcers
92
In whom does vulvar cancer usually occur in?
Women in their 60s
93
What are the risk factors for vulvar cancer?
- Menopausal status - CIN, VIN, HPV - Cigarettes - h/o cervical CA
94
What is the best way to catch vulvar cancer?
Annual exam, with bx of lesions
95
What are the s/sx of vulvar cancer?
Vulvar pruritis Pain Bleeding
96
What is the treatment for vulvar cancer?
Wide local excision and pelvic radiation to nodes if there are mets
97
What is the prognosis for vulvar SCC?
75%
98
What is vaginal intraepithelial neoplasia?
Vaginal epithelial cancer.
99
What is the treatment for VaIN? (2)
Local resection | 5FU
100
How do you f/u VaIN?
Colposcopy q 6 months until disease free x2 years, then annually
101
What is the most common type of vaginal cancer?
SCC--probably extension of cervical disease
102
Clear cell adenocarcinoma of the vagina is associated with what?
In utero exposure to DES
103
Peak incidence of vaginal cancer is in whom?
Women age 60s
104
DES exposure leads to what?
Clear cell adenocarcinoma of the vagina
105
What is the most common presentation of vagial cancer?
Asymptomatic, but can present with: - Watery, blood tinged vaginal discharge - Pruritus - Post menopausal bleeding
106
What is the prognosis for vaginal cancer?
45-55%

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