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Flashcards in Vulvar Diseases Deck (106)
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1
Q

What is the cause of bacterial vaginosis?

A

Gardnerella Vaginalis

2
Q

What are the three major infectious causes of vulvovaginitis?

A
  • BV
  • Candidiasis
  • Trichomoniasis
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
4
Q

What is the discharge associated with BV?

A

Thin white

5
Q

What is the discharge associated with candidiasis?

A

White curdy discharge

6
Q

What is the discharge associated with trichomoniasis?

A

Yellow-green froth

7
Q

What is the normal vaginal pH?

A

3.8-4.2

8
Q

What is the KOH whiff test used to diagnose?

A

BV

9
Q

What is the treatment for BV?

A

Metronidazole

10
Q

What is the treatment for vaginal candidiasis?

A

Fluconazole

11
Q

What is the treatment for trichomonas?

A

Metronidazole

12
Q

What is the MOA of metronidazole?

A

inhibits nucleic acid synthesis by disrupting the DNA of microbial cells

13
Q

What are the characteristics of physiologic vaginal discharge?

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

What comprises physiologic vaginal discharge?

A

Endometrial fluid

Cervical mucus

15
Q

What is the definition of BV?

A

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

16
Q

Which vaginal infection has a fishy odor?

A

BV

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

18
Q

What is the gold standard test for diagnosing BV?

A

Gram stain

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

20
Q

Why is treatment needed urgently for pregnant women?

A

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

21
Q

Is vulvovaginal candidiasis an STI?

A

No, but partners can transmit it

22
Q

Who is vulval candidiasis more likely to occur in?

A

Pregnant, obese, DM women

23
Q

Why are vaginal candida infections more common in younger women?

A

Candida needs estrogenized tissue to colonize

24
Q

What are the s/sx of candidiasis?

A
  • Itching
  • Burning
  • External dysuria
  • Dyspareunia
25
Q

What are the gross characteristics of vaginal candidiasis?

A

Bright red tissue with odorless cottage cheese discharge

26
Q

What are the histological findings of candia?

A

Pseudohyphae

27
Q

Germ tube = ?

A

Candida albicans

28
Q

India ink stain = ?

A

Cryptococcus neoformans

29
Q

What is the treatment for recurrent vaginal candidiasis?

A

Oral fluconazole x6 months

30
Q

Pts with recurrent vaginal candidiasis should be evaluated for what diseases?

A
  • DM

- Autoimmune diseases

31
Q

What is the fungi that is resistant to all azoles? Treatment?

A

T. Glabrata

Intravaginal boric acid

32
Q

Is trichomoniasis sexually transmitted?

A

Yes, but can also survive in swimming pools and hot tubs

33
Q

What is the effect of trichomoniasis and HIV?

A

Trich increases the transmission of HIV

34
Q

Strawberry cervix = ?

A

Trichomonas

35
Q

How do you diagnose trichomonas?

A

Microscopic exam of vaginal secretions in saline

36
Q

Do you treat the partner for trich? In pregnancy?

A

yes to both

37
Q

What is atrophic vaginitis?

A

Atrophy of vaginal epithelium d/t decreased estrogen levels (usually in postmenopausal women)

38
Q

What changes in the vagina with atrophic vaginitis?

A

Thinning of the epithelium, and pH elevated to more than 4.7

39
Q

What are the s/sx of atrophic vaginitis?

A
  • Decreased vaginal discharge
  • Dryness
  • itching
  • burning
  • dyspareunia
40
Q

What is the treatment for atrophic vaginitis?

A

water based moisturizing preps

Topical/oral estrogen therapy

41
Q

What is lichen sclerosis?

A

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
Q

What are the s/sx of lichen sclerosus?

A
  • Intense Pruritus
  • dysuria/dyspareunia
  • Pain with defecation
43
Q

Keyhole lesions around the vagina = ?

A

Lichen sclerosus

44
Q

How do you diagnose lichen sclerosus?

A

Clinically and/or Bx, and to r/o CA

45
Q

What are the general care measures with lichen sclerosus?

A
  • 100% cotton underwear
  • Avoid tight clothing
  • No soaps to the vulva
46
Q

What is the pharmacotherapy for lichen sclerosus?

A

Superpotent steroid ointment BID x months

47
Q

What is lichen simplex chronicus?

A

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
Q

What are the exam findings of lichen simplex chronicus?

A

Labia majora and minora and perineal body are diffusely reddened with occasional hyperplastic or hyperpigmented plaques

49
Q

What is the treatment for lichen simplex chronicus?

A
  • D/c irritant
  • Antipruritic meds
  • Anti depressants
50
Q

What is lichen planus?

A

Rare inflammatory skin condition that presents with desquamative lesion of the vagina, and can develop

51
Q

What are the exam findings of lichen planus?

A

Whitish, lacy bands of keratosis near the reddish ulcerated-like lesions

52
Q

What are the s/sx of lichen planus?

A
  • Chronic vulvar burning / itching
  • Insertional dyspareunia
  • Profuse vaginal discharge
53
Q

What should be done in the evaluation of lichen planus?

A

Bx to r/o cancer

54
Q

What are the histological characteristics of lichen planus?

A

No atypia, but thinned, loss of rete ridges, and with lymphocytic infiltrate

55
Q

What are the histological characteristics of the discharge with lichen planus?

A

Large numbers of acute inflammatory cells without significant numbers of bacteria

56
Q

What is the treatment for lichen planus?

A

Topical steroids

57
Q

Cigarette paper-like skin = ?

A

Lichen sclerosis

58
Q

Erosive vaginitis with demarcated edges = ?

A

Lichen planus

59
Q

Symmetric with variable pigmentation = ?

A

Lichen simplex chronicus

60
Q

White, lacy network with flat topped lilac papules and plaques = ?

A

Lichen planus

61
Q

Lichenified, hyperplastic plaques of red to reddish brown = ?

A

Lichen simplex chronicus

62
Q

What is psoriasis?

A

AD, long-lasting autoimmune disease characterized by patches of abnormal skin. These skin patches are typically red, itchy, and scaly

63
Q

What is the treatment generally for psoriasis? How about for the vagina?

A

Generally = topical coal tar and UV light

Vagina = Topical steroids

64
Q

What is eczema?

A

Dermatitis, also known as eczema, is inflammation of the skin. It is characterized by itchy, erythematous, vesicular, weeping, and crusting patches

65
Q

What are the two types of dermatitis?

A

Eczema and seborrheic

66
Q

What is seborrheic dermatitis?

A

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
Q

What are the characteristics of the lesions with seborrheic dermatitis?

A

Pale to yellow-pink and may be oily appearing

68
Q

What is the general treatment for vulvar dermatitis?

A

Remove the offending agent and good perineal hygiene

69
Q

What is the pharmacotherapy for vulvar dermatitis?

A

5% Solution of aluminum acetate several times a day

Topical steroids

70
Q

What are sebaceous cysts?

A

Blockage of sebaceous gland ducts, causing small, smooth nodular masses, and contain cheesy material

71
Q

What are cysts of the canal of Nuck?

A

A hydrocele in the location where the round ligament inserts into the labia majora

72
Q

What are the Bartholin glands?

A

Vestibular glands that secrete mucus

73
Q

What is the treatment for Bartholin gland cysts?

A

I&D

74
Q

What is marsupialization of a cyst?

A

Turning it inside out to prevent the refilling of the cavity

75
Q

If a bartholin gland cyst presents in a woman over 40 yrs for the first time, what should be suspected?

A

Bx to r/o gland carcinoma

76
Q

What is the only time abx are needed for Bartholin gland cysts?

A

If there is N. Gonorrhea present or cellulitis

77
Q

What is Paget’s disease of the vagina?

A

a rare, slow-growing, usually noninvasive intraepithelial (in the skin) adenocarcinoma

78
Q

What are the s/sx of Paget’s disease of the vagina?

A

Chronic pruritus with Velvety-red lesions that become eczematous and scar into white plaques

79
Q

In whom is Paget’s disease of the vagina more common?

A

Women over 60

80
Q

What is the treatment for Paget’s disease of the vagina?

A

Bx and wide, local excision

81
Q

What is the recurrence rate for Paget’s disease of the vagina?

A

High

82
Q

What is the prognosis for Paget’s disease of the vagina that spreads to the lymph nodes?

A

Invariably fatal

83
Q

What is vulvar intraepithelial neoplasia (VIN)?

A

Cellular atypia contained within the epithelium

84
Q

What percent of patients with VIN have concurrent CIN? What percent have HPV changes?

A

60%

80-90% with HPV changes

85
Q

What is the most common presentation of VIN?

A

Asymptomatic but can present with vulvar pruritus or vulvodynia

86
Q

What is the treatment for VIN?

A

Assume that it will progress to vulvar cancer, and perform a wide, local excision

87
Q

What should be done to f/u VIN?

A

Colposcopy q 6 months until disease free for 2 years

88
Q

What is the recurrence rate with VIN?

A

18-55%

89
Q

What is the most common type of vulvar cancer?

A

Squamous cell carcinoma

90
Q

Where is vulvar cancer usually found (anatomically)?

A

Labia majora

91
Q

What are the gross characteristics of vulvar cancer?

A

Cauliflower-like masses to hard indurated ulcers

92
Q

In whom does vulvar cancer usually occur in?

A

Women in their 60s

93
Q

What are the risk factors for vulvar cancer?

A
  • Menopausal status
  • CIN, VIN, HPV
  • Cigarettes
  • h/o cervical CA
94
Q

What is the best way to catch vulvar cancer?

A

Annual exam, with bx of lesions

95
Q

What are the s/sx of vulvar cancer?

A

Vulvar pruritis
Pain
Bleeding

96
Q

What is the treatment for vulvar cancer?

A

Wide local excision and pelvic radiation to nodes if there are mets

97
Q

What is the prognosis for vulvar SCC?

A

75%

98
Q

What is vaginal intraepithelial neoplasia?

A

Vaginal epithelial cancer.

99
Q

What is the treatment for VaIN? (2)

A

Local resection

5FU

100
Q

How do you f/u VaIN?

A

Colposcopy q 6 months until disease free x2 years, then annually

101
Q

What is the most common type of vaginal cancer?

A

SCC–probably extension of cervical disease

102
Q

Clear cell adenocarcinoma of the vagina is associated with what?

A

In utero exposure to DES

103
Q

Peak incidence of vaginal cancer is in whom?

A

Women age 60s

104
Q

DES exposure leads to what?

A

Clear cell adenocarcinoma of the vagina

105
Q

What is the most common presentation of vagial cancer?

A

Asymptomatic, but can present with:

  • Watery, blood tinged vaginal discharge
  • Pruritus
  • Post menopausal bleeding
106
Q

What is the prognosis for vaginal cancer?

A

45-55%