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Foundations 3 > Vulvar Disorders > Flashcards

Vulvar Disorders Flashcards

1
Q

What is Lichen Sclerosus?

A

Autoimmune: autoantibodies attack extracellular matrix and basement membrane. Immune dysfunction affecting all levels of skin.

Lymphocytic infiltrate of skin. Assoc w/ thyroid disorder and HLA.

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2
Q

What Koebner’s phenomenon? How does this effect Lichen Sclerosus

A

Trauma to an area makes the condition worse

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3
Q

Who is Lichen Lichen Sclerosus mostly seen in?

A

Post menopausal women

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4
Q

What is the most common symptom seen in Lichen Sclerosus

A

Pruritus*

Also pain and pyspareunia

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5
Q

What are physical exam findings in Lichen Sclerosus

A

Sharp well demarcated white plaques, figure 8

Cellophane paper appearance (waxy and hyperkaerototic

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6
Q

What is a hallmark findings in Lichen Sclerosus ?

What is a seen in severe cases

A

Fragility

Loss of anatomical landmarks

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7
Q

How is Lichen scleorosus diagnosed

A

Vulvar biopsy

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8
Q

Treatment for Lichen Sclerosus

A
  1. Topical ultrapotent steroid OINTMENT

Known as Clobetasol (Temovate)

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9
Q

What is important to know when applying treatment towards Lichen sclerosus

A

Educate patient to apply only to affected area

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10
Q

What can occur if Lichen sclerosus is left untreated?

A

Squamous cell cancers

RF: elderly and hyperkeratotic lesions

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11
Q

Does lichen sclerorus go away?

A

no, chronic condition

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12
Q

Who is likely to aquire Lichen Simplex Chronicus

A

Patients with hx of atropy

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13
Q

What is a precipitating factor that will trigger Lichen Simplex chornicus

A

Vulvar pruritis

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14
Q

How does Lichen Simplex chronicus typically present

A

Initially poorly marginated red, scaling papules and plaques

Chronic:
Lichenification (callus)
Hypopigementation with moisture

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15
Q

What is first line treatment for Lichen simplex complex

A

Identify underlying triggers

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16
Q

Causes of Lichen planus?

A

autoimminue disorder

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17
Q

Clinical presentation of Lichen planus

A

Introital irritation-superficial dyspareunia

Burning and /or pruritis

Vaginal dis harge

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18
Q

Slide 23

A

slide 23

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19
Q

Treatment for Lichen planus

A

Topical steroids - Hydrocortione (like lichen simplex complex)

20
Q

Definition of Vulvar Intraepithelial Neoplasia

A

neoplastic cells confined to squamous epithelium

21
Q

Which types/grades of Vulvar Intraepithelial neoplasia are most concerning that lead to cancer?

How are they further differentiated

A

VIN 2
VIN 3

VINu or VINd

22
Q

Which HPV types are VINu associated with?

A

type 16, 18, 31

23
Q

Clinical presentation for VINu?

A

Most are asymptomatic

Vulvar burning and pruritus in 50% of cases

Associated often with high grade CIN therefore colposcopy / Pap smear is mandatory

Biopsy all pigmented lesions

24
Q

How is VINu diagnosed?

A

Vulvar Colposcopy

25
Q

Physcial exam findings for VINu?

A

Hypo and Hyperpigmentation

26
Q

Treatment for VINu?

A

None provided are guaranteed due to failure to include all lesions

27
Q

What is the standard care for VINu

A

Surgical- CO2 laster vaporization

28
Q

Who is VINd seen mos commonly in?

Is it related to HPV

A

Seen in older women (70 or older)

No relation to HPV

29
Q

How is VINd caused?

A

− Associated with squamous cell hyperplasia (Lichen Sclerosis)
− Unidentified carcinogenic agents combined with local environment of chronically irritated/inflamed skin lead to dysplastic cell

30
Q

How is VINd treated?

A

Prevention- proper treatment of underlying conditions

Treatment: surgical exision of lesions

31
Q

How is VINu prevented during follow up?

A

Vaccination- Gardasil

32
Q

What are post treatment follow up recommendation for VINu and VINd

A

colposcopic vulvar inspection at 6 and 12 months and then annually thereafter

33
Q

The incidence of vulvar cancer has ________ what type of peak?

A

Bimodal peak

Women 20-40 years is HPV related (VINu)

Women 60-70 years is due to chronic irritation and poorly understood co-factor (VINd)

34
Q

What are clinical presentations for Vulvar cancer?

A

ASYMPTOMATIC is MC

Pruritus is the second most common condition
Vulvar bleeding
Vulvar pain

Need to inspect the vulva

35
Q

Treatment for Vulvar Cancers?

A

Staging based on FIGO

Surgical removal of tumor with inguinal node dissection

36
Q

What is the MCC type of vulvar cancer?

A

Squamous cell carcinomas

37
Q

What are clinical presentations of Behcet’s disease?

A

Genital ulcers

38
Q

What is the criteria to diagnose Behcet’s disease?

A

o Recurrent oral aphthae at least 3 times in 1 year plus 2 of the following:

"	Recurrent genital ulcers
"	Uveitis
"	Skin lesions
"	(+) Pathergy test
"	2mm papule at injection site w/in 48hr
39
Q

Treatment for Behcet’s disease?

A

High dose steroid

Temovate 0.05% ointment

40
Q

What are Bartholin Cysts?

A

Bilateral glands found at the 4 and 8 clock positions

41
Q

How do Batholin cysts present?

A

Acute, painful unilateral labial swelling - less pain with cyst
Dyspareunia
Pain with sitting or walking
Drainage

42
Q

Different between Batholin Cysts and abscess?

A

slide 52

43
Q

Treatment for Bartholin Cysts

A

Incision and drainage and instertion of Word catheter

Cultures and empirical antibiotic therapy

Sitz baths 2-3 days after I&D

No intercourse until cather is removed

44
Q

What is the cause of Vuvlodynia?

A

Unknown

but onset usually is around menopause

45
Q

Clinical presentation of Vulvodynia?

A

Absent clinical findings
Vulvar “burning”
Raw or stabbing sensation

46
Q

On physical exam how can you differentiate and diagnose Vulvodynia

A

Use a q-tip to palpate the vestibule where we expect the pain

47
Q

Treatment for Vulvodynia

A

slide 62 and slide 63

Foundations 3 (25 decks)

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