Vulvar Disorders/Dysplasia/CA Flashcards Preview

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Flashcards in Vulvar Disorders/Dysplasia/CA Deck (67):
1

vulvular dystrophies are characterized by what two key features?

pruritus and white lesions of the vulva

2

t or f: vulvuar lesions must be biopsied to rule out malignancy

TRUE

3

t or f: an increased risk of vulvar carcinoma is associated with lichen plans and lichen sclerosus.

TRUE

4

t or f: paget disease of the vulva is frequently associated with cancers

TRUE (these pts are at increased risk of cancer)

5

t or f: recurrence of paget disease of the vulva is fairly uncommon

FALSE (its actually very common and requires yearly screening)

6

pruritic, erythematous, eczematoid lesions of the vulva are indicator of what?

paget of the vulva

7

t or f: paget of the vulva is more common in women in their 20s to 30s

FALSE; post menopausal women (white)

8

paget of the vulva is associated with which two carcinomas?

adenocarcinoma of the GI tract or breast

9

how is the diagnosis of paget of the vulva made?

direct bx which reveals paget's cells

10

what is the treatment of a solitary paget lesion without malignancy?

wide excision to subq fat

11

what three exams/tests need to be performed annually in pts with paget disease?

breast exam, screening for GI disease, and cytology of cervix and vulva

12

this vulvar disorder is a hypertrophic dystrophy caused by chronic irritation resulting in raised, white, thickened lesions

lichen simplex chornicus

13

what are the two main complaints (in terms of symptoms) associated with lichen simplex chronicus?

itching and scratching

14

These are fine white lacy lesions commonly associated with lichen planus

Wickham striae (often found on the papules).

15

microscopic examination of lichen simplex chornicus will reveal which two things?

acanthosis and hyperkeratosis

16

this vulvar dystrophy is characterized by a paper like appearance of the vulva on both sides and epidermal contractures

lichen sclerosis

17

what does microscopic examination of lichen sclerosis reveal?

epithelial thinning with a layer of homogenization below and inflammatory cells

18

what are some commons signs that help reveal lichen planus?

purple (shiny purple lesions), polygonal, planar pruritic

19

how is the diagnosis of lichen planus made?

3 to 5 mm punch biopsy

20

what is the medical management of lichen planus? (pharma)

steroid creams (testosterone, clobetasol/temovate); oral steroid in severe cases; remember you can also use uv light for continued scratching

21

which vulvar dystrophy is characterized by red plaques covered by silver scales?

psoriasis

22

what is the pharma treatment for psoriasis of the vulva?

steroid creams and vitamin d

23

t or f: vestibulitis is associated w/insertional dyspareunia and post coital pain

TRUE

24

what does the colposcopic examination of the lesion of vestibulitis reveal?

acetic acid turns the affected area white, BUT these lesions are NOT dysplastic

25

t or f: TCA application is a treatment option for vestibulitis

true; vestibulectomy is a drastic option

26

vestibulitis diagnosis can be made how?

cotton tipped applicator application produces pain

27

vestibular glands (bartholin) are located where in the vestibule?

at 5 and 7 o'clock

28

t or f: bartholin gland cysts tend to be bilateral

FALSE - unilateral

29

t or f: bartholin gland cysts can rupture on their own w/in a few days of development

TRUE

30

what are the bartholin glands analogous to in the male?

Cowper's gland

31

what is the function of the bartholin glands?

to secret thick, alkaline fluid during coitus

32

t or f: bartholin gland cysts often produce severe unilateral pain

FALSE; often not painful

33

t or f: a normal bartholin gland is not palpated

TRUE

34

what is the MCC of bartholin gland abscess?

infection causing main duct draining the gland to become occluded

35

what is the mainstay of treatment for bartholin gland abscess?

i&d followed by marsupialization

36

what is the alternative to marsupialization when treating bartholin gland abscess?

placement of ward catheter

37

what is the most common vulvar cyst?

sebaceous cyst (epidermoid)

38

is an epidermoid cyst more common on the labia minora or majora?

majora; (remember, this is where the hair - cysts form when the pilosebaceous ducts become occluded)

39

t o f: most epidermoid cysts do NOT require treatment

TRUE

40

hidradenitis suppurativa is commonly found where?

in intertriginous areas of the body

41

t or f: women are more likely to develop hidradenitis suppurativa than men

true

42

this condition is a chronic infection of the apocrine glands

hidradenitis suppurativa - as the infection grows over time, scaring and pits can form

43

how is the diagnosis of hidradenitis suppurativa made?

biopsy

44

what is the treatment of hidradenitis suppurativa?

topic steroid creams and oral antibiotics

45

what is the most common complaint in vulvar cancer?

itching and burning of the vulva (with raised white lesions)

46

what are the two high and low risk strains of HPV we vaccinate against with Guardasil?

6 11 (low) 16 18 (high)

47

lower numbered strains of HPV are typically responsible for what pathology? higher strains?

condylomas/vulvar warts; dysplasia and CA

48

t or f: vulvar cancer risk factors include HPV (16, 18, 31, 33)

TRUE

49

what are the precancerous lesions of the vulva called?

VIN (vulvar untraepithelia neoplasia)

50

t or f: a hx of vulvar skin dz is a risk factor for VIN

TRUE

51

what are the two mainstay procedures for diagnosis of VIN?

colposcopy and biopsy

52

at what staging level of VIN is it considered carcinoma-in-situ?

VIN III

53

in general, the bigger the VIN lesion what are the treatment options?

small lesions can get wide local excision while larger lesions require lasers and vulvectomy

54

t or f: vulvar intraepithelial lesions are just as likely as cervical intraepithelial lesions to become high grade or cancers

FALSE - LESS LIKELY

55

what is the most common type of vulvar CA?

squamous cell (90%)

56

post menopausal or premenopausal women more at risk for vulvar CA?

post

57

how is the diagnosis of vulvar CA made?

bx

58

what is the MCC of vulvar dysplasia>

labia majora

59

what is the difference between the condyloma acuminata and lata?

acuminata is associated with HPV (pearly, and plaque-like or cauliflower appearance); lata associated with secondary syphilis (non-painful, raised, grayish-white lesions)

60

what type of vaginal CA is associated with in utero DES exposure?

clear cell adenocarcinoma

61

what is the general treatment and staging of vulvar cancer?

as the stage increases in number, the more invasive the cancer; as the cancer becomes more invasive you have to surgically removes more involved organs

62

vaginal CA présents typically in which age group?

post menopausal women

63

what is the most common type of vaginal CA (cell type)?

squamous cell carcinoma

64

t or f: having VIN and/or CIN is a risk factor for vaginal CA

TRUE

65

as the stage increases with vaginal CA how does the tx change?

with an increase in stage you move away from surgery and move towards radiation only

66

how is vulvar CA staged?

surgical

67

how is vaginal CA staged?

clinical