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Special Pops Exam 1 > Vulvar & Vaginal Disease -> > Flashcards

Vulvar & Vaginal Disease -> Flashcards

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1
Q

Which vulvar disorders have white lesions?

A

Lichen sclerosus & Lichen simplex chronicus

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2
Q

Which vulvar disorders have dark lesions?

A

Melanosis or Lentigo & Melanoma

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3
Q

What are the pelvic floor muscle disorders?

A

Cystocele (bladder), Rectocele (rectum), Enterocele (small bowel), Uterine prolapse

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4
Q

What is the most common benign epithelial vulvar disorder?

A

Lichen Sclerosis

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5
Q

Who is lichen sclerosis most common in?

A

Postmenopausal women >60

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6
Q

How is lichen sclerosis characterized?

A

Marked inflammation, epithelial thinning, distinctive dermal changes

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7
Q

Cause of lichen sclerosis?

A

Chronic inflammatory process: unknown etiology but possibly autoimmune, genetic, hormonal, HPV, trauma

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8
Q

S/sx of lichen sclerosis?

A

Vulvar pain, dyspareunia (pain w sex), and/or asx white lesions

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9
Q

Characteristics of acute lichen sclerosis?

A

erythema/edema of vulva, white plaques (lichenification/keratosis), intense itching causing telangiectasia/hemorrhages, erosions, fissures, ulceration

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10
Q

Characteristics of chronic lichen sclerosis?

A

Thin, wrinkled, white skin
Anterior labia minora fuse
Stenosis of introitus (vaginal opening)
Perianal involvement (leads to dyspareunia)

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11
Q

Possible complications of lichen sclerosis?

A

3-5% inc. risk SCC of vulva

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12
Q

How to diagnose lichen sclerosis?

A

Biopsy (4mm vulvar punch)

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13
Q

Treatment goal of lichen sclerosis?

A

Control pruritus

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14
Q

How to control pruritus w/ lichen sclerosis?

A

General hygiene, oral antihistamines, topical steroids (taper until improved, then PRN), education

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15
Q

Prognosis of lichen sclerosis?

A

Chronic: will recur if tx stopped

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16
Q

Interchangeable terms for vulvar lichen simplex chronicus?

A

Hyperplastic dystrophy, squamous cell hyperplasia, atopic eczema, neurodermatitis

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17
Q

How is vulvar lichen simplex chronicus characterized?

A

Benign d/o caused by persistent itching of the skin creating thickened epithelial layer w/ hyperkeratosis (dermal layer is spared)

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18
Q

Causes of vulvar lichen simplex chronicus itching?

A

Perfumed pad use, chronic vulvovaginal infections

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19
Q

S/sx of vulvar lichen simplex chronicus?

A

Pruritus, thickened epithelium, maceration (d/t humidity), raised white lesion

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20
Q

How to diagnose vulvar lichen simplex chronicus?

A

Biopsy to r/o malignancy

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21
Q

Treatment of vulvar lichen simplex chronicus?

A

Hygiene, lubricants, sitz baths, antihistamines, topical steroids

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22
Q

How long does vulvar lichen simplex chronicus typically take to heal?

A

6 weeks

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23
Q

What do dark lesions of the vulva result from?

A

Inc. # of concentration of melanin or hemosiderin pigment, possible trauma, nevus or melanoma (if persistent), Kaposi’s sarcoma, dermatofibroma, seborrheic keratosis

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24
Q

Do all dark lesions require biopsy?

A

YES

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25
Appearance of melanosis?
Benign pigmented flat lesion
26
What does vulvar melanoma arise from? Is melanoma of the vulva common?
Pigmented nevi (uncommon but aggressive)
27
Bartholin gland location?
Deep in posterior 1/3 of each labia majora
28
Where is the duct opening for bartholin glands?
Open into vestibule at 4 o'clock & 8 o'clock position
29
What causes bartholin cyst/infection/abscess?
Obstruction of the bartholin gland ducts
30
S/sx of bartholin cyst?
Pain, tender, palpable mass, dyspareunia, pain w/ walking
31
PE for bartholin cyst?
Palpable, tender, fluctuant mass If infected: edema/inflammation
32
Tx of bartholin cyst?
I&D w/ packing or catheter placement if large If infected: Abx to cover E.coli/Staph
33
Solution for recurrent bartholin cysts?
Gland excision
34
If bartholin gland/cyst enlargement occurs in a postmenopausal female, what should be done?
Bx (r/o malignancy)
35
Where may vulvar cancer arise from?
Skin, subcutaneous tissue, or glandular elements of vulva
36
90% of vulvar cancers are what type?
SCC
37
Other types of vulvar cancer (other than SCC)?
BCC, melanoma, carcinoma of bartholin gland
38
Is vulvar cancer common or uncommon?
Uncommon, <5%
39
Peak incidence (age) of vulvar cancer?
60-70 yet inc. in women <50 d/t HPV
40
RF for vulvar cancer?
Tobacco, HIV, hx of cervical cancer/dysplasia, HPV, chronic vulvar irritation
41
S/s of vulvar cancer?
Pruritus, possible mass, bleeding, pain *20% are asx
42
PE for vulvar cancer?
SCC appearance range: large/cauliflower lesions ----> small/ulcerative lesions
43
How to diagnose vulvar cancer?
Bx
44
Tx for vulvar cancer?
Complete excision of all tumor if possible
45
Prognosis of vulvar cancer WITHOUT lymph node involvement?
90%
46
Prognosis of vulvar cancer WITH lymph node involvement?
40%
47
Key for good prognosis of vulvar cancer?
Early dx & tx
48
Top 3 causes of vaginitis? Others?
Candidiasis, BV, Trichomonas (others: chemical, allergy, reactive, STD, atrophic)
49
Normal vaginal pH in mostmenarchal and premenopasual women?
3.8-4.2
50
Factors that alter vaginal environment?
Hygiene products, hormones/contraceptives, vaginal meds, Abx, STIs, sex, stress, medical diseases
51
Hx for evaluation of vaginitis?
Discharge (quantity, duration, color, consistency, odor), prior episodes, STDs, sexual activity, contraceptive method, last menses, douching practices
52
What is a saline wet mount for vaginitis eval?
Swab of discharge on slide w/ 1-2 drops of 0.9% isotonic NaCl (under microscope)
53
What is a potassium hydroxide prep for vaginitis eval?
Swab of discharge on slide w/ 10% KOH solution (under microscope)
54
What is a whiff test for vaginitis eval?
Release of fishy odor after 10% KOH added to discharge (d/t release of amines)
55
Purpose of cultures for vaginitis?
Not as useful for vaginitis (results not immediately available) *useful to test for co-existing STDs
56
Most common species of yeast infection?
Candidia albicans
57
RF of candidiasis?
DM, HIV, obesity, pregnancy, meds (abx, steroids, OCPs), frequent sex, chronic debilitation
58
S/sx of candidiasis?
Vulvar pruritus/erythema, white/cheesy discharge, possible burning after urination
59
PE for candidiasis?
Erythema, +/- swelling of labia/vulva, satellite lesions (discrete/pustulopapular), cottage cheese like discharge
60
How to diagnose candidiasis?
Vaginal culture, pH <4.5*, wet mount slide *helps differentiate between trich & BV
61
Wet mount slide for candidiasis would reveal what?
Hyphae and budding yeast
62
Whiff test for candidiasis (+ or -)?
Negative
63
Tx of candidiasis?
Antifungal/imidazole meds: topical, suppository, oral, many OTC
64
OTC meds for candidiasis?
Fluconazole, Miconazole, Nystatin, Clotrimazole
65
What is the most common cause of symptomatic bacterial infection in reproductive-aged women?
BV
66
BV happens due to an overgrowth of which organisms?
Gardnerella vaginalis, Mobiluncus spp, anaerobic gram neg. rods, Peptostrep spp
67
Is BV related to sexual activity?
Uncommon in non-sexually active women, not an STI - no counterinfection in men
68
S/sx of BV?
"fishy"/white-grey discharge, pruritus, 50% asx
69
PE for BV?
Frothy, thin, homogenous, white/grey discharge that is adherent to vaginal wall
70
How to diagnose BV?
3/4 need to be met: -homogenous white/grey, adherent discharge -pH >4.5 -positive whiff test -clue cells on wet mount
71
What are clue cells?
Vaginal epithelial cells covered w/ many vaginal rods & cocci
72
Possible complications of BV?
Inc. risk of preterm labor, premature rupture of membranes, abnormal paps needing repeat, infections of cervix w/ procedures
73
Tx for BV?
Metronidazole PO/gel or Clindamycin cream/PO/suppositories
74
85% of vaginal neoplasms are what type?
SCC (ulcerative or exophytic)
75
Are vaginal neoplasms common?
No, rare (<1%)
76
Other types of vaginal neoplasms (other than SCC)?
Adenocarcinoma, sarcomas, melanomas (rare but aggressive)
77
What is the most common cause of malignancy involving the vagina?
Secondary carcinoma: extension of cervical cancer
78
RF for vaginal neoplasms?
Tobacco, HPV, multiple partners, hx of lower genital tract neoplasia, in utero DES (synthetic estrogen) exposure
79
In utero DES exposure causes what type of vaginal neoplasm & at what age?
Adenocarcinoma, mean age 19
80
Most common location of vaginal SCC? What can it invade directly?
Posterior wall of upper 1/3 of vagina, can directly invade bladder/rectum
81
S/sx of vaginal neoplasms?
Often asx, postmenopausal/postcoital bleeding MC, discharge, mass, urinary sx
82
How to diagnose vaginal neoplasms?
Bx
83
Staging of vaginal neoplasms is based on what?
Clinical findings only: lesion depth/spread
84
Treatment for vaginal neoplasms?
Radiation, Chemo, +/- Surgery depending on stage
85
Prognosis of vaginal neoplasms depends on what?
Size/stage of disease at time of dx
86
Stage I vaginal neoplasm? 5 year survival rate?
Limited to mucosa, 77% survival
87
Stage II vaginal neoplasm? 5 year survival rate?
Involves subvaginal tissue (but not pelvic wall), 52% survival
88
Stage III vaginal neoplasm? 5 year survival rate?
Involves pelvic wall, 42% survival
89
Stage IV vaginal neoplasm? 5 year survival rate?
Beyond pelvis --> other organs, 18% survival
90
Pelvic organ prolapse includes what organs?
Anterior vaginal, posterior vaginal, uterine, enteroceles
91
Pelvic organ prolapse is more common in ______ women.
Postmenopausal/older *prevalence inc. w/ age
92
Cause of pelvic organ prolapse?
Defects in pelvic supporting structures --> relaxation abnormalities
93
RF for pelvic organ prolapse?
Age, inc. parity, obesity, hx of pelvic surgery, chronic cough, chronic constipation, heavy lifting, vaginal deliveries, physical debilitation, neurologic decline
94
S/sx of pelvic organ prolapse?
Asx to severe, fullness/pressure/heaviness, bulging mass, sx worse with bearing down, back/pelvic pain, urinary/bowel sx, dyspareunia, coital laxity/looseness
95
PE for pelvic organ prolapse?
Examine in supine for obvious prolapse, have pt. strain, if unable to produce in supine --> standing position w knees slightly bent/ask to bear down
96
Tx for pelvic organ prolapse?
Conservative: pessary to support uterus/vaginal walls, kegels/PT, local estrogen therapy Or surgery
97
Side effects of pessary for pelvic organ prolapse?
Infections, fistulas if neglected (need changing q2-3 mos)

Special Pops Exam 1 (8 decks)

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