vulvar/vaginal disease

Question 1

musty, fishy odor with incr thin gray-white to yellow discharge; mild vulvar irritation, pH >4.5

Answer 1

BV

Question 2

incr in WBC, loss of normal lactobacilli, clue cells “ ground glass”

Answer 2

BV

Question 3

gold standard for BV

Answer 3

gram stain

Question 4

clinical dx of BV made with 3/4 of what criteria

Answer 4

1. abnormal gray discharge
2. pH >4.5
3. • whiff test
4. • clue cells

Question 5

BV tx (2)

Answer 5

1. oral or topical metronidazole

2. topical clindamycin

Question 6

itching, burning, external dysuria, dyspareunia, thick odorless cottage cheese, pH 4-5

Answer 6

candida

Question 7

dx of candida

Answer 7

visualization of blastospores or pseudohyphae on saline or KOH microscopy

Question 8

tx of candida

Answer 8

vaginal application of imidazole, miconazole, clotrimazole, terconazole

Question 9

what sort of azole to use in pregnancy for tx of candida infxn

Answer 9

oral fluconazole

Question 10

if recurrence of candida within 1 month of tx

Answer 10

oral fluconazole x 6 mon

Question 11

tx of T glabrata

Answer 11

intravaginal boric acid capsules or gentian violet

Question 12

where does trich live?

Answer 12

vagina, skene ducts, urethra

Question 13

transmission of trich

Answer 13

sexual, pools, hot tubes

Question 14

trich pH

Answer 14

> 4.5

Question 15

appearance of vulva with trich

Answer 15

edema or erythema

Question 16

strawberry cervix

Answer 16

trich

Question 17

dx of trich

Answer 17

1. microscopic exam

2. nucleic acid probe test

Question 18

trich tx

Answer 18

oral metronidazole or tinidazole

Question 19

tx of trich in pregnancy

Answer 19

oral metronidazole or tinidazole

Question 20

atrophy of vaginal epithelium due to decr estrogen levels

Answer 20

atrophic vaginitis

Question 21

expected pH in atrophic vaginitis

Answer 21

> 4.7

Question 22

decr vaginal discharge, dryness, ithcing, burning, dyspareunia, urinary urgency, recurrent UTI

Answer 22

atrophic vaginitis

Question 23

tx of atrophic vaginitis (2)

Answer 23

1. local water-based moisterizers

2. topical or oral estrogen tx

Question 24

pruritis that can interfere with sleep, pruritis ani, inflammatory process

Answer 24

lichen sclerosis

Question 25

tx of lichen sclerosis

Answer 25

1. improve general care | 2. superpotent steroid ointment (clobetasol)

Question 26

an itch that rashes

Answer 26

lichen simplex chronicus

Question 27

develops secondary to an irritant dermatitis

Answer 27

lichen simplex chronicus

Question 28

labia majora/minora and perineal body can be diffusely reddened with occ hyperplastic plaques of red-brown

Answer 28

lichen simplex chronicus

Question 29

tx of lichen simplex chronicus

Answer 29

1. d/c irritant 2. antipruritic: diphenhydramine or hydroxyzine + mod strength steroid cream 3. antidepressant

Question 30

presents as a desquamative lesion of the vagina on the inner labia minora and vuvlar vestibule

Answer 30

lichen planus

Question 31

whitish lacy bands or keratosis (wickham striae)

Answer 31

lichen planus

Question 32

presents with chronic vulvar burning, insertional dyspareunia, profuse vaginal discharge

Answer 32

lichen planus

Question 33

does biopsy of lichen planus show any atypia?

Answer 33

no

Question 34

tx of lichen planus

Answer 34

topical steroids

Question 35

between lichen simplex chronicus and lichen planus, which requires a shorter course of tx?

Answer 35

lichen planus

Question 36

between lichen simplex chronicus and lichen planus, which is more likely to recur?

Answer 36

lichen planus

Question 37

tx of psoriasis

Answer 37

1. coal tar + UV light | 2. topical steroids

Question 38

inflammatino of sebaceous glands with lesions that are pale red to yellow-pink; may be covered by oil appearing scaly crust

Answer 38

seborrheic dermatitis

Question 39

tx of vulvar dermatitis

Answer 39

1. remove offending agent 2. 5% soln Al acetate 3. topical corticosteroids

Question 40

small smooth nodular material on vulva that may be excised

Answer 40

sebaceous (inclusion) cysts

Question 41

collection of peritoneal fluid within round ligament insertion into labia majora

Answer 41

cyst of the canal of nuck

Question 42

when to tx bartholin's gland cyst with Abx

Answer 42

+ N. gonorrhea OR cellulits

Question 43

premalignant conditions of the vulva

Answer 43

1. paget's disease | 2. Vulvar intraepithelial neoplasia (VIN)

Question 44

chronic pruritis, velvety-red lesions that become eczematous & scar into white plaques, age >60

Answer 44

paget's disease

Question 45

tx of paget's disease

Answer 45

wide local excision

Question 46

dx of VIN

Answer 46

colposcopy + biopsy

Question 47

tx of VIN

Answer 47

wide local excision or laser excision

Question 48

f/u of VIN: colposcopy every____ until

Answer 48

every 6 months until disease free x 2 years

Question 49

most common type of vulvar cancer

Answer 49

squamous cell carcinoma

Question 50

where is vulvar cancer usus found?

Answer 50

labia majora

Question 51

dx of vulvar cancer

Answer 51

need to have annual exam & do a biopsy if indicated

Question 52

tx of vulvar cancer

Answer 52

wide local excision with inguinal lymph node dissection

Question 53

how to dx premalginant disease of vagina

Answer 53

1. PAP 2. colposcopy 3. biopsy

Question 54

tx of VaIN

Answer 54

local resection, laser ablation or 5FU

Question 55

in utero exposure to DES assc'd with

Answer 55

clear cell adenocarcinoma

Question 56

peak incidence for vaginal cancer

Answer 56

age 60

Question 57

watery, blood tinged vaginal discharge, postmenopausal bleeding, vaginal pruritis

Answer 57

vaginal cancer

Question 58

tx of stage I, II vaginal cancer

Answer 58

surgical resection

Question 59

tx of stage III, IV vaginal cancer

Answer 59

radiation