Vulvovaginal

Question 1

What tissue makes up vulvar and vaginal tissue

Answer 1

Squamous epithelial cells

Question 2

What hormone helps thicken the vaginal mucosa

Answer 2

Estrogen

Question 3

What produces lactic Acid and is a natural barrier

Answer 3

Lactobacilli

Question 4

What is caused by an alteration in normal vaginal flora

Answer 4

Bacterial vaginosis

Question 5

What bacteria causes bacterial vaginosis

Answer 5

Gardenerella vaginalis

Question 6

What does BV do to the ph of the vagina?

Answer 6

Increases the PH

Question 7

Name the dx.

Fishy malodorous, thin Grey white milky discharge

Answer 7

Bacterial vaginosis

Question 8

What is needed for dx of BV

Answer 8

3/4 Amsels criteria

Question 9

What is the 4 parts of Amsel’s criteria

Answer 9

Homogeneous thin Grey white discharge
+ whiff test
+ clue cells
Vaginal PH >4.5

Question 10

What is added in order to determine the whiff test

Answer 10

Koh

Question 11

Treatment for bacterial vaginosis

Answer 11

Metronidazole (Flagyl) 500 mg BID for 7 days

Question 12

Do you need to treat sexual partners for BV

Answer 12

No

Question 13

What bacteria causes candidiasis

Answer 13

Candida albicans

Question 14

The following can cause what vaginal dz? 
Antibiotics 
Douching 
Increased estrogen levels 
Increased blood sugar 
Decreased immune system

Answer 14

Candidiasis

Question 15

Name the dx.

Intense itching and redness near the vagina with a thick white vaginal discharge

Answer 15

Candidiasis

Question 16

What is the gold standard to diagnosis candidiasis

Answer 16

Vaginal culture

Question 17

What will you see on wet prep of candidiasis

Answer 17

Branching pseudohyphae and budding spores

Question 18

What is the treatment of candidiasis

Answer 18

Antifungals : azoles
Topical: for vulvar sx
Systemic: Fluconazole (Diflucan) 150mg once

Question 19

When is candidiasis considered recurrent

Answer 19

More than 4 cases a year

Question 20

What is the most prevalent non-viral STI

Answer 20

Trichomoniasis

Question 21

What bacteria causes trichomoniasis

Answer 21

Trichomonas vaginalis

Question 22

Name the dx.

Frothy, thin yellow-green, malodorous discharge with a strawberry cervix

Answer 22

Trichomoniasis

Question 23

What does the discharge look like in trichomoniasis

Answer 23

Frothy, thin yellow-green, malodorous discharge

Question 24

What does the wet prep show in trichomoniasis

Answer 24

Motile flagellates and increased number of PMNs

Question 25

Treatment of trichomoniasis

Answer 25

Metronidazole (Flagyl) 2g one dose

Question 26

Does the partner of a pt with trichomoniasis need treated?

Answer 26

Yes

Question 27

If you want to retest for trichomoniasis when is it suggested

Answer 27

3 months

Question 28

What are you at risk for with trichomoniasis

Answer 28

Increased risk of PID and infertility Hiv Preterm delivery and premature rupture of membranes in pregnancy

Question 29

What is due to topical irritants that causes discharge, itching, and burning

Answer 29

Chemical vaginitis

Question 30

Treatment for chemical vaginitis

Answer 30

Stop the offending agent

Question 31

What causes atrophic vaginitis

Answer 31

Decreased estrogen levels

Question 32

What is the treatment of atrophic vaginitis

Answer 32

Vaginal moisturizers and lubricants

Question 33

What is a complication of a FB in the vagina

Answer 33

TSS

Question 34

What causes Toxic shock syndrome

Answer 34

Endotoxins of s. Aureus

Question 35

Name the dx. | A patient comes to you with a high fever, sore throat, malaise, and a macular rash of palms and soles

Answer 35

Toxic shock syndrome

Question 36

How do you diagnosis TSS

Answer 36

Positive wound or mucosal culture

Question 37

What is the treatment of TSS

Answer 37

Empiric antibiotics | Clindamycin IV + vancomycin IV

Question 38

What is the most common benign epithelial vulvar disorder

Answer 38

Lichen sclerosis

Question 39

What are patients at risk of if they have lichen sclerosis

Answer 39

Squamous cell carcinoma

Question 40

Name the dx. | White lesions that form plaques, intense itching, if scratched can cause telangiectasia, fissures and ulcers

Answer 40

Lichen sclerosis

Question 41

How do you diagnosis lichen sclerosis

Answer 41

Biopsy

Question 42

Treatment of lichen sclerosis

Answer 42

High potency steroid: Clobetasole 0.05%

Question 43

What glands help lubricate during sexual arousal

Answer 43

Bartholin gland

Question 44

Name the dx. | Patient comes to you with a pain near her vagina. States that she noticed a bump down there that is painful and swollen

Answer 44

Bartholin cyst

Question 45

Treatment of bartholin cyst

Answer 45

Infected: I&D Or Word catheter: leave in 4-6 weeks Recurrent abscess: marsupialization

Question 46

When can you not preform marsupialization on a bartholin cyst

Answer 46

When acutely infected

Question 47

What 2 premalignant lesions are associated with HPV

Answer 47

Vulvar intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VAIN)

Question 48

What are risk factors for developing VIN and VAIN

Answer 48

Smoking and immunocompromised

Question 49

Patients may present with vulvar itching or pain. This is often associated with candidiasis but they get no relief from treatment. Lesions may be white, brown, red, or black

Answer 49

Vulvar intraepithelial neoplasia

Question 50

How do you diagnosis vulvar intraepithelial neoplasia

Answer 50

Biopsy

Question 51

What is follow up for vulvar intraepithelial neoplasia

Answer 51

Every 6 months for 5 years after last treatment and then annually

Question 52

This is often diagnosed by abnormal Pap smear, but no cervical lesions are found

Answer 52

Vaginal intraepithelial neoplasia

Question 53

How do you diagnosis vaginal intraepithelial neoplasia

Answer 53

Biopsy

Question 54

What is the follow-up plan for vaginal intraepithelial neoplasia

Answer 54

Cytology smears every 6 months for 1–2 years then annually

Question 55

What is the treatment for vaginal intraepithelial neoplasia and vulvar intraepithelial neoplasia

Answer 55

Wide excision Laser ablation: for multiple small lesions For young pts can use topical Imiquimob

Question 56

What decreases your risk of developing vulvar intraepithelial neoplasia or vaginal intraepithelial neoplasia

Answer 56

HPV vaccine

Question 57

What is the most common type of vulvar cancer

Answer 57

Squamous cell carcinoma

Question 58

What are the 2 pathways for development of vulvar cancer

Answer 58

1. Relation to HPV infection-younger women | 2. Chronic inflammation and vulvar dystrophy-older women

Question 59

Name the dx. | Long history of itching with a vulvar lump/mass that is normally raised

Answer 59

Vulvar cancer

Question 60

Where does squamous cell carcinoma in vulvar cancer normally arise

Answer 60

Labia

Question 61

How do you treat vulvar cancer

Answer 61

Wide local excision with lymph node dissection

Question 62

What is the most important prognostic factor when diagnosing vulvar cancer

Answer 62

Lymph node involvement

Question 63

What cancer is vaginal cancer normally associated with

Answer 63

Squamous cell carcinoma

Question 64

What type of cancer is most common with vaginal cancer

Answer 64

Squamous cell carcinoma

Question 65

Name the dx. | Abnormal Pap smear. On the posterior 1/3 of vagina is a mass

Answer 65

Vaginal cancer

Question 66

Where is the most common site for vaginal cancer

Answer 66

Posterior upper 1/3 of vagina

Question 67

What is the treatment for vaginal cancer

Answer 67

Hysterectomy + vaginectomy + lymphadenectomy if stage 1 | Chemo and XRT for advanced stages

Question 68

What was prescribed to pregnant women to prevent miscarriage in 1938-1971

Answer 68

Diethylstilbestrol (DES)

Question 69

What is DES linked to

Answer 69

Clear cell carcinoma of vagina in women