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DU PA Non-Ca Gyn Dis
Duke PA Non-Cancerous Gynecologic Disorders
| Question | Answer |
|---|---|
| chronic, intense vulvar prurits, thin/white onion skin/cigerette paper, disfigurement, stenosis of vaginal introitus | lichen sclerosus |
| treatment of lichen sclerosus | potent topical steroids |
| an itch that rashes, progressive vulvar pruritis and burning, itch/scratch cycle, thickened/white, unilateral/localized | lichen simplex chronicus |
| treatment for lichen simplex chronicus | topical steroids (medium potency), hydroxyzine, SSRI's |
| violaceous, flat topped papules (erosive), white patches/ulcerations, may have oral/vaginal lesions, chronic burning and itching (autoimmune) | lichen planus |
| treatment for lichen planus | topical steroids, douches, suppositories, vaginal estrogen cream if atrophic |
| appearance of endocervical polyps | red/flame shaped, fragile, mm to 2-3 cm |
| appearance of ectocervical polyps | pale/flesh color, smooth/rounded/elongated, may have broad based pedicle |
| leiomyomas | benign uterine neoplams, fibroids |
| most common presenting symptom of fibroids | heavy bleeding |
| how are fibroids diagnosed | ultrasound |
| fibroids: treatment | usually asymptomatic & don't require tx (usu involute at menopause); myomectomy or hysterectomy if sx; GnRH mimicking tx |
| when a fibroid rapidly outgrows blood supply and dies off, most frequently associated with pregnancy | red degeneration |
| functional (physiolgic) ovarian cysts usually spontaneously __ | regress |
| failure of ovulation, follicle continues to grow, may rupture and cuase acute pelvic pain, surgery is not indicated | follicular cysts |
| missed onset of menses, corpus luteum fails to involute and continues to enlarge after ovulation. secretes progesterone, adnexal enlargement, one-sided pain | persistent corpus luteum cyst |
| characteristics of a cyst that is probably benign | mobile, cystic, unilateral, smooth |
| characteristics of a cyst that is probably malignant | fixed, solid, bilateral, nodular |
| functional ovarian cysts treatment | symptomatic treatment |
| functional ovarian cysts: risk of __ is large | torsion |
| oligo/amenorrhea, obesity, infertility, hirsutism, acanthosis nigricans, acne, insulin resistance the diagnosis is probably __ | polycystic ovary syndrome (PCOS) |
| treatment for PCOS | oral contraceptives, weight loss, metformin, spironolactone |
| PCOS treatment for the patient who does not want to take oral contraceptives | medroxyprogesterone for withdrawal bleed |
| PCOS hirsutism treatment | spironolactone, Yasmin |
| complications of PCOS | type 2 DM, hypertension, hyperlipidemia, CV disease, infertility, recurrent SAB, depression |
| discomfort of the vulva in the absence of specific cause | vulvodynia |
| The term __ denotes intense itching of the vulvar epithelium and mucous membranes from any cause | Pruritis vulvae |
| What do ulcerative lesions suggest | Granulomatous sexually transmitted disease or cancer |
| Appropriate tests for sexually transmitted disease should be conducted along with __ | biopsy to rule out cancer |
| A dystrophic lesion of the vulva having a white appearance due to a decrease in vascularity | Lichen sclerosis |
| During an acute phase of lichen sclerosus, the vulvar epithelium is moderately | Erythematous |
| The epidermal thickening of neoplasia obscures the underlying vasculature and, in conjunction with the macerating effects of the moist environment usually produces a __ | Hyperplastic white lesion |
| Is a localized white lesion resulting from transient loss of pigment in a residual scar after healing from an ulcer | Leukoderma |
| What usually results in a red lesion | Thinning or ulceration of the epidermis, vasodilation of inflammation or an immune response, or the neovascularization of a neoplasia |
| Is characterized by velvety soft red lesion that spreads over the vulvar skin | Paget’s disease (adenocarcinoma in situ of the vulva) |
| Vulvar epithelium may darken following the use of __ | Estrogen cream or oral contraceptive pills |
| A benign darkly pigmented flat lesion that may be mistaken for a melanoma | Melanosis or lentigo |
| Symptomatic vulvar varicosities in a patient who is not pregnant are __ | Uncommon and may signify an underlying vascular disease in the pelvis |
| Multiple, small, dark blue, asymptomatic papules discovered incidentally during exam of older patient. Excision biopsy only needed if they bleed repeatedly | Senile cherry hemangiomas |
| The most common vulvar dermatologic disorder, it is a benign, chronic, inflammatory process | Lichen sclerosus |
| Appearance of lichen sclerosus lesions in the acute phase | Red or purple, involving non-hair bearing areas of the vulva, perineum, and perianal area in an hourglass pattern |
| What is the appearance of chronic lichen sclerosus | Skin is thin, wrinkled, and white and has a cigarette paper appearance |
| There is an estimated 4-6% chance of developing __ with chronic lichen sclerosus | Squamous cell carcinoma |
| In well developed disease lichen sclerosus is characterized by __ of the epidermis on biopsy | Hyperkeratosis, epithelial atrophy, and flattening of the rete pegs. |
| What is the first step in the treatment of lichen sclerosus | Stop the itch-scratch cycle and minimize dermal inflammation |
| Physical exam of vulva with lichen sclerosus reveals | Thin, white, wrinkled tissue, with a cigarette paper appearance. Agglutination of the labia minora and prepuce, introital stenosis |
| Physical exam of vulva with squamous cell hyperplasia | Circumscribed, single or multifocal, raised white lesion on vulva or adjacent tissue (generally labia major and clitoris) |
| Physical exam of vulva with lichen simplex chronicus | Thickened white epithelium on vulva, generally unilateral and localized |
| Physical exam of vulva with lichen planus | Sharply marginated violaceous, flat topped papules on the skin and less sharply marginated white plaques on oral and genital mucous membranes |
| Physical exam of vulva with psoriasis reveals | Red moist lesions +- scale |
| __ can help restore moisture to cells and reconstruct the epithelial barrier with squamous cell hyperplasia | Sitz baths and lubricants |
| Cysts of __ origin are lined with squamous epithelium and filled with oily material and desquamated epithelial cells | Epidermal |
| __ may result from traumatic suturing of skin fragments during closure of the vulvar mucosa and skin after trauma or episiotomy | Epidermal inclusion cysts |
| Most epidermal cysts arise from __ | Occlusion of pilosebaceous ducts |
| Sebaceous cysts almost always involve the __ | Labia majora |
| Apocrine sweat glands are numerous in the skin of the __ | Labia majora and mons pubis |
| Where are Bartholin’s glands/ducts located | Deep in the posterior third of each labium majus |
| Enlargement of Bartholin’s glands in the post menopausal patient may represent__ | Malignancy and requires biopsy |
| Primary treatment of a bartholin’s duct cyst or abscess | Drainage with a Word catheter, or by marsupialization. |
| __ arise from muscle in the round ligament and appear as firm, symmetric, freely mobile tumors ddeep in the substance of the labium majus | Leiomyomas |
| __ arise from proliferation of fibroblasts and vary in size | Fibromas |
| Vulvar pain in the absence of relevant, visible physical findings | Vulvodynia |
| The patient suffering from vulvodynia describes her symptoms as __ | Burning, rawness, irritation, dryness, and hyperpathia |
| Mapping of tender surfaces with a cotton tipped applicator should be performed under what circumstances | In a patient with vulvar pain in the absence of relevant, visible physical findings (vulvodynia) |
| What are the components of proper vulvar hygiene | Cotton underwear, keeping area dry, avoidance of constrictive garments and irritating agents |
| What is the initial conservative approach to localized provoked vulvodynia | Topical estradiol twice daily, 5% lidocaine ointment 2x daily, calcium citrate, fluconazole, pelvic floor therapy with biofeedback |
| Treatment of generalized unprovoked vulvodynia is mostly __ | Unsuccessful |
| Fibroids: Acute pain associated with: | "red degeneration" or torsion of pedunculated myoma |
| Ovarian cyst on ultrasound | no cyst but “free fluid in cul de sac” |
| Asymptomatic, unilateral cystic adnexal mass | Dermoid (teratoma); Mobile, nontender, often high in pelvis |
| PCOS: endocrine | insulin resistance, increased LH:FSH ratio; increased testosterone |
Created by:
bwyche
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