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DU PA Non-Ca Gyn Dis

Duke PA Non-Cancerous Gynecologic Disorders

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