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