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Questions and Answers
A postmenopausal woman presents with a gradual, solid, and painless enlargement of the Bartholin gland. What is the most appropriate next step in diagnosis?
A postmenopausal woman presents with a gradual, solid, and painless enlargement of the Bartholin gland. What is the most appropriate next step in diagnosis?
- Prescribe topical corticosteroids to reduce inflammation.
- Perform a biopsy of the lesion. (correct)
- Schedule routine follow-up appointments to monitor for changes in size or symptoms.
- Initiate broad-spectrum antibiotics to cover potential infection.
A patient presents with a unilateral, palpable mass in the posterior vaginal introitus found during a pelvic exam. Which diagnostic step is MOST crucial if the patient is over 40 years old?
A patient presents with a unilateral, palpable mass in the posterior vaginal introitus found during a pelvic exam. Which diagnostic step is MOST crucial if the patient is over 40 years old?
- Recommending warm compresses and pain relievers.
- Prescribing broad-spectrum antibiotics to cover common bacterial infections.
- Initiating conservative treatment with sitz baths.
- Performing a biopsy of the mass. (correct)
Which of the following treatment approaches is LEAST likely to be used as a primary intervention for Bartholin gland carcinoma?
Which of the following treatment approaches is LEAST likely to be used as a primary intervention for Bartholin gland carcinoma?
- Chemotherapy
- Wide local excision
- Radiation therapy
- Drainage and marsupialization (correct)
A 55-year-old woman presents with intense pruritus and well-demarcated white plaques around her vulva and perineal area. The lesions have a wrinkled, 'tissue paper' appearance. Which condition is most likely?
A 55-year-old woman presents with intense pruritus and well-demarcated white plaques around her vulva and perineal area. The lesions have a wrinkled, 'tissue paper' appearance. Which condition is most likely?
What physiological process primarily leads to the formation of a Bartholin cyst?
What physiological process primarily leads to the formation of a Bartholin cyst?
Which of the following is the MOST common initial symptom associated with a small Bartholin cyst?
Which of the following is the MOST common initial symptom associated with a small Bartholin cyst?
A young girl is brought in with suspected lichen sclerosus. Where is the LEAST likely location to find extragenital manifestations of this condition?
A young girl is brought in with suspected lichen sclerosus. Where is the LEAST likely location to find extragenital manifestations of this condition?
Which of the following factors is LEAST likely to be directly implicated in the etiology of lichen sclerosus?
Which of the following factors is LEAST likely to be directly implicated in the etiology of lichen sclerosus?
A 32-year-old woman is diagnosed with a Bartholin gland abscess. Culture results reveal a polymicrobial infection. Which of the following organisms is MOST likely to be identified?
A 32-year-old woman is diagnosed with a Bartholin gland abscess. Culture results reveal a polymicrobial infection. Which of the following organisms is MOST likely to be identified?
A patient with advanced lichen sclerosus reports significant dyspareunia and dysuria. What is the MOST likely underlying cause of these symptoms?
A patient with advanced lichen sclerosus reports significant dyspareunia and dysuria. What is the MOST likely underlying cause of these symptoms?
What is the primary anatomical location of the Bartholin glands?
What is the primary anatomical location of the Bartholin glands?
A clinician is evaluating a child with suspected lichen sclerosus. Which clinical feature should raise suspicion for other conditions, such as sexual abuse?
A clinician is evaluating a child with suspected lichen sclerosus. Which clinical feature should raise suspicion for other conditions, such as sexual abuse?
A 28-year-old patient presents with a Bartholin cyst that is 2 cm in diameter and asymptomatic. What is the MOST appropriate initial management strategy?
A 28-year-old patient presents with a Bartholin cyst that is 2 cm in diameter and asymptomatic. What is the MOST appropriate initial management strategy?
A patient is diagnosed with lichen sclerosus affecting the anogenital region. Which of the following is a typical long-term complication if the condition is left untreated?
A patient is diagnosed with lichen sclerosus affecting the anogenital region. Which of the following is a typical long-term complication if the condition is left untreated?
A patient with a history of malignancy in the labia presents with a suspected Bartholin cyst. What is the MOST important diagnostic step to consider?
A patient with a history of malignancy in the labia presents with a suspected Bartholin cyst. What is the MOST important diagnostic step to consider?
What is The MOST important function of the Bartholin glands?
What is The MOST important function of the Bartholin glands?
A 32-year-old woman presents with acute unilateral pain and swelling in her posterior vaginal introitus. A pelvic exam reveals a tender mass surrounded by edema and erythema. She also reports dyspareunia and pain while walking. Her temperature is normal. Based on the information, what is the MOST likely diagnosis?
A 32-year-old woman presents with acute unilateral pain and swelling in her posterior vaginal introitus. A pelvic exam reveals a tender mass surrounded by edema and erythema. She also reports dyspareunia and pain while walking. Her temperature is normal. Based on the information, what is the MOST likely diagnosis?
A 28-year-old woman with a Bartholin gland abscess is being considered for treatment. The abscess is 4 cm in diameter. Which of the following is the MOST appropriate initial surgical intervention?
A 28-year-old woman with a Bartholin gland abscess is being considered for treatment. The abscess is 4 cm in diameter. Which of the following is the MOST appropriate initial surgical intervention?
A 35-year-old immunocompromised patient presents with a Bartholin gland abscess. After incision and drainage, the infection is not resolving, and there are signs of cellulitis. Which of the following is the MOST appropriate next step in management?
A 35-year-old immunocompromised patient presents with a Bartholin gland abscess. After incision and drainage, the infection is not resolving, and there are signs of cellulitis. Which of the following is the MOST appropriate next step in management?
A 45-year-old woman has experienced three Bartholin gland abscesses in the past year, each treated with incision and drainage. She is otherwise healthy. What is the MOST appropriate long-term management strategy?
A 45-year-old woman has experienced three Bartholin gland abscesses in the past year, each treated with incision and drainage. She is otherwise healthy. What is the MOST appropriate long-term management strategy?
A clinician suspects malignancy in a patient presenting with a Bartholin gland mass. Which diagnostic procedure is MOST critical to perform?
A clinician suspects malignancy in a patient presenting with a Bartholin gland mass. Which diagnostic procedure is MOST critical to perform?
A 26-year-old woman presents with a small (2 cm) Bartholin gland abscess. What is the MOST appropriate initial management?
A 26-year-old woman presents with a small (2 cm) Bartholin gland abscess. What is the MOST appropriate initial management?
Which of the following is the MOST appropriate first-line treatment for anal lesions, according to the provided information?
Which of the following is the MOST appropriate first-line treatment for anal lesions, according to the provided information?
A 30-year-old pregnant woman develops a Bartholin gland abscess. Which of the following considerations is MOST important when determining the treatment approach?
A 30-year-old pregnant woman develops a Bartholin gland abscess. Which of the following considerations is MOST important when determining the treatment approach?
A patient with a Bartholin gland abscess is being treated with empiric antibiotics. The culture results reveal MRSA. What adjustment to the antibiotic regimen is MOST appropriate?
A patient with a Bartholin gland abscess is being treated with empiric antibiotics. The culture results reveal MRSA. What adjustment to the antibiotic regimen is MOST appropriate?
A 60-year-old female patient presents with chronic anal lesions. Why is a biopsy recommended in this case?
A 60-year-old female patient presents with chronic anal lesions. Why is a biopsy recommended in this case?
A patient with anal lesions also reports experiencing painful defecation leading to secondary constipation. How are these symptoms related according to the content?
A patient with anal lesions also reports experiencing painful defecation leading to secondary constipation. How are these symptoms related according to the content?
What age range is MOST commonly associated with HPV-related vulvar cancer?
What age range is MOST commonly associated with HPV-related vulvar cancer?
Which of the following is NOT listed as a risk factor for vulvar cancer?
Which of the following is NOT listed as a risk factor for vulvar cancer?
A 70-year-old woman presents with vulvar pruritus, a burning sensation, and a whitish patch on her vulva. Which of the following conditions is MOST likely associated with these symptoms?
A 70-year-old woman presents with vulvar pruritus, a burning sensation, and a whitish patch on her vulva. Which of the following conditions is MOST likely associated with these symptoms?
Which of the following clinical features is LEAST likely to be associated with vulvar cancer?
Which of the following clinical features is LEAST likely to be associated with vulvar cancer?
What is the MOST common type of malignant vulvar cancer?
What is the MOST common type of malignant vulvar cancer?
A patient presents with localized pruritus and an eczematous lesion on the vulva. Which of the following conditions is MOST likely suspected?
A patient presents with localized pruritus and an eczematous lesion on the vulva. Which of the following conditions is MOST likely suspected?
Which of the following is a common characteristic of VIN, usual type?
Which of the following is a common characteristic of VIN, usual type?
A vulvar biopsy reveals squamous epithelium with slightly irregular borders, mild cellular atypia, and enlarged nuclei. Which carcinoma is MOST suggested by the histological findings?
A vulvar biopsy reveals squamous epithelium with slightly irregular borders, mild cellular atypia, and enlarged nuclei. Which carcinoma is MOST suggested by the histological findings?
Which of the following is NOT typically considered a nonneoplastic epithelial disorder (vulvar dermatoses) that can act as a precursor lesion to vulvar cancer?
Which of the following is NOT typically considered a nonneoplastic epithelial disorder (vulvar dermatoses) that can act as a precursor lesion to vulvar cancer?
Which of the following factors would be MOST indicative of a poorer prognosis for a patient diagnosed with vulvar intraepithelial neoplasia (VIN)?
Which of the following factors would be MOST indicative of a poorer prognosis for a patient diagnosed with vulvar intraepithelial neoplasia (VIN)?
Differentiated VIN is most commonly associated with which of the following conditions?
Differentiated VIN is most commonly associated with which of the following conditions?
A patient is diagnosed with VIN, and treatment options including both excision and ablation are being considered. Which factor is MOST critical in determining the appropriate treatment approach?
A patient is diagnosed with VIN, and treatment options including both excision and ablation are being considered. Which factor is MOST critical in determining the appropriate treatment approach?
A biopsy of a vulvar lesion shows a well-differentiated squamous cell carcinoma with a warty appearance. This MOST suggests which subtype of vulvar cancer?
A biopsy of a vulvar lesion shows a well-differentiated squamous cell carcinoma with a warty appearance. This MOST suggests which subtype of vulvar cancer?
Flashcards
Bartholin Glands
Bartholin Glands
Located on both sides of the inner labia, these glands produce mucus to moisturize the vaginal mucosa.
Bartholin Cyst Formation
Bartholin Cyst Formation
Blockage of the Bartholin duct leads to accumulation of secretions, resulting in cyst formation.
Bartholin Cyst Symptoms
Bartholin Cyst Symptoms
Often asymptomatic, but can cause swelling and mild dyspareunia (painful intercourse).
Diagnosing Bartholin Cyst
Diagnosing Bartholin Cyst
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Pelvic Exam Finding (Bartholin Cyst)
Pelvic Exam Finding (Bartholin Cyst)
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Bartholin Cyst: Biopsy Indications
Bartholin Cyst: Biopsy Indications
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Conservative Treatment for Bartholin Cyst
Conservative Treatment for Bartholin Cyst
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Bartholin Gland Abscess
Bartholin Gland Abscess
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Bartholin Abscess: Clinical Features
Bartholin Abscess: Clinical Features
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Bartholin Abscess: Pelvic Exam Findings
Bartholin Abscess: Pelvic Exam Findings
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Bartholin Abscess: Surgical Treatment
Bartholin Abscess: Surgical Treatment
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Marsupialization indication
Marsupialization indication
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Fistulization with Word Catheter
Fistulization with Word Catheter
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Antibiotic Treatment Indications
Antibiotic Treatment Indications
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Empiric Antibiotic Coverage
Empiric Antibiotic Coverage
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Gland Excision Indication
Gland Excision Indication
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Bartholin Gland Carcinoma
Bartholin Gland Carcinoma
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Bartholin Carcinoma Symptom
Bartholin Carcinoma Symptom
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Bartholin Carcinoma Treatment
Bartholin Carcinoma Treatment
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Lichen Sclerosus
Lichen Sclerosus
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Lichen Sclerosus Cause
Lichen Sclerosus Cause
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Lichen Sclerosus in Women
Lichen Sclerosus in Women
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Lichen Sclerosus Symptoms
Lichen Sclerosus Symptoms
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Lichen Sclerosus Appearance
Lichen Sclerosus Appearance
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Anal Lesions
Anal Lesions
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Anal Lesion Treatment
Anal Lesion Treatment
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Lichen Sclerosus Risk
Lichen Sclerosus Risk
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Vulvar Cancer
Vulvar Cancer
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Vulvar Cancer Age
Vulvar Cancer Age
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Vulvar Cancer Risk Factors
Vulvar Cancer Risk Factors
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Vulvar Cancer Symptoms
Vulvar Cancer Symptoms
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Vulvar Cancer Type
Vulvar Cancer Type
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Vulvar Carcinoma Types
Vulvar Carcinoma Types
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Paget Disease of the Vulva
Paget Disease of the Vulva
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Vulvar Dermatoses
Vulvar Dermatoses
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Vulvar Intraepithelial Neoplasia (VIN)
Vulvar Intraepithelial Neoplasia (VIN)
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VIN, Usual Type
VIN, Usual Type
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VIN, Differentiated Type
VIN, Differentiated Type
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Diagnosis of VIN and Vulvar Cancer
Diagnosis of VIN and Vulvar Cancer
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Treatment for VIN/Vulvar Cancer
Treatment for VIN/Vulvar Cancer
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Study Notes
Bartholin Cyst
- Located on both sides of the inner labia
- Mucus is secreted into two ducts that appear in the posterior vaginal introitus
- Women in reproductive age group
- Often asymptomatic, causes swelling and mild dyspareunia
- During a pelvic exam, a unilateral, palpable mass is found in the posterior vaginal introitus
- Biopsy needed when patient is 40+ years
- Biopsy needed when progressive, solid and painless mass found during pelvic exam
- Biopsy needed when patient is unresponsive to treatment and has a history of malignancy
- Indicated for smaller asymptomatic cysts ≤ 3 cm
- Sitz bath facilitates rupture of the cysts, warm compresses
- Surgery for cysts that are larger cysts > 3 cm or infected
Bartholin Gland Abscess
- Occurs when the obstructed duct becomes infected
- Women of reproductive age group
- Polymicrobial infection usually due to e.Coli, staphylococcus, streptococcus, n. gonorrhoeae and c. trachomatis
- Acute unilateral pain and tender swelling
- Dyspareunia
- Pain while walking and sitting
- Fever (20% of patients)
- Prompt relief with discharge indicates spontaneous rupture of abscess
- Pelvic exam reveals a unilateral, tender mass, surrounded by edema and erythema
- Incision and drainage followed by marsupialization or fistulization
- Recurring abscesses
- Small abscesses (< 3 cm) cannot undergo catheterization, require supportive therapy like Sitz baths, warm compresses
- Biopsy if malignancy is suspected
- Antibiotics recommended
Bartholin Gland Carcinoma
- Primarily in postmenopausal women
- Gradual, solid and painless enlargement
- Diagnosis via biopsy
- Resection of the lesion
- Chemotherapy and radiation if surgery isn't possible
Lichen Sclerosus
- Chronic inflammatory disease caused by white, atrophic plaques with intense pruritus
- Unknown cause, but may be genetic, autoimmune or hormonal
- Rare disease (2%)
- Females > Males
- Most commonly affects (perimenopausal and postmenopausal) women
- Bimodal age distribution: Prior to puberty, during perimenopause/menopause (mean of 52 years)
- Well-demarcated white papules and plaques
- Anogenital is most common, causes severe pruritus and erosive scarring
- Lesions most common in in the anogenital area
- Lesions described as having a tissue paper or parchment paper appearance, narrowed introitus
- Clinical diagnosis
- Biopsy recommended in adult patients and in children with atypical lesions
- Potent or superpotent topical steroids
- Intralesional corticosteroids or calcineurin inhibitors, retinoids
- Requires monitoring and is associated with SCC
Vulvar Cancer
- rare carcinoma that predominantly occurs after menopause.
- Rare (0.7% of female cancers)
- HPV cancer 35-65 years.
- Non-HPV related cancers (e.g., lichen sclerosus), 55-85
- Common with HPV 16,18, 31, and 33
- E.g., lichen sclerosus, vulvar or cervical intraepithelial neoplasia (VIN/CIN)
- Tobacco and immunosuppression
- Local pruritus with burning sensation, plaques ulcerations patches of discoloration.
- Dysuria, dyspareunia, inguinal lymphadenopathy
- Squamous cell carcinoma (SCC) and subtypes: >80%
- Paget disease of the vulva affects localized pruritus and eczematous lesions
- Squamous epithelium indicates with infiltrative growth
Vulvar Intraepithelial Neoplasia
- Precancerous lesions caused by dysplasia of squamous cells
- Usual type lesion is associated with HPV and is Commonly multifocal
- Differentiated-type lesion associated with lichen sclerosus and is unifocal
- Tissue Biopsy needed for diagnosis
- Treatment: excision or ablation
- Progression to vulvar carcinoma (in <10% of cases)
Vaginal Cancer
- Squamous cell is most common, occurs secondary to cervical cancer;
- Clear cell adenocarcinoma- secondary to vaginal adenosis, seen in daughters of women who received diethylstilbestrol during pregnancy
- Sarcoma botryoides rarely is a malignant rhabomyosarcoma, peak incidence in childhood, clear polypoid masses resemble a bunch of grapes
- Upper third of the posterior vaginal wall (most common site)
- HPV 16/18 causes vaginal bleeding
- Diagnosis: Pelvic examination
- Treatment: Radiotherapy
- Stage 1-limited to the vaginal wall
- Stage 2-involved subvaginal tissue, not pelvic wall
- Stage 3-extended to pelvic wall
- Stage 4- extended beyond pelvis or involves bladder/rectum
Condyloma Acuminatum
- Also known as anogenital warts. flat or exophytic lesions on the anogenital/perineal skin.
- Human papillomavirus (HPV) types infect mucosal epithelium (e.g., HPV types 6 and 11)
- Lesions typically asymptomatic can cause itching or pain.
- Clinical diagnosis, may biopsy when uncertain in diagnosis
- Tailor treatment to patient preference and number of warts. Topical agents or cryotherapy
- Application of tropical estrogen.
- HPV is difficult to eradicate; the risk of transmission exists.
- HPV vaccination is the most effective prevention
Anomalies of the Vulva & Vagina
- Imperforate Hymen
- Agenesis of the upper vagina
- Agenesis of the lower vagina
- Transverse vaginal septum
- Labial Fusion
Imperforate Hymen
- A hymen without an opening
- Symptoms include: Primary Amenorrhea, Urinary retention and abdominal mass
- Excision to treat
Agenesis of upper vagina
- Condition in which the vagina is abnormally closed or absent
- Primary amenorrhea, infertitlity
- Perinneal exam shows vaginal dimple and hymenal frindge
Agenesis of lower vagina
- Abnormal development of the sinovaginal bulbs and vaginal plate
- primary amenhorrea and pelivc pain
- Normal uterus and ovaries
Transverse vaginal septum
- Asymptomatic before reaching puberty
- Can cause primary amenorrhoea and periodic lower abdominal pain
- Diagnose w/ transvaginal untrasonography or MRI
- treat w/ vaginal dialators
Labial Fusion
- caused by the Absence of estrogen
- Leads to not see the opening or recurrent UTI's
- Can treat w/ topical estrogen
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