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88 Cards in this Set
- Front
- Back
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What is the most common type of histological vulva carcinoma ? |
Invasive Squamous Cell Carcinoma Basal cell carcinoma Malignant Melanoma Sarcoma Barhtolin's gland carcinoma |
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Name 4 symptoms patients with vulva carcinoma most commonly present with |
Tumour mass Pain Bleeding Pruritis |
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How does vulva carcinoma spread ? |
Directly: Perineum Vagina Anus Urethra
Lymphatically to draining lymph nodes
Distantly via haematogenous spread |
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What is the treatment of choice for vulva carcinoma ? |
Local excision with biletral lymph node dissection
Vulvectomy with biletral lymph node dissection
Individualized chemo and radiotherapy |
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Paget's disease is sometimes associated with what ? |
Paget's disease is an adenocarcinoma of the apocrine glands, most of these patients also have a concomitant genital malignancy |
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Briefly discuss your management of VIN III |
Vulvar Intraepithelial Neoplasia-
Wide local excision Superficial Vulvectomy Laser treatment |
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For which condition is marsupialization operation performed ? |
Barhtolin's gland cyst |
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What is the anatomical location of the opeing of the duct of the Bartholin gland ? |
The duct of the gland opens into the vestibulum between the labia minora and the margin of the hymen |
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Where is the Bartholin gland located ? |
Two bulbs, about the size of small peas are situated on either side of the vestibulum in the lower third of the vagina |
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What is meant by the term marsupialization of a cyst ? |
It involves making an incision along the entire length of the gland and allowing the contents of the abscess to drain or evacuate |
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What is lichen sclerosus ? |
A non-neoplastic epithelial disorder of the skin and mucosa of the vulva of the vagina |
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When does lichen sclerosus usually occur ? |
It presents most commonly in post menopausal women |
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What is the most common symptom of lichen sclerosus ? |
Pruritis |
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How is the diagnosis of lichen sclerosus confirmed ? |
On inspection the skin is thin with loss of vulva architecture and distinction between the labia |
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What is the treatment for lichen sclerosus ? |
Clobetasol for adults
Betamethasone for children |
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True or false: Squamous carcinoma of the vulva has a peak incidence between the ages of 30-40 years |
False. It has a peak incidence between 65-75 years |
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True or false: Paget's disease of the vulva is caused by an abnormal melanocytic proliferation in the epidermis |
False. It is caused by adenocarcinoma |
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True or false: Endocervical adenocarcinoma is associated with human pappilloma virus types 16 or 18 |
True |
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True or false: Endocervical adenocarcinoma presents with a barrel shaped cervix clinically |
False |
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True or false: Sarcoma botryoides of the vagina is common in postmenopausal women |
False. It is a stromal cancer occuring in children under the age of 5 years |
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True or false: Trichomonas vaginalis can be treated with a B-lactam antimicriobial drug |
False. It is treated with metronidazole |
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True or false: Candida albicans can be transmitted by sexual contact |
False. It is caused by endogenous bacterial overgrowth |
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True or false: Bacterial vaginosis is a sexually transmitted disease |
False |
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True or false: Treponema pallidum is a systemic infection |
True |
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True or false: The diagnosis of genital ulcers is mostly clinical, and laboratory investigations are not routinely requested |
False |
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Name 5 organisms that cause genital ulcers |
Treponema palidum Chlamydia trichomatis Herpes simplex virus Haemophilus ducreyi Calymmatobacterium granulomatis |
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Which organism is regarded as a marker in bacterial vaginosis ? |
Gardnerella vaginalis |
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Describe the clinical picture of bacterial vaginosis |
Offensive vaginal discharge Burning sensation Pruritis Mild erythema |
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What are the diagnostic criteria for Bacterial Vaginosis ? |
3 of the following 5
Typical vaginal discharge Vaginal pH > 4.5 Positive amine test Presence of clue cells Positive culture |
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Name 2 agents that are used in the treatment of bacterial vaginosis |
Metronidazole Clindamycin |
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Discuss briefly regarding Trichomonas vaginalis |
The causative organism: It is caused by the trichomonas vaginalis protozoan which is spread by sexual contact
Clinical presentation: Vaginitis Urethritis Skene's ducts Bartholin's glands Bladder Endocervix
Diagnosis: Wetmount smear Pap-smear Culture
Treatment: Metronidazole Clindamycin |
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Which patients are at higher risk of being infected with HSV type 2 ? |
Multiple sexual partners and not practicing protected sex |
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Which drugs is used to manage recurrent painful genital herpes ? |
Acyclovir |
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Why can HSV-2 be transmitted despite condom use ? |
Because all potential spots for viral shedding are not covered, such as the labia minora, majora, clitoris, mons pubis and perineum |
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Name 2 complications of genital herpes |
Meningitis Secondary bacterial infection Psychological problems |
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Which medical condition is HPV 6 and 18 most likely associated with ? |
6 - Genital warts 18 - Cervical cancer |
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Discuss the diagnosis of a gonococcal infection in a woman |
Gram stain displays gram negative dilpococci Culture is positive for the organism |
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List the 4 most common causes of plevic pain |
Ectopic Pregnancy Endometriosis UTI's Appendicitis |
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Name the possible causes of secondary dymenorrhoea |
Endometriosis Tumours/fibroids Pelvic inflammatory disease Mullerian Tract anomalies Adenomyosis
Myomas Polyps Infection Cervical stenosis
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Name the different groups in which endometrial hyperplasia can be classified |
Simple or complex with or without atypia |
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List the gynaecological causes of chronic pelvic pain |
Endometriosis Adenomyosis Pelvic inflammatory disease Pelvic venous congestion Leiomyomata Residual ovary syndrome |
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True or false: Although cigarette smoking is important in the aetiology of lung cancer, it plays no role in the development of cervix cancer |
False |
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True or false: Cervical cancer is associated with HPV infection and affects mainly young patients between the ages of 20 and 30 years |
True |
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List the risk factors for developing cervical carcinoma |
HPV 16 + 18 Smoking HIV |
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List 4 common symptoms of cervical cancer |
Bleeding Pain Offensive discharge Fistula formation Pruritis Assymptomatic |
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What is the most effective screening test for carcinoma of the cervix ? |
Pap Smear Cytology |
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What is the reason for performing a colposcopy ? |
A colposcopy needs to be performed when a cervical smear indicates the presence of HSIL |
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Name 3 indications for cone biopsy of the cervix |
Cytology showing LSIL Unsatisfactory coloscopy Suspected endocervical adenocarcinoma |
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Define leiomyomata/fibroid |
A tumout of the Mullerian duct origin composed of smooth muscle interlaced with fibrous bands |
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Classify the leiomyomata/fibroids according to their position in the uterine wall |
Sub mucous Sub serous Intra Mural |
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What is hyaline degeneration of a fibroid ? |
It is a type of degeneration caused by gradual decrease in blood supply to the fibroid, which causes central necrosis and leaving a cystic space |
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Name the clinical features of fibroids |
Vaginal discharge Post menopausal women Pain Infertility Abdominal mass |
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Discuss the treatment options for someone with fibroids |
Medical: GnRHa Depo provera
Surgical: Hysterectomy Myomectomy |
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True or false: Leyiomyomas of the uterus have a 10% malignant risk |
False |
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True or false: Endometrial carcinoma is surgically staged |
False |
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True or false: Endometrial carcinoma usually presents in an early stage |
True |
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True or false: Dilation and curettage is a better diagnostic tool to diagnose endometrial carcinoma than endometrial sampling with a pipelle |
True |
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True or false: Endometrial carcinoma is primarily treated with radiotherapy |
False |
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Name the risk factors for developing endometrial carcinoma |
Hypertension Diabetes Mellitus Functioning ovarian tumour Obesity Family history Early menarche/ delayed menopause Infertility Chronic unopposed exposure to estrogen |
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How do patients with endometrial carcinomas present clinically ? |
Post menopausal bleeding Pain Vaginal discharge |
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Name the major groups of tumours of the ovary |
Functional benign cysts Non-functional benign cysts Tumour like conditions Ovarian neoplasms |
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Give a classification of ovarian neoplasms with one example of each |
Epithelial tumours - Cystadenofibromas Stromal tumours - Granulosa cell tumour Germ cell tumours - Teratoma Metastatic tumours - Breast carcinoma |
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What is the best method to screen for ovarian carcinoma ? |
Serum measurement of CA 125 levels |
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Define Endometriosis |
The presence of tissue, histologically similar to the endometrium outside the uterine cavity |
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Define Adenomyosis |
Endometrial glands and stroma located randomly in the myometrium |
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Name the symptoms of endometriosis |
Dysmenorrhoea Pelvic pain Infertility Dyspareunia Menstrual irregularities Cyclic haematuria Rectel bleeding |
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What are the symptoms of adenomyosis ? |
Dysmenorrheoa Large volumes of bleeding during menstruation Dyspareunia |
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What are the most common causitive organisms of PID ? |
Neisseria gonorrhoeae Chlamydia trachomatis Garderella vaginalis |
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What are the clinical features of a patient with PID according to the Gainesville classification ? |
Stage 1 - Early salpingitis + tender adnexa Stage 2 - Late salpingitis + Pelvic peritonitis Stage 3 - Pyosalpinx + Tubal occlusion Stage 4 - Ruptured tubo-ovarian cyst + Peritonitis + septicaemia |
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List the complications of PID |
Recurrence Infertility Ectopic pregnancy Psychological problems Mortality Chronic pain |
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Name 5 aetiological factors of genital prolapse |
Congenital - Connective tissue disease
Childbirth - Prologned labour; Instrumental delivery
Iatrogenic - Poor hysterectomy technique
Riased intra-abdominal pressure - Obesity |
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Describe the 3 grade of genital prolapse |
Grade 1 - Descent in vagina but not introitus Grade 2 - Descent down in vagina but not through introitus Grade 3 - Descent through introitus |
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Define Cystocele |
Prolapse of the bladder |
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Define Enterocele |
herniation of pouch of douglas into the vagina |
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Define Rectocele |
Rectum bulging into the vagina |
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List the different stages of sexual arousal |
Transition Desire Arousal Resolution Regractory |
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What does the acronym PLISSIT stand for ? |
P - Permision LI - Limited information SS - Specific Suggestions IT - Intensive therapy |
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Name 3 factors that enhance sexual expression |
Mutual exploration Genital stimulation Erotic Stimulation |
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Name 4 factors that inhibit sexual expression |
Abuse Incest Exhibitionism Rape |
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Name 5 organic causes of sexual dysfunction in women |
Vaginisms Apareunia Dyspareunia |
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Define Vaginisms |
A vaginism is the involuntary spasm of the pubococcygeus and levator ani muscles with penetration of the vagina |
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State the circumstances under which consent for sexual intercourse will not be valid |
Fear induced Sleep Alcohol Durgs Under ages Mental retardation |
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List the diferent samples you would collect in a rape survivor |
Semen Saliva blood Fingernail scrapings Foregin matter |
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True or false: Bonney's blue is a useful stain for the identification of abnormal cells during colposcopy |
True |
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True or false: The Schiller test is used to identify glycogen in normal squamous cells |
True |
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True or false: The treatment of choice for LSIL on cytology smear is vaginal hysterectomy |
False |
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True or false: CIN III on colposcopy directed biopsies is an indication for radical radiotherapy |
True |
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True or false: Anual pap smear can prevent all cervical cancers |
False |
