EOR - GYN (Women's Health) With Complete Solutions

adolescent female presents with *primary amenorrhea* and cyclic pelvic pain PE: may be notable for absence of an identifiable vaginal lumen, a tense bulging hymen, and possibly increasing abdominal girth - ANSWER imperforate hymen resulting in obstruction of the outflow tract and build up of secretions in the vagina = hydrocolpos and mucocolpos hematocolpos = build up of menstrual flow in the vagina hematometra = ...in the uterus adolescent female presents with *primary amenorrhea* and cyclic pelvic pain PE: normal external female genitalia and a short vagina that appears to end in a blind pouch - ANSWER transverse vaginal septum - occurs when the Mullerian tubercle is not canalized what is vaginal atresia - ANSWER agenesis of the lower vagina -lower vagina fails to develop and is replaced by fibrous tissue -reproductive organs are normal -presents in adolescent female with primary amenorrhea and cyclic pelvic pain -PE: *vaginal dimple* tx: vaginal pull-through procedure what is vaginal agenesis - ANSWER Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome congenital absence of the vagina and the absence of hypoplasia of all or part of the cervix, uterus, and fallopian tubes Benign (non-neoplastic) Epithelial Disorders of the Vulva and Vagina - ANSWER Lichen sclerosis Lichen planus Lichen simplex chronicus Vulvar psoriasis symmetric white, thinned shin on labia, perineum, and perianal region shrinkage and agglutination of labia minora Sx: usu pruritus or dyspareunia (often asymptomatic) - ANSWER Lichen sclerosis Tx: high-potency topical steroids (clobetasol or halobetasol 0.05%) 1-2x/d for 6-12 weeks then maintenance multiple shiny, flat, red-purple papules, usu on the inner aspects of the labia minora and vestibule with lacy white changes; often erosive Sx: pruritis with mild inflammation to severe erosions - ANSWER vulvar Lichen planus -uncommon- Tx: Tx: high-potency topical steroids (clobetasol or halobetasol 0.05%) 1-2x/d for 6-12 weeks then maintenance thickened skin with accentuated skin markings and excoriations due to chronic itching and scratching (scratch-itch cycle) - ANSWER Lichen simplex chronicus Tx: med-to-high potency topic steroids for 2x/d for 6+ weeks how does vulvar psoriasis present - ANSWER red moist lesions, sometimes scaly asymptomatic or sometimes pruritis Tx: topical steroids, UV light what is the most common vulvar malignancy and what benign skin lesion may cause an increased risk of this malignancy - ANSWER squamous cell carcinoma is the most common vulvar lesions - 90% (melanoma is 2nd - 5% of vulvar cancer) SCC may arise of chronic irritation from lichen sclerosus radical vulvectomy and groin node disection is indicated if the lesion is >2cm with invasion of >1.0mm squamous cell carcinoma of the vulva - ANSWER pts commonly present with a lump and have a long-standing hx of pruritis (chronic scratch-itch cycle is thought to stimulate squamous carcinoma) mean age: 65y smoking increases risk of vulvar cancers (esp in setting of HPV) describe Paget's disease of the vulva - ANSWER white, plaque-like lesions poorly demarcated erythema no discrete mass lacy-white mottling describe Verrucous carcinoma of the vulva - ANSWER cauliflower-like lesions VIN 1 is what - ANSWER vulvar intraepithelial neoplasia type I = mild displasia lesion that demonstrates minimal to mild squamous atypia limited to the lower epidermis either nonneoplastic, reactive atypia, or an effect of an HPV infection most often occurs in *condylomata acuminata* VIN, usual type - ANSWER (combo of VIN 2 and VIN 3) high-grade HPV-related lesions distinguished only by degree of abnormality true neoplasia - will lead to carcinoma if left untreated 60% of women with VIN 3 (pr vaginal intraepithelial neoplasia [VAIN] 3) will also have what - ANSWER Cervical intraepithelial neoplasia (CIN) lesions classic presentation of VIN, usual type - ANSWER vulvar pruritis chronic irritation raised mass lesions (locatlized, fairly well-isolated, and raised above normal epithelial surface,, slightly rough texture - range of color) often smoker or second-hand smoke exposure Tx for VIN 3 - ANSWER wide local excision following biopsies to r/o invasive cancer what is endometriosis - ANSWER presence of endometrial tissue - estrogen-sensitive lesions - outside of the uterine cavity Endometriosis sx and presentation - ANSWER cyclic pelvic (worse 1-2 days before menses, then subsides at or right after onset of flow) pain/dysmenorrhea dyspareunia sometimes abnormal bleeding, bowel and bladder sx, and infertility uterosacral nodularity and tenderness on rectovaginal examination fixed retroverted uterus when ovary is involved - a tender, fixed adnexal mass may be palpable on bimanual/viewed on u/s how to definitively dx endometriosis - ANSWER *direct visualization* with laparoscopy or laparotomy presence of endometrial glands and stroma outside of the uterus DDx for endometriosis (think o