d120 question with answers
1. Discuss the 4 Principles of Practice - -a. Safety is paramount
b. Adhere to ethical practices
c. Value base system health care delivery
d. Prevention and early migration of disease
-1. Identify the appropriate age and interval of recommended health screening for women. - -a.
Woman 19-49 MMR, hep b, and varicella for those non immune.
b. Girls 11-26 HPV vaccine
c. Tdap 19-64 replace Td
d. Women 50> influenza annually
i. 19-49 annually for health care workers
ii. Chronic diseases, HD, DM
iii. Pregnant women
e. Pneumococcal 65 >or chronic disease, alcohol, immunocompromised
f. Contraindicated in pregnant women
i. MMR
ii. Varicella
iii. HPV
-1. Outline the elements of the Well Woman Physical (refer to your women's health SOAP note
from D117) - -a. History
b. Physical Exam
i. (1) inspection of the external genitalia, vagina, and cervix; (2) collection of cytologic
specimens from the exocervix (or ectocervix) and superficial endocervical canal; and (3)
palpation of the cervix, uterus, and adnexa.
-1. Outline the elements of the Well Woman Physical (refer to your women's health SOAP note
from D117)
e cervix, uterus, and adnexa. - -a. History
b. Physical Exam
i. (1) inspection of the external genitalia, vagina, and cervix; (2) collection of cytologic
specimens from the exocervix (or ectocervix) and superficial endocervical canal; and (3)
palpation of th
-1. Differentiate the signs of pregnancy
a. Presumptive Skin and mucus membrane changes - -i. Chadwick sign dark discoloration of
vulva vaginal walls
ii. Abdominal stria
iii. Linea nigra midline of lower abdomen
iv. Chloasma pigmentation under eyes (hormonal contraceptives)
b. Probable physical changes
,i. Uterine enlargement Piskacek Sign
ii. Hagar Sign softer cervix
iii. Pregnancy test
c. Positive
i. Fetal heartbeat endo ultrasound (6 weeks)
ii. Fetal movements (7-8 weeks)
-1. Identify the benign conditions of the vulva. - -a. White lesions
i. Vitiligo
1. Loss of pigment / observation
ii. Lichen sclerosis
1. Intense itching and dyspareunia/topical steroids, carcinoma
iii. Lichen planus
1. Auto immune Wickham striae, classic fernlike or lacy patterns./ topical steroids
iv. Lichen simples chronicus
1. Mimics psoriasa biosy needed/ immediate potency topical steroids
v. Vulvovaginal atrophy
1. Postmenamaual decreased fat / estrogen creams/ moisturizers/ lubricants
-a. Red Lesions - -i. Eczema
1. Allergic contact mc, itching swelling and crusting /discontinue use of allergen
ii. Seborrheic dermatitis
1. Red glazed shiney appreace on skin folds, greasy scalp areas/topical steroids
iii. Psoriasis
1. Auto immune, red plaques with clear borders, biopsy, itscing is common, pustular form
confused with candidia/ topical steroids
-a. Pigmented lesions - -i. Genital melanosis
1. Dark pigment on muscus menbranes/ expectant management
ii. Acanthosis nigricans
1. Pigmented areas on vulva, axilla and neck r/t insulin resistance/ weight loss and glucose
control.
-a. Ulcerations a fissures - -i. Aphthous ulcers
1. Painful like canker sores 2cm wide to 1cm deep / symptomatic
,ii. Bechet disease
1. Genital and oral ulcers with uveitis in combo with antivirals or IBS/depends
iii. Chrons disease
1. Granulomatous intestinal tract inflammatory process/ treat bowels disease
iv. Traumatic ulcerations
1. Scratching itching neglect /counseling suspect psych disorder
-a. Solid cysts or masses - -i. Epidermal cysts
1. MC, obstructed hair follicle/ body hair care/ deflation
ii. Vulvar vestibular papillomatosis
1. Soft elongated papules/ reassurance
iii. Genital warts
1. Human papilloma virus
iv. Fox-fordyce disease
1. Chronic inflammation of apocrine glands/systemic antipruritic
v. Hidradenitis suppurativa
1. Red papules painful recurrent seen in obesity/ corticosteroids, abt for celluutis, oral
contraceptive reduces reoccurrence
vi. Vascular lesion
1. tortuous varicosities; cherry angiomas and hematomas/Evaluation, compression; possible
evacuation of expanding hematoma
vii. Urethral caruncle
1. Solitary red papule at the urethral meatus; usually <1 cm diameter; appears as a collar
around urethral opening/ Observation and biopsy as needed; estrogen creams; surgery rarely
indicated
-a. The most significant of the vulvar anomalies are those that - -pose challenges to the
assignment of gender at birth.
-a. Ambiguous genitalia can present with - -clitoromegaly, bifid clitoris, or midline fusion of the
labioscrotal folds.
-Clitoral agenesis may result from the failure - -of the genital tubercle to develop. Incomplete
development of the genitalia can result in a cloaca with no separation of the bladder and the
vagina.
, -. Female pseudo hermaphroditism is caused by - -in utero masculinization due to androgens
from maternal or fetal congenital adrenal hyperplasia, androgen-producing tumors of the
mother's ovary or adrenal glands, or the mother's use of exogenous androgens. Often the
infant will present with ambiguous genitalia.
The enlarged clitoris is the most conspicuous abnormality.
-a. Male pseudohermaphroditism, which most commonly results from - -mosaicism, may occur
with varying degrees of virilization and müllerian development.
-a. Androgen insensitivity syndrome (a form of male pseudohermaphroditism and formerly
called testicular feminization) is a - -genetic deficiency of androgen receptors that results in a
46,XY infant developing female external genitalia and, later in life, secondary sexual
characteristics.
-a. True hermaphroditism is rare. The affected child has - -some degree of both female and
male development externally and internally; dual gonadal development occurs with either a
combined ovotestes or separate gonads.
-1. Discuss iatrogenic anatomical changes of the vulva. - -a. WHo
i. Type I—Partial or total removal of the clitoris and/or prepuce (clitoridectomy)
ii. Type II—Partial or total removal of the clitoris and labia minora, with or without the excision
of the labia majora (excision)
iii. Type III—Narrowing of the vaginal orifice with creation of a covering seal by cutting and
appositioning the labia minora and/or the labia majora, with or without excision of the clitoris
(infibulation)
iv. Type IV—All other harmful procedures to the female genitalia for nonmedical purposes; for
example, pricking, piercing, incising, scraping, and cauterizing
-a. Epithelial Changes - -i. Papillomatosis
1. Appear like papilloma virus/ reassurance
ii. Contact dermatitis
1. irritation/ discontinue irritant
-a. Ulcerations and fistulas - -i. Ulcers
1. most ulceration of the vagina is associated with acute infection due to herpes simplex or
cytomegalovirus;/ steroids
ii. Fistulas
1. bladder or rectum into the vagina may occur due to surgical complication, infection, or
malignancy/ surgical
1. Discuss the 4 Principles of Practice - -a. Safety is paramount
b. Adhere to ethical practices
c. Value base system health care delivery
d. Prevention and early migration of disease
-1. Identify the appropriate age and interval of recommended health screening for women. - -a.
Woman 19-49 MMR, hep b, and varicella for those non immune.
b. Girls 11-26 HPV vaccine
c. Tdap 19-64 replace Td
d. Women 50> influenza annually
i. 19-49 annually for health care workers
ii. Chronic diseases, HD, DM
iii. Pregnant women
e. Pneumococcal 65 >or chronic disease, alcohol, immunocompromised
f. Contraindicated in pregnant women
i. MMR
ii. Varicella
iii. HPV
-1. Outline the elements of the Well Woman Physical (refer to your women's health SOAP note
from D117) - -a. History
b. Physical Exam
i. (1) inspection of the external genitalia, vagina, and cervix; (2) collection of cytologic
specimens from the exocervix (or ectocervix) and superficial endocervical canal; and (3)
palpation of the cervix, uterus, and adnexa.
-1. Outline the elements of the Well Woman Physical (refer to your women's health SOAP note
from D117)
e cervix, uterus, and adnexa. - -a. History
b. Physical Exam
i. (1) inspection of the external genitalia, vagina, and cervix; (2) collection of cytologic
specimens from the exocervix (or ectocervix) and superficial endocervical canal; and (3)
palpation of th
-1. Differentiate the signs of pregnancy
a. Presumptive Skin and mucus membrane changes - -i. Chadwick sign dark discoloration of
vulva vaginal walls
ii. Abdominal stria
iii. Linea nigra midline of lower abdomen
iv. Chloasma pigmentation under eyes (hormonal contraceptives)
b. Probable physical changes
,i. Uterine enlargement Piskacek Sign
ii. Hagar Sign softer cervix
iii. Pregnancy test
c. Positive
i. Fetal heartbeat endo ultrasound (6 weeks)
ii. Fetal movements (7-8 weeks)
-1. Identify the benign conditions of the vulva. - -a. White lesions
i. Vitiligo
1. Loss of pigment / observation
ii. Lichen sclerosis
1. Intense itching and dyspareunia/topical steroids, carcinoma
iii. Lichen planus
1. Auto immune Wickham striae, classic fernlike or lacy patterns./ topical steroids
iv. Lichen simples chronicus
1. Mimics psoriasa biosy needed/ immediate potency topical steroids
v. Vulvovaginal atrophy
1. Postmenamaual decreased fat / estrogen creams/ moisturizers/ lubricants
-a. Red Lesions - -i. Eczema
1. Allergic contact mc, itching swelling and crusting /discontinue use of allergen
ii. Seborrheic dermatitis
1. Red glazed shiney appreace on skin folds, greasy scalp areas/topical steroids
iii. Psoriasis
1. Auto immune, red plaques with clear borders, biopsy, itscing is common, pustular form
confused with candidia/ topical steroids
-a. Pigmented lesions - -i. Genital melanosis
1. Dark pigment on muscus menbranes/ expectant management
ii. Acanthosis nigricans
1. Pigmented areas on vulva, axilla and neck r/t insulin resistance/ weight loss and glucose
control.
-a. Ulcerations a fissures - -i. Aphthous ulcers
1. Painful like canker sores 2cm wide to 1cm deep / symptomatic
,ii. Bechet disease
1. Genital and oral ulcers with uveitis in combo with antivirals or IBS/depends
iii. Chrons disease
1. Granulomatous intestinal tract inflammatory process/ treat bowels disease
iv. Traumatic ulcerations
1. Scratching itching neglect /counseling suspect psych disorder
-a. Solid cysts or masses - -i. Epidermal cysts
1. MC, obstructed hair follicle/ body hair care/ deflation
ii. Vulvar vestibular papillomatosis
1. Soft elongated papules/ reassurance
iii. Genital warts
1. Human papilloma virus
iv. Fox-fordyce disease
1. Chronic inflammation of apocrine glands/systemic antipruritic
v. Hidradenitis suppurativa
1. Red papules painful recurrent seen in obesity/ corticosteroids, abt for celluutis, oral
contraceptive reduces reoccurrence
vi. Vascular lesion
1. tortuous varicosities; cherry angiomas and hematomas/Evaluation, compression; possible
evacuation of expanding hematoma
vii. Urethral caruncle
1. Solitary red papule at the urethral meatus; usually <1 cm diameter; appears as a collar
around urethral opening/ Observation and biopsy as needed; estrogen creams; surgery rarely
indicated
-a. The most significant of the vulvar anomalies are those that - -pose challenges to the
assignment of gender at birth.
-a. Ambiguous genitalia can present with - -clitoromegaly, bifid clitoris, or midline fusion of the
labioscrotal folds.
-Clitoral agenesis may result from the failure - -of the genital tubercle to develop. Incomplete
development of the genitalia can result in a cloaca with no separation of the bladder and the
vagina.
, -. Female pseudo hermaphroditism is caused by - -in utero masculinization due to androgens
from maternal or fetal congenital adrenal hyperplasia, androgen-producing tumors of the
mother's ovary or adrenal glands, or the mother's use of exogenous androgens. Often the
infant will present with ambiguous genitalia.
The enlarged clitoris is the most conspicuous abnormality.
-a. Male pseudohermaphroditism, which most commonly results from - -mosaicism, may occur
with varying degrees of virilization and müllerian development.
-a. Androgen insensitivity syndrome (a form of male pseudohermaphroditism and formerly
called testicular feminization) is a - -genetic deficiency of androgen receptors that results in a
46,XY infant developing female external genitalia and, later in life, secondary sexual
characteristics.
-a. True hermaphroditism is rare. The affected child has - -some degree of both female and
male development externally and internally; dual gonadal development occurs with either a
combined ovotestes or separate gonads.
-1. Discuss iatrogenic anatomical changes of the vulva. - -a. WHo
i. Type I—Partial or total removal of the clitoris and/or prepuce (clitoridectomy)
ii. Type II—Partial or total removal of the clitoris and labia minora, with or without the excision
of the labia majora (excision)
iii. Type III—Narrowing of the vaginal orifice with creation of a covering seal by cutting and
appositioning the labia minora and/or the labia majora, with or without excision of the clitoris
(infibulation)
iv. Type IV—All other harmful procedures to the female genitalia for nonmedical purposes; for
example, pricking, piercing, incising, scraping, and cauterizing
-a. Epithelial Changes - -i. Papillomatosis
1. Appear like papilloma virus/ reassurance
ii. Contact dermatitis
1. irritation/ discontinue irritant
-a. Ulcerations and fistulas - -i. Ulcers
1. most ulceration of the vagina is associated with acute infection due to herpes simplex or
cytomegalovirus;/ steroids
ii. Fistulas
1. bladder or rectum into the vagina may occur due to surgical complication, infection, or
malignancy/ surgical
