QUIZ W. QUESTIONS (and Photos) SEE NEXT POST FOR ANSWERS...

[Guest guest]

HI all thought this might be a bit of fun 'and' educational too *smile*

It's from a test I took a long time ago that's fairly short with a snyopsis of the patients health history first and then 4 questions....

After some thoughts of your own I'll send in the answers next .

See how you do.

Dee~

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THE VULVA,

A QUICK QUIZ.......

Authors: Lori Boardman, MD, ScM and Lynette J. Margesson, MD

Case:

A 28-year-old fitness instructor presented with a three-year history of severe vulvar itching.

The itching started gradually, and she initially self medicated on multiple occasions with a topical over-the-counter imidazole for yeast and with Vagisil®.

When the itching persisted, she saw her family doctor, who treated her with fluconazole and sent her to her gynecologist. The gynecologist diagnosed vaginitis and prescribed oral metronidazole and topical clindamycin. The itching and discomfort worsened, to the point where she was unable to sleep through the night without waking to scratch. She was seen by her local dermatologist who prescribed a low-dose corticosteroid lotion with no improvement.

The patient has a history of asthma and reports that one of her children has eczema. Her gynecologic history is significant for a history of what the patient describes as yeast infections. Her current medications include oral contraceptive pills. Although she has no known medication allergies, she does report an allergy to nickel jewelry. Finally, as a result of her job, she showers two to three times daily.

On examination, the vulva, while structurally intact, is remarkable for it's whitened and thickened skin involving the inner labia majora extending throughout the perineum. This entire area is filled with numerous small fissures as well as small eroded weeping lesions. The vaginal exam reveals a small amount of clear discharge. Microscopy is normal, without yeast, clue cells, trichomonads or white blood cells. Lactobacilli are present, and the pH is less than 4.0. A vaginal fungal culture is negative.

1.

What is the most likely diagnosis?

a.

Lichen planus

b.

Lichen simplex chronicus

c.

Lichen sclerosus

d.

None of the above

2.

Possible contributing factors from the patient’s history include:

a.

Exposure to topical antimycotics

b.

Exposure to topical antibiotics

c.

Exposure to topical anesthetics

d.

All of the above

3.

Appropriate additional tests in this patient may include all except:

a.

Biopsy

b.

Patch testing

c.

HIV testing

d.

Vaginal fungal culture

e.

Vaginal bacterial culture

4.

Initial therapy for lichen simplex chronicus consists of:

a.

Oral corticosteroid

b.

Mid-potency topical corticosteroid

c.

Topical clindamycin

d.

None of the above