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Can you make the right diagnoses?
Norman F. Miller Professor of Gynecology, Director, Pelvic Floor Research, Group Director, Fellowship in Female Pelvic Medicine and Reconstructive Surgery
Dr Hope K Haefner, MD, is Profesor in the Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor.
Dr Diana Curran, MD is associate Professor, Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor.
Three more chances to test your diagnostic skills.
These cases represent some common vulvar diseases that your patients may present with. Can you make the correct diagnoses and identifiy the best treatment plans?
Presentation
A 34-year-old G3P2 is referred to your clinic for evaluation due to chronic vulvar lesions that intermittently become painful with purulent discharge despite antibiotics.
| A. Acne vulgaris | A. General care (avoid vulvar irritants and tight clithing, lose weight, smoking cessation) |
| B. Folliculitis | B. Systemic antibiotics - doxycycline 100 mg po BID for 12 weeks |
| C. Hidradenitis Suppurativa | C. Yasmin |
| D. Deroofing of sinus tracts | |
| E. All of the above |
Presentation
A 65-year-old woman with a history of well-controlled vulvar lichen sclerosus presents to your clinic with acutely worsening vulvar pruritus and pain that feel like paper cuts. She has been using topical triamcinolone 0.1% regularly without improvement.
| A. Lichen sclerosus flare | A. Wet preparation (saline and 10% KOH) | A. 10% |
| B. Vulvar candidiasis | B. Yeast culture, and if positive, identification of species | B. 25% |
| C. Vulvovaginal atrophy | C. Vulvar biopsy | C. 50% |
| D. A & B | D. 75% |
Correct diagnosis: B. Vulvar candidiasis
Correct test: D. Wet preparation and yeast culture
Percent affected: D. 75%
Presentation
A 33-year-old woman is referred to you by her primary care physician for evaluation of two non-healing lesions on the vulva. She has tried multiple treatments for yeast without improvement. She is otherwise healthy.