Can you make the right diagnoses?

October 14, 2019

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

Correct diagnosis: C. Hidradenitis Suppurativa

Correct treatment plan: 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.

A. Squamous cell carcinoma (SCC)	A. Vulvar biopsy
B. Cutaneous Crohn's disease	B. Aerobic culture
C. Group A	C. Polymerase chain reaction (PCR) tests for
D. Chancroid	D. Syphilis serological test
E. Primary syphilis

Correct diagnosis: B. Cutaneous Crohn's disease

Correct test: A. Vulvar biopsy