Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

Benign Disorders of the Lower Reproductive Tract

4–1. Pathology involving the vulva is common, and lesions may result from which of the following?

a. Trauma

b. Neoplasia

c. Immune responses

d. All of the above

4–2. Which of the following agents is commonly implicated in allergic contact dermatitis?

a. Lanolin

b. Cosmetic ingredients

c. Clobetasol propionate

d. All of the above

4–3. Vulvar hygiene is a cornerstone of lichen sclerosus management and includes all EXCEPT which of the following?

a. Wearing preferably nylon or synthetic underwear

b. Avoiding use of scented bath products and soaps

c. Avoiding use of a harsh washcloth to clean the vulva

d. Avoiding commercial washing detergents for undergarments

4–4. Which of the following vulvar disorders is characterized by a chronic inflammatory skin condition mainly of the anogenital skin as shown in this image?


Reproduced, with permission, from Gala RB: Benign disorders of the lower reproductive tract. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 4-1.

a. Lichen planus

b. Lichen sclerosus

c. Contact dermatitis

d. Hidradenitis suppurativa

4–5. Which of the following autoimmune disorders have been reported to show a consistent relationship with lichen sclerosus?

a. Graves disease

b. Diabetes mellitus

c. Systemic lupus erythematosus

d. All of the above

4–6. Which of the following preparations provide first-line therapy for lichen sclerosus?

a. Estrogen cream

b. Testosterone cream

c. Ultrapotent topical corticosteroid ointment

d. All of the above

4–7. Although several treatments are available for psoriasis (shown here), the most widely used, rapid, and effective agent is which of the following?


a. Alefacept

b. Infliximab

c. Vitamin D analog

d. Topical corticosteroid

4–8. Which of the following vulvar dermatoses commonly presents with oral lesions, such as the one shown here?


Photograph contributed by Dr. Edward Ellis.

a. Lichen planus

b. Lichen sclerosus

c. Pemphigus vulgaris

d. Fox-Fordyce disease

4–9. Treatment of vaginal lichen planus is challenging, and symptomatic relief has been reported using which of the following?

a. Minocycline

b. Estrogen cream

c. Sequential vaginal dilators

d. Vaginal corticosteroid suppositories

4–10. Which of the following vulvar disorders is characterized by this image?


Reproduced, with permission, from Gala RB: Benign disorders of the lower reproductive tract. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 4-10.

a. Vitiligo

b. Lichen planus

c. Lichen sclerosus

d. Hidradenitis suppurativa

4–11. Which of the following vulvar disorders can be disfiguring and involves apocrine gland-bearing follicular epithelium?

a. Crohn disease

b. Lichen planus

c. Hidradenitis suppurativa

d. Erythema multiforme major

4–12. Early treatment of hidradenitis suppurativa involves which of the following?

a. Topical corticosteroid ointment

b. Infliximab, a monoclonal antibody

c. Surgical excision of apocrine gland sinus tracts

d. Warm compresses, topical antiseptics, and systemic antibiotics

4–13. Which of the following is a painful, self-limited mucosal lesion?

a. Vitiligo

b. Aphthous ulcer

c. Pemphigus vulgaris

d. All of the above

4–14. Epithelium pigmentation changes may include which of the following?

a. Vitiligo

b. Melanoma

c. Acanthosis nigricans

d. All of the above

4–15. Which of the following is the second most common vulvar malignancy and accounts for up to 10 percent of all vulvar cancers?

a. Melanoma

b. Basal cell carcinoma

c. Squamous cell carcinoma

d. Bartholin gland adenocarcinoma

4–16. The loss of epidermal melanocytes in areas of depigmented vulvar skin is shown in this image and is termed which of the following?


Image contributed by Sharon Irvin, WHNP.

a. Vitiligo

b. Acanthosis

c. Fox-Fordyce disease

d. Nigricans acrochordon

4–17. The most common cause of vitiligo involves genetic factors. What percent of patients have at least one affected first-degree relative?

a. 10

b. 20

c. 40

d. 50

4–18. Bartholin gland duct cysts form in direct response to which of the following?

a. Vulvar irritation

b. Cervical gonorrhea

c. Gland duct obstruction

d. Chronic lichen sclerosus

4–19. The image below best represents which of the following vulvar disorders?


Reproduced with permission from Hoffman BL, Horsager R, Roberts SW: Williams Obstetrics 23rd Edition Study Guide. New York, McGraw-Hill, 2011, Figure 40-13.

a. Skene gland abscess

b. Urethral diverticulum

c. Epidermal inclusion cyst

d. Bartholin gland duct cyst

4–20. Which of the following is generally the treatment of choice for recurrent Bartholin gland duct abscess?

a. Systemic antibiotics

b. 5-percent lidocaine ointment

c. Bartholin gland duct marsupialization

d. Warm compresses and frequent sitz baths

4–21. This midline cystic mass best represents which of the following vulvar disorders?


Image contributed by Dr. Sasha Andrews.

a. Gartner duct cyst

b. Bartholin gland cyst

c. Urethral diverticulum

d. Nabothian cyst

4–22. According to the October 2003 ISSVD World Congress, which of the following terms most often describes burning vulvar pain occurring in the absence of relevant visible findings or specific, clinically identifiable disorders?

a. Dermatitis

b. Vulvodynia

c. Hidradenitis

d. Vestibulitis

4–23. The pain of vulvodynia is described as which of the following?

a. Provoked

b. Unprovoked

c. Generalized

d. All of the above

4–24. Although no specific laboratory test can diagnose vulvodynia, which of the following tests may help exclude an underlying vaginitis?

a. Cervical Pap test

b. Keyes punch biopsy

c. Human papillomavirus (HPV) serology

d. Wet prep, vaginal pH evaluation, and herpes viral serology

4–25. In general, which of the following forms of therapy may be initially recommended to stabilize and improve vulvodynia symptoms?

a. Surgical excision

b. Intralesional injections

c. Oral antidepressants and anticonvulsants

d. Vulvar care and 5-percent lidocaine ointment

Chapter 4 ANSWER KEY