Item : li\='Mark <] [> jl ~· L":flll , ~

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Item 1 of2

A 26-year-old woman comes to the clinic for a routine examination. The patient has been
doing well and has no concerns. She is a gymnast and her main activity is the balance
beam; last year, she sustained a vulvar contusion during a competition, but otherwise
she has been healthy. The patient is sexually active and uses an intrauterine device for
contraception. She occasionally drinks alcohol but does not smoke cigarettes or use
illicit drugs. Examination shows a mobile, soft, well-circumscribed mass the size of an
egg at the 4 o'clock position on the left vulva. Which of the following is the most likely
diagnosis for this patient?

o A. Bartholin duct cyst

0 B. Condylomata acuminate
0 C. Gartner duct cyst
0 D. Hematoma
o E. Molluscum contaglosum
0 F. Primary syphilis
0 G. Squamous cell carcinoma

[ Submit j
Item: • ? Mnrk <J [> jf ~ ~ , GJI[ID
Q. ld: 1~111 Previous Next lab Vetlues Note a Calculator Reverse Color Text Zoom

The following vignette applies to the next 2 items.

----------------------~
Item 1 of 2

A 26-year-old woman comes to the clinic for a routine examination. The patient has been
doing well and has no concerns. She is a gymnast and her main activity is the balance
beam; last year, she sustained a vulvar contusion during a competition. but otherwise
she has been healthy. The patient is sexually active and uses an intrauterine device for
contraception. She occasionally drinks alcohol but does not smoke cigarettes or use
illicit drugs. Examination shows a mobile, soft, well-circumscribed mass the size of an
egg at the 4 o'clock position on the left vulva. Which of the following is the most likely
diagnosis for this patient?

A. Bartholin duct cyst (81 %]

B. Condylomata acumlnata (1%]
c. Gartner duct cyst (8%)
D. Hematoma (10%)
E. Molluscum contaglosum (0%]
F. Primary syphilis (0%]
G. Squamous ceil carcinoma (0%)

Proceed to Next Item

Explanation: User ld:

This patient has an asymptomatic Bartholin duct cyst, which is common in women age
530. Duct obstruction may be due to dried mucoid glandular secretions or local trauma.
or it may be Idiopathic; the resultant fluid accumulation causes gland distension, resulting
in a cyst. This soft, mobile, nontender cystic mass is usually asymptomatic and may
be found Incidentally at the 4 or 8 o'clock position at the base of the labium
majus. With sufficient enlargement, it may cause discomfort during walking, sitting.
exercise, and Intercourse.

(Choice B) Condylomata acuminata result from infection by human papillomavlrus types

6 and 11. They are exophytic or sessile growths that may be solitary or multiple but do
not form cystic masses.

(Choice C) A Gartner duct cyst results from incomplete regression of the Wolffian duct

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 Explanation: User

This patient has an asymptomatic Bartholin duct cyst, which is common in women age
S30. Duct obstruction may be due to dried mucoid glandular secretions or local trauma,
or it may be Idiopathic: the resultant fluid accumulation causes gland distension, resulting
in a cyst This soft, mobile, nontender cystic mass is usually asymptomatic and may
be found incidentally at the 4 or 8 o'clock position at the base of the labium
majus. With sufficient enlargement, it may cause discomfort during walking, sitting,
exercise, and Intercourse.

(Choice B) Condylomata acumlnata result from infection by human papillomavlrus types

6 and 11. They are exophytic or sessile growths that may be solitary or multiple but do
not form cystic masses.

(Choice C) A Gartner duct cyst results from incomplete regression of the Wolffian duct
during fetal development. These cysts may be single or multiple and are submucosal
along the lateral (parallel) aspects of the upper anterior vagina. In contrast to Bartholin
gland cysts, they do not Involve the vulva.

(Choice D) A vulvar hematoma results from local trauma and presents as a tender,
ecchymotic, Indurated, firm mass.

(Choice E) Molluscum contaglosum presents as small, firm, painless bumps with central
pits. Although mostly asymptomatic, it may cause local itching.

(Choice F) Primary syphilis presents with a chancre, which is a round, painless ulcer.
not a cystic mass.

(Choice G) Most vulvar cancers are squamous cell carcinomas. The most common
presenting sign Is a raised and fleshy, often ulcerated, vulvar lump or mass. long-
standing vulvar pruritus, not a painless. cystic mass, is the most common symptom.

Educational objective:
Bartholin cysts present as soft. mobile, well-circumscribed masses at the base of the
labia majora and are usually asymptomatic.

References:
1. Benign tumors and tumor-like lesions of the vulva.

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Item 2 of2
Which of the following Is the most appropriate course of action for this patient?

0 A Colposcopy
o B. Cryotherapy
0 C. Incision and drainage
o D. Observation
0 E. Penicillin

f Submit l
 Item: • ? Mnrk <J [> jf ~ ~ , GJI[ID
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Item 2 of2

Which of the following Is the most appropriate course of action for this patient?

A Colposcopy (0%)
B. Cryotherapy (1 %)
C. Incision and drainage (56%)
D. Observation (42%)
E. Penicillin (1 %)

Proceed to Next Item

Explanation : User ld

An asymptomatic Bartholin cyst In a young woman does not require intervention.

Observation Is recommended as spontaneous drainage and resolution may occur.
Symptomatic cysts are treated the same as a Bartholin abscess, with incision and
drainage (Choice C). Placement of a Word catheter after drainage reduces the risk of
recurrence.

(Choice A) Colposcopy Is used for the evaluation of vulvar or cervical intraeplthellal

neoplasia.

(Choice B) Cryotherapy may be used to treat vulvar condylomata acuminata, but not a
Bartholin cyst.

(Choice E) Penicillin is the first-line treatment for all stages of syphilis. Antibiotics are
not required for Bartholin cysts and are recommended for Bartholin abscesses only If
cellulitis (eg, erythema, fever) Is present.

Educational objective:
Observation Is recommended for an asymptomatic Bartholin cyst. A symptomatic cyst Is
treated like an abscess. with Incision and drainage, followed by placement of a Word
catheter.

References :
1. Benign tumors and tumor-like lesions of the vulva.
2. Word balloon catheter for Bartholin's cyst and abscess as an office
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 Item: • ? Mnrk <J [> jf ~ ~ , GJI[ID
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Which of the following Is the most appropriate course of action for this patient?

A. Colposcopy (0%)
B. Cryotherapy [1 %)
C. Incision and drainage (56%]
D. Observation [42%)
E. Penicillin [1 %]

Proceed to Nexlllem

Explanation: User ld

An asymptomatic Bartholin cyst In a young woman does not require intervention.

Observation Is recommended as spontaneous drainage and resolution may occur.
Symptomatic cysts are treated the same as a Bartholin abscess, with incision and
drainage (Choice C). Placement of a Word catheter after drainage reduces the risk of
recurrence.

(Choice A) Colposcopy Is used for the evaluation of vulvar or cervicallntraeplthellal

neoplasia.

(Choice B) Cryotherapy may be used to treat vulvar condylomata acumlnata, but not a
Bartholin cyst.

(Choice E) Penicillin Is the first-line treatment for all stages of syphilis. Antibiotics are
not required for Bartholin cysts and are recommended for Bartholin abscesses only If
cellulitis (eg, erythema, fever) is present.

Educational objective:
Observation Is recommended for an asymptomatic Bartholin cyst A symptomatic cyst Is
treated like an abscess. with Incision and drainage, followed by placement of a Word
catheter.

References:
1. Benign tumors and tumor-like lesions of the vulva.
2. Word balloon catheter for Bartholin's cyst and abscess as an office
procedure : clinical time gained.

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Media Exhibit

colposcopy

Colposcopy

Colposcope Speculum

Vagina

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