Meet Mona

Mona is 76yo lady with persistent vulvar itch that has been driving her crazy for the past 3 months.  

She also has NIDDM, chronic renal failure and cirrhosis.

She has no bowel upset, perianal itch, burning or hyperesthesia. There is no vaginal bleeding. She is not itchy elsewhere.  

There are a number of initial diagnoses that spring to mind. You would like to explore her symptoms further but she has to catch the Handibus soon and is grumbling that you have already kept her waiting for 45 mins. You know that Mittens, the shaggy Persian cat, passed away many months ago. One less factor to consider.

So, based on the limited info you have before you, and starting with the most likely diagnosis first…

What else would you consider? (Remember to only click on those options you would realistically choose in practice. When done, click on the [ >> Finished…] button