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MFSRH > 5 - Specialist Gynaecology > Flashcards

5 - Specialist Gynaecology Flashcards

1
Q

% of cases of cervical cancer in developing world

A

80%

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2
Q

Risk factors for HPV

A

Increased number of sexual partners Immunocompromise Cigarette smoking Low socio economic status Prolonged use of COCP Higher number of pregnancies Less than 25 years old Early age your first intercourse

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3
Q

Prevention of HPV infection

A

Avoid sexual intercourse / fewer sexual partners Use condoms Gardasil vaccination

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4
Q

Referral criteria for colposcopy

A

3 consecutive inadequate smears Borderline nuclear abnormality (squamous /glandular) + HR HPV 1 x mild dyskaryosis +HR HPV 1 x moderate dyskaryosis 1 x severe dyskaryosis 1 x smear with possibility of invasion 1 x smear with possibility of glandular neoplasia. after treatment (by loop or thermocoagulation) if HR HPV positive (irrespective of cervical smear result).

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5
Q

what does colposcopy involve?

A

Magnified stereoscopic visualization of the cervix. +/- directed tissue sampling. The entire transformation zone must be visualized.

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6
Q

How does application of aceto-white effect the cervix

A

Application of acetic acid to atypical epithelium results in temporary coagulation of cytokeratins within the surface epithelium. Causing whitening. Dysplastic cells have a higher nuclear:cytoplasmic ratio and acetic acid causes cellular dehydration. Dysplastic cells have less cytoplasm and dehydrate more easily and become more white

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7
Q

What can aceto-white staining in colposcopy indicate

A

CIN HPV infection Healing tissue Invasive disease.

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8
Q

What does iodine staining in colposcopy indicate?

A

Iodine stains normal tissue brown due to its glycogen content. It fails to stain abnormal squamous epithelium as a consequence of poor glycogenation

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9
Q

What does punctation in colposcopy indicate?

A

CIN (stippled appearance of capillary vessels at an abnormal squamocolumnar junction)

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10
Q

What does mosaicism in colposcopy indicate?

A

CIN = an abnormal vascular feature

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11
Q

In colposcopy the severity of the lesion corrolates with what features

A

the intensity of acetowhite change sharp margins atypical blood vessels.

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12
Q

Treatment of CIN1

A

low malignant potential usually resolves spontaneously encourage smoking cessation if persistent may be treated (excision/ablation)

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13
Q

Treatment of CIN2 / 3

A

higher malignant potential standard treatment is excisional biopsy offer ‘see-and-treat’ treatment

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14
Q

What is Large loop excision of the transformational zone (LLETZ)

A

Removal of the transformational zone using an electrodiathermy loop under local anaesthetic

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15
Q

What is Laser cone colposcopy treatment

A

Removal of the transformational zone using the laser as a ‘knife’ under local anaesthesia

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16
Q

What is Knife cone biopsy colposcopy treatment

A

Requires GA and allows a deep specimen to be taken – can be necessary in cases of glandular CIN (CGIN)

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17
Q

When is hysterectomy indicated for cervical changes / cancer

A

If other gynaecological problems co-exist or if local excision has failed

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18
Q

What is Radical electrodiathermy colposcopy treatment

A

Burning the transformational zone under general anaesthesia

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19
Q

What is Cold coagulation colposcopy treatment

A

Tissue is boiled by applying a probe heated to 100–120°C – performed under local anaesthesia

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20
Q

What is Cryocautery colposcopy treatment

A

Freezing the tissue – performed under local anaesthesia

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21
Q

What is laser colposcopy treatment

A

Vaporising the tissue – local anaesthesia

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22
Q

Follow up after LLETZ

A

6month test of cure. If HR HPV -ve for return to routine recall. If HR HPV +ve for repeat colposcopy

23
Q

management of moderate and severe dyskaryosis when colposcopy appears normal / low grade

A

punch biopsy If CIN 2 / 3 for LLETz If CIN 1 discuss at cytopathology meeting and repeat smear + colposcopy in 6m

24
Q

management of borderline / mild dyskaryosis with +ve HR HPV

A

refer to colposcopy. If normal appearance repeat smear and colp at 12m If low grade changes for punch biopsy

25
Q

Management of an abnormal looking cervix with a normal smear

A

Refer to colposcopy - if normal for routine recall

26
Q

Considerations for colposcopy in pregnancy

A

Defer routine smear screening Colposcopy in pregnancy aims to exclude invasive disease. Should be performed by an experienced colposcopist. Biopsy only to exclude invasive lesions (increased risk of haemorrhage_ Arrange postpartum follow-up (3–4 months postdelivery).

27
Q

What is HPV

A

Human Papillomavirus Double-stranded DNA virus containing eight genes. Infects epithelial cells. Usually transmitted by sexual contact.

28
Q

How many types of HPV

A

more than 100 subtypes of HPV

29
Q

What are low risk HPV

A

HPV 6 and 11, which can cause anogenital warts and respiratory papillomatosis

30
Q

What are high risk HPV

A

high risk – HPV 16 and 18, cause cervical, anogenital + head and neck cancers. responsible for 70% of cervical cancers. Other high risks are 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68. r

31
Q

What % of cervical cancer is HPV related

A

99% of cervical cancers are due to HPV

32
Q

HPV vaccination types

A

Gardasil® – quadrivalent (6, 11, 16 and 18) Used in UK since 2012 Cervarix® – bivalent (16 and 18)

33
Q

Why Is cervical screening not offered below age 25

A

Changes in cervix at this age usually resolve Detection of changes under 25 lead to overtreatment with side-effects.

34
Q

Frequency of cervical screening in UK

A

Three years aged 25 to 49 Five years aged 49 to 64

35
Q

Number of false negative smears

A

10%

36
Q

Sensitivity of the cervical smear screening

A

70%

37
Q

Since smear introduction in 1986 what is the % reduction in incidence of cervical cancer

A

20% fall in mortality 7% per year

38
Q

Categories of smear results

A

Negative (94%) Inadequate (2.2%) Borderline (3.4%) Mild dyskaryosis (1.5%) Moderate dyskaryosis (0 .4%) Severe dyskaryosis (0.6%) Glandular neoplasia (Less than 0.1%)

39
Q

Four steps involved in liquid-based cytology processing

A

Collect sample using brush Rinse sample into vial Cap and label vial and send to lab Gentle dispassion to break up blood, mucus, debris. Draw fluid through filter and collect layer of cellular material for transfer to slide.

40
Q

What percentage of Smears taken are inadequate

A

2.2% in England

41
Q

Natural history of CIN3

A

32% regress 56% persist 12% invasive carcinoma

42
Q

Natural history of CIN2

A

43% regress 35% persist 22% progress 5% invasive carcinoma

43
Q

Natural history of CIN1

A

57% regress 32% persist 11% progress 1% invasive carcinoma

44
Q

Depth of changes in CIN3

A

Entire epithelium

45
Q

Depth of changes in CIN 2

A

Basal two thirds of epithelium

46
Q

Depth of changes in CIN 1

A

Basal third of epithelium

47
Q

Cytological features associated with HPV

A

Koilocytosis (vaculolated cells) Hyperkeratosis Multinucleation

48
Q

Management options for pelvic organ prolapse

A

Conservative, pessaries or surgery

49
Q

Conservative / lifestyle changes for pelvic organ prolapse

A

weight loss pelvic floor training Targeted physiotherapy

50
Q

Surgical options for pelvic organ prolapse

A

Hysterectomy Uterosacral-cervical ligament plication Sacrospinous hysteropexy Posterior vaginal slingplasty with mesh Abdominal sacrohysteropexy Laparoscopic ventrosuspension Laparoscopic uterosacral ligament plication Laparoscopic uterine sling suspension

51
Q

Aims of hysteropexy

A

Restore and reinforce the uterine support by suspending the uterus from the sacral promontary using mesh. And restore vaginal length.

52
Q

Definition of infertility

A

Failure to conceive after regular intercourse for two years in the absence of known reproductive pathology

53
Q

Lifestyle advice for couples wishing to conceive

A

Regular intervals Smoking cessation BMI

54
Q

what does this show?

A

punctation. May be associated with CIN

MFSRH (18 decks)

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