Benign & Neoplastic Cervical & Uterine Abnormalities

Question 1

pt. p/w:

a. Translucent or yellow cyst
b. Millimeters to 3 cm
c. Usually asxs

Found on speculum exam

Answer 1

nabothian cysts

Question 2

Tx for nabothian cysts…

Answer 2

nothing

Question 3

pt. p/w:

a. < 3cm polyp
b. Post-coital bleeding
c. AUB

Found on speculum exam

Answer 3

Cervical Polyps

Question 4

tx for cervical polyps

Answer 4

polypectomy if sxs

Question 5

The region of cervix composed of squamous exocervix and columnar endocervical epithelium…

Answer 5

transformation zone

Question 6

An adequate pap smear requires a sample from what cells of the cervix?

Answer 6

endocervical

Question 7

Where does HPV enter?

Answer 7

breaks in the transformation zone

Question 8

Type 16 HPV is associated with _____

Type 18 HPV is associated with _______

Answer 8

16 = SCC

18 = adenocarcinoma (columnar)

Question 9

the below are RFs for…

a. Multiple sexual partners
b. Early sexual activity
c. Hx of STI
d. Smoking/Immunosuppression
e. Long-term COC use
f. Multiparity

Answer 9

HPV

Question 10

Gardasil protects against the ____ MC types of HPV

Answer 10

9

Question 11

when performing HPV testing, it is important to differentiate between what two courses?

Answer 11

transient and persistent

Question 12

2 positive HPV tests indicates a _____% chance of CIN II/III w/in 3 years

Answer 12

21%

Question 13

When should Cervical CA screening be initiated despite onset of sexual activity?

Answer 13

21

Question 14

the below describes the cervical CA screening regiment for what population??

a. HPV screen after initiation of intercourse
b. COC counseling
c. Gardasil
d. STI screen

Answer 14

adolescents

Question 15

Do adolescents get a routine pap smear?

Answer 15

e. No pap unless high risk

Question 16

nearly half of HPV cases occur in what age range?

Answer 16

15-24

Question 17

any women up to the age of ___ should be vaccinated with gardisil

Answer 17

45 yo

Question 18

Two components of a pap smear…

Answer 18

cytology (check for abnormal cells)

HPV DNA testing (age dependent)

Question 19

Pap smear is performed as a screen for…

Answer 19

cervical CA

Question 20

Why perform dual pap and HPV testing?

Answer 20

increased sensitivity (86.9%)

Question 21

Does screening prior to 21 yo reduce rate of cervical CA?

Answer 21

no

Question 22

Why no HPV testing in adolescent population?

Answer 22

they clear HPV quickly (no time for neoplastic change)

Question 23

Do adolescents need a pelvic exam/pap smear for routine screening?

Answer 23

no

Question 24

How should STI screen be conducted in adolescent population?

Answer 24

urine screen

Question 25

Women 21-29 screening proptocol

Answer 25

pap smear only q 3 years

Question 26

Women 30-64 screening protocol...

Answer 26

pap smear + HPV q 5 years

Question 27

HIV+ screening protocol

Answer 27

at time of dx q 6 mo x 1 year then q yearly

Question 28

the below should receive pap smears at what frequency? imunocompromised hx of cervical CA CIN II/III Hx DES exposure

Answer 28

yearly

Question 29

If the below characteristics are present, when can cervical CA screening stop? 3 negative cytology alone 2 negative combo testing occurred w/in 5 years no CIN 2+ w/in 20 years

Answer 29

65 yo

Question 30

If a women over 65 reports a new sexual partner, does screening resume?

Answer 30

no

Question 31

If hysterectomy with cervix removal, what two factors allow for cessation of cervical CA screening?

Answer 31

performed for benign dz no CIN 2+ w/in 20 years

Question 32

If on speculum exam you see a cervical lesion, what do you do?

Answer 32

No pap smear Bx

Question 33

What type of abnormal pap smear? Can be HPV neg if: - c. trachomatis - HSV - vulvovaginal atrophy

Answer 33

ASCUS

Question 34

What type of abnormal pap smear? CIN I lesions Enlarged, hyperchromatic nuclei abundant cytoplasm

Answer 34

LSIL

Question 35

Why no HPV result with HSIL pap smear?

Answer 35

assume HPV presence

Question 36

What What type of abnormal pap smear? CIN II-III, AIS lesion Enlarged, hyprechromatic nuclei little/no cytoplasm

Answer 36

HSIL

Question 37

(+) ASCUS or LSIL protocol if Age 21-24

Answer 37

repeat in 1 year

Question 38

(+) HSIL protocol

Answer 38

colposcopy

Question 39

What grade CIN? a. Regression w. in 12 mo b. Lower 1/3 of epithelial lining

Answer 39

CIN I

Question 40

What grade CIN? a. 43% of lesions regress, 35% persist, 22% progress b. Lower 2/3 of epithelial lining

Answer 40

CIN II

Question 41

What grade CIN? a. 32% regress, 56% persist, 14% progress b. > 2/3 epithelial lining

Answer 41

CIN III

Question 42

What indicates a satisfactory colposcopy?

Answer 42

visualization of CTZ

Question 43

Abnormal pap smear indicates what test?

Answer 43

colposcopy

Question 44

If unsatisfactory colposcopy, what is performed?

Answer 44

endocervical curettage (ECC)

Question 45

When wouldn't you want to perform LEEP for abdnormal cervical lesions? (3)

Answer 45

invasion suspected gland abnormality pregnant

Question 46

LEEP has a ___% cure rate

Answer 46

90-95

Question 47

Tx of choice for abnormal cervical lesion...

Answer 47

LEEP

Question 48

LEEP recovery takes ___ weeks

Answer 48

4

Question 49

Cervical CA is the _____ MC GYN CA in the US

Answer 49

3rd

Question 50

Which type of cervical CA? MC prevalence falling 3mm or less = micro 3+ mm or visible lesion = invasive

Answer 50

SCC

Question 51

What type of cervical CA? prevalence rising Types: endocervical, endometriod, clear cell, adenoid cystic

Answer 51

cervical adenocarcinoma

Question 52

Pt. p/w: a. Abnormal vaginal bleeding b. Pelvic pain + radiation to thigh = advanced disease c. vaginal d/c

Answer 52

cervical CA

Question 53

cervical CA is the only GYN CA that is _____ staged

Answer 53

clinically staged (rest are surgically staged)

Question 54

To stage cervical CA, you must examine what other 3 tissues?

Answer 54

bladder, uterus, rectum

Question 55

What imaging is indicated for cervical CA staging?

Answer 55

CXR/CT for thoracic involvement MRI for extension

Question 56

Pt. p/w: a. AUB, Pain, Pelvic Pressure, Infertility b. Spontaneous abortion

Answer 56

uterine fibroids

Question 57

AUB is indicative of which kind of uterine fibroid?

Answer 57

submucosal

Question 58

What imaging modality is helpful in visualization of size and location of submucosal uterine fibroids?

Answer 58

saline-infused sonohystogram

Question 59

Depot Lupron does what to uterine fibroids?

Answer 59

decrease size, improve anemia

Question 60

steroidal or lysteda treatments for fibroids don't work for which type?

Answer 60

submucosal fibroids

Question 61

Which uterine fibroid surgery? i. Preserves fertility ii. Intramural, subserosal, pedunculated fibroids iii. must have c-section after surg.

Answer 61

myomectomy

Question 62

Which uterine fibroid surgery? i. Preserves fertility ii. Only on submucosal iii. outpatient

Answer 62

hysteroscopy

Question 63

Which uterine fibroid surgery? i. Must continue contraceptive ii. But no future childbearing/doesn't preserve fertility iii. preserves uterus iv. outpatient

Answer 63

endometrial ablation

Question 64

Which uterine fibroid therapy? i. preserves uterus, not fertility ii. cuts blood supply to fibroid iii. C/I numerous, large fibroids iv. hospitalization

Answer 64

Uterine artery embolization

Question 65

Pt. presents with: a. Menorrhagia b. Dysmenorrhea c. Pelvic pain d. Hx of uterine surgery

Answer 65

adenomyosis

Question 66

Definitive tx and dx for adenomyosis

Answer 66

hysterectomy

Question 67

symptomatic tx for adenomyosis...

Answer 67

contraceptives

Question 68

Pt. p/w: a. Premenstrual pelvic pain that subsides after menses b. infertility c. dysmenorrhea/dyspareunia

Answer 68

endometriosis

Question 69

only way to Dx endometriosis...

Answer 69

laparascopy | ovaries, chocolate cysts

Question 70

Tx of mild endometriosis

Answer 70

nsaids

Question 71

tx for mod-severe endometriosis

Answer 71

OCPs

Question 72

major RF for endometrial hyperplasia...

Answer 72

obesity

Question 73

MC sxs of endometrial hyperplasia... (2)

Answer 73

oligomenorrhea | post-menopausal bleed

Question 74

workup for endometrial hyperplasia

Answer 74

pelvic exam pelvic exam endometrial bx

Question 75

endometrial thickness < 4mm... is that concerning?

Answer 75

no

Question 76

When would you do D&C hysteroscopy for endometrial hyperplasia?

Answer 76

inconclusive EMB

Question 77

Tx for endometrial hyperplasia w/o atypia... (3)

Answer 77

i. Mirena IUD ii. Provera iii. Reassess w. EMB

Question 78

Tx for endometrial hyperplasia w/ atypia

Answer 78

1. Hysterectomy 2. Progesterone therapy (high risk endometrial CA

Question 79

Which type of endometrial CA? i. Favorable prognosis, well differentiated tumors ii. Adenocarcinoma: MC iii. unopposed estrogen

Answer 79

Type I

Question 80

Which type of endometrial CA? a. Rare, not associated w. estrogen b. Poor prognosis c. poorly differentiated

Answer 80

Serous carcinoma

Question 81

Which type of endometrial CA? a. Rare, not associated w. estrogen b. Poor prognosis c. poorly differentiated d. aggressive/high grade

Answer 81

clear cell carcinoma

Question 82

MC sxs of endometrial CA (2)

Answer 82

post-menopausal bleed | AUB

Question 83

Tx of endometrial CA...

Answer 83

a. Hysterectomy + bilateral salpingoophorectomy w. pelvic and periaortic lymphadenectomy

Question 84

MC GYN CA?

Answer 84

endometrial CA