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Women's Health > Benign & Neoplastic Cervical & Uterine Abnormalities > Flashcards

Benign & Neoplastic Cervical & Uterine Abnormalities Flashcards

1
Q

pt. p/w:

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

Found on speculum exam

A

nabothian cysts

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2
Q

Tx for nabothian cysts…

A

nothing

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3
Q

pt. p/w:

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

Found on speculum exam

A

Cervical Polyps

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4
Q

tx for cervical polyps

A

polypectomy if sxs

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5
Q

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

A

transformation zone

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6
Q

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

A

endocervical

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7
Q

Where does HPV enter?

A

breaks in the transformation zone

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8
Q

Type 16 HPV is associated with _____

Type 18 HPV is associated with _______

A

16 = SCC

18 = adenocarcinoma (columnar)

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9
Q

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

A

HPV

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10
Q

Gardasil protects against the ____ MC types of HPV

A

9

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11
Q

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

A

transient and persistent

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12
Q

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

A

21%

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13
Q

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

A

21

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14
Q

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

A

adolescents

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15
Q

Do adolescents get a routine pap smear?

A

e. No pap unless high risk

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16
Q

nearly half of HPV cases occur in what age range?

A

15-24

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17
Q

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

A

45 yo

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18
Q

Two components of a pap smear…

A

cytology (check for abnormal cells)

HPV DNA testing (age dependent)

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19
Q

Pap smear is performed as a screen for…

A

cervical CA

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20
Q

Why perform dual pap and HPV testing?

A

increased sensitivity (86.9%)

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21
Q

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

A

no

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22
Q

Why no HPV testing in adolescent population?

A

they clear HPV quickly (no time for neoplastic change)

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23
Q

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

A

no

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24
Q

How should STI screen be conducted in adolescent population?

A

urine screen

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25
Q

Women 21-29 screening proptocol

A

pap smear only q 3 years

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26
Q

Women 30-64 screening protocol…

A

pap smear + HPV q 5 years

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27
Q

HIV+ screening protocol

A

at time of dx

q 6 mo x 1 year then q yearly

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28
Q

the below should receive pap smears at what frequency?

imunocompromised
hx of cervical CA
CIN II/III Hx
DES exposure

A

yearly

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29
Q

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

A

65 yo

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30
Q

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

A

no

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31
Q

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

A

performed for benign dz

no CIN 2+ w/in 20 years

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32
Q

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

A

No pap smear

Bx

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33
Q

What type of abnormal pap smear?

Can be HPV neg if:

  • c. trachomatis
  • HSV
  • vulvovaginal atrophy
A

ASCUS

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34
Q

What type of abnormal pap smear?

CIN I lesions

Enlarged, hyperchromatic nuclei

abundant cytoplasm

35
Q

Why no HPV result with HSIL pap smear?

A

assume HPV presence

36
Q

What What type of abnormal pap smear?

CIN II-III, AIS lesion

Enlarged, hyprechromatic nuclei

little/no cytoplasm

37
Q

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

A

repeat in 1 year

38
Q

(+) HSIL protocol

A

colposcopy

39
Q

What grade CIN?

a. Regression w. in 12 mo
b. Lower 1/3 of epithelial lining

40
Q

What grade CIN?

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

41
Q

What grade CIN?

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

42
Q

What indicates a satisfactory colposcopy?

A

visualization of CTZ

43
Q

Abnormal pap smear indicates what test?

A

colposcopy

44
Q

If unsatisfactory colposcopy, what is performed?

A

endocervical curettage (ECC)

45
Q

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

A

invasion suspected
gland abnormality
pregnant

46
Q

LEEP has a ___% cure rate

47
Q

Tx of choice for abnormal cervical lesion…

48
Q

LEEP recovery takes ___ weeks

49
Q

Cervical CA is the _____ MC GYN CA in the US

50
Q

Which type of cervical CA?

MC
prevalence falling

3mm or less = micro

3+ mm or visible lesion = invasive

51
Q

What type of cervical CA?

prevalence rising

Types: endocervical, endometriod, clear cell, adenoid cystic

A

cervical adenocarcinoma

52
Q

Pt. p/w:

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

A

cervical CA

53
Q

cervical CA is the only GYN CA that is _____ staged

A

clinically staged (rest are surgically staged)

54
Q

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

A

bladder, uterus, rectum

55
Q

What imaging is indicated for cervical CA staging?

A

CXR/CT for thoracic involvement

MRI for extension

56
Q

Pt. p/w:

a. AUB, Pain, Pelvic Pressure, Infertility
b. Spontaneous abortion

A

uterine fibroids

57
Q

AUB is indicative of which kind of uterine fibroid?

A

submucosal

58
Q

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

A

saline-infused sonohystogram

59
Q

Depot Lupron does what to uterine fibroids?

A

decrease size, improve anemia

60
Q

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

A

submucosal fibroids

61
Q

Which uterine fibroid surgery?

i. Preserves fertility
ii. Intramural, subserosal, pedunculated fibroids
iii. must have c-section after surg.

A

myomectomy

62
Q

Which uterine fibroid surgery?

i. Preserves fertility
ii. Only on submucosal
iii. outpatient

A

hysteroscopy

63
Q

Which uterine fibroid surgery?

i. Must continue contraceptive
ii. But no future childbearing/doesn’t preserve fertility
iii. preserves uterus
iv. outpatient

A

endometrial ablation

64
Q

Which uterine fibroid therapy?

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

A

Uterine artery embolization

65
Q

Pt. presents with:

a. Menorrhagia
b. Dysmenorrhea
c. Pelvic pain
d. Hx of uterine surgery

A

adenomyosis

66
Q

Definitive tx and dx for adenomyosis

A

hysterectomy

67
Q

symptomatic tx for adenomyosis…

A

contraceptives

68
Q

Pt. p/w:

a. Premenstrual pelvic pain that subsides after menses

b. infertility
c. dysmenorrhea/dyspareunia

A

endometriosis

69
Q

only way to Dx endometriosis…

A

laparascopy

ovaries, chocolate cysts

70
Q

Tx of mild endometriosis

71
Q

tx for mod-severe endometriosis

72
Q

major RF for endometrial hyperplasia…

73
Q

MC sxs of endometrial hyperplasia… (2)

A

oligomenorrhea

post-menopausal bleed

74
Q

workup for endometrial hyperplasia

A

pelvic exam
pelvic exam
endometrial bx

75
Q

endometrial thickness < 4mm… is that concerning?

76
Q

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

A

inconclusive EMB

77
Q

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

A

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

78
Q

Tx for endometrial hyperplasia w/ atypia

A
  1. Hysterectomy
  2. Progesterone therapy
    (high risk endometrial CA
79
Q

Which type of endometrial CA?

i. Favorable prognosis, well differentiated tumors
ii. Adenocarcinoma: MC
iii. unopposed estrogen

80
Q

Which type of endometrial CA?

a. Rare, not associated w. estrogen
b. Poor prognosis
c. poorly differentiated

A

Serous carcinoma

81
Q

Which type of endometrial CA?

a. Rare, not associated w. estrogen
b. Poor prognosis
c. poorly differentiated
d. aggressive/high grade

A

clear cell carcinoma

82
Q

MC sxs of endometrial CA (2)

A

post-menopausal bleed

AUB

83
Q

Tx of endometrial CA…

A

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

84
Q

MC GYN CA?

A

endometrial CA

Women's Health (10 decks)

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