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women's health exam 2 > Cervical and uterine > Flashcards

Cervical and uterine Flashcards

1
Q

What is the transformation zone in the cervix

A
  • lies between exocervix and endocervical canal
  • squamo-columnar junction
  • metaplastic squamous epithelium
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2
Q

HPV 16 has a higher frequency of what type of cervical cancer

A

squamous cell carcinoma

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3
Q

HPV 18 has a higher frequency of what type of cervical cancer

A

adenocarcinoma

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4
Q

list the high risk and low risk strains of HPV

A
  • high risk: 16, 18
  • low risk: 6, 11
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5
Q

risk factors for HPV infection

A

multiple sex partners

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6
Q

What is the best screening test for cervical cancer

A
  • HPV DNA testing
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7
Q

when is screening for cervical cancer initiated

A
  • screen women starting at the age of 21 despite the age of sexual debut
    • ​this recommendation does not apply to high-risk populations (immunocompromised)
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8
Q

what cervical cancer screening is done for women aged 21-29

A
  • cytology performance only q 3 years
  • DO NOT perfomr HPV DNA testing
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9
Q

what cervical cancer screening is done for women aged 30-64

A
  • cytology + HPV DNA testing q 5 years or
  • cytology alone q 3 years
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10
Q

who are the patients at high-risk for developing cervical cancer who need yearly screening

A
  • HIV positive women
  • immunocompromised
  • personal hx of cervical cancer
  • hx of CIN II/III
  • exposure to DES in utero
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11
Q

When performing speculum examination and an abnormal cervical lesion is noted, perform what

A
  • biopsy
    • not a pap smear
      • a pap smear is a screening tool
      • biopsy is diagnostic
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12
Q

follow up for women aged 21-24 who have atypical cells of undetermined significance (ASC-US)

A
  • repeat pap smear in 1 year regardless of HPV result
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13
Q

follow up for women aged 24-64 who have atypical cells of undetermined significance (ASC-US)

A
  • must reflex to HPV DNA
    • negative HPV DNA = normal cytology
      • repeat pap smear/co-testing in 3 years
    • positive HPV DNA -> refer for colposcopy
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14
Q

follow up for women aged 21-24 who have Low-grade squamous intraepithelial lesions (LSIL)

A
  • repeat pap smear in 1 year regardless of HPV result
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15
Q

follow up for women aged 24-64 who have Low-grade squamous intraepithelial lesions (LSIL)

A
  • refer for colposcopy despite HPV result or
  • repeat Pap smear/co-testing in 1 yr if HPV DNA testing is negative
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16
Q

Low-grade squamous intraepithelial lesions (LSIL) are usually consistent with

A
  • Cervical intraepithelial neoplasia I
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17
Q

follow up if “High-grade squamous intraepithelial lesion” (HSIL) is present

A
  • assume HPV DNA is present
  • refer for colposcopy (all ages)
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18
Q

“High-grade squamous intraepithelial lesion” (HSIL) are usually consistent with

A
  • CIN II-III
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19
Q

followup for ages 21-29 with negative cytology, no endocervical cells

A
  • routine screening - repeat Pap in 3 years
  • DO NO perform HPV DNA testing
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20
Q

followup for ages > or = 30 with negative cytology, no endocervical cells

A
  • perform HPV DNA testing
    • negative: repeat pap in 5 years
    • positive:
      • refer for colposcopy if HPV 16/18 or
      • repeat cytology and HPV in 12 months
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21
Q

differenatiate between cervical intraepithelial neoplasia I, II, and III

A
  • I: involves lower third of epithelial lining
  • II: involves lower two-thirds of epithelial lining
  • III: involves more than two-thirds of epithial lining
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22
Q

What are the two types of cervical cancer

A
  • cervical squamous cell cancer
  • cervical adenocarcinoma
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23
Q

which HPV strains are most associated for cervical cancer

A
  • HPV 16, 18
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24
Q

clinical presentation

  • frequently asymptomatic
  • abnormal vaginal bleeding
    • ​most common
  • postcoital bleeding
  • pelvic pain, unilateral with radiation into hip or thigh
  • vaginal discharge
A
  • cervical cancer
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25
Q

uterine fibroids arise from

A

smooth muscle cells within the uterine wall

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26
Q

where are submucosal uterine fibroids located

A
  • lie just beneath the endometrium
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27
Q

where are subserosal uterine fibroids located

A
  • lie just at the serosal surface of the uterus
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28
Q

where are intramural uterine fibroids located

A
  • lie within the uterine wall
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29
Q

clinical presentation

  • abnormal uterine bleeding
  • pain
  • pelvic pressure
  • infertility
  • spontaneous abortion
A

uterine fibroids

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30
Q

MOA of Depot Lupron

A
  • GnRH agonist that will decrease uterine fibroid size
    • not approved for use over 6 months
31
Q

steroidal therapies are indicated for what types of uterine fibroids

A
  • patients with prolonged, heavy menses with no submucosal fibroids
32
Q

what steroidal therapies are used in tx of uterine fibroids

A
  • OCP
  • mirena IUD
  • ortho evra
  • nuva ring
33
Q

MOA of Lysteda

A
  • tranexamic acid
  • oral antifibrinolytic for menorrhagia
  • use only during menstrual cycle
34
Q

Lysteda is indicated for tx of what symptoms/types of uterine fibroids

A
  • indicated for patients with prolonged, heavy menses with no submucosal fibroids
  • used only during menstrual cycle
35
Q

Myomectomy is perfomed on what uterine fibroids

A
  • intramural, subserosal, and pedunculated fibroids
36
Q

function of Myomectomy

A
  • surgical treatment of uterine fibroid that preserves fertility/uterus
37
Q

When is abdominal or Minilaparatomy Myomectomy used

A
  • pts with contraindications to laparoscopy
  • fibroid size does not permit laparoscopic approach
  • prior pelvic or abd radiation therapy
  • severe hip disease
  • inadequate renal or hepatic function
38
Q

hysteroscopy is performed on what type of uterine fibroids? what is its function

A
  • only performed on submucosal fibroids
  • uses a heated loop to resect fibroid; preserves fertility/uterus
39
Q

When is endometrial ablation used in surgical tx of uterine fibroids? what does it preserve?

A
  • tx of menorrhagia
  • preserves utuerus
  • childbearing rare after procedure
40
Q

What does uterine artery embolization preserve

A
  • preserves uterus
    • not fertility
41
Q

contraindications for uterine artery embolization

A
  • numerous and large fibroids
42
Q

What is adenomyosis

A
  • growth of endometrial glands and stroma into uterine myometrium
43
Q

clinical presentation

  • menorrhagia
  • dysmenorrhea
  • pelvic pain
  • h/x of previous uterine surgery
    • c-section
    • prior myomectomy
A

adenomyosis

44
Q

how is adenomyosis diagnosed

A
  • bimanual exam reveals diffuse uterine enlargement
  • definitive daignosis requires histologic examination after hysterectomy
45
Q

medical options for treatment of adenomyosis

A
  • improve dysmenorrhea and menorrhagia
    • OCP
    • mirena IUD
    • nuva ring
46
Q

surgical options for adenomyosis

A
  • hysterectomy: definitive
  • uterine artery emboliziation
  • endometrial ablation
47
Q

define endometriosis

A
  • presence of endometrial glands and stroma outside of teh endometrial cavity and uterine musculature
    • usually in pelvis but can be elsewhere
48
Q

clinical presentation

  • premenstrual pelvic pain
    • pain subsides after menses
  • infertility
  • dysmenorrhea
  • dysparenunia
  • elevated CA-125
A
  • endometriosis
    • lesion growth stimulated by estrogen and progesterone
49
Q

what physical exam findings are consistent with endometriosis

A
  • tenderness at posterior cul-de-sac
  • fixed or retroverted uterus (secondary to adhesions)
50
Q

how is endometriosis diagnosed

A
  • laparoscopy
    • erythematous, petechial lesions on peritoneal surface
    • surrounding peritoneum thickened and scarred
51
Q

most common site of endometriosis

A
  • ovaries
    • “chocholate cysts”
52
Q

treatment of mild endometriosis

A
  • NSAIDS
53
Q

treatment of moderate-severe endometriosis

A
  • goal: interrupt stimulation of endometrial tissue
    • OCP
    • Progestins (depo provera, mirena IUD)
    • Depot lupron
    • Laparoscopy with excision
    • hysterectomy
54
Q

risk factors for endometrial hyperplasia

A
  • obesity
55
Q

what stimulates endometrial hyperplasia

A
  • unopposed estrogen leads to endometrial hyperplasia
    • estrogen stimulates proliferation of endometrium
    • progesterone has antiproliferative effects causing shredding of lining
56
Q

clinical presentation

  • asymptomatic
  • post-menopausal bleeding
  • menorrhagia
  • intermenstrual bleeding
  • prolonged menses (> 7 d)
  • descreased menstrual interval (< 21 d)
  • oligomenorrhea/amenorrhea
A

endometrial hyperplasia

57
Q

how is endometrial hyperplasia diagnosed

A
  • pelvic ultrasound
    • assess endometrial thickness
  • endometrial biopsy
  • D&C hysteroscopy
58
Q

treatment of endometrial hyperplasia without atypia

A
  1. Mirena IUD
  2. provera 10 mg qd for 3-6 months
  3. reassess with endometrial biopsy to ensure resolution
59
Q

treatment of endometrial hyperplasia with atypia

A
  • hysterectomy is treatment of choice
  • progesterone therapy
60
Q

what is the most common gynecologic cancer

A

endometrial cancer

61
Q

risk factor for endometrial cancer

A

obesity

62
Q

primary causative factor of endometrial cancer

A
  • estrogen
    • progression from endometrial hyperplasia
63
Q

endometrial cancer type I

A
  • arise due to unopposed endogenous or exogenous estrogen
64
Q

endometrial cancer type II

A
  • arise independently of estrogen and seen with endometrial atrophy
  • poor prognosis
65
Q

what is the most common type of endometrial cancer

A
  • adenocarcinoma
66
Q

List the four endometrial cancer classifications

A
  1. adenocarcinoma
  2. adenocarcinoma with squamous differentiation
  3. serous carcinoma
  4. clear cell carcinoma
67
Q

which two types of endometrial cancer are not associated with hyperestrogenic state

A
  • serous carcinoma
  • clear cell carcinoma
68
Q

clinical presentation

  • abnormal vaginal bleeding
  • abd cramping
  • back pain
  • weight loss
  • dyspareunia
A

endometrial cancer

69
Q

what screening for endometrial cancer is recommended in women with lynch syndrome (aka HNPCC)

A

Colaris testing

70
Q

what lab value is elevated in 20% of stage I pts with endometrial cancer

A

CA-125

71
Q

treatment of endometrial cancer

A
  • hysterectomy with bilaterally salpingoophorectomy with pelvic and peraortic lymphadenectomy
  • radiation used in pts with contraindications to surgery
  • chemotherapy used infrequently
72
Q

next step for ‘’ unsatisfactory” cytology result in a woman < 30

A

repeat PAP in 2-4 months

73
Q

next step for ‘’ unsatisfactory” cytology result in a woman > 30

A
  • obtain HPV DNA test
    • negative: repeat pap in 2-4 months
    • positive
      • refer for colposcopy or
      • repeat cytology in 2-4 months

women's health exam 2 (3 decks)

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