Cervical D/O

Question 1

Which area of the female reproductive system is sterile?

Answer 1

Uterus/Cervix

Question 2

Before vaginal delivery

Answer 2

nulliparous

Question 3

After vaginal delivery

Answer 3

Multiparous

Question 4

What is the squamocolumnar junction?

Answer 4

Where the columnar cells meets the squamous cells of the cervix

Question 5

Where does cervical cancer happen?

Answer 5

SCJ or in the transformation zone

Question 6

What is it called when the SCJ moves inward over time?

Answer 6

Squamous metaplasia

Question 7

Where do premalignant neoplastic changes occur?

Answer 7

Transformation zone

Question 8

Yellowish translucent raised pearl-like lesions on ectocervix; 1mm-3cm

Answer 8

Nabothian cysts

Question 9

Do you need to treat nabothian cysts?

Answer 9

No, they are benign!

Question 10

Small, pedunculated neoplasms that originate from the endocervix; common in multigravidas over age 20

Answer 10

Cervical polyps

Question 11

How do you treat a cervical polyp?

Answer 11

They are mostly benign but can be easily removed if desired

Question 12

What can cervical polyps cause?

Answer 12

Asymptomatic or intermenstrual/postcoital bleeding and spotting

Question 13

How do you remove a cervical polyp?

Answer 13

Grasp with forceps then twist

Question 14

Causes purulent vaginal discharge, sometimes postcoital bleeding, urethritis symptoms

Answer 14

Acute cervicitis

Question 15

What pathogens can cause acute cervicitis?

Answer 15

Gonorrhea
Chlamydia
Candida
Bacterial vaginosis
Thricomonas (Strawberry cervix)

Question 16

What does acute cervicitis put you at risk for if not treated?

Answer 16

PID

Question 17

Symptoms include leukorrhea, vulvar irritation, postcoital/intermenstrual bleeding, dysmenorrhea, low abd/back pain, dyspareunia

Answer 17

Chronic cervicitis

Question 18

When do you give antibiotics for chronic cervicitis?

Answer 18

ONLY if a pathogen is identified

Question 19

Narrowing of endocervical canal, usually at level of internal os

Answer 19

Cervical stenosis

Question 20

What can cause cervical stenosis?

Answer 20

Congenital
Hypoestrogenic state
Neoplastic
Post-surgical

Question 21

What does LEEP stand for?

Answer 21

loop electrosurgical excision procedure

Question 22

What does cervical stenosis cause?

Answer 22

Partial to full occlusion of the os, obstruction of menstrual flow that can lead to amenorrhea and/or infertility

Question 23

What are the two most common histologic types of cervical cancer?

Answer 23

1. Squamous cell (69%)

2. Adenocarcinoma (25%)

Question 24

What is the 3rd most common GYN cancer diagnosis?

Answer 24

Cervical cancer

Question 25

In developing countries, what is the 2nd most common type of cancer and cause of death among ALL types of cancer in women?

Answer 25

Cervical cancer

Question 26

How much of a decrease has there been in the last 50 years in developed countries for cervical cancer?

Answer 26

75%

Question 27

What are the symptoms of cervical cancer?

Answer 27

Early is frequently asymptomatic Irregular or heavy vaginal bleeding Postcoital bleeding

Question 28

What might you find on PE when you visualize the cervix in a patient with cervical cancer?

Answer 28

Cervix has raised, friable lesions

Question 29

How do you diagnose cervical cancer?

Answer 29

Histologic evaluation of cervical biopsy

Question 30

Where does cervical cancer originate?

Answer 30

At transformation zone (@ SJC or junction between squamous epithelium of ectocervix and glandular epithelium of endocervical canal)

Question 31

What is the management for cervical cancer?

Answer 31

Early-stage: Radial hysterectomy, fertility-sparing surgery, radiation with or without chemotherapy

Question 32

What is the principal method for cervical cancer screening?

Answer 32

Pap smear

Question 33

What does a Pap smear screen for?

Answer 33

Cervical cancer or cervical intraepithelial neoplasia

Question 34

Which strains of HPV are responsible for about 70% of cervical cancer?

Answer 34

16 and 18

Question 35

HPV 16 is associated with higher rates of _____ cancer

Answer 35

Squamous cancers

Question 36

HPV 18 is associated with higher rates of _____ cancer

Answer 36

Adenocarcinoma

Question 37

When should you start/stop pap smears?

Answer 37

21 start 65 stop

Question 38

Do you check a pap smear if a patient is under age 21 if they are sexually active?

Answer 38

NO

Question 39

How often do you do a screening pap in patients 21-29

Answer 39

Every 3 years

Question 40

If a patient doesn't have a cervix, do they need a pap smear?

Answer 40

No