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Women's Health - GYN > Cervical Diseases > Flashcards

Cervical Diseases Flashcards

1
Q

os

A

opening in middle of cervix

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2
Q

Most common site of dysplasia

A

“transformation zone” = squamocolumnar-junction

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3
Q

cervical ectropion

A

large squamocolumnar-junciton; may be normal but get consult

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4
Q

Chadwick’s sign

A

engorgement and bluish tint of cervix, vagina, and labia due to increased blood flow; early sign of pregnancy

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5
Q

How does cervix change during pregnancy?

A

softer on palpation, bigger and elongated, more white secretions

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6
Q

How does cervix change during postmenopause?

A

May have petechiae on surface caused by friction on thin, dry, atrophic epithelium

shallow, thin, friable

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7
Q

Normal postpartum cervix

A

healed lacerations from delivery

“fish mouth” os

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8
Q

Diagnosis of cervicitis in lab and on PE

A

Mucopurulent discharge from cervix
Wet Mount with > 10 WBC’s/HPF
Cervix often friable

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9
Q

Causes of cervicitis

A 
Chlamydia
GC
Herpes
Mycoplasma
Ureaplasma
Other organisms
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10
Q

strawberry cervix =

A

Trichomonas

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11
Q

Treatment of cervicitis

A

Treat STD

If organism unknown, treat empirically with Doxy 100 mg PO BID x 7 days

Treat partner?

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12
Q

Benign fleshy lesions with stalk on cervix

A

polyps

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13
Q

Common symptom of cervical polyps?

A

post-coital and intermenstrual bleeding

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14
Q

Signs that cervical polyps are not benign

A
  • different color than rest of cervix

- angiogenesis (increased blood vessels within)

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15
Q

Common benign cervical lesions and treatment

A 
polyps (none)
Nabothian cysts (none)
Laceration (suturing)
Myomas (excise if large)
Cervical stenosis (dilation)
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16
Q

Asymptomatic retention cyst covering a gland on cervical. Appear white on exam.

A

Nabothian cysts

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17
Q

Lesions caused by delivery that create a “fish mouth” appearance

A

Laceration

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18
Q

Smooth, firm mass on cervix without stalk. Usually asymptomatic and solitary.

A

Myomas

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19
Q

Presentation of cervical stenosis

A

Frequently in post-menopausal women

Occurs at internal os

+/- dysmenorrhea and infertility

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20
Q

Treatment of cervical stenosis

A

dilation

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21
Q

Specific strains of HPV that are associated with invasive cervical cancer?

A

16 and 18

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22
Q

Risk factors for cervical cancer

A 
SMOKING
First coitus < 20 yro
Multiple sex partners
Immunosuppression
African American
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23
Q

_____ is a cofactor necessary, but not sufficient, to develop cervical cancer.

A

HPV

many HPV+ women with never develop cervical cancer; clear infection within 8-24 mon

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24
Q

Why is it so rare for young women to get cervical cancer?

A

younger have stronger immune systems that are likely to clear HPV infection

25
Q

What does HPV vaccine prevent?

A

cervical, vulvar, and vaginal cancers

throat, anal, and penile cancer

precancerous or dysplastic lesions

genital warts

26
Q

What HPV types are included in Gardasil?

A

Types 6, 11, 16, 18

27
Q

What does optimal Pap smear sample include?

A

squamous and columnar epithelium, particularly of transformation zone (TZ)

28
Q

What is “thin prep?”

A

Pap smear sample rinsed in liquid-based cytology vial and sent to lab for staining and fixing on slide

used for dx assessments of HPV, gonorrhea, chlamydia

29
Q

How can Pap smear be used for dx?

A

Pap smear does not diagnose!

use cervical tissue sampling from TZ from Pap smear to dx

30
Q

Who should have a Pap smear? (according to ASCCP guidelines)

A

Begin at 21 yo regardless of onset of sexual activity

31
Q

How often should pap smear be done for average risk women 21 years or older?

A

Annual screening until 3 consecutive pap smears are negative

Then screen every 3 years OR every 5 years with HPV co-testing

32
Q

When can pap smear screening be discontinued?

A

At age 65 if adequate prior screening and not otherwise high risk (3 consecutive neg cytology or 2 consecutive neg HPV w/i 10 years)

Total hysterectomy for benign conditions

33
Q

How often should pap smear be done for high risk women?

A

20 years of annual screening after treatment even if goes past age 65

34
Q

Who are the high risk women for pap smear screening?

A

cervical intraepithelial neoplasia
cervical cancer
HIV+ or immunocomp’d

35
Q

What is next step if abnormal pap smear results?

A

co-test with HPV DNA testing = “Reflex HPV testing”

36
Q

What is the Bethesda Classification System?

A

Classification of pap smear results

Evals likelihood of cells to progress to cancer

37
Q

Describe reported specimen adequacy of Bethesda System.

A

satisfactory # of squamous cells?
endocervical/TZ cells present?
any inflammation or blood?

38
Q

Possible positive findings on pap smear reported by Bethesda System

A

Squamous intraepithelial lesion (SIL): low grade (LSIL) or high grade (HSIL) cervical cancer precursors

Atypical squamous cells: ASC-US or ASC-H

Atypical glandular cells (AGC)

Adenocarcinoma in situ (AIS)

39
Q

What should you do if positive results on pap smear?

A

refer to gynecology for colposcopy

40
Q

What is colposcopy?

A

Primary technique for eval of abnormal pap smears

Acetic acid solution applied to cervix epithelium and then viewed with binocular microscope to magnify abnormalities

Cervical biopsies taken of abnormal tissue

41
Q

How is cervical tissue sample collected for biopsy?

A

directed biopsy and endocervical curettage (D&C)

42
Q

When does colposcopy indicate need for excision?

A

CIN II or III (moderate to severe dysplasia)

43
Q

Procedures to treat cervical dysplasia and cancer

A

Ablation: cryotherapy or laser
Excision: LEEP (electrosurgical loop), laser conization, or cold-knife conization

44
Q

When is hysterectomy not appropriate for cervical cancer treatment?

A

NEVER use as 1st line treatment for CIN-1

Not used as 1st line for CIN-2 or 3 except in special circumstances

45
Q

Management of atypical squamous cells ASCUS (undetermined significance)

A

Usually a self-limited disease

Women age 21-24:
Consider HPV testing (if negative continue routine screening)
If positive or unknown, repeat Pap smear every 12 months for 2 years
Any increase refer!

Women 25 and older:
If HPV positive, refer for colposcopy

Postmenopausal and immunosuppressed:
refer for colposcopy

Pregnant women:
managed as if non-pregnant

46
Q

Management of atypical squamous cells ASC-H

A

Refer for colposcopy

47
Q

If ASC-H results on pap smear, ______ cannot be excluded.

A

HSIL

48
Q

Management of atypical glandular cells (AGC)

A

Refer for colposcopy

49
Q

What is the only difference in management of LSIL and ASC-US?

A

Pregnant women with LSIL always needs colposcopy

ASC-US only if over 25 yo and positive HPV

50
Q

Management of high-grade squamous intraepithelial (HSIL)

A

Refer for colposcopy

No endocervical curettage in pregnant woman

51
Q

What is method of inserting speculum on pelvic exam?

A

insert with blades oblique, then dive down and turn

52
Q

Why would you not see cervix os on pelvic exam?

A

speculum on top of it or not inserted far enough

53
Q

How is the bimanual exam of pelvis performed?

A

insert 2nd and 3rd digits of one hand and use opposite hand to palpate abdomen on suprapubic region

Examine uterus - note cervical position

Examine adnexa - assess ovaries, fallopian tubes, and support structures

54
Q

What is uterine prolapse?

A

uterus drops into vaginal canal due to weakened supporting structures (elderly, women with multiple children)

55
Q

What is cystocele?

A

bladder prolapse; bladder falls into vaginal canal due to weakened structure

56
Q

What is rectocele?

A

rectal prolapse; vaginal bulge from front wall of rectum pushing into back wall of vagina

57
Q

How to chart normal pelvic exam?

A

external genitalia without erythema/edema/lesion
no discharge noted from vagina/urethra
Cervix smooth without erythema/lesion
NTTP without CMT
Uterus/adnexa without mass/nodule and NTTP

58
Q

What is rectrovaginal exam? When is it indicated?

A

insert one finger in vagina and one in rectum

suspicion of post pelvic mass or eval of chronic pelvic pain

Women's Health - GYN (12 decks)

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