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Womens Health Exam 1 > Cervical disorder > Flashcards

Cervical disorder Flashcards

1
Q

What is the transformation zone of the cervix?

A

The area where the cells of the vagina (squamous cells) and the cells of the uterus (columnar or glandular cells) meet. Also called the squamocolumnar junction

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2
Q

Cervical changes premenarchal

A

Columnar cells (blue) are within the
endocervix, while the ectocervix and vagina are completely lined with
squamous epithelium (yellow). The SCJ lies close to the external os.

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3
Q

Cervical changes post menarche

A

The SCJ is generally found on the ectocervix post menarche, with
increased eversion during pregnancy

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4
Q

Cervical changes post menopause

A

The SCJ is often found within
the endocervical canal post
menopause

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5
Q

Etiology of cervicitis

A

Most common causes are Herpes
simplex virus, Chlamydia,
Gonorrhea, HPV, Trichomonas (70%
asymptomatic), Cytomegalovirus,
and Bacterial vaginosis
Should also evaluate for syphilis,
hep B, HIV, and HPV as needed

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6
Q

Risk factors for Cervicitis

A

Women age 19 – 25y
Multiple sexual partners
Unprotected intercourse (no
condom use)
High risk sexual partner
Infected sexual partner
Hx of STIs
Current/prior drug use

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7
Q

Cervicitis clinical features

A

Often asymptomatic
Change in vaginal discharge: Thick, runny, colored, malodorous
Post-coital bleeding**
Vulvar burning/itching
Dysuria, urgency, ↑ Urination
Cervical friability
Lower abdominal pain
Dysmenorrhea
Cervical motion tenderness (chandelier sign)

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8
Q

Diagnosis of cervicitis

A

Take detailed social sexual history
Physical
Wet mount
pH
Pap smear
Nucleic acid amplification testing (CT, GC,
Trich)

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9
Q

complications of cervicitis

A

Cervical hemorrhage, Leukorrhea, Cervical
Stenosis, Salpingitis (inflammation of the
fallopian tubes), PID, infertility, ectopic
pregnancy, and chronic pelvic pain

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10
Q

Etiology of PID

A

PID encompasses a spectrum of
inflammatory disorders of the upper
female genital tract

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11
Q

Risk factors of Cervicitis

A

Undiagnosed infection
Multiple sexual partners
Inconsistent condom use
High risk partner
Partner with hx of infection
Can be from IUD as well, from
introducing bacteria into the area.

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12
Q

DDx for PID

A

Ectopic Pregnancy***
Endometritis
Salpingitis
Tubo-ovarian abscess
Pelvis peritonitis
STIs

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13
Q

Clinical Features of PID

A

Pelvic pain
Cervical motion tenderness
Cervical discharge of unknown cause
Cervical friability
Oral temperature >101*F
Abundant WBCs on wet mount
Elevated C-reactive protein
Elevated erythrocyte sedimentation
rate

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14
Q

Diagnosis of PID

A

Standard is Laparoscopy
Supported by ESR, CRP, CT/NG, Bx of endometrium,
US, CT, MRI, etc.
Difficult to diagnose due to wide variety of
symptoms and presentations

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15
Q

Treatment of PID

A

Typical Management (outpatient):
Ceftriaxone 150mg IM
PLUS Doxycycline 100mg PO BID x 14d
With or without Metronidazole 500mg PO BID x 14d
Abstain from intercourse during treatment to prevent transmission

Presumptive treatment should be initiated in sexually active women if they are experiencing pelvic/lower abdominal pain with no other identifiable etiology

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16
Q

Complications of PID

A

Yeast infection (Tx)
GI upset (Tx)
Adherence to medication
Fertility issues**
Ectopic pregnancies (scarring)**
Chronic pelvic pain**
Male partners within 60 days of PID diagnosis need presumptive treatment for CT and GC regardless of etiology of PID

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17
Q

Atypical squamous cells of
undetermined significance

A

ASC-US

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18
Q

Atypical squamous cells in which high-
grade lesions cannot be excluded

A

ASC-H

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19
Q

Low-grade squamous intraepithelial
lesion
Cellular changes consistent with CIN I

A

LSIL:

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20
Q

High-grade squamous intraepithelial
lesion
Includes cellular changes consistent with
CIN II and CIN III

A

HSIL

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21
Q

Disordered grown of the lower third of
the epithelial lining

A

CIN I

22
Q

Abnormal maturation of the lower 2/3
of the lining.

A

CIN II

23
Q

Involves more than 2/3 of the
epithelial thickness

A

CIN III

24
Q

Involves the full thickness
of the epithelium - covered in a later unit

A

Cancer in Situ (CIS):

25
Q

Cervical Dysplasia etiology

A

Cigarette smoking
Human Papilloma Virus (HPV)
infection
HPV is found in more than
80% of CIN lesions

26
Q

Risk factors of cervical dysplasia

A

Multiple sexual partners
HPV infection
Genital neoplasia
HIV or AIDS
Hx of Immunosuppression
Multiparous
Long term oral contraceptive pill
user
High-risk sexual partners
HPV infection (more to come)
Hx of a partner with HPV
infection
Lower genital neoplasia
Hx of exposure to cervical
neoplasia

27
Q

There are ____ types of HPV, of which ____
strains infect ano-genital tissue

A

130; 30-40

28
Q

HPV prevention

A

➢ Condom usage is 60% effective but
does not protect from labial-scrotal
transmission
➢ Gardasil, Gardasil-9, and Cervarix
■ NEW 2 doses 9-14 yo
■ 3 doses 15-26yo

29
Q

HPV transmission

A

Contagious spread through sexual contact

30
Q

HPV wart appearance

A

Usually flat, papular or pedunculated growths on genital mucosa
- Resemble a cauliflower texture
- Often located in multiple locations
- Diagnosed by visual inspection

31
Q

Will HPV warts resolve on their own?

A

No

32
Q

How to treat HPV warts

A

85% Tri-chloric acid or freezing
Imiquimod 5% (aldara) placed on the wart for 8-10 hrs, 3x weekly for several weeks/months

33
Q

Cervical dysplasia Ddx

A

Cervicitis
Pelvic Inflammatory Disease
Vaginitis
Trichomoniasis
Herpes Lesion
Abnormal cells on pap from
surrounding tissue, not from cervix

34
Q

Clinical Features of cervical dysplasia

A

Often asymptomatic
Visible cervical lesion
Friable cervix
Bleeds easily
Post-coital bleeding

35
Q

Evaluation/screening of cervical dysplasia

A

PAP initial
Obtain cervical cytology or biopsy
Check for vaginal infections

36
Q

USPSTF recommendation grading for pap smears in women ages 21-65

A

A

37
Q

Cervical Dysplasia diagnosis

A

Cervical cytology (pap smear)
Cervical biopsy

38
Q

Management of Cervical dysplasia

A
  • CIN I spontaneously regresses in
    a large number of patients, therefore multiple paps over time is typical first line
    management
  • More severe dysplasia can also regress (not as frequently)
  • All patients with CIN II and CIN
    III need treatment
  • Excisional Tx preferred for this group (histologic HSIL)
  • Treatment for pregnant women should be done postpartum
39
Q

Cervical Dysplasia complications

A

If HPV infection is not cleared it
takes approx. 3-5 years for
development of CIN II or CIN III
It takes an additional 10-20
years to progress to cervical
cancer
30-40% of CIN III
progresses to cancer

40
Q

_____% of CIN III
progresses to cancer

A

30-40

41
Q

Colposcopy

A

A Colposcopy allows for evaluation of an abnormal pap
smear
The colposcope uses magnification(5-15x) and light, in
combination with aqueous acetic acid, and sometimes
iodine to allow abnormal cells to be seen more easily
punch biopsies are obtained as needed for further
pathologic analysis

42
Q

Advantages and disadvantages of a colposcopy

A

Advantages
Inexpensive
Relatively quick (approx. 10-20 min)
Can be done in the office
Low risk of infection

Disadvantages:
Discomfort
Possible infection

43
Q

Cryosurgery

A

compressed nitrogen gas flows through a cryo probe making the metal cold enough to freeze and destroy the abnormal cervical tissue

44
Q

Advantages and disadvantages to cryosurgery

A

Advantages:
Inexpensive
Easy to do
Widespread availability
Minimally invasive
Can be done in the office
Does not require anesthesia
Low complication rate

Disadvantages:
Can be difficult to cover the entire lesion
Mild uterine cramping
Copious watery vaginal discharge for several weeks
Possible infection and cervical stenosis (Rare)
not good for more extensive forms of CIN

45
Q

Loop Electrosurgical Excision Procedure
(LEEP)

A

LEEP uses a small, fine, wire loop that excises tissue with the assistance of an electrosurgical generator
Varying loop sizes are available
Usually take a second thin layer off for histologic evaluation (called a “top hat”)

46
Q

Advantages and disadvantages of LEEP procedure

A

Advantages:
Easy
Low cost
Fewer complications than Cold Knife Conization
Allows for additional tissue samples for histology

Disadvantages:
Requires local anesthesia
Requires an insulated speculum to prevent
electrical conduction
Requires a grounding pad
Requires a vacuum to remove smoke PRN
Bleeding
Possible Infection
Cervical Stenosis

47
Q

Which types of HPV cause genital warts?

A

Types 6, 11, 42, 43, and 44 cause warts and low grade lesions

48
Q

Cold Knife Conization

A

Excision of a cone-shaped section of the cervix with a scalpel
Done under local or general anesthesia

49
Q

Advantages and disadvantages of cold knife conization

A

Advantages:
- Can be individualized to accommodate cervical anatomy, as well as the lesion size and shape
- Histologic specimens are devoid of thermal damage (Found with Cryo and LEEP)

Disadvantages:
Done in the operating room ($$$)
Bleeding
Infection
Cervical stenosis
Cervical insufficiency
Higher complication rate

50
Q

Cervical cancer is most prevalent in women over _____

A

40

Womens Health Exam 1 (7 decks)

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