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Gen Med: Ob/gyn > Cervical Disorders > Flashcards

Cervical Disorders Flashcards

1
Q

What are the general characteristics of cervical dysplasia and neoplasia?

A
  1. Human papilloma virus (HPV) types 16,18,31, 33 & 45 linked to cervical CA
  2. HPV types 6 & 11 linked to condyloma acuminata
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2
Q

What are the rf for cerival dysplasia and neoplasia?

A
  1. Early age for 1st intercourse
  2. Early childbearing
  3. Multiple sex partners
  4. High risk sex partner
  5. Hx STD’s
  6. Low socioeconomic status
  7. African-American
  8. Cigarette smoking
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3
Q

What is the pathophys for cerival dysplasia and neoplasia?

A
  1. Atypical changes at transformation zone of cervix initiate cervical intraepithelial neoplasia (CIN)
    A. Pre-invasive phase of cervical CA
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4
Q

What is mild cervical dysplasia?

A
  1. Mild dysplasia (CIN I)
  2. May progress to moderate dysplasia (CIN II), severe dysplasia (CIN III) & carcinoma in situ (CIS)
  3. May stay the same
  4. May regress
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5
Q

What is the prognosis for pts with CIN III?

A
  1. 1/3 of pts w/CIN III develop invasive CA

2. Mean age for cervical CA Dx = 47 yrs

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6
Q

What sxs for cervical dysplasia and neoplasia?

A
  1. Most pts w/abnormal Pap smears are asymptomatic
  2. May see cervical erosion, ulceration, mass
  3. Advanced or invasive cervical CA:
    A. +/- Abnormal vaginal bleeding
    B. +/- Vaginal discharge
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7
Q

How is cervical dysplasia and neoplasia?

A
  1. Thin Prep Pap smear

2. HPV DNA testing is standard

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8
Q

What are the US Preventative Task Force guidelines for PAP smears?

A
  1. 21-65: Pap smear q 3 yrs
    OR
  2. 30-65 yrs: Pap Smear & HPV testing q 5 yrs
  3. > 65yrs D/C screening
  4. S/P TAHBSO for non-dysplasia -> D/C screening
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9
Q

What are the American COllege of Gynecology guidelines for PAP smears?

A
  1. 21-30 yrs, Pap smear q 2 yrs
  2. ≥ 30 yrs w/3 (-) Pap smears -> Pap q 3 yrs
  3. > 65 yrs w/3 consecutive (-) Paps -> D/C screening
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10
Q

When is a colposcopy recommended after a PAP smear?

A

If HPV DNA (+) (16,18,31,33, 45), refer for colposcopy

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11
Q

How is cervical dysplasia and neoplasia treated?

A
  1. Based on classification of Dz
  2. Mild lesions may resolve spontaneously
  3. Pre-invasive lesions:
    A. CryoTx
    B. LEEP
    C. Conization
  4. Hysterectomy reserved for more severe abnormalities
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12
Q

What is a colposcopy?

A
  1. 13.5x mag of cervix, vagina, vulva, anal epithelium
  2. Reveals columnar-squamous “transformation zone” (TZ) at the juncture of the ectocervix & endocervix
  3. Cervical Bx obtained
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13
Q

Define LEEP. What is it used for?

A
  1. Loop Electrosurgical Excision Procedure
  2. Used for vulvar & cervical lesions
  3. Low-voltage, high-freq alternating current wire loop cautery
  4. Done if intraepithelial lesion is confined to ectocervix
    A. CIN II & CIN III
  5. If lesion extends into endocervical canal, deeper LEEP or cone Bx done
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14
Q

What is cervical conization?

A
  1. Scalpel (“cold-knife conization”)

2. Excision of a cone-shaped portion of cervix surrounding the endocervical canal, including entire transformation zone

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15
Q

How can cervical dysplasia and neoplasia be prevented?

A 
1. Gardasil vaccine:
A. Recommended for all females (males) ages 11-26 yrs
B. Three injections over 6 months
C. Prevents 4 types (6,11,16,18) of HPV
2. Condoms decrease incidence
3. Recommend D/C tobacco
4. Recommend regular GYN care
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16
Q

What is early stage cervical cancer?

A
  1. Stage IA2 to IIA2
  2. Cancer is confined to the cervix in stage I, and substages define how large the lesion is
  3. Cancer has spread to uterus, vagina or paracerical region in stage II
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17
Q

How is early stage cervical cancer treated?

A
  1. Radical hysterectomy & pelvic lymph node dissection
  2. Post-op radiation Tx w/ or w/o chemoTx
  3. 1° radiation Tx w/chemoTx
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18
Q

What is stage III cervical cancer?

A

Extension into pelvic side wall or lower third of the vagina

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19
Q

What is stage IV cervical cancer?

A

Extension to other organs or beyond true pevis

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20
Q

How is cervical cancer stage IIB to IVA treated?

A

1° radiation w/chemoTx

21
Q

How is cervical cancer stage IVB and persistnet or recurrent dz treated?

A
  1. ChemoTx is palliative & not curative
  2. Supportive
  3. Personal and family support
22
Q

Define incompetent cervix

A

An abnormally weak cervix & can gradually widen during pregnancy

23
Q

What complications can arise from an incompetent cervix?

A

Left untreated, can result in spont. AB or premature delivery

24
Q

What is the etiology of incompetent cervix?

A
  1. Congenital abnormalities (DES exposure)
    A. Diethylstilbestrol
    B. Used 1938 –1971 to prevent miscarriage
    C. Vaginal CA & uterine/cervix anomalies in daughters
  2. Trauma from D&C
  3. Effect from cone Bx
25
Q

What are the characteristics of incompetent cervix?

A
  1. Accounts for ≈15% of recurrent spontaneous AB
    A. Usually occur in 2nd trimester
    B. Cervix opens 2°to pressure from developing fetus after13th week of pregnancy
26
Q

How is an incompetent cervix treated?

A
  1. Cervical Cerclage

2. 85-90% effective

27
Q

What organisms can cause cervicitis?

A
  1. Neisseria gonorrhea
  2. Chlamydia trachomatis
  3. HSV
  4. HPV
  5. VVC
  6. BV
    Can be acute or chronic
28
Q

what can chlamydia infection lead to?

A
  1. Can cause fetal conjunctivitis & PID

2. Often co-exists w/ Neisseria gonorrhea

29
Q

How does NG infect a person?

A

Similar to Chlamydia, GC can colonize at cervix, ascend to cause PID & salpingitis

30
Q

What HSV type usually causes genital herpes?

A

HSV Type II in > 90% of genital herpes infections

31
Q

What are the sxs of HSV?

A
  1. Vesicular lesions on cervix, similar to lesions on vulva
  2. May produce constitutional sx’s (low grade fever, myalgias, malaise, adenop.)
  3. After acute outbreak, HSV resides in epithelial cells of cervix
32
Q

How is a pregnant woman with an active infection managed?

A

C-section

33
Q

What are the general characteristics of HPV?

A
  1. Usually invisible to naked eye
  2. Apply dilute acetic acid -> HPV lesions appear white
  3. Colposcopy evaluation -> white epithelium w/ coarse appearance
34
Q

What types of HPV are associated with cancer and neoplasms?

A

Types 16,18, 31,33, 45 usually asst w/cervical intraepithelial neoplasia (CIN) & invasive cancers

35
Q

What are the common sxs of cervicitis?

A
  1. Most asymptomatic, screen women at risk
  2. Acute cervicitis / acute vaginitis
    A. Purulent vaginal discharge: Thick, yellow/green & creamy -> Neisseria gonorrhea or chlamydia trachomatis (most common pathogen)
    B. Foamy & greenish -> Trichomonas
    C. White & curd like -> Candidiasis
    D. Thin & grey -> BV caused by gardnerella vaginalis
  3. Chronic cervicitis / chronic vaginitis
    A. Purulent vaginal discharge
    B. Fibrosis & stenosis of cervix may be present
36
Q

How does the cervix appear in cervicitis?

A
  1. Reddened, edematous, friable w/all infections
  2. Cervical tenderness w/bi-manual exam
  3. Sx’s of urethritis
37
Q

How is cervicitis dxed?

A 
1. NS wet prep
A. Trichomonas: flagellated protozoans 
B. BV: “clue cells” 
2. KOH Prep
A. BV:  (+) whiff test
B. Candidiasis:  hyphae
3. Gram stain
A. Gonorrhea: Gm (-) intracellular diplococci
4. Bacterial culture
A. Gonorrhea
5. Polymerase Chain Reaction (PCR)
A. Higher sensivity & specificity compared w/bacterial cultures:
B. Chlamydia trachomatis-most common 
C. Neiserria gonorrhea
38
Q

How should pts with GC, chlamydia and HSV be managed?

A
  1. Pts w/GC, chlamydia, HSV should also be offered counseling & testing
    A. HIV
    B. Hepatitis B
    C. Syphylis
39
Q

How is trichomonas cervicitis treated?

A

metronidazole 2 gm po x 1 dose or 500 mg bid x 7 days

40
Q

How is candidiasis cervicitis treated?

A

Fluconazole (Diflucan) 150 mg po x 1 dose or azole creams/supp (clotrimazole 1 applicatorful q hs x 5 days)

41
Q

How is chlamydia cervicitis treated?

A

azithromycin 1 gm po x single dose or doxycycline 100 mg po bid x 7 days

42
Q

How is gonorrhea cervicitis treated?

A
  1. ceftriaxone 250 mg IM x single dose

2. If (+) GC -> Tx for chlamydia due to high frequency of co-infection!

43
Q

How is BV cervicitis treated?

A
  1. metronidazole 500 mg po bid x 7 days
  2. Tx pregnant women-can cause premature labor or premature rupture of membranes
  3. Dose adjusted if pregnant: metronidazole 250 mg po tid x 7 days
44
Q

Hwo is chronic cervicitis/vaginitis txed?

A
  1. If (+) for STD, treat identified pathogen

2. If (-) for STD, colposcopy & possible surgical Tx (cryosurgery, electrocauterization, LEEP) may be useful

45
Q

What are vulvar malignancies?

A
  1. Most are squamous cell CA

2. Most occur in postmenopausal women (mean age 65 yrs at Dx)

46
Q

What are vaginal neoplasms?

A
  1. Rare
  2. Women w/DES exposure in utero ↑ risk for adenoCA of vagina
  3. Vaginal melanoma also occurs
47
Q

What are the rf for vaginal neoplasms and vulvar malignancies?

A
  1. Obesity
  2. HTN
  3. DM
  4. Arteriosclerosis
  5. Hx chronic vulvar itching
  6. HPV & smoking
48
Q

How are vaginal neoplasms and vulvar malignancies dxed?

A
  1. Bx areas that are suspicious

A. Hyper & hypopigmented areas of vulva & vagina

49
Q

How are vaginal neoplasms and vulvar malignancies treated?

A
  1. Local excision, topical 5FU & laser therapy for early vulvar lesions
  2. Surgical excision for most vaginal neoplasms
  3. Radiation therapy for:
    A. AdenoCA
    B. Radical hysterectomy
    C. Vaginectomy

Gen Med: Ob/gyn (13 decks)

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