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Summer FDTN Exam 3 > cervical disorders > Flashcards

cervical disorders Flashcards

1
Q

What is a Nabothian cyst

A

Benign cyst that forms when columnar (glandular) epithelium is covered by squamous epithelium (retain glandular material)
Yellow or transluscent filling

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2
Q

Hoe do you diagnose and treat a nabothian cyst

A

Usually found incidentally on speculum exam

excision not required

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3
Q

What are cervical polyps

A

benign polyps, <3cm, likely 2/2 chronic inflammation of cervical canal

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4
Q

Cervical polyps can cause

A

post-coital bleeding or abnormal uterine bleeding

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5
Q

How do you treat cervical polyps

A

If symptomatic, polypectomy

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6
Q

What is normal cervical histology

A

Ectocervix: stratified squamous
Transformation zone: squamo-columnar junction (metaplasia)
Endocervical canal: mucin producing columnar

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7
Q

What does an adequate cervical sample include

A

endocervical tissue

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8
Q

What is cervical ectropion

A

normal variation, endocervical canal becomes everted

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9
Q

What is the pathophys of HPV

A
  • virus enters cervical epithelium through microlacerations (2/2 intercourse)- TZ is very susceptible to HPV
  • HPV infects basal layer and only local cells
  • Virus stays latent for mo-yrs (until host cant fight anymore, or, a trigger)
  • Mature basal epithelial cells travel away from BM, to surface
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10
Q

Which strains of HPV cause CIN

A

HPV 16: SCC

HPV 18: adenocarcinoma (many have HSIL as well)

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11
Q

What strains of HPV can block the protective apoptic process

A

HPV E6 and E7

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12
Q

Low risk HPV strains are

A

6 and 11

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13
Q

Nearly half of all HPV patients are (age)

A

15-24

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14
Q

RF for HPV infection are

A 
Multiple sexual partners!!!
Smoking 
immunosupresison 
early onset sex 
Hx STD 
long term OCP use (estrogen receptors on HPV gene) 
Hx VIN/VaIN
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15
Q

What is the HPV vaccine

A

Gardasil 9- protects against 6, 11, 16, 18, 31, 33, 45, 52, 58
ONLY US option
*still need pap smear based on age guidelines

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16
Q

How do you dose Gardasil 9

A

<15: 2 doses, 0 and 6-12 months

15+: 3 doses, 0, 1-2, and 6 months

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17
Q

How do you perform a pap smear

A

Thin prep or Surepath

insert into cervix, rotate 180

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18
Q

What is the HPV DNA test

A

Cervista, or Hybrid Capture high risk HPV

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19
Q

At what ages do you perform PAP smear testing

A

21 y/o (no matter onset of sex) - 65 y/o, every 3 years
NO HPV testing 21-24
(these guidelines do not apply to high risk pops, ex. immunocompromised)

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20
Q

When do you begin co-testing for HPV

A

30+ y/o, every 5 years

NOT indicated if s/p hysterectomy

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21
Q

Why not screen for cervical cancer with PAP before 21?

A

It does NOT reduce the rate of cervical cancer

  1. 1% of cervical cancer occurs prior to 20 y/o
    - No pap unless high risk!!
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22
Q

Who don’t we screen for HPV in young women

A

You acquire HPV shortly after intercourse, but almost all cases clear w/in 1-2 yrs WITHOUT neoplastic change
-early screening can lead to anxiety, higher expenses, and overuse of follow up procedures

23
Q

What SHOULD adolescent encounters include

A

contraceptive counseling
STI screening (urine sample, no speculum if ASx)
HPV vaccine education/admin
Safe sex practices

24
Q

For women 21-29, screening includes

A

Cytology alone q3 years

NO HPV testing

25
Q

For women 30-64, screening includes

A

Cytology + HPV DNA testing q5 years
or
Cytology alone q3 years

26
Q

What pts are high risk for developing cervical cancer (yearly PAP)

A 
HIV + 
immunocompromised 
Hx cervical cancer 
Hx CIN 2/3 
Exposure to DES from mom
27
Q

How do you screen HIV + women

A

screen q6 months year of diagnosis
screen q1 year after first year
*start screening at whatever age the diagnosis is

28
Q

When do you stop screening for cervical cancer (not high risk obvs)

A 
at 65 if in the past 10 years: 
3 consecutive negative cytology alone 
2 consecutive negative Co-testing results 
Most recent test w/in 5 years 
NO Hx of CIN w/in 20 years
29
Q

What screening should you do if a woman >65 y/o reports a new sexual partner

A

TRICK question; None!

don’t resume screening even if she has a new partner

30
Q

When does screening stop in a woman w/ a hysterectomy (w/ cervix removed)

A

at time of surgery, if for a benign disease
and NO Hx of CIN 2 w/in 20 years
-If you had a hysterectomy for a sketch reason, still need to swabvaginal cuff and wall

31
Q

**What do you do if on speculum exam you note an ABNORMAL cervical lesion

A

BIOPSY!!!!!!
any abnormal lesion needs to be biopsied, NOT pap smeared
a PAP is screening tool. Biopsy is diagnostic!

32
Q

What is ASC-US

A

Atypical Cells of Underetmined Significance

They dont look that bad, they are the least worrisome pathologic finding

33
Q

What causes ASC-US, if not HPV

A

Chlamydia trachomatis
Herpes simplex
Vulvovaginal atrophy

34
Q

What is LSIL

A

Low grade Squamous Intraepithelial Lesion

35
Q

What is HSIL

A

High grade Squamous Intraepithelial Neoplasm

Assume HPV is present!!

36
Q

Does HSIL with negative HPV mean you are in the clear

A

NO- it carried a 29% 5 year risk for CIN 3+

That is why you need Colposcopy immediately for HSIL

37
Q

What does a negative cytology with no endocervical cells indicate

A

You did not get an adequate sample, you only got EXOcervical cells

38
Q

What does Unsatisfactory cytology indicate

A

insufficient squamous component; HPV test can be falsely negative

39
Q

Persistently (+) HPV test (2x) is associated with

A

21% chance that CIN 2-3 will persist in 36 months

40
Q

What is CIN I

A

Lesion involving lower 1/3 of epithelial lining

typically regresses in 12 months

41
Q

What is CIN II

A

Lesion involving lower 2/3

43% regress, 35% persist

42
Q

What is CIN III

A

Lesion involving >2/3 epithelial lining

32% regress, 56% persist

43
Q

Explain satisfactory vs unsatisfactory colposcopy results

A

Satis: completely visualize transformation zone
Unsatis: incomplete visualization of transformation zone. Have to perform endocervical curettage

44
Q

What is a colposcopy

A

apply 5% acetic acid
magnified view of the cervix
Biopsy epithelium that turns white (leukoplakia, ulceration, punctation, mosaicism, atypical vessels)

45
Q

What is a LEEP

A

Loop Electrosurgical Excision Procedure (aka cauterizing);
High electrical current rapid heating of tissue (steam envelope surrounds wire vaporizing adjacent tissue)- send tissue to patho

46
Q

When is a LEEP contraindicated

A

if invasion is suspected
glandular abnormality on PAP
Patient is pregnant

47
Q

LEEP has replaced

A

Laser surgery in the treatment if CIN

48
Q

Follow up for LEEP includes

A

avoid heavy lifting, sex, douching, tampon or cream use for 4 weeks
May have malodorous discharge for 2-3 wewks
First menses after LEEP may be heavier 2/2 partially removing endocervical canal

49
Q

Side effects of LEEP include

A

Bleeding
Infection
Cervical obliteration, incompetence, stenosis
Pre-term delivery

50
Q

What follow up testing is required after LEEP

A

Co-testing at 12 and 24 months
If you have (+) margins after LEEP, repeat cytology and EEC at 4-6 months
If you have persistent CIN2 after LEEP, repeat LEEP, or hysterectomy

51
Q

Mean age of cervical cancer diagnosis is

A

48 years old

52
Q

What are the types of cervical cancer

A

Squamous (MC HPV 16): prevalence falling. 3mm or less is microinvasive. >3 is invasive
Adenocarcinoma (MC HPV 18): prevalence rising. endocervical, endometrioid, clear cell, adenoid cystic

53
Q

How does cervical cancer present

A

Asymptomatic!
**Abnormal vaginal bleeding (cervix is friable)
post-coital bleeding
unilateral pelvic pain with radiation to hip/thigh (mets)
Vaginal discharge (watery, mucoid, purulent, malodorous)

Summer FDTN Exam 3 (25 decks)

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