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1. Foundations III > Cervical disorders > Flashcards

Cervical disorders Flashcards

1
Q

What is a nabothian cyst?

A

cystic structure that forms when columnar epithelium is covered by squamous epithelium (glandular material becomes retained)

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2
Q

Describe nabothian cysts

A
  • translucent or yellow
  • benign
  • asymptomatic
  • excision not required
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3
Q

Sx of cervical polyps?

Tx?

A

benign
-may cause post-coital bleeding or abnormal uterine bleeding

Polypectomy for symptomatic patients

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4
Q

What is the transformation zone?

A
  • squamo-columnar junction

- metaplastic squamous epithelium

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5
Q

adequate cervical sampling requires presence of?

A

endocervical sampling

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6
Q

What cervical tissue is very susceptible to HPV virus compared to squamous tissue?

A

transformation zone/metaplastic tissue

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7
Q

HPV 16 causes what kind of cervical CA MC?

HPV 18 causes what kind?

A

16= squamous cell carcinoma

18= adenocarcinoma

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8
Q

Low risk types of HPV?

High risk?

A

Low: 6, 11
High: 16, 18

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9
Q

Risk factors for HPV?

A
  • multiple sexual partners
  • smoking
  • immunosuppression
  • early onset sexual activity
  • hx of STD
  • long-term oral contraceptive use
  • multiparity
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10
Q

Under age 25 should not receive what type of screening?

A

HPV

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11
Q

When do you start screening for cervical CA?

A

age 21 despite the age of sexual debut

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12
Q

Do most women w/ HPV produce neoplastic change?

A

NO

Nearly all cases are cleared w/in 1-2 yrs w/o producing neoplastic change

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13
Q

What screenings should be done in adolescents?

A
  • contraceptive counseling
  • STI screening
  • HPV vaccine/education
  • Safe sex practices
  • No Pap unless in high-risk population
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14
Q

For cervical CA screening, women aged 21-29 should get what

A

-Cytology every 3 years

NO HPV testing

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15
Q

For cervical CA screening, women aged 30-64 should get what

A

-Cytology (+) HPV DNA every 5 yrs
OR
-Cytology alone every 3 yrs

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16
Q

Patients who are HIV +, immunocompromised, hx of cervical CA, hx of CIN II/III, or have exposure to DES need a cervical CA screening how frequently?

A

every year

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17
Q

When does cervical screening stop?

A

Age 65 if: In past 10 yrs
-pt has 3 prior consecutive cytology results
OR
-2 consecutive negative co-testing results
(most recent has to be w/in 5 yrs, cannot have hx of CIN 2/3 in 20 yrs)

18
Q

If a 66 year old women with no PMHx of CIN 2/3 or + cytology has a new sexual partner, do you perform a cervical screening?

A

No!

stop at age 65

19
Q

If a women has a hysterectomy, when can you stop cervical CA screenings?

A

at time of surgery if cervix is removed
&
(was performed for benign dz & no hx of CIN2+)

20
Q

when performing a speculum exam & an abnormal cervical lesion is noted, what do you do?

A

perform a BIOPSY

NOT a Pap smear

21
Q

Is a Pap smear a diagnostic or screening tool?

Biopsy?

A

Pap= screening

Biopsy= diagnostic

22
Q

What is an ASC-US?

A

Atypical cells of undetermined significance

23
Q

If a pt age 21-24 has ASC-US, what do you do?

A

repeat cytology in 1 yr

24
Q

If a pt age 25+ has ASC-US, what do you do?

Explain what to do next based on results

A

Must reflex to HPV DNA

Negative= normal cytology, repeat co-test in 3 yrs
Positive HPV= colposcopy

25
Q

What is LSIL

A

Low grade squamous intraepithelial lesion

26
Q

If a pt age 21-24 has LSIL, what do you do?

Explain what to do next based on results

A

Repeat cytology in 1 yr

+ASC-H/HSIL: colposcopy
- ASCUS/LSIL: cytology 1 yr

another year later
+ASC-H/HSIL= high grade lesion= colposcopy

27
Q

If a pt age 25 has LSIL, what do you do?

A

refer for colposcopy despite HPV result
OR
Repeat co-testing in 1 yr is HPV testing is neg

28
Q

If a pt has HSIL/ASC-H, what do you do?

A

assume HPV present
refer for colposcopy
(lesions usu. c/w CIN II/III)

29
Q

If you get a cytology result back of negative cytology, no endocervical cells, what do you do in a 21-29 yo pt?

A

routine screening- repeat PAP in 3 yrs, no HPV

30
Q

If you get a cytology result back of negative cytology, no endocervical cells, what do you do in a >30 yo pt?

A

perform HPV DNA test

31
Q

If you get a cytology result of “unsatisfactory cytology”, what do you do if no HPV testing ordered?

If HPV testing was ordered?

A

Not ordered= repeat Pap 2-4 mo

HVP testing done= if negative repeat Pap in 2-4 mo

32
Q

A 30+ yo woman w/ negative cytology but + HPV… what do you do?

A
  • Colposcopy if genotype 16/18

- repeat co-testing in 12 mo if not genotype 16/18

33
Q

What is positive HPV DNA test (x2) a/w?

A

21% chance it will be CIN II/III w/in 36 mo

34
Q

What is considered a satisfactory colposcopy exam?

A

complete visualization of transformation zone

35
Q

When is LEEP indicated in age 21-24?

A
  • persistent HSIL (24 mo)
  • CIN 2+
  • Unsatisfactory colposcopy
36
Q

If pt is 25+ w/ HSIL/ASC-H, colposcopy or LEEP?

A

If colposcopy done and HSIL/CIN 1 –> Keep or co-testing

If colposcopy done and HSIL/CIN 2+–> LEEP

37
Q

LEEP is contraindicated in who?

A
  • if invasion is suspected
  • glandular abnormality on Pap
  • Pt is pregnant
38
Q

Cervical squamous cell CA is most a/w what type of HPV?

A

strain 16

39
Q

Cervical adenoma is most a/w what type of HPV?

A

strain 18

40
Q

Characteristics of cervical squamous cell cancer

A
  • prevalence 65-85% and falling!
  • microinvasion (<3 mm)
  • invasive (>3 mm or visible)
41
Q

Prevalence and types of Cervical adenocarcinoma

A
  • Prevalence 1-25% and rising

- Endocervical, Endometrial, Clear Call, Adenoid Cystic

42
Q

Presentation of cervical CA

A

ASYMPTOMATIC
MC sx= abnormal vaginal bleeding

  • postcoital bleeding
  • unilateral pelvic pain w/ radiation to thigh
  • vag discharge

1. Foundations III (20 decks)

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