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Women's Health > Cervical Disorders - Exam 3 > Flashcards

Cervical Disorders - Exam 3 Flashcards

1
Q

What are the 2 MC causes of cervicitis?

A

gonorrhea and chlamydia- 2 MC

trich, mycoplasma, BV, and yeast

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2
Q

What are the 2 MC viruses that cause cervicitis? What are chronic causes of cervicitis?

A

HSV and HPV

pessary, contraceptive devices, tampons, spermicides

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3
Q

What are 2 complications of cervicitis?

A

PID

passing infection to newborn during delivery

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4
Q

What is the main presenting symptom in cervicitis? What are 4 additional s/s?

A

DISCHARGE but may be asymptomatic!! - discharge is main presenting symptom

vaginal bleeding: postcoital or intermenstrual

cervical tenderness

salpingitis: pelvic pain, fever, chills, abnormal menses

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5
Q

**Draw the chart that differentiates gonorrhea/chlamydia, candidiasis, trich, bacterial and HSV from each other

A
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6
Q

What am I?

A

chlamydial cervicitis

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7
Q

What am I? What dx?

A

strawberry cervix commonly found in trich

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8
Q
A

cervical candidiasis

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9
Q

What are the difference between acute and chronic cervicitis in terms of presentation?

A

have all the same s/s and can still be asymptomatic!

discharge is still MAIN presenting symptoms but chronic is LESS than acute

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10
Q

What is the pap smear/colposcopy finding in trich?

A

“double hairpin capillaries”

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11
Q

What does a large number of PMNs or leukocytes indicate on pap smear/colposcopy?

A

acute cervicitis

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12
Q

How can trich and yeast be identified?

A

directly on microscopy

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13
Q

What am I?

A

HPV infected cervical cell

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14
Q

What am I?

A

normal cervical epithelial cell

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15
Q

What is the treatment for gonrrhea/chlamydia, candidiasis, trich, bacterial, HSV, salpingitis, HPV?

A
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16
Q

What is the prevention for cervicitis?

A

avoid getting an STI with abstinence or barrier method

remove cervix if having a hysterectomy

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17
Q

What is cervical insufficiency? Up to ____ weeks. What is the end result?

A

Painless cervical shortening or dilation in the second or early third trimesters

up to 28 weeks

results in preterm birth

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18
Q

What are risk factors for cervical insufficiency?

A

Hx of cervical insufficiency

Hx of cervical injury, surgery, or conization

DES exposure

Anatomic abnormalities

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19
Q

What are the s/s of cervical insufficiency? When does it classically occur?

A

significant cervical dilation (2+ cm) with minimal contractions

Classically in the second trimester

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20
Q

In cervical insufficiency at ____ cm dilated, what can occur?

A

4cm +

active contractions or ROM may occur

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21
Q

How is cervical insufficiency diagnosed?

A

US at 14-16 wks or later to evaluate internal anatomy of lower uterus and cervix

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22
Q

What is the early prediction of cervical insuffiency?

A

there is NOT one

Prior to pregnancy and in 1st trimester - no way to determine if cervix will eventually be incompetent

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23
Q

**What are the 4 stages of cervical insufficiency?

A

T, Y, V, U

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24
Q

What is the tx of choice for cervical insufficiency? Describe it. What 2 things do you need to confirm first?

A

Cervical Cerclage - typical treatment of choice

Purse-like ring of stitch around the cervix

  1. Confirm viable intrauterine pregnancy prior to placement!!!
  2. culture for gonorrhea, chlamydia, group B strep and tx if needed
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25
What are the CI to cervical insufficiency?
ROM (rupture of membranes) infection fetal demise
26
____ is used for supplemental therapy in cervical insufficiency. When should you start? Continue until _____
vaginal progesterone or IM/SC hydroxyprogesterone caproate start around 16 weeks and continue until 36+ weeks can due before or after surgical cerclage to promote cervix staying closed
27
_____ are often asymptomatic cystic structures on the surface of the cervix. What will the pt complain of?
Nabothian Cysts patient may feel a lump when placing a cervical cap or diaphragm
28
What am I? What is the tx?
nabothian cysts BENIGN!! no tx necessary and usually will resolve spontaneously
29
What am I?
nabothian cysts
30
What are the different classifications of cervical dysplasia? What classifications need to be treated? What are the 2 exceptions?
Always treat CIN II and III except: 1. Pregnant women (wait until postpartum period) 2. CIN II in adolescents (high spontaneous regression chance, lower cancer risk)
31
How common is cervical dysplasia? When does CIS incidence peak? What age range has cervical cancer peak incidence?
1.05-13.7% CIS peak incidence - 25-35 years Cervical cancer peak incidence - 40+ years
32
What will cervical dysplasia look like on PE?
often NO signs and cervix will look completely normal on PE Diagnosis usually made by abnormal routine cytology smear
33
What are risk factors for cervical dysplasia? **What is the super highlighted one?
Multiple sexual partners Early onset of sexual activity High-risk sexual partner **HPV infection** THIS IS THE MAJOR ONE History of sexually transmitted infection Immunosuppression (including HIV/AIDS) Multiparity Long term oral contraceptive pill use
34
HPV present in ____ of all CIN lesions and in _____ of all invasive cervical cancers
>80% 99.7%
35
What are the high risk types of HPV? Do most HPV+ women develop CIN or cervical cancer?
High-risk types - 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 NO, they do NOT develop
36
_____ have a negative synergistic effect with HPV. What is the cervical dysplasia prevention?
cigarettes HPV vaccination!!!!
37
How effective is the HPV vaccination against preventing CIN II or worse?
93-100% and is good for prophylactic tx NOT therapeutic
38
What age should you start screening for cervical cancer? What is the recommendation throughout a pt's lifetime?
starting at 21 years old Ages 21-29 - Pap every 3 yrs Ages 30-65 - Pap every 3 yrs OR Pap+HPV every 5 yrs Age > 65 - Stop screening if… no history of moderate/severe dysplasia or cancer AND... 3 negative Paps OR 2 negative Pap+HPV in a row in past 10 yrs (last result in the last 5 yrs)
39
What 4 factors automatically disqualifies a pt from following the recommended cervical cancer screening guidelines? What are the recommendations for this subset of pts?
hx of cervical cancer HIV+ immunodeficient DES exposure May still need yearly Paps even after hysterectomy
40
What is the grading system called for abnormal pap smears? What are the 5 different options? What do they each stand for?
Bethesda system 1. ASC-US: Atypical Squamous Cells undetermined significance 2. ASC-H: Atypical Squamous Cells cannot exclude high-grade lesion 3. LGSIL: Low-grade Squamous Intraepithelial Lesion 4. HGSIL: High-grade Squamous Intraepithelial Lesion 5. AGC: Atypical glandular cells
41
What Bethesda system grade corresponds to CIN I? CIN II and CIN III?
LGSIL - > CIN I HGSIL -> CIN II and CIN III
42
What are 2 different types of atypical glandular cells? What do each mean? What are they associated with?
Glandular cells - normal components of the endocervix; secrete mucus Atypical - do not match normal glandular cells but are not definitely cancer Associated with adenocarcinoma of endocervix or of endometrium
43
What are the 3 different options for the tx of an ASC-US pap result?
Repeat serial cytology - q 6 mo till 2 consecutive normal Second abnormal smear - colposcopy Test for high-risk HPV - Refer for colposcopy if positive Immediate referral to colposcopy
44
If choosing to repeat serial cytology in ASC-US, what needs to be treated before repeat testing?
Before repeat smear - treat underlying conditions Hormones if atrophic vaginitis Antimicrobials for infections
45
Which Bethesda system grade treatment is straight to colposcopy?
LSIL, HSIL, ASC-H, AGC
46
What are the procedure steps for a colposcopy? Can you take bx if pregnant?
3-5% aqueous acetic acid solution applied +/- Lugol’s solution (iodine/iodide) Illuminated low-power magnification to inspect cervix, vagina, vulva, anal epithelium bx of abnormal areas and curette or brush of endocervical canal +No endocervical sampling done if pregnant+
47
What is Lugol's solution? When is it used? Does HPV lesion take up the solution well?
iodine/iodide solution sprayed during colposcopy to help visualize suspicions areas NO!! HPV does not uptake the iodine solution well
48
What are indications for colposcopy?
Abnormal cervical cytology or HPV testing Clinically abnormal cervix Unexplained intermenstrual or postcoital bleeding Vulvar or vaginal neoplasia History of in utero DES exposure
49
What does coarse punctation combined with acetowhite lesion indicate?
more than likely a high grade cancer aka NOT a good finding
50
What is the best way to perform a colposcopy direct bx?
do a slow smooth bx motion for LESS pain
51
What is the management for a CIN I lesion after colposcopy?
expectant management due to high chance of spontaneous regression
52
What is the management for CIN II/III after colposcopy?
surgical therapy!! either ectocervix-only lesion -> use cryotherapy, laser ablation or superficial LEEP OR deeper LEEP or cone bx
53
When would you want to use a deeper LEEP/cone bx?
lesion extends to endocervical canal endocervical curettage shows dysplasia or other abnormality major discrepancy between cytology and colposcopy
54
Draw the summary chart of pap smear results and follow-up tests and tx
55
Which cervical dysplasia treatment can be done in the office without anesthesia? What substance? What are the margins?
Cryotherapy Nitrous oxide or carbon dioxide - supercooled probe Activated until blanching extends 7 mm beyond probe in all directions
56
What are the pros and cons of cryotherapy?
pros: easy to use, low costs, available, low risk of complications cons: f/u colposcopy can be unsatisfactory, only appropriate for superficial lesions
57
What are the SEs of cryotherapy?
mild uterine cramping, copious watery discharge for several weeks
58
How does the carbon dioxide laser work? When is it used?
Destroys tissue with narrow zone of injury by vaporizing tissue to a depth of at least 7mm Used for ablation of transformation zone or as a tool for cone biopsies
59
What are the pros and cons of a carbon dioxide laser?
Pros - precise, versatile, can be done in office or as outpatient hospital procedure Cons - requires local or general anesthesia, expensive, requires significant training
60
When are LEEP procedures used? What is the general principle?
Frequently used for CIN II and CIN III Small fine wire loop attached to electrosurgical generator and used to excise part of the cervix
61
Do you need anesthesia for LEEP procedure?
yes, done in the office under local anesthesthesia
62
What are the cons of the LEEP?
increased risk of premature delivery in pregnancy and do NOT have clean edges
63
What is the general principle of the cold knife conization?
Excision of cone-shaped portion of cervix using a scalpel and can be individualized to accommodate lesion
64
What are the pros and cons of cold knife conization?
Pros - Histologic specimen has no thermal artifact Cons - Expensive, needs to be done in OR (regional or general anesthesia), increased risk for premature delivery (cervical insufficiency) aka LOTS of cervical tissue is cut away with this procedure and usually considered 2nd line!
65
How successful are the treatment rates for cervical dysplasia? Treatment reduces risk of cervical cancer by ____. But still have higher risk of cervical cancer than the general population for at least ____
80-90% successful treatment rates 95% 20-25 years
66
What is the average age of cervical cancer diagnosis? Over ___ with early cancer can be cured
51 but can occur as young as 20s or during pregnancy 95%
67
HPV DNA found in ___ of all cervical carcinomas. ____ most common; HPV- __ and HPV- __
99.7% HPV-16 then 18 then 45
68
70-75% of cervical cancer is ______ carcinoma 20-25% are _____ 3-5% are ____
70-75% squamous cell (think ectocervix) 20-25% - adenocarcinomas (think endocervix) 3-5% - adenosquamous carcinomas
69
What is the MC symptom for cervical cancer? Name some additional ones? _____ is frequently present
MC symptom - abnormal vaginal bleeding Bloody leukorrhea, scant spotting, frank bleeding, postcoital Leukorrhea
70
What would indicate a fistula formation that is associated with cervical cancer? What are some late stage findings?
Involuntary loss of urine or feces through vagina weakness, weight loss, anemia, pelvic pain Pain is usually unilateral, may radiate to hip or thigh
71
What is the difference between endophytic and exophytic cervical signs? When are they seen?
Endophytic - barrel-shaped enlargement of cervix Exophytic - friable, bleeding, cauliflower-like lesions (think outer into tissue) typically associated with later stage cervical cancer
72
What is this picture demonstrating?
in cervical cancer eventually - parametrial involvement may lead to nodular thickening of the uterosacral ligaments with fixation of cervix
73
Can cancer still be present despire negative cytology?
YES!! so need to bx any suspicious lesion
74
What should you do if biopsy reveals CIS or if colposcopy is negative but Pap is significantly abnormal? What should you do if you find gross evidence of invasive cancer?
conization conization not indicated; simple biopsy only
75
What is the tx for cervical cancer?
radical hysterectomy and lymphadenectomy +/- radiation and chemotherapy Advanced - chemotherapy is usually palliative, not curative
76
What are the prognostic factors in cervical cancer?
stage lymph node status tumor volume depth of invasion lymphovascular invasion
77
What is the 5 year survival rate of pts with less advanced cervical cancer? later disease (+ lymph nodes)?
less advanced: 88-96% 5-year survival rates later disease: 64-73% 5-year survival rates
78

Women's Health (16 decks)

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