Cervical Dysplasia

Question 1

t or f: squamous cell carcinoma of the cervix is non-existent in women who have had no sexual contact

Answer 1

TRUE

Question 2

what is the yearly exam done to assess for cervical dysplasia?

Answer 2

papanicolaou smear

Question 3

approximately what percent of cervical dysplasia is related to HPV?

Answer 3

80%

Question 4

t or f: all cervical dysplasia will eventually progress to CA

Answer 4

FALSE: some may progress to CA, some may remain the same, some may regress to normal

Question 5

t or f: there is a genetic component to cervical dysplasia

Answer 5

TRUE - genetic disposition is a risk factor for cervical dysplasia

Question 6

t or f: young women whose mothers took DES during pregnancy are at increased risk for cervical dysplasia

Answer 6

TRUE

Question 7

what are the two HPV types that cause a majority of cervical cancer?

Answer 7

16 and 18

Question 8

what is the name of the border between the squamous lining of the vagina and the columnar cells of the uterus?

Answer 8

squamocolumnar junction (remember this is located on the cervix)

Question 9

what is the difference between location of the squamocolumnar junction in nulliparous women vs. pregnant women?

Answer 9

in nulliparous the SCJ is typically at the external os; in pregnant women it tends to migrate out and is visible to the naked eye

Question 10

the area near the ectocervix where columnar cells undergo metaplasia and become squamous cells is referred to as what?

Answer 10

the transformation zone (TZ)

Question 11

what areas of the cervix must be biopsied to rule out cancer of the cervix?

Answer 11

TZ must be biopsied

Question 12

t or f: the adolescent cervix is more susceptible to carcinogenic stimuli than the elderly

Answer 12

TRUE

Question 13

what are the basic guidelines for pap smears?

Answer 13

start at age 21 and done every 3 years; at age 30 done every 5 years (if done with HPV co-testing) otherwise every 3 years

Question 14

what are two signs on cytologic analysis that points towards cervical dysplasia?

Answer 14

clumping of chromatin and decreased cytoplasm resulting in higher nucleus to cytoplasm ratio

Question 15

how do neoplastic cells appear under colposcopy when acetic acid is applied?

Answer 15

the acid dehydrates the cell and causes precipitation of nucleic proteins - neoplastic cells appear whiter b/c of higher nucleus/cytoplasm ratio

Question 16

what is the one circumstance underwhich a colposcopy would be rendered inadequate?

Answer 16

if the transformation zone is not fully visualized

Question 17

t or f: cervical biopsy is contraindicated in pregnancy

Answer 17

FALSE (endo cervical curretage IS however contraindicated)

Question 18

what are some contraindications to cervical biopsy?

Answer 18

PID and cervcitis

Question 19

what is the next step after biopsy results or ECC is positive for CIN II or III?

Answer 19

cone biopsy or LEEP ( loop electrosurgical excision procedure )

Question 20

from where is the specimen taken for cone biopsy?

Answer 20

cone shaped piece of the endocervical canal is taken

Question 21

desrcibe the LEEP?

Answer 21

a small wire loop with an electric current is used to excise the TZ and endocervix

Question 22

what is the one drawback for evaluation of biopsy margins with LEEP? (THINK …)

Answer 22

it can be difficult due to thermal artifact

Question 23

please describe how to properly dispense the gardasil vaccine.

Answer 23

3 doses of 0.5mL IM at 0 2 and 6 months

Question 24

against which types of HPV does the gardasil vaccine protect against?

Answer 24

6.11.16.18

Question 25

what was the first bivalent HPV vaccine approved and for which types does it cover?

Answer 25

cervarix, types 16 and 18