Cervix 1 Flashcards

1
Q

žCystic structure that forms when columnar epithelium is covered by squamous epithelium

Glandular material becomes retained

What is this?

A

Nabothian cysts

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2
Q

žAppear as translucent or yellow

žRange in size from millimeters to 3cm

žBenign

žAsymptomatic – seen during speculum exam

Clinical px of what?

A

Nabothian cysts

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3
Q

is excision required for nabothian cysts?

A

NO

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4
Q

žEtiology is unknown but may be due to chronic inflammation of cervical canal

what dz?

A

cervical polyps

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5
Q

žUsually < 3cm

žBenign

žMay cause post-coital bleeding or abnormal uterine bleeding

What dz?

A

cervical polyps

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6
Q

tx for symptomatic cervical polyps pts

A

polypectomy

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7
Q

what kind of tissue is he ectocervix made of?

A

stratified squamous epithelium

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8
Q

what type of tissue is the transformation zone made of?

A

Squamo-columnar junction

Metaplastic squamous epithelium

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9
Q

what kind of tissue is the endocervical canal made of?

A

single layer of mucin-producing columnal cells

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10
Q

describe adequate sampling of cervix

A

requires presence of endocervical sampling

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11
Q

how does HPV enter the body?

A

žThe virus enters the cervical epithelium through microlacerations that occur during intercourse.

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12
Q

HPV Pathophys:

žThe ___________ is very susceptible to the virus vs. squamous tissue.

A

žThe TZ/metaplastic tissue is very susceptible to the virus vs. squamous tissue.

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13
Q

what layer does HPV affect first?

A

infects basal layer first and only locally infects neighboring cells

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14
Q

can the HPY virus remain latent?

A

YES; žThe virus can remain latent for months to years until the host immune system no longer can successfully suppress the virus or poorly understood co-factors are present.

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15
Q

žMature___________ cellscontaining viral HPV migrate away from the basement membrane toward the surface.

A

žMature basal epithelial cells containing viral HPV migrate away from the basement membrane toward the surface.

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16
Q

what are the 2 main HPVs that are responsible for progressing to cervical cancer?

A

16 & 18

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17
Q

MC type of CA associated with HPV 16

A

squamous cell carcinoma

18
Q

MC type of CA associated with HPV 18

A

Adenocarcinoma

19
Q

low risk types of HPV cancer

A

6 & 11

20
Q

RF for HPV infection

A

_*Multiple sexual partners*_

žSmoking: Carcinogens found in cervical mucus

žImmunosuppression

žEarly onset of sexual activity

žHistory of STIs

žHx VIN or VAIN

žLong-term oral contraceptive use

21
Q

how can you prevent HPV?

A

Gardasil 9 vaccine: protects against types 6, 11, 16, 18, 31, 33, 45, 52, 58

22
Q

Dosage schedule of HPV vaccines

A

< 15 y/o, 2 doses at 0 and 6-12 months

≥ 15 y/o, 3 doses at 0, 1-2, and 6 months

23
Q

do pap smears or HPV DNA testing have higher sensitivity/specificity?

A

HPV DNA testing

24
Q

do pts who have received vaccination require ongoing cervical screening based on age appropriate guidelines?

A

yes

25
Q

screening is for what type of pts?

A

asx or pts with risk factors

26
Q

when is HPV screening initiated?

A

Screen women starting at the age of 21 despite the age of sexual debut

27
Q

does screening prior to the age of 21 reduce their rate of cervical CA?

A

NO

28
Q

HPV:

T/F: žNearly all cases are cleared within 1-2 yrs without producing neoplastic change.

A

True

29
Q

what can early onset screening cause

A

ž increases anxiety & morbidity

accrue higher expenses

overuse of follow-up procedures

30
Q

Adolescent pt encounters should include what 5 things?

A

Contraceptive Counseling

STI screening: Urine sample

HPV vaccination education/administration

Safe sex practices

No Pap smear unless in high-risk population

**Speculum exam is not required in asx women**

31
Q

screening for cervical CA in women 21-29 y/o

A

Cytology performance alone q 3 years

Do not perform HPV DNA testing

32
Q

screening for cervical CA in women 30-64 y/o

A

Cytology/HPV DNA co-testing q 5 years

OR

Cytology alone q 3 years

33
Q

Cervical CA screening for HIV + women

A

Begin screening at the age of diagnosis

Screened q 6 mos the year of diagnosis then q year

34
Q

What 5 populations are at high-risk for developing cervical CA and who need yearly screening?

A

HIV positive women

Immunocompromised

Personal history of cervical cancer

History of CIN II/III

Exposure to diethylstilbestrol (DES)in utero

35
Q

You can stop cervical CA screening for non-risk women at age 65 if in the past 10 years….

A

Patient has evidence of 3 prior consecutive negative results with cytology alone

OR

2 consecutive negative Co-testing results

**The most recent test has to have occurred within 5 years

**Cannot have a history of CIN 2+ within last 20 years

36
Q

should you resume screening if a woman reports a new sexual partner?

A

NO

37
Q

žWhen does screening stop in women after hysterectomy (cervix is removed)?

A

Stops at the time of surgery

If Hysterectomy performed for benign disease

If No history of CIN 2 + within 20 years

38
Q

What additional procedure should you perform in the following?

WHEN PERFORMING SPECULUM EXAMINATION AND AN ABNOMRAL CERVICAL LESION IS NOTED

A

biopsy. NOT papsmear

39
Q

pap smear vs biopsy

A

pap smear = screening tool

bipsy = diagnostic

40
Q
A