Cervix 1

Question 1

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

Glandular material becomes retained

What is this?

Answer 1

Nabothian cysts

Question 2

žAppear as translucent or yellow

žRange in size from millimeters to 3cm

žBenign

žAsymptomatic – seen during speculum exam

Clinical px of what?

Answer 2

Nabothian cysts

Question 3

is excision required for nabothian cysts?

Answer 3

NO

Question 4

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

what dz?

Answer 4

cervical polyps

Question 5

žUsually < 3cm

žBenign

žMay cause post-coital bleeding or abnormal uterine bleeding

What dz?

Answer 5

cervical polyps

Question 6

tx for symptomatic cervical polyps pts

Answer 6

polypectomy

Question 7

what kind of tissue is he ectocervix made of?

Answer 7

stratified squamous epithelium

Question 8

what type of tissue is the transformation zone made of?

Answer 8

Squamo-columnar junction

Metaplastic squamous epithelium

Question 9

what kind of tissue is the endocervical canal made of?

Answer 9

single layer of mucin-producing columnal cells

Question 10

describe adequate sampling of cervix

Answer 10

requires presence of endocervical sampling

Question 11

how does HPV enter the body?

Answer 11

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

Question 12

HPV Pathophys:

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

Answer 12

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

Question 13

what layer does HPV affect first?

Answer 13

infects basal layer first and only locally infects neighboring cells

Question 14

can the HPY virus remain latent?

Answer 14

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.

Question 15

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

Answer 15

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

Question 16

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

Answer 16

16 & 18

Question 17

MC type of CA associated with HPV 16

Answer 17

squamous cell carcinoma

Question 18

MC type of CA associated with HPV 18

Answer 18

Adenocarcinoma

Question 19

low risk types of HPV cancer

Answer 19

6 & 11

Question 20

RF for HPV infection

Answer 20

_*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

Question 21

how can you prevent HPV?

Answer 21

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

Question 22

Dosage schedule of HPV vaccines

Answer 22

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

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

Question 23

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

Answer 23

HPV DNA testing

Question 24

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

Answer 24

yes

Question 25

screening is for what type of pts?

Answer 25

asx or pts with risk factors

Question 26

when is HPV screening initiated?

Answer 26

Screen women starting at the age of **21** **_despite the age of sexual debut_**

Question 27

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

Answer 27

NO

Question 28

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

Answer 28

True

Question 29

what can early onset screening cause

Answer 29

ž increases **anxiety & morbidity** accrue **higher expenses** **overuse** of follow-up procedures

Question 30

Adolescent pt encounters should include what 5 things?

Answer 30

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\*\*

Question 31

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

Answer 31

Cytology performance alone **q 3 years** **_Do not perform HPV DNA testing_**

Question 32

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

Answer 32

**Cytology/HPV DNA** co-testing **q 5 years** OR **Cytology alone q 3 years**

Question 33

Cervical CA screening for HIV + women

Answer 33

Begin screening at the **age of diagnosis** **Screened q 6 mos** the year of diagnosis **then q year**

Question 34

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

Answer 34

**HIV positive** women **Immunocompromised** Personal **history of cervical cancer** History of **CIN II/III** Exposure to **diethylstilbestrol (DES)in utero**

Question 35

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

Answer 35

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

Question 36

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

Answer 36

NO

Question 37

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

Answer 37

Stops **at the time of surgery** If Hysterectomy performed for **benign disease** If No history of **CIN 2 + within 20 years**

Question 38

What additional procedure should you perform in the following? WHEN PERFORMING **SPECULUM EXAMINATION** AND AN **ABNOMRAL CERVICAL LESION IS NOTED**

Answer 38

**biopsy.** NOT papsmear

Question 39

pap smear vs biopsy

Answer 39

pap smear = **screening tool** bipsy = **diagnostic**