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GK F3E5 > Cervix 2 > Flashcards

Cervix 2 Flashcards

1
Q

screening procedure if ASC-US is found in women ages 21-24

ASC-US (atypical cells of undetermined significance)

A

repeat cytology in 1 year

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2
Q

screening procedure if ASC-US in women 25 or older

A

Must reflex to HPV DNA

Negative HPV DNA = NORMAL cytology

Repeat co-testing in 3 years

Positive HPV DNA = colposcopy

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3
Q

Causes of ASCUS cytology in the absence of HPV include what?

A

Chlamydia trachomatis

Herpes simplex

Vulvovaginal atrophy

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4
Q

screening if on dx:

žLSIL: low grade squamous intraepithelial lesion

žAge 21 – 24

A

Preferred to repeat cytology in 1 year

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5
Q

žscreening if on dx:

žLSIL: low grade squamous intraepithelial lesion

Age 25+

A

Refer for colposcopy despite HPV result

OR

Repeat co-testing in 1 year if HPV DNA testing is negative

Lesions usually consistent with CIN I

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6
Q

screening if on dx:

žHSIL/ASC-H: High grade

A

Assume HPV DNA is present

Refer for colposcopy despite HPV result (all ages)

Negative HPV HSIL carries a 5 year risk for CIN 3+ of 29%

Lesions usually consistent with CIN II-III, AIS

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7
Q

what screening should follow if on dx:

žNegative cytology, no endocervical cells

for women 21 – 29

A

Routine screening – repeat Pap in 3 years

DO NOT perform HPV DNA testing

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8
Q

what screening should follow if on dx:

žNegative cytology, no endocervical cells

for women Age ≥ 30

A

Perform HPV DNA testing

If Negative: Repeat Pap in 5 year

If Positive: Refer for colposcopy if HPV 16/18

OR

Repeat cytology and HPV in 12 months

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9
Q

What can cause an unsatisfactory cytology?

A

Due to insufficient squamous component

HPV test may be falsely negative due to insufficient sampling

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10
Q

If you get an unsatisfactory cytology and there was No HPV testing done, what screening should follow?

A

Repeat Pap in 2 – 4 months (any age)

Do NOT add on HPV test if not initially ordered

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11
Q

If you get an unsatisfactory cytology and there was HPV testing performed for women age > 30, what screening should follow?

A

Negative HPV: Repeat Pap in 2 – 4 months

Positive HPV: Refer for colposcopy

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12
Q

Screening for women 30+ years with negative cytology but positive high risk HPV DNA

A

Colposcopy if genotype is (+) for HPV 16/18

Repeat co-testing in 12 months for non- HPV 16/18

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13
Q

follow up screening if combined screening of HPV DNA and cytology is negative in 12 months

A

repeat co-testing in 3 yrs

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14
Q

follow up screening if combined screening of HPV DNA and cytology is positive in 12 months

A

refer for colposcopy

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15
Q

why do we perform a combined screening?

A

žImportant to differentiate between transient and persistent HPV infection.

žPersistently positive HPV DNA test (x2) is associated with a 21% chance CINII/III will be present within 36 months*

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16
Q

CIN I: Lesions typically regress in what amount of time?

A

12 mos

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17
Q

CIN I involves what part of epithelial lining?

A

lower third

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18
Q

CIN II involves what part of epithelial lining?

A

lower 2/3rds

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19
Q

CIN III involves what part of epithelial lining?

A

more than 2/3rds of epithelial lining

20
Q

satisfactory colposcopy

A

Complete visualization of transformation zone

21
Q

žUnsatisfactory colposcopy

what additional procedure do you have to perform?

A

Incomplete visualization of transformation zone

Have to perform endocervical curettage (ECC)

22
Q

žMagnified view of cervix after application of 5% acetic acid

what procedure is this?

A

colposcopy

23
Q

mgmt for women 21-24 y/o who test positive for ASCUS or LSIL

A

Cytology ALONE in 12 months

If Persistent ASCUS/LSIL at 24 months: Colposcopy

24
Q

mgmt for women 21-24y/o who test positive for ASC-H/HSIL

A

colposcopy

25
Q

mgmt for women >24 who test positive for ASCUS but negative for HPV

A

co-testing @ 3 yrs

26
Q

mgmt for women >24 who test positive for LSIL/CIN 1, negatie HPV

A

Co-testing at 12 months

If Negative: Co-test in 3 years

Abnormal: Colposcopy

27
Q

mgmt for women >24 y/ol with persistent CIN for 24 months

A

LEEP Vs Continued follow-up

28
Q

mgmt for women 21-24 y/o who test positive for HSIL/ASC-H

A

colposcopy

do not triage to LEEP!!**

29
Q

mgmt for women 21-24 y/o who test positive for HSIL/CIN I or less

A

Cytology and colposcopy q 6 months up to 24 months

30
Q

LEEP indications

A

—Persistent HSIL (24 mos)

—CIN 2+

—Unsatisfactory colposcopy

31
Q

mgmt for women 25+ who test positive for HSIL/ASC-H

A

colposcopy or LEEP

32
Q

mgmt for women 25+ who test positive for HSIL/ASC-H & completed a colposcopy & are HSIL/CIN 1 or less

A

LEEP

or

Co-testing at 12 and 24 months

If Negative: Re-test at age appropriate interval

If HPV positive and cytology < HSIL: Colposcopy

If HSIL at 12 or 24 months: LEEP

33
Q

mgmt for women 25+ who test positive for HSIL/ASC-H & completed a colposcopy & are HSIL/CIN 2+

A

LEEP

34
Q

žHigh electrical current density results in rapid heating of the nearby tissue.

žA steam envelope surrounding the wire is created which vaporizes adjacent tissue.

žTissue sent for pathology

What procedure is this

A

Loop Electrosurgical excision procedure

35
Q

Ci of LEEP

A

if invasion is suspected

glandular abnormality on PAP

pregnancy

36
Q

what has replaced laser surgery for tx of CIN?

A

LEEP

37
Q

LEEP post-procedure instructions/education

A

žAvoid heavy lifting for 4 weeks to avoid bleeding

žMalodorous vaginal discharge for 2-3 weeks

žAvoid intercourse for 4 weeks

žAvoid douches, creams and tampons within the vagina for 4 weeks

žFirst menses after LEEP is heavier due to partial removal of endocervical canal

38
Q

F/U post LEEP:

A

žRepeat co- testing at 12 and 24 months

If Both negative: re-test in 3 years

If Abnormal: repeat colposcopy with ECC

** age appropriate screening for at least 20 years even if > 65**

39
Q

If + margins after LEEP

A

Repeat cytology and ECC at 4 – 6 months

40
Q

If persistent CIN 2+ following LEEP

A

Repeat LEEP

Hysterectomy

41
Q

avg age of dx for cervical CA

A

35-44 y/o

42
Q

HPV type 16 and 18 associated in 70% of cases

Prevalence is 65-85% and ↓falling

Microinvasion (< 3 mm)

Invasive (> 3mm or visible lesion)

what type of cervical CA?

A

Cervical squamous cell CA

43
Q

HPV type 16 and 18 associated in 86% of cases

Prevalence is 1-25% and ↑rising

Types: Endocervical, Endometrioid, Clear Cell, Adenoid Cystic

what type of cervical CA?

A

cervical adenocarcinoma

44
Q

žFrequently ASYMPTOMATIC

_žMC sx: Abnormal vaginal bleeding**_

Postcoital bleeding

žUnilateral pelvic pain with radiation into the hip or thigh

Sign of advanced disease

žVaginal discharge: Watery, mucoid, purulent, malodorous

Clinical px of what?

A

cervical CA

45
Q
A

GK F3E5 (19 decks)

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