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Repro Exam I > Cervix > Flashcards

Cervix Flashcards

1
Q

non specific chronic cervicitis - cause and symptom

A

Change in microbiome - loss of acidosis from normal lactobacilli | reddened transformation zone

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2
Q

common infections causing cervicitis

A

Gonococcus
chlamydia
mycoplamas
Herpes simplex virus

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3
Q

What can infections cause in the cervix?

A

atypia on the pap smear - interpretation can be a difficult

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4
Q

Chlamydia - symptoms

A

man - white urethral discharge w/ or w/o pain, swollen testical, epididymitis, prostatis, reactive arthritis, Reiter’s syndrome
women - usually asymptomatic, PID, ectopic pregnancy
prenatal - conjunctivitis/pneumonia/blindness, spontaneous abortions, premature birth

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5
Q

How diagnose chlamydia

A

nucleic acid amplification test (NAAT)

aka PCR on swab specimin or Pap liquid

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6
Q

Chlamydia trachomatis histology

A

mature squamous epithelium - chronic follicular cervicitis

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7
Q

test for herpes

A

Tzank test

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8
Q

histology for herpes

A

multinucleated cells w/ intra-nuclear, ground glass viral inclusions, inflammatory debris

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9
Q

cervical herpes symptoms

A

painful blisters/ ulcers

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10
Q

test for gonococcus

A

thayer-martin agar (chocolate agar)

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11
Q

gonococcus symptoms

A

white pus in vagina

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12
Q

are polyps typically malignant or benign: Describe

A

benign, broad based(sessile) or stalk (pedunculated)

>5cm -> called a tumor

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13
Q

Describe endocervical polyp

A

common, up to 5 cm, benign, spotting of blood(internal bleeding, mass of cervical os

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14
Q

treatment for endocervical polyp

A

polypectomy

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15
Q

What is nabothian cyst?

A

endocervical glands blocked and filling w/ mucus

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16
Q

Nabothian cyst treatment

A

none needed, remove if unsure

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17
Q

leading cause of cancer in third world

A

cervical neoplasms

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18
Q

Primary cause of cervical neoplasms

A

high risk HPV: 16 - 60% 18 10%

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19
Q

Cervical neoplasm host factors

A

young at first intercourse, multiple sex partners, male partner w/ multiple partners, immunosuppression, BCPs, smoking

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20
Q

How does HPV cause hepatocellular carcinoma

A

inserts into hepatic DNA

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21
Q

Describe HPV replication

A

infects immature squamous cells, replicates in maturing squamous cells

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22
Q

What 2 tumorogenic proteins does HPV code for?

A

viral E6 - inactivates p53
viral E7 - inhibits Rb protein from binding E2F
E2F binds promotors (c-myc) -> enter cell cycle

23
Q

Classification for Premalignant Squamous Cervical lesions

A

Mild Dysplasia - CIN I - Low grade SIL
Moderate dysplasia - CIN II - High grade SIL
Severe Dysplasia - CIN III - High grade SIL
CIS - CIN III - High grade SIL
(SIL - squamous intraepithelial lesion)
(CIN - cervical intraepithelial neoplasm)

24
Q

What must be done for premalignant squamous cervical lesions?

A

Cone biopsy

25
Q

What happens to most HPV infections?

A

95% get removed by the immune system in ~ 1 year

26
Q

DNA in high risk HPV

A

viral dna incorporated into cell

27
Q

Describe CIN? (cervical intraepithelial neoplasia)

A

progressive expansion of immature basal cells and cytologic atypia above the lower third of thickness

28
Q

Hallmarks of low grade SIL?

A

Koilocytic atypia - raisinoid nucleus from disruption of cytoskeleton by viral particles

29
Q

What is Ki-67

A

marker of cellular proliferation - should be confined to basal layer(proliferative zone)

30
Q

What is P16

A

cell cycle regulator targets Rb- will be high when cells are proliferating because of abnormal activation by RB is inactivated by E7 HPV

31
Q

What is a leugal stain

A

stains normal cervical tissue brown

32
Q

Cervical intraepithelial neoplasia - histology

A 
increase nuclear/cytoplasmic ratio
koilocytosis - wrinkly raisinoid nucleus
hyperchromasia
increased mitotic figures
decreased differentiation
33
Q

Typical course of cervical dysplasia

A

90% regress over 2 years

10% go to HSIL —-> 10% of those to cancer over 10 years (faster in immunocompromised)

34
Q

cervical dysplasia treatment(abnormal pap smear)

A

colposcopy and cervical biopsy
removal of dysplastic tissue by
cryotherapy, electrocautery, topical 5-fluoruracil, conization

35
Q

Age to discontiue cervical cancer screening

A

65 (may change - older people getting busy)

36
Q

What is a cold cone biopsy

A

a large area of tissue around the cervix is excised for examination

37
Q

what to do for adenocarcinoma in stiu of endocervix

A

cone biopsy - evaluate margins

probably lead to hysterectomy (after had enough kids)

38
Q

What do you do with an abnormal white area on the cervix after application of 3% acetic acid(acetowhite) solution

A

biopsy for CIN

39
Q

CIN I - histology

A

nuclear changes in lower 1/3 of cervical epithelium

expansion of basal cells

40
Q

CIN III - histology

A

nuclear changes in full thickness of cervical epithelium

41
Q

Most common cervical cancer

A

80% SCC
15% adenocarcinoma
5% adenosquamous CA and small cell CA

42
Q

Age of peak incidence of invasive cervical CA

A

45 years old

43
Q

Which cervical CA have more aggressive courses

A

adenocarcinoma and small cell carcinoma(neuroendocrine)

44
Q

Staging and prognosis in cervical carcinoma

A

T1 - small and shallow - 97% @ 5 years
T2 - beyond cervix - 70%
T3 - to pelvic sidewall - 36%
T4 - tumor beyond pelvis/into bladder/rectum - 7%

45
Q

How do most women die from cervical cancer?

A

invasion of local structure, ie obstruction of ureters leading to renal failure (50%)

46
Q

How do you treat cervical cancer

A

radical hysterectomy

47
Q

what are squamous pearls indicative of?

A

squamous cell carcinoma

round nodules with concentric laminated layers - “nests”

48
Q

What is adenocarcinoma in situ (AIS)

A

precursor lesion to invasive adenocarcinoma
same invasive carcinoma sequence as SCC
can form in multiple sites
glands - so large dark nuclei w/o mucin

49
Q

False negative rate of pap smear

A

10% false negative

50
Q

False negative rate of HPV DNA testing

A

4-7% (combined w/ pap smear >99.5% sensitive)

not used in women <30 - too high infection rate

51
Q

HPV strains covered by old vaccine(guardasil)

A

6, 11 (condylomas) and 16, 18 (cancers)

52
Q

HPV strains coverend by new vaccine (9v)

A

6/11/16/18/31/33/45/52/58

53
Q

Does the vaccine completely prevent cervical cancer

A

No, still other strains

54
Q

what are condyloma acuminta

A

genital warts caused by HPV 6,11(usually)

Repro Exam I (7 decks)

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