Cervix

Question 1

What are you checking for during a cervix exam?

Answer 1

cervix
-size/symmetry 
-shape
-color
-abnormalities 
OS
-size/shape
-squamocolumnar jxn

Question 2

What is the squamocolumnar jxn?

Answer 2

the most common site of dysplasia

may or may not be visible

Question 3

What is cervicitis?

Answer 3

inflammation of the cervix

Question 4

What can cx cervicitis?

Answer 4

chlamydia
gonorrhea
herpes
mycoplasma
ureaplasma

Question 5

What is the sx/pe for cervicitis?

Answer 5

mucopurulent discharge at the cervix

friable

Question 6

What tests for cervicitis?

Answer 6

wet mount - >10WBC/HPF

culture

Question 7

How to tx cervicitis?

Answer 7

tx the STD

if no organism –> doxycyline 100mg PO BID x7days

Question 8

What are benign cervical lesions?

Answer 8

polyps
nabothian cysts
laceration 
myomas
cervical stenosis

Question 9

What are polpys and how can they be treated?

Answer 9

fleshy lesions w/ STALK that is the SAME COLOR as the cervix

just remove - do not need to tx

Question 10

What is nabothian cyst?

Answer 10

common
retention cyst in the squamous mucosa
single or cluster of nodules

Question 11

Sx for nabothian cyst?

Answer 11

asymptomatic

Question 12

Tx for nabothian cyst?

Answer 12

resolve on it’s own

Question 13

How do lacerations happen?

Answer 13

d/t delivery and not tx’d then - will form a fish mouth appearance

Question 14

What are myomas?

Answer 14

smooth firm mass

single fibroid

Question 15

How to tx myomas?

Answer 15

excise if large b/c it causes sx

refer

Question 16

Where does the cervical stenosis happen?

Answer 16

internal OS

Question 17

Cx of cervical stenosis?

Answer 17

congenital or acquired

Question 18

Sx of cervical stenosis?

Answer 18

asymptomatic
dysmenorrhea
infertility - difficulty getting pregnant b/c sperm cannot get in

Question 19

Who are at risk for cervical stenosis?

Answer 19

post menopausal

Question 20

Cervical stenosis - tx?

Answer 20

refer

Question 21

What is a cofactor of cervical cancer?

Answer 21

HPV-16,18

Question 22

Who are at RF for cervical cancer?

Answer 22

never been screened or not screened w/in 5yrs
young age of sex
multiple sex partners
smoking
immunosuppression
AA

Question 23

What must you do to dx cervical cancer?

Answer 23

microscope to tell the diff between cancer and warts

Question 24

Tx of cervical cancer?

Answer 24

removal of cervix

Question 25

What is the prognosis of cervical cancer?

Answer 25

very good b/c it is a slow growing cancer

Question 26

What is HPV and cervical cancer?

Answer 26

cofactor necessary but not sufficient to cervical cancer

Question 27

How to dx HPV?

Answer 27

DNA testing

Question 28

How to tx HPV?

Answer 28

vaccine - prevent | viral - self limiting

Question 29

What can Gardasil prevent?

Answer 29

cervical, vulvar, vagina, throat, anal, penile | ONLY HPV 6, 11, 16, 18

Question 30

What is the scheduling for Gardasil?

Answer 30

0, 2, 6mo

Question 31

Who and what age can get Gardasil?

Answer 31

males and females: 9-26yo

Question 32

What is the pap smear?

Answer 32

screening test NOT diagnostic

Question 33

When to start screening for pap smear?

Answer 33

21yo

Question 34

When to do routine screening for pap smear?

Answer 34

if 3 neg screens in a row --> q3 yrs OR q5yrs w/ HPV co testing

Question 35

What is liquid based cytology?

Answer 35

slide to check the cells

Question 36

What is the broom technique?

Answer 36

rotate broom 5x --> rinse in vial 10x

Question 37

If pap smear is positive - next step?

Answer 37

colposcopy

Question 38

What is the diff between thin prep and slide pap smear?

Answer 38

nothing. same results

Question 39

When do you stop pap smears?

Answer 39

stop @ 65yrs OR hysterectomy | -3 neg OR 2 neg w/HPV co testing w/in 10yrs

Question 40

What to do someone is at high risk?

Answer 40

20yrs of screening despite passing 65yo

Question 41

What does the bethesda system include?

Answer 41

``` specimen adequacy negative for intraepithelial lesions/malignancy SIL Atypical squamous cells atypical glandular cells adenocarcinoma in situ ```

Question 42

What are the classifications for SIL?

Answer 42

LSIL - low grade | HSIL - high grade

Question 43

How to counsel for LSIL?

Answer 43

21-24yo - pos HPV --> pap smear q12mo x2yrs >25yo - pos HPV --> refer (colpscopy + cervical bx + sample endocervical canal) >25 - neg HPV --> q3yrs pap smear + HPV postmenopausal - refer pregnant - refer (colposcopy, bx if suspicious)

Question 44

How to counsel for HSIL?

Answer 44

IF CIN 3/invasive cancer --> colposcopy + bx

Question 45

What are the classifications for atypical squamous cells?

Answer 45

ASC-US | ASC-H

Question 46

How to counsel ASC-US?

Answer 46

21-24yo - pos HPV --> pap smear q12mo x2yrs >25yo - pos HPV --> refer (colpscopy + cervical bx + sample endocervical canal) >25 - neg HPV --> q3yrs pap smear + HPV postmenopausal - refer pregnant - same as above according to age immunosuppressed - refer

Question 47

How to counsel ASC-H?

Answer 47

refer

Question 48

How to counsel atypical glandular cells?

Answer 48

refer

Question 49

What is colposcopy?

Answer 49

used for further studying for abnormal pap smear binocular microscope + acetic acid solution used cervical bx