Cervix Flashcards

1
Q

whwhat is the main component of the vaginal flora

A

lactobacilli

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2
Q

what do lactobacilli produce?

A

lactic acid and h202

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3
Q

what can lead to acute cervicitis?

A

bleeding
sex
douching
antibiotics

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4
Q
how do bleeding 
sex 
douching
antibiotics
lead to acute cervicitis?
A

lead to a higher ph
decreases h202
overgrowth of other bacteria

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5
Q

what are the clinical signs of endocervical polyps

A

vaginal spotting or bleeding

protrudes from cervical os

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6
Q

what are the micro signs of endocervical polyps?

A

loose fibrous stoma and dilated mucous glands with inflammation

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7
Q

how do you tx cervical polyps?

A

excise

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8
Q

what causes cervical cancer?

A

HR HPV

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9
Q

what type of virus is HPV?

A

DNA

double stranded

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10
Q

what are examples of HR (high risk) hpv strands?

A

16 18 31 33

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11
Q

what stain of hpv is most implicated in cervical cancer?

A

hpv 16

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12
Q

what strain of hpv causes most cases of adenocarcinoma of the cervix?

A

hpv 18

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13
Q

what type of cells are difficult to pick up with pap smears?

A

qAtypical glandular cells the precursors to adenocarcinoma of the cervix

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14
Q

what type of hpv causes condyloma cuminatum?

A

low risk ( 11 and 6)

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15
Q

what are risk factors for cervical cancer?

A
multiple sex partners
young age at 1st intercourse (coitarche)
high parity
persistent infection with HR HPV
immunosupresion
OCPs
Smoking
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16
Q

when do you usually see HPV?

A

high peak in 20s

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17
Q

what types of cells does HPV infect?

A

immature basal cells in areas of epithelial breaks
immature metaplastic cells
(cannot infect mature superficial squamous cells in ectocervix, vulva and vagina unless damage to surface epithelium)

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18
Q

Where can you find immature squamous epithelium making them vulnerable to HPV?

A

cervical cancer

anal cancer

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19
Q

what type of nucleus do you see in cells infected with HPV?

A
kilocyte atypic 
SIL-nuclear enlargement
hyperchromasia (dark staining)
coarse chromatin granules
variation in nuclear size and shape
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20
Q

HPV has genes E6 and E7 what do they effect?

A

E6: binds p53
E7: Rb

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21
Q

what is the difference between CIN1/LSIL and CIN2-3/HSIL histologically

A

LSIL take up lower 1/3 of epithelium

while HSIL takes up 2/3 of the epithelium or more

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22
Q

what stains correlate with hpv infection

A

HPV DNA ISH staining
Ki67 staining
p16 staining

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23
Q

what is the peak age for cervical cancer?

A

45

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24
Q

what type of cancer is most likely to develop from HSiL?

A

squamous cell carcinoma

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25
where does cervical adenocarcinoma develop from?
from adenocarcinoma in situtu
26
how do you treat micro invasive cervical carcinoma?
with one biopsy
27
how do you treat invade cervical carcinoma
hysterectomy
28
what is the micro of cervical cancer?
nest and tongues of malignant squamous epithelium | invade underlying stroma
29
how do adenocarcinomas appear?
proliferation of glands large hyper chromatic nuclei mitosis glands appear darker then normal
30
what do neuroendocrine cervical carcinomas look like
kinda look like small cell carcinoma of lung but in cervix
31
how deep does microinvaseive SCC invade ins take 1a1?
no deeper than 3 mm and no wider then 7mm
32
what does stage 2 cancer mean
involvement beyond the cervix
33
pap examines cells from what zone?
transformation zone
34
when should you have your first pap
at age 21 or age of first sexual intercourse
35
what causes cervical infections?
chlamydia trachoma's | neisseria gonorrhaeae
36
what are the signs and symptoms of cervical infections?
vaginal discharge...possibly mucopurulent post coital bleeding dyuria
37
how do you diagnose cervical infection?
NAAT-nucleic acid amplification test
38
how do you treat Neisseria Gonorrhaea?
Deftriaxone Ciprofloxacin Levofloxacin Cefixime
39
how do you treat Chlamydia
Azithromycin | or Doxycycline
40
Which population has the highest rate of death due to cervical cancer?
african american women
41
what is the mean age of diagnosis for cervical cancer?
50 years old
42
what are the risk factors for cervical cancer
``` early age of intercourse (less than 16) number of sexual partners smoking lower SES high risk male partner hpv ```
43
do you diagnose cervical cancer?
colposcopy
44
what ar ether sings and symptoms of cervical cancer?
``` dysplasia-asymptotic irregular vaginal bleeding vaginal discharge pelvic pain leg edema bowl/bladder symtpoms ```
45
describe the physical exam of someone with cervical cancer?
exophytic: is like cauliflower filling up the vaginal walls or can appear as a hard mass with induration lucrative friable or necrotic
46
how to treat cervical caner
very early: cone biopsy or cyst | otherwise: radiation/chemo
47
what causes the transverse vaginal septum?
failure of fusty of urogenital sinus with mullein ducts during embryological development
48
how does transverse vaginals septum present?
with amenorrhea, possible pelvic pain
49
what causes longitudinal vaginal septum?
incomplete fusion of the lower parts of the two mulleriand ucts
50
what are the sings and symptoms of longitudinal vaginal septum?
may be asymptomatic may have dyspareunia
51
what is the cause of bacterial vaginosis?
associated with significant reduction in hydrogen peroxide producing lactobacillus
52
what are the signs and symptoms of bacterial vaginosis?
thin white or gray vaginal discharge foul smelling fishy odar
53
what do you see in the micro of bacterial vaginosis?
clue cells | release of volatile amines with addition of KOH-"whiff test"
54
how do you treat bacterial vaginosis?
oral metronidazole | clindamycin cream
55
in what patients do you see candida albicans ?
``` best immunosuprresed DM pregnancy antibiotics ```
56
how would you describe the yeast candida albicans ?
dimorphic with yeast buds and pseduhyphae
57
how do you tx candida albicans ?
``` vaginal antifungals (clotrimazole, miconazole, nystatin, terconazole) oral antibfungales (fluconazole) ```
58
what is trichomoniasis?
single celled protozoan parasite
59
what are the signs and symptoms of a trichomoniasis infection?
- foul thin yellow or green discharge | - may cause sub epithelial hemorrhages on cervix (strawberry cervix)
60
how do you diagnose trichomoniasis?
saline prep- will see mobile flagellated protozoa visible | -elevated vaginal ph
61
how do you treat trichomoniasis?
metronidazole or tinidazole