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Pathology/ICM-GYN Module > Cervix > Flashcards

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
Q

where does cervical adenocarcinoma develop from?

A

from adenocarcinoma in situtu

26
Q

how do you treat micro invasive cervical carcinoma?

A

with one biopsy

27
Q

how do you treat invade cervical carcinoma

A

hysterectomy

28
Q

what is the micro of cervical cancer?

A

nest and tongues of malignant squamous epithelium

invade underlying stroma

29
Q

how do adenocarcinomas appear?

A

proliferation of glands
large hyper chromatic nuclei
mitosis
glands appear darker then normal

30
Q

what do neuroendocrine cervical carcinomas look like

A

kinda look like small cell carcinoma of lung but in cervix

31
Q

how deep does microinvaseive SCC invade ins take 1a1?

A

no deeper than 3 mm and no wider then 7mm

32
Q

what does stage 2 cancer mean

A

involvement beyond the cervix

33
Q

pap examines cells from what zone?

A

transformation zone

34
Q

when should you have your first pap

A

at age 21 or age of first sexual intercourse

35
Q

what causes cervical infections?

A

chlamydia trachoma’s

neisseria gonorrhaeae

36
Q

what are the signs and symptoms of cervical infections?

A

vaginal discharge…possibly mucopurulent
post coital bleeding
dyuria

37
Q

how do you diagnose cervical infection?

A

NAAT-nucleic acid amplification test

38
Q

how do you treat Neisseria Gonorrhaea?

A

Deftriaxone
Ciprofloxacin
Levofloxacin
Cefixime

39
Q

how do you treat Chlamydia

A

Azithromycin

or Doxycycline

40
Q

Which population has the highest rate of death due to cervical cancer?

A

african american women

41
Q

what is the mean age of diagnosis for cervical cancer?

A

50 years old

42
Q

what are the risk factors for cervical cancer

A 
early age of intercourse (less than 16)
number of sexual partners
smoking
lower SES
high risk male partner
hpv
43
Q

do you diagnose cervical cancer?

A

colposcopy

44
Q

what ar ether sings and symptoms of cervical cancer?

A 
dysplasia-asymptotic
irregular vaginal bleeding
vaginal discharge
pelvic pain
leg edema
bowl/bladder symtpoms
45
Q

describe the physical exam of someone with cervical cancer?

A

exophytic: is like cauliflower filling up the vaginal walls
or can appear as a hard mass with induration
lucrative friable or necrotic

46
Q

how to treat cervical caner

A

very early: cone biopsy or cyst

otherwise: radiation/chemo

47
Q

what causes the transverse vaginal septum?

A

failure of fusty of urogenital sinus with mullein ducts during embryological development

48
Q

how does transverse vaginals septum present?

A

with amenorrhea, possible pelvic pain

49
Q

what causes longitudinal vaginal septum?

A

incomplete fusion of the lower parts of the two mulleriand ucts

50
Q

what are the sings and symptoms of longitudinal vaginal septum?

A

may be asymptomatic may have dyspareunia

51
Q

what is the cause of bacterial vaginosis?

A

associated with significant reduction in hydrogen peroxide producing lactobacillus

52
Q

what are the signs and symptoms of bacterial vaginosis?

A

thin white or gray vaginal discharge foul smelling fishy odar

53
Q

what do you see in the micro of bacterial vaginosis?

A

clue cells

release of volatile amines with addition of KOH-“whiff test”

54
Q

how do you treat bacterial vaginosis?

A

oral metronidazole

clindamycin cream

55
Q

in what patients do you see candida albicans ?

A 
best
immunosuprresed
DM
pregnancy
antibiotics
56
Q

how would you describe the yeast candida albicans ?

A

dimorphic with yeast buds and pseduhyphae

57
Q

how do you tx candida albicans ?

A 
vaginal antifungals (clotrimazole, miconazole, nystatin, terconazole)
oral antibfungales (fluconazole)
58
Q

what is trichomoniasis?

A

single celled protozoan parasite

59
Q

what are the signs and symptoms of a trichomoniasis infection?

A
  • foul thin yellow or green discharge

- may cause sub epithelial hemorrhages on cervix (strawberry cervix)

60
Q

how do you diagnose trichomoniasis?

A

saline prep- will see mobile flagellated protozoa visible

-elevated vaginal ph

61
Q

how do you treat trichomoniasis?

A

metronidazole or tinidazole

Pathology/ICM-GYN Module (11 decks)

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