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Women's Health Exam 2 (ASL) > Cervix And Uterus Problems (Lauren 🌭) > Flashcards

Cervix And Uterus Problems (Lauren 🌭) Flashcards

1
Q

When you contract HPV, do you start having abnormal Pap smears right away?

A

No, the virus remains latent for awhile and for some reason it becomes active and thats when it starts causing problems

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2
Q

If you got a hysterectomy for endometriosis or fibroids or something, when should you stop doing Paps?

A

Right then and there

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3
Q

When should you start screening women for cervical cancer?

A

AGE 21

**

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4
Q

What are the surgical options for Adenomyosis?

A

Hysterectomy (definitive treatment)

Uterine Artery Embolization

Endometrial ablation (WORST option. They’re gonna have more pain afterward and youre just gonna have to do a hysterectomy anyways)

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5
Q

What is the ONLY modifiable risk factor for HPV, CIN, and VAIN?

A

Smoking

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6
Q

What is the tumor marker in endometrial cacner?

A

CA-125

She barely talked about this

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7
Q

Why does Depot Lupron help for endometriosis?

A

It shuts off the ovaries and kills off any microscopic cells by cutting off their estrogen and progesterone supply

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8
Q

What is a “Satisfactory” vs “Unsatisfactory” colposcopy?

A

Satisfactory: they could see the entire transformation zone

Unsatisfactory: couldn’t see the whole TZ, so they need to do an endocervical curettage (ECC)

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9
Q

What is a LEEP?

A

Loop Electrosurgical Excision Procedure

They slice out any lesions and send it to pathology

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10
Q

What is the risk of hysteroscopy?

A

Fluid overload and hyponatremia

All that fluid you blow into the uterus can flow out the Fallopian tubes

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11
Q

What are the 4 classifications of endometrial hyperplasia?

A

Simple hyperplasia without atypia

Complex hyperplasia without atypia

Simple atypical hyperplasia

complex atypical hyperplasia

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12
Q

What is the clinical presentation of Adenomyosis?

A

Menorrhagia

Dysmenorrhea

Pelvic pain

Hx of prior uterine surgery

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13
Q

How do you treat hyperplasia with atypia?

A

Hysterectomy if they’re done having kids

Progesterone if they still want kids. (Mirena IUD or Megace)

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14
Q

Whyyyy do they put vinegar on your cervix when they do a colposcopy?

A

Causes HPV-infected cells to turn white and they can see the exact spots they need to biopsy

“Acetowhite epithelium”

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15
Q

At what age should you stop doing Paps?

A

Age 65

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16
Q

Are prophylactic HPV vaccines having a good effect on women’s health

A

They sure are!

Reductions in CIN III, Colposcopy, Treatments, and cervical cancer!

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17
Q

Unopposed ________ leads to endometrial hyperplasia and atypia

A

Estrogen

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18
Q

Endometrial ablation is used to treat __________

A

Menorrhagia

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19
Q

What is a D+C Hysteroscopy and why would you do one instead of endometrial biopsy for the workup of endometrial hyperplasia?

A

It is a full thickness sample of the the entire uterus that is done while the patient is under anesthesia.

Done if lining is too thick to rely on EMB results, cervical stenosis, or EMB gave you insufficient sample

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20
Q

What effect does progesterone have on the endometrium?

A

It has antiproliferative effects causing shedding of the endometrial lining.

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21
Q

What will you find on physical exam of a woman with endometriosis?

A

Tenderness at posterior cul-de-sac

Fixed or Retroverted uterus (secondary to adhesions. Endometriosis is an adhesive process)

Adnexal masses or tenderness

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22
Q

What do you need to do if you suspect endometrial hyperplasia?

A

Pelvic exam

Pelvic ultrasound to assess thickness

Endometrial Biopsy or D+C Hysteroscopy

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23
Q

Why don’t we do Pap smears in women under 21?

A

Because at that age almost ALL of them will clear the virus before it causes any problems.

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24
Q

What is the BEST test we have to screen for cervical cancer?

A

Pap smear with HPV testing

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25
Q

What kinds of labs could be done to diagnose endometrial cancer?

A

CBC

Endometrial Biopsy or D+C

Transvaginal ultrasound

Pap smear (not specifically for screening for endometrial cancer, but it might get picked up)

CA-125

(This is probably not on the test)

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26
Q

Which two types of surgeries for uterine fibroids will preserve fertility/ability to safely get pregnant?

A

Myomectomy

Hysteroscopy

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27
Q

How will the lab report abnormal biopsy results?

A

CIN I, II, III

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28
Q

What are the 2 broad Types (not classifications) of endometrial cancer, and what are the main points of each one?

A

Type I: caused by estrogen. Good prognosis due to well-differentiated tumors.

Type II: has nothing to do with estrogen. Poor prognosis due to poorly-differentiated tumors

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29
Q

What does it mean if your Pap comes back “HSIL” or “ASC-H”

A

“High Grade”

You can assume you have HPV

Lesions would probably be CIN II/III or AIS if you did a biopsy

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30
Q

How will women with endometrial cancer present?

A

Abnormal bleeding, ESPECIALLY post-menopausal bleeding

Cramping, back pain

Weight loss

Dyspareunia

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31
Q

What are the possible complications of LEEP?

A

Bleeding

Infection

Cervical incompetence or stenosis

Pre-term delivery (baby falls out of your now-thinner cervix)

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32
Q

What kind of imaging can be done for uterine fibroids?

A

Transvaginal ultrasound*****

Saline-infused Sonohystogram- filling uterus with water and then doing an ultrasound. For submucosal fibroids only

Hysteroscopy- camera into uterus. Submucosal fibroids only. Done in OR

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33
Q

What are the risk factors for endometrial hyperplasia?

A

OBESITY OBESITY 🐖 OBESITY

Early menarche

Late menopause

Never having kids

Tamoxifen (increased estrogen receptors in uterus)

Unopposed estrogen replacement therapy

Diabetes

PCOS

Hx of breast or ovarian cancer

Pelvic radiation

Lynch Syndrome (HNPCC)

**OBESITY WAS IN RED

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34
Q

Adenomyosis is associated with ________

A

Prior surgery on the uterus (C-section or myomectomy)

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35
Q

What are fibroids made of?

A

Collagen, smooth muscle and elastin wrapped up in a nice pseudocapsule

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36
Q

Why does it matter if you have a transient vs a persistent HPV infection?

A

Persistently positive HPV test is associate with a pretty good chance that you’ll have CIN II/III within 3 years

(Probably not on test)

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37
Q

Cervical cancer is the ONLY cancer that is staged (clinically/surgically)

A

Clinically

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38
Q

Uterine Artery Embolization preserves ________ not _______

A

Uterus

Fertility

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39
Q

What are your options for screening women age 30-64 for cervical cancer?

A

Cytology plus HPV testing q 5 years

OR

Cytology alone q 3 years

OR

HPV alone q 5 years

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40
Q

For women age 21-29, what do you need to do to screen them for Cervical cancer?

A

Cytology every 3 years

Do NOT do HPV testing

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41
Q

After a myomectomy, a patient MUST avoid:

1.

2.

A

Pregnancy for 3-6 months

Vaginal deliveries forever

(Uterus will rip open and you’ll die)

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42
Q

What are the 2 types of cervical cancer?

A

Squamous Cell (most common but prevalence is declining)

Adenocarcinoma (prevalence is rising)

BOTH are associated with HPV 16 and 18 in most cases

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43
Q

When does endometriosis cause pain?

A

Premenstrual**

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44
Q

If we start screening women before age 21, will it reduce their rate of cervical cancer?

A

NO

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45
Q

What are the surgical procedures available for uterine fibroids?

A

Myomectomy

Hysteroscopy

Endometrial ablation

Uterine Artery Embolization

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46
Q

Hysteroscopy is a nice little outpatient procedure that is only performed on __________ fibroids

A

Submucosal

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47
Q

Who is considered at HIGH RISK for developing cervical cancer and needs a Pap every year even before age 21?

A

HIV+

Immunocompromised

History of cervical cancer

History of CIN II/III

Exposure to DES in utero (removed from market in 1970)

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48
Q

How would you detect uterine fibroids when you do a pelvic exam?

A

Uterus would feel all big and lumpy on bimanual exam

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49
Q

What are the symptoms of endometrial hyperplasia?

A

Post menopausal bleeding

Menorrhagia

Intermesntrual bleeding

Prolonged menses >7 days

Decreased menses interval less than 21 days

Oligomenorrhea/Amenorrhea

(WOW pretty much ANYTHING! These seem pretty vague and nonspecific to me, but she said any of these would make her do an endometrial biopsy so thats why i made this card)

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50
Q

Can you get an endometrial ablation on your lunch break?

A

Yes this procedure only takes 2 minutes and you can go home in 1-2 hours

Local anesthesia only

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51
Q

True or false:

A Pap smear can be used to test for other STDs

A

False.

Cytology and HPV only

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52
Q

What percentage of sexually active adults will acquire an HPV infection of their genital tract before they are age 50

A

75-80%

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53
Q

How do you treat Hyperplasia without atypia?

A

With progesterone

(Mirena IUD or Provera)

(If there’s no atypia, there’s no problem)

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54
Q

Who should get a Pap every single year forever for the rest of their life?

A

High risk women

History of cervical CA, immunocompromised, CIN II/III, DES exposure

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55
Q

What is the most common diagnosis responsible for hospitalization of women 15-44 yo?

A

Endometriosis

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56
Q

You have an 84 year old patient come in and she reports that she has finally decided to put herself out there and make a tinder profile. She says she has 2 new boyfriends and she is sexually active with them.
Should you do a Pap just in case?

A

No. Do not resume Paps after age 65

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57
Q

Soooo what should you do for a 19 year old patient that comes in for her well woman exam if you’re not supposed to do a Pap?

A

Contraceptive talk

STI screening (with urine sample)

Gardasil shot

Safe sex talk

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58
Q

What are the 3 “zones” of the cervix?

A

Exocervix- squamous epithelium

Transformation zone-metaplastic squamous epithelium

Endocervical canal- columnar cells

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59
Q

Should you ever resume Pap smears after age 65?

A

No

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60
Q

Why would obesity cause endometrial hyperplasia?

A

Adipose releases estrogen

61
Q

How do you contract HPV

A

The virus enters the cervical epithelium through microlacerations that occur during intercourse

62
Q

If your patient requests Gardasil vaccine but she is already positive for HPV 16, should you still do it?

A

YES

63
Q

What does it mean if your Pap smear comes back “No endocervical cells or unsatisfactory”

A

Your sample was missing endocervical cells or sufficient squamous cells

64
Q

What is the 3rd most common GYN cancer in the US?

A

Cervical cancer

65
Q

What does it mean if your Pap comes back with “ASC-US?’

A

“Atypical cells of undetermined significance”

Can be caused by:
HPV
Chlamydia
Herpes
Vulvovaginal atrophy
66
Q

DEFINITIVE diagnosis of Adenomyosis requires________________*****

A

Histological exam after hysterectomy

⭐️⭐️⭐️⭐️⭐️⭐️⭐️

67
Q

If you got the Gardasil vaccine, do you still need to get Pap smears?

A

Yes

68
Q

When you’re doing a Pap smear:

Adequate sampling requires presence of ___________ sampling

A

ENDOCERVICAL ***

69
Q

What do you need to do when you discover a Nabothian cyst on exam

A

Nothing

70
Q

What will you feel on bimanual exam of Adenomyosis?

A

Diffuse uterine enlargement=

“GLOBULAR” uterus 🌎

71
Q

How is hysteroscopy done?

A
  1. Blow up uterus like water balloon

2. Stick a camera up vagina and into uterus and cut out the fibroid with a heated loop

72
Q

When is LEEP contraindicated?

A

Invasion is suspected

Glandular abnormality on Pap

Pregnant

73
Q

Why is it SO important to send the tissue you cut out during a LEEP to pathology?

A

To make sure you got clear margins

74
Q

What does it mean if your Pap report comes back “LSIL”

A

“Low Grade”

Usually consistent with CIN I if you were to do a biopsy

75
Q

WHY are HPV 16 and 18 such a problem?

A

They have E6 and E7 which block the protective apoptosis process

76
Q

Is there any test out there you can use to ONLY test for HPV

A

Yes it is called Cobas, and it didn’t seem like she was a big fan of doing “HPV only” testing

77
Q

What do you need to tell your patient after you do a LEEP?

A

No heavy lifting for 4 weeks

You’ll have some smelly discharge for 2-3 weeks

Nothing goes in the vagina for 4 weeks (penises, fingers, tampons, douches, etc)

First period after LEEP will be heavy since you just removed part of the cervical canal

78
Q

A 19yr old female comes into your office for her well woman exam and says that she lost her virginity at age 12 and estimates that she has had 75 sexual partners since then. She has also been smoking a pack a day since she was 5 years old.
Do you need to do a Pap smear and screen her for HPV today?

A

NO!!!!

You screen them starting at age 21 unless they’re High Risk

79
Q

What is the ONLY WAY to diagnose endometriosis?

A

LAPARASCOPY
⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️💫

THIS IS A TEST QUETION!

80
Q

What causes the symptoms from uterine fibroids?

A

Location and size

81
Q

Can you remove cervical polyps if they are bothering the patient?

A

Yep just twist em off

82
Q

Why is contraception MANDATORY after an endometrial ablation?

A

If you get pregnant after this, the zygote would implant right into your myometrium=placenta accreta= you die

83
Q

Youre doing a pelvic exam on your SP during women’s health lab and when you get to the bimanual part, you feel a GLOBULAR uterus. You ask the SP how many C-sections she’s had and she confirms that she’s had 2. You know exactly what’s going on here. Ms. Black hands you the transvaginal ultrasound probe and there it is, Adenomyosis.
Can you diagnose this standardized patient with Adenomyosis?

A

NO!!

The ONLY way to diagnose Adenomyosis is to do a hysterectomy and then look at the histology

**SHE HINTED that this would be a test question*

84
Q

What is this:
Benign, yellow, asymptomatic cyst on the cervix. Forms when columnar epithelium is covered by squamous epithelium and the glandular material becomes retained

A

Nabothian Cyst

85
Q

If doing a LEEP has a 90-95% cure rate, why don’t we just do it every time someone has cervical dysplasia?

A

Because it would be better if she beat HPV on her own and developed the antibodies against that strain of HPV

86
Q

HOw does a Uterine Artery Embolization work?

A

Interventional Radiologist threads a catheter into the uterine artery and injects some shit that cuts off the blood supply to the fibroid

87
Q

What are the risk factors for endometrial cancer?

A

Exact same risk factors as for endometrial hyperplasia (obesity, lots of estrogen exposure, etc)

88
Q

What part of the cervix does HPV LOVEEEEE

A

Transformation zone **

89
Q

What is the MOST common GYN cancer?

A

Endometrial Cancer

💫💫💫💫

90
Q

Other than a Mirena IUD, what kind of progesterone would you give for hyperplasia without atypia vs with atypia?

A

Without: Provera

With: Megace

(Idk she made a point to say you wouldn’t give Provera for hyperplasia with atypia)

91
Q

Is infertility common among women with endometriosis?

A

Yes 30-40% of women are infertile

92
Q

Are Serous carcinoma and Clear Cell Carcinoma associated with a hyperestrogenic state?

A

NO!!!

Only Adenocarcinoma and Adenocarcinoma with Squamous differentiation are

93
Q

Uterine fibroids arise from ___________ ________ cells within the uterine wall

A

Smooth muscle

94
Q

What will you see when you stick a laparascope in someone’s belly and she has endometriosis?

A

Erythematous, petechiae lesions on peritoneal surface

Surrounding peritoneum thickened and scarred

Ovaries will have lesions or endometriomas (“chocolate cysts”)

Adhesions

95
Q

What is the most common site of disease in endometriosis?

A

OVARIES

96
Q

True or false:

Most CIN I lesions will regress in 12 months

A

True

97
Q

Can endometrial hyperplasia progress to endometrial cancer?

A

Yes

98
Q

In endometrial hyperplasia, what is the main reason that the endometrium grows out of control?

A

ESTROGEN

*******

99
Q

What are the 2 pieces of information you can get from a Pap smear?

A

Cytology- are the cells normal?

HPV testing- is HPV present?

100
Q

What are the risk factors for HPV infection (and therefore CIN and VAIN)?

⭐️⭐️⭐️⭐️⭐️⭐️

A

MULTIPLE SEXUAL PARTNERS🌟

Early onset of sexual activity

History of STDs

Smoking!

Immunosuppresion

Long term oral contraceptive use

Multiparity

101
Q

When it comes to uterine fibroids what is the role of estrogen and progesterone?

A

Estrogen: makes them grow

Progesterone: increases mitosis and suppresses apoptosis

102
Q

What are the different classifications of uterine fibroids?

A

Submucosal: lie just beneath the endometrium

Subserosal: lie just at the subserosal surface of the uterus

Intramural: lie within the uterine wall (in the muscle)

103
Q

What is this:

“The presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature”

A

Endometriosis

104
Q

What is the treatment for endometrial cacner?

A

Hysterectomy with bilateral salpingoophorectomy (MUST take ovaries to get rid of estrogen)

Chemo/radiation

105
Q

Why do you have to take the ovaries when you do a hysterectomy to treat endometriosis?

A

Because if you remove the estrogen and progertsoen supply, it will kill off any microscopic endometriosis cells that might be hiding

106
Q

What causes the pelvic pain of endometriosis?

A

The lesions grow when they’re exposed to hormones, but their expansion is inhibited by the surrounding organs/fibrosis, which causes pressure and inflammation PAIN

107
Q

What is the most common location of endometriosis?

****

A

Ovaries

*****

108
Q

What needs to be done before an endometrial ablation?

A

You gotta get all those lumpy fibroids out of the uterus because the walls have to be smooth and non distorted

109
Q

What are the two REALLY bad strains of HPV?

A

16

18

110
Q

We don’t totally understand what causes uterine fibroids, but we have a pretty good idea that WHAT is involved in making them grow

A

Estrogen

111
Q

HPV 16 is most associated with (Squamous Cell Carcinoma/Adenocarcinoma)

A

Squamous

112
Q

Endometrial ablation preserves the ________ but not _______

A

Uterus

Fertility

113
Q

When the lab gives you the cytology report back for a PAP SMEAR, how are abnormal results going to be reported?

A

ASC-US

LSIL

HSIL

(Not CIN I,II, III etc. which comes from a Biopsy report)

114
Q

What are the pharmacological options for treating uterine fibroids?

A

Depot Lupron

Hormones

Lysteda (Tranexamic acid)

115
Q

You are doing a totally routine pelvic exam on your patient and when you open up the speculum, you see a SUPER suspicious lesion on her cervix and you’re almost positive it is cancerous.
What is your next step?

A.) Pap smear

B.) Biopsy

A

BIOPSY**

Pap smears are for screening

Biopsies are for DIAGNOSING

🌟🌟🌟🌟🌟🌟🌟
WAS IN BIG RED CAPITAL LETTERS

116
Q

How is cervical cancer staged?

A

CLinical examination of the bladder, uterus, and rectum.

117
Q

What’s the difference between CIN I, II and III?

A

CIN I: 1/3 of epithelial lining

CIN II: 2/3 of epithelial lining

CIN III: more than 2/3 of epithelial lining

118
Q

When does endometrial pain go away?

A

PAIN SUBSIDES WHEN YOUR PERIOD STARTS

🌈🌈🌈🌈🌈🌈🌈🌈🌈🌟🌟🌟🌟🌟⭐️⭐️⭐️⭐️

119
Q

How do your treat endometriosis when it is mild?

A

NSAIDS

120
Q

What is the most common type of endometrial cacner?

A

Adenocarcinoma (Type I)

*****

121
Q

What are “Chocolate Cysts”

A

Endometrial tissue on the ovaries

When you cut them open it looks like chocolate inside 💩

122
Q

Why does endometriosis pain go away for a week when you start your period?

A

Hormones are at their lowest level.

Estrogen and progesterone make the lesions grow, and the expansion leads to pressure and inflammation = pain.

123
Q

What are the medical options for treating Adenomyosis (keeping in mind that the main complaint is dysmenorrhea and menorrhagia)?

A

birth control pills

Mirena

NuvaRing

124
Q

What is a colposcopy?

A

Its like a microscope they stick in your vagina to get a real good view of your cervix and then they pour some vinegar on it

(Biopsy usually done at this time too)

125
Q

Most cervical polyps cause no problems and no symptoms. If a woman were to have any symptom though, what would it be?

A

Bleeding after sex

126
Q

What kind of symptoms can be caused by uterine fibroids?

A

Abnormal bleeding (submucosal only)

Pain- caused by fibroid dying

Pelvic pressure- compression of organs, urinary frequency

Infertility- submucosal impinges on intrauterine cavity

Spontaneous abortion

127
Q

How does Depot Lupron help with fibroids?

A

Its a GnRH agonist that shuts off estrogen and progesterone. Usually given before surgery to shrink the uterus so you can do a laparoscopic approach and lose less blood.

128
Q

How often should women age 21-29 get Pap smears?

A

Every 3 years

Only have the lab do cytology, dont test for HPV

129
Q

Are fibroids common?

A

Yes 25% of women of childbearing age have them

Half of all black women get them

130
Q

What are the 2 HPV vaccines available

A

Gardasil 9

Cervarix

131
Q

If you diagnose cervical cancer, what kind of imaging do you need to do to make sure the chest isn’t involved?

A

Chest CT or CXR

132
Q

What test do you need to do if you diagnose endometrial cacner?

A

Colaris®️ Test- to test for HNPCC (Lynch Syndrome)

133
Q

HPV 18 is most associated with (Squamous cell carcinoma/Adenocarcinoma)

A

Adenocarcinoma

Most patients with adenocarcinoma also have squamous cell

134
Q

What is Adenomyosis?

A

Growth of endometrial glands and stroma into the uterine myometrium. (Invagination of endometrium into the myometrium)

135
Q

How do Lysteda (Tranexamic acid) and hormonal therapy (oral contraceptive pills, Mirena, Nuvaring, etc) help with fibroids?

A

Decrease heavy menstrual periods

Do not help submucosal fibroids

136
Q

How do you treat endometriosis when it is moderate-severe?

A

Interrupt stimulation of endometrial tissue aka SHUT OFF her period:

OCP’s in a continuous cycle (no placebo week)

Progestin (Depo-provera or Mirena)

Depot Lupron

Laparascopy with excision

Hysterectomy with ovary removal

137
Q

What do we think causes endometriosis?

A

Retrograde menstruation

Period blood goes up and out instead of into your tampon

138
Q

What are the 4 Classifications of endometrial cancer?

A

Adenocarcinoma (Type I)

Adenocarcinoma with squamous differentiation (Type I)

Serous Carcinoma (Type II)

Clear cell carcinoma (Type II)

139
Q

What are the side effects/complications of Uterine Artery Embolization?

A

Extreme pain afterwards- requires admission for IV pain meds

If the Embolization stuff floats to the ovaries too you can get premature ovarian failure

140
Q

When you do a Pap smear, you need to rotate the endocervical brush (90/180/360) degrees

A

180

141
Q

Cervical cancer is usually ASYMPTOMATIC, but if a woman is going to have one symptom, what will it be?

A

Abnormal bleeding/ bleeding after sex

May also have pain or persistent weird discharge, but the bleeding part was in red

142
Q

Endometriosis increases your risk for____________

A

Clear cell ovarian cancer

143
Q

Where is the MOST tenderness in a patient with endometriosis

A

Posterior cul du sac

144
Q

What happens to the position of the uterus in a patient with endometriosis

A

Retroverted secondary to adhesions

145
Q

In the treatment of uterine fibroids, what is the maximum amount of time a patient can be on GnRH agonists (Depot Lupron)

A

6 months

146
Q

When can a patient take Tranexamic acid (Lysteda) in the treatment of uterine fibroids

A

Only during menstural cycle

No submucosal fibroids can be present

147
Q

Which surgery option for uterine fibroids preserves the uterus but NOT fertility

A

Uterine artery embolization

148
Q

What is the only way we can definitively diagnose adenomyosis

A

Histologic exam AFTER hysterectomy

Women's Health Exam 2 (ASL) (1 decks)

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