CIS - HPV

Question 1

Patient comes in with increasing fatigue with increased sleep schedule.

Why is it pertinent to ask her about snoring/sore throat, swelling in legs, or depression

Answer 1

Snoring/sore throats —> sleep apnea

Swelling in legs = CHF

Depression —> sleep is a physical manifestation of depression

Question 2

Dyspareunia

Answer 2

Pain with sexual intercourse

Question 3

Why is it important to know that the patient is taking a garlic supplement

Answer 3

Garlic supplements are natural anticoagulants, and since the patient is having vaginal bleeding problems it’s important to know if she is on anticoagulation

Question 4

Pap smear

• what position is the patient put in

Answer 4

Cells are scraped from the Cervical and examined under a microscope to check for disease

Lithotomy position

Question 5

Dysplasi

Answer 5

the presence of cells of an abnormal type within a tissue, which may signify a stage preceding the development of cancer

Question 6

When the pathology report reads high-grade squamous intraepithelial lesion, moderate dysphasia, and CIN II, what two things would you order

Answer 6

HPV reflex

Colposcopy

Question 7

Colposcopy

Answer 7

Putting vinegar on abnormal cervix to look for abnormal cells
—> will turn white on contact with abnormal squamous cells

Question 8

What did the severe dyslexia, CIN III/CA in situ show under the microscope

Answer 8

Increased nuclei

Question 9

HPV characteristics

• size
• envelope yes/no
• type of DNA

Answer 9

Small
Non-enveloped
Circular ds-DNA

Question 10

HPV types 1, 2, and 4 cause what

Answer 10

Common warts

Question 11

HPV types 6 and 11 cause what

Answer 11

Condyloma acuminatum

Genital warts, men and women

Question 12

Types 16 and 18 of HPV cause what

Answer 12

Cervical, penile, rectal, and oropharyngeal cancer

Question 13

5 risk factors for HPV infection

Answer 13

Sexual activity
Cigarette smoking
Socioeconomic reasons
Immunosuppressive
History of STI

Question 14

Transient infection of HPV

Answer 14

Results in HPV-infected cervix but not precancer or cancer

Question 15

What two proteins make HPV 16 and 18 high risk

Answer 15

HPV E6

HPV E7

Question 16

How does HPV E6 cause cancer

Answer 16

Inhibits p53

Increases telomerase expression

Question 17

How does HPV E7 cause cancer

Answer 17

It inhibits p21, which causes increased CDK4/cyclin D concentration which inhibits RB-E2F complex, allowing E2F to be free and promote cell division

Also directly breaks up the RB-E2F complex

Question 18

Normal symptoms of cervical cancer

Answer 18

Abnormal vaginal bleeding (post-coital, status post menopause, spotting)

Dyspareunia

Vaginal discharge

Question 19

Two possible associated symptoms to cervical cancer

Answer 19

Lower back pain

Urinary symptoms

Question 20

What is the recommended screening for ages 0-20

Answer 20

No screening

Question 21

What is the screening recommendation for ages 21-29

Answer 21

Cytology (pap smear) every three years

Abnormal Pap tests may be followed up with HPV testing

Question 22

What is the recommended screening for cervical cancer for ages 30-65

Answer 22

Cytology (pap smear) + HPV testing every 5 years

Or cytology every 3 years

Question 23

What is the recommended screening for cervical cancer of people over the age of 65

Answer 23

No cervical cancer screening required IF the women has had regular screening in the previous 10 years and no serious precancers in the last 20 years

OR
Continue testing if an abnormality was found in the last 20 years

Question 24

Gardasil

• how many vaccines
• protection from what

Answer 24

Two HPV vaccines