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EndoRepro 2 Exam 1 > Clin: Pap Smear - Wooton > Flashcards

Clin: Pap Smear - Wooton Flashcards

1
Q

what is the site where more than 90% of cervical neoplasia arise?

A

squamocolumnar junction (SCJ)

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2
Q

what happens to the SCJ as women age?

A

it moves up into the cervical canal, becoming protected

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3
Q

how many strains of HPV are associated with cancer?

A

15

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4
Q

which 4 strains cause the majority of cancer?

A
  • *16, 18**, 31, 45

- 16 and 18 responsible for 70% of cervical cancer

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5
Q

which HPV strains are associated with genital warts and low grade lesions?

A

6, 11

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6
Q

what are the risk factors for cervical neoplasia?

A
  • multiple sexual partners
  • young age at first intercourse
  • smoking (3.5x greater risk)
  • organ transplant
  • DES exposure
  • high parity (esp with multiple partners)
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7
Q

what are the screening guidelines for females under 21?

A

NO screening

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8
Q

what are the screening guidelines for females age 21-29?

A

pap cytology every 3 years

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9
Q

what are the screening guidelines for females age 30-65?

A

HPV and cytology every 5 years

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10
Q

what are the screening guidelines for females age 65 and over?

A

no screening following adequate negative prior screening

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11
Q

what are the screening guidelines for females after hysterectomy?

A

NO screening

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12
Q

a satisfactory specimen on the 2001 Bethesda system has both what?

A

endo and ectocervix spacimen

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13
Q

what organisms can be identified using the 2001 Bethesda system?

A
  • trichomonas
  • fungal organisms consistent with Candida
  • shift in flora suggestive of bacterial vaginosis
  • bacteria morphologically consistent with actinomyces
  • cellular changes consistent with HSV
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14
Q

what epithelial cell abnormalities can be identified using the 2001 Bethesda system?

A

atypical squamous cells
- of undermined significance (ASC-US)
- cannot exclude high grade (ASC-H)
low grade squamous intraepithelial lesion (LSIL)
high grade squamous intraepithelial lesion (HSIL)
squamous cell carcinoma

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15
Q

what is the order of cervical changes leading to cervical cancer?

A

normal -> LSIL -> HSIL -> cervical cancer

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16
Q

what if a woman tests positive for ASC-US, but negative for HPV?

A

repeat co-testing in 3 years

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17
Q

what if a woman tests positive for ASC-US, and is HPV positive?

A

needs colpo

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18
Q

what if a woman tests positive for LSIL, but negative for HPV?

A

repeat co-testing in 1 year

19
Q

what if a woman tests positive for LSIL with positive HPV test?

A

needs colpo

20
Q

what if a woman tests positive for LSIL with no HPV test?

A

still needs colpo to be safe

21
Q

what if a woman tests positive for HSIL?

A

requires automatic colpo workup

22
Q

what is the gold standard for diagnosis and treatment of cervical cancer?

A

colpo with directed biopsy

23
Q

what happens to abnormal cells when they are washed with 3% acetic acid?

A

acetowhite changes: the acid dehydrates the cells and large nuclei of abnormal cells turn white

NOTE: must visualize the entire SCJ

24
Q

LSIL is considered what on the CIN grading system?

A

CIN I

25
Q

HSIL is considered what on the CIN grading system?

A

CIN II or III

26
Q

when mosaicism is visualized on a cervix, what CIN stage is it almost always?

A

CIN III (high grade lesion)

27
Q

cryotherapy and laser ablation are examples of what type of treatment?

A

ablative

28
Q

cold knife cone (CKC) and loop electrode excision procedure (LEEP) are examples of what type of treatment?

A

excisional

29
Q

when would you perform excisional techniques?

A
  • endocervical curettage positive (needs cold knife cone)
  • unsatisfacotry colposcopy (no SCJ)
  • substantial discrepancy between pap and biopsy (high grade pap vs negative colpo)
30
Q

what are the risks of excisional procedures?

A
  • increased risk cervical incompetence and resultant second trimester pregnancy loss
  • increased risk PPROM
  • cervical stenosis
  • operative risks (bleeding, infection)
31
Q

97% of cervical cancer is caused by what?

A

HPV

  • SQQ = 80%
  • adenocarcinoma = 15%
32
Q

watery vaginal bleeding, postcoital bleeding, intermittent spotting
- spread by direct invasion and lymphatic spread

A

cervical carcinoma

33
Q

how would you manage microinvasive cervical cancer?

A

cold knife cone or hysterectomy

34
Q

how would you manage invasive cervical cancer?

A

radical hysterectomy with lymph node dissection

35
Q

how would you manage bulky disease cervical cancer?

A

radical hysterectomy with lymph node dissection or radiation therapy and cisplatin-based chemo

36
Q

how would you manage stage IIb and greater cervical cancer?

A

external beam radiation and concurrent cisplatin-based chemo

37
Q

how can you prevent cervical cancer?

A
  • sexual abstinence/limiting number of partners
  • use of barrier protection
  • regular exams and pap smears (est to reduce morbidity/mortality by 40%)
  • HPV vaccination
38
Q

what is the injection series for HPV vaccine?

A

1st dose, 2nd dose 2 months later, 3rd dose 6 months from first

recommended routine vaccination for all girls and boys 9-26
FDA approved use in men/women ages 27-45

39
Q

what vaccination routine does the ACIP recommend for adolescents less than 15 years of age?

A

2 routine doses separated by 6-12 month intervals

40
Q

can you receive the HPV vaccine if you’ve had an abnormal pap?

A

yes

41
Q

can you receive the HPV vaccine during pregnancy or breastfeeding?

A

pregnancy - NO

breastfeeding - yes

42
Q

what does the 4 strain Guardasil protect against?

A

6, 11, 16, 18

- 70% of cervical, vaginal and 50% of vulvar cancers

43
Q

what does the 9 strain vaccine protect against?

A

6, 11, 16, 18, 31, 33, 45, 52, 58

44
Q

what are the side effects for Cervarix (older vaccine that protected against 16 and 18, but no longer available in US)?

A
  • syncope
  • dizziness
  • nausea
  • headache
  • fever

EndoRepro 2 Exam 1 (25 decks)

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