Clinical Flashcards
What’s the purpose behind HPV typing?
To help determine risk for CIN
How sensitive is a conventional pap smear for detecting a high grade lesion HGSIL?
60-70%
How do you properly perform a pap smear?
separate the labia, insert speculum angle it down toward the posterior fornix, backup and re-advance to cervix, lock in place.
When should you use a cytobrush vs a spatula on a cervix? What technique is best for getting the sample?
cytobrush with nulliparous or cervical stenosis
spatula with larger cervix
Turn in only one direction 360 degrees
What are some common pap smear screening errors?
Inadequate sample of transition zone cells, inadequate fixative, inaccurate ID, or improper recording of results
What is some potential harm the patient can experience from a pap smear?
Anxiety
stigma STI
bleeding and pain
overtreatment: If paps are done too frequently. This can lead to shortened cervix= preterm birth, or stenotic cervix= cesarian birth b/c of a failure to dilate.
What is the Bethesda classification? How can normal reactive changes or infection obscuring findings?
Uniform system of terminology for reporting cervical cytology findings.
Atrophy of the vagina, radiation, IUDs, infection, can all obfuscated an accurate diagnosis between dysplasia and normal reactivity. These changes may suggest healing, or reaction to viruses or bacteria.
What is the classification of glandular cells?
Glandular or columnar cells of the endocervix can be characterized by the following criteria:
Atypical glandular cells AG (add US undetermined sig)
Adenocarcinoma in situ AIS
Adenocarcinoma
When should you start and end pap screening? What about following a dx or CIN2 or higher? What are some special considerations when considering when to stop screening for your particular patients?
start 21 regardless of age of sexual onset
End 65 usually (assuming adequate prior screening)
CIN2 or higher 20 post dx
Special considerations: risk factors persistent infection, immunocompromised, smoking, multiple sex partners, hysterectomy, DES exposure,
When might you do HPV testing on a woman under 30 y/o? Woman over 65?
If she had an abnormal pap result
Postmenopausal with LGSIL
Name the three HPV vaccines and what strains they protect against?
Gardasil quadravalent 6,11,16,18 (m/f 9-26)
Cervarix bivalent 16,18 (f 9-25)
9 Valent includes 31,33,45,52,58
CIN and LGSIL are both classifications of dysplastic squamous epithelium; which is associated with cytology and which with histology?
CIN histology
LGSIL cytology
What do the major risk factors for endometrial cancer have in common? name some
Estrogen
PCOS-increased peripheral estrone HRT Obesity Tamoxifen estrogen tumor Age increase risk of development
When should you begin reporting endometrial cells on a pap smear, how can you facilitate this and what is the importance of the rule?
40 y/o
Put date of LMP on the requisition form
Postmenopausal women with bleeding are at higher risk of developing cancer than younger women that bleed regularly, though it’s also concerning when a young woman has out of cycle bleeding.
It’s true that a lot of birth control can cause breakthrough bleeding but you still have to consider other things: cancer, anemia, miscarriage etc.
Your next patient had a slightly abnormal pap a month ago and presents for her endocervical curettage because she’s getting older and her SCJ has receded into the endocervix a bit. Nothing much in her hx has changed except she recently became pregnant. How would you move forward with the procedure?
You wouldn’t b/c she’s pregnant
C/I for endocervical curettage and endometrial biopsy
The transformation zone lies between the original and new SCJ and is characterized by what cells types?
A) Anaplastic
B) Metaplastic
C) Dysplastic
D) Neoplastic
B metaplastic. These cells have recently become columnar epithelium having transitioned from non-keratinized squamous epithelium.
What 3 steps would you use to view a cervix for a colposcopy and what changes would you be looking for?
Wipe it off with saline
Use acetic acid to dry and remove mucous
Iodine-normal epithelium is brown abnormal is yellow
Look for acetowhite changes which signal increased cellular density
Vascular abnormalities-punctation or mosaicism
If the SCJ is not visible use an endocervical curettage
Biopsy anything abnormal (patient is having the procedure b/c of an abnormal pap)
How do you treat dysplasia of the cervix?
knife conization, laser, LEEP, D&C endometrial cells
Rx Trichloroacetic acid, podophyllin, cryotherapy
What are the 3 phases of hair growth? What are the 3 types of hair?
Anagen -active
Catagen-(think catabolism) regression
Telogen- rest phase
Lanugo-(nu/new) baby hair everywhere
vellus-fine soft white hair
Terminal hair- long coarse pigmented
Can vellum hair become terminal or vice versa?
Vellus to terminal in puberty
terminal to vellus in androgenic alopecia
What’s the first question you need to ask when you discover someone has increased body hair?
hypertrichosis (no androgen excess) or hirsutism (+/-) virilization (androgen excess)
What’s the definition of hypertrichosis?
Excessive body hair that is not androgen dependent and usually may be treated cosmetically-can be distributed in a localized or general area
What are the causes of hypertrichosifs?
Familial-beckers nevus, or wolfman syndrome
Rx phenytoin, penicillamine, diazoxide, minoxidil, cyclosporine
Anorexia, malnutrition, hypothyroid, porphyria, trauma
What is virilzation?
mature masculine somatic characteristics by a girl, woman, or prepubescent male ranging from hirsutism to adrenocortical or gonadal dysfunction, or androgenic therapy.
What are some of the visible androgenic effects?
hair in a male distribution, muscle and bone growth, acne, increased libido, clitoromegaly, deeper voice.
What are some adrenal causes of hirsutism (+/-) virilization?
adrenal adenoma or carcinoma
CAH, Cushings
What are some ovarian causes of hirsutism (+/-) virilization?
PCOS
dysgerminomas, luteoma, arrhenoblastomas
Acromegaly, hyperprolactinemia, and hypothyroid have what in common?
androgen excess
What are some Rx reasons for excessive androgens?
anabolic steroids, Danazol suppress FSH/LH, OCP with progestins
