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OB/GYN > Disorders of the Cervix > Flashcards

Disorders of the Cervix Flashcards

1
Q

Inflammation of the cervix

This is most often caused by an infection that is caught during sexual
activity

Very common – affects more than half of all women at some people during their adult life

A

Cervicitis

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2
Q

What are the risk factors for cervicitis?

A

High-risk sexual behavior
History of STIs
Multiple sexual partners
Sex at an early age
Sexual partners who have engaged in high-risk sexual behavior or have had an STI

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3
Q

List some STIs that can cause cervicitis

A

Chlamydia
Gonorrhea
Trichomoniasis
Herpes virus
HPV

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4
Q

Infection of the upper genital tract after initial infection of the cervix

A

Pelvic Inflammatory Disease

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5
Q

What are the main organisms that can cause pelvic inflammatory disease?

A

C. trachomatis
N. gonorrhea

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6
Q

What can result from scarring and damaged fallopian tubes (PID complications)

A

Infertility

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7
Q

What is the greatest risk factor for PID?

A

prior PID

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8
Q

What are some risk factors for PID?

A

Adolescence
Multiple sex partners
Previous PID
IUD use
Post abortion
Post-op pelvic surgery

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9
Q

What are some complications of PID?

A

Tubo-ovarian abscess
Fitz-Hugh-Curtis syndrome
Infertility
Ectopic Pregnancies
Repeated infections
Adhesions (Chronic pelvic pain, dysparenunia)

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10
Q

Adhesions between the liver and diaphragm

A

Fitz-Hugh-Curtis syndrome

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11
Q

Rupture of a tubo-ovarian abscess with septic shock is a life-threatening complication with mortality approaching what percentage?

A

10%

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12
Q

Extremely common infection, occurring in up to 80% of sexually active women by age 50

Transmission by contact with infected genital skin, mucous membranes or body fluids (partner may have subclinical infection)

Unlike most STDs, sequelae of infection may take years to develop

A

HPV Infection

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13
Q

What is present in 99.7% of invasive cervical cancers?

A

HPV

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14
Q

Persistent HPV infection, especially high viral loads have a higher likelihood of what?

A

CIN and cervical cancer

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15
Q

Which HPV type is the most persistent?

A

HPV 16

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16
Q

Most HPV infections are transient, and what percentage of immunocompetent women will have a spontaneous resolution over a two year period

A

90%

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17
Q

What are some cofactors with HPV in pathology detectable CIN?

A

Immunosuppression
Smoking
Multiple sex partners

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18
Q

With patients with HPV, which percentage will have pathology detectable CIN?

A

5%

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19
Q

What are the two types of HPV associated with genital condyloma and low grade lesions (CIN 1)?

A

6
11

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20
Q

What are the four types of HPV associated with high grade lesions and invasive cancer?

A

16
18
31
33

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21
Q

Which two HPV subtypes account for 2/3 of cervical cancer cases?

A

16 and 18

22
Q

What risk factor is associated with a 3.5 fold increase in the risk of
developing cervical cancer?

A

Cigarette smoking

23
Q

On pap smears, you should not do what testing prior to age 30?

A

HPV-DNA

24
Q

What is the biggest mistake in primary care?

A

The biggest mistake in primary care is getting an abnormal pap
without HPV testing

25
Q

You can do this type of cervical cancer screening when patient is on their period

A

Thin prep

26
Q

Disordered growth and development of the epithelial lining of the
cervix

A

Called cervical intraepithelial neoplasm (CIN)

Formerly known as “dysplasia”

27
Q

CIN is most commonly detected in women of what age range?

A

women in their 20s

28
Q

CIN Classification:

Disordered growth or abnormal maturation of the lower 1/3 of the epithelial lining

A

CIN I: mild dysplasia, LSIL

29
Q

CIN Classification:

Disordered growth or abnormal maturation of the lower 2/3 of the epithelial lining

A

CIN II: moderate dysplasia, HSIL

30
Q

CIN Classification:

Disordered growth or abnormal maturation in more than the lower 2/3 of the epithelial lining

A

CIN III: severe dysplasia, HSIL

31
Q

CIN Classification:

Full thickness

A

Carcinoma in Situ: CIS

32
Q

Management of Abnormal Pap Smear:

Often the next step following an abnormal pap smear

Used to direct biopsies of abnormal areas

A

Colposcopy

33
Q

Management of Abnormal Pap Smear:

Office procedure in which nitrous oxide or carbon dioxide is used as a refrigerant to super-cool a probe

ectocervix only

A

Cryotherapy

34
Q

Cure rate for CIN I is about what percentage with cryotherapy?

A

90%

35
Q

Management of Abnormal Pap Smear:

Rarely used these days

Ectocervix only

Requires special training and attention to safety as well as local or general anesthesia

Can be used for ablation of abnormal tissue or as a cutting instrument for a cone biopsy

A

CO2 laser

36
Q

Management of Abnormal Pap Smear:

Provides additional histological examination – most effective diagnostic test

Most popular – can do in office under paracervical block

Procedure of choice for CIN II and CIN III

A

Loop Electrosurgical Excision Procedure (LEEP) - (Cone-Shaped Excision)

37
Q

Management of Abnormal Pap Smear:

For very advanced forms

Excision of a cone-shaped portion of the cervix using a scalpel - provides additional histological examination

Results in a specimen without thermal artifact

An endocervical curettage is performed following the procedure to assess the remaining endocervical canal

Done in OR under local or general anesthesia

A

Cold Knife (Cone-Shaped Excision)

38
Q

List the complications of a Cold Knife (Cone-Shaped Excision) procedure

A

bleeding
infection
cervical stenosis
cervical incompetence

39
Q

Which abnormal pap procedure is not performed in pregnancy due to risk of infection or abortion?

A

Loop Electrosurgical Excision Procedure

40
Q

Management of Abnormal Pap Smear in pregnancy:

What are the indications for the colposcopy?

A

Colposcopy is performed using the same indications in non-pregnancy

41
Q

Management of Abnormal Pap Smear in pregnancy:

What are limited unless colpo reveals signs suggestive of
carcinoma in situ or invasive disease

A

biopsies

42
Q

Management of Abnormal Pap Smear in pregnancy:

If dysplasia is found, repeat colpo and pap smear how often?

A

each trimester

43
Q

Management of Abnormal Pap Smear in pregnancy:

The LEEP procedure is only indicated in pregnancy when?

A

in suspected invasive disease

44
Q

What percentage of CIN I will spontaneously regress without treatment?

A

~60%

45
Q

If CIN I persists for how long before then treat

A

two years

46
Q

What is the 3rd most common gynecological cancer?

A

cervical cancer

47
Q

Cervical cancer etiology is from what cause 90% of the time?

A

HPV

48
Q

Cancer is preceded by an identifiable precursor lesions (CIN) that may
progress to cancer

A

cervical cancer

49
Q

List some risk factors for cervical cancer

A

Early age at first coitus

Multiple sex partners

History of HPV infection in patient or partner (HPV types 16, 18, 31, 33, 35)

Personal history of cervical dysplasia

Immunocompromised (HIV)

smoking

50
Q

What are some methods to help prevent cervical cancer?

A

Sexual abstinence
Barrier protection
Regular exams and cytology screening
HPV vaccines

OB/GYN (14 decks)

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