Disorders of the Cervix

Question 1

What is a normal nonpatholagical darker red portion of the cervix located in the center of the cervical os

Answer 1

Squamocolumnar Junction or ectropion

Question 2

How does the cervix change during pregnancy. What is the name for these changes

Answer 2

It becomes engorged, red, and softer w/ more white secretions. May also take on grayish blue tint = Chadwick sign

Question 3

3 parts of diagnosis of cervicitis

Answer 3

1) mucopurulent discharge
2) wet mount w/ > 10 wbc
3) cervix often friable

Question 4

What pathogens cause cervicitis

Answer 4

Chlamydia, GC, Herpes, Mycoplasma, Ureaplasma, …

Question 5

White milky discharge with foul smelling fishy order

Answer 5

Bacterial Vaginosis (BV): anaerobic microbes

Question 6

How should cervicitis be treated if no organism can be identified?

Answer 6

Doxycycline 100mg PO BID x 7 days

Question 7

What is a Nabothian cysts

Answer 7

Common findings
Asymptomatic
Retention cyst -squamous mucosa covering a gland
No treatment needed

Question 8

What is a Myoma?

Answer 8

Smooth, firm mass
Usually solitary
Usually small and asymptomatic
Can excise if large and causing symptoms

Question 9

A congenital or acquired narrowing of the cervix that may be asymptomatic or cause dysmenorrhea, or infertility.

Answer 9

Cervical Stenosis

Question 10

Cervical cancer is most frequently what type of cancer? Who gets it? Why?

Answer 10

Squamous cell carcinoma
Sexually active women (esp never been screened or > 5 yr)
HPV: 16 - 18

Question 11

Risk factors for Cervical Cancer

Answer 11

Young age at 1st coitus (<20 years)
Multiple sexual partners
Sexual partner with multiple sexual partners
Immunosuppression
Smoking (4-fold increased risk)

Question 12

What HPV genotypes does guardasil cover

Answer 12

6-11-16-18

Question 13

What type of test is a Pap Smear

Answer 13

Screening test

Question 14

What tests are indicated after positive Pap Smear finding?

Answer 14

Colposcopy, +/- HPV testing

Question 15

Pap Smear Guidlines

Answer 15

Begin at 21 yo
Annual screening until 3 consecutive negative paps, then
Avg risk: every 3 years or every 5 years w/ HPV co-testing.
High risk: every year for 20 years after treatment
every year for HIV+/ immunocompromised
Discontinue at 65yo if adequate prior screening/ not high risk (3x consecutive neg cytology/ 2 neg HPV w/in 10 yr)

Question 16

What is an ASC-US vs ASC-H

Answer 16

atypical squamous cells of undetermined significance vs “Cannot exclude High grade SIL (HSIL :High grade Squamous Intraepithelial Lesion)

Question 17

What is a system for reporting cervical or vaginal cytologic diagnoses, used for reporting Pap smear results.

Answer 17

The Bethesda system

Question 18

How are Cervical Intraepithelial Neoplasia (CIN) ‘s rated

Answer 18

CIN 1 – disorder growth in lower 1/3 of epithelium
CIN 2 – disordered growth in lower 2/3 of epithelium
CIN 3 – disordered growth > 2/3 of epithelium
Invasive – full thickness dysmaturity

Question 19

Procedures to Treat Cervical Dysplasia and Cancer

Answer 19

Ablation Techniques: Cryotherapy, Laser

Excisional Techniques:LEEP :Loop Electrosurgical Excision Procedure, Laser conization, Cold-knife conization

Question 20

What level of Dysplasia/Cancer get hysterectomy?

Answer 20

Used to treat CIN 3 in patients who have completed childbearing
Not appropriate as first-line treatment for CIN-2 or 3 except in special circumstances
Never appropriate as first-line treatment of CIN-1

Question 21

Monitoring for ASC-US (undetermined significance) or LSIL on Pap?

Answer 21

For women 21-24 years of age – Consider HPV testing (if negative can continue routine screening)
If HPV positive or unknown, repeat Pap smear every 12 months for 2 years - Any increase refer!

For women 25 years of age and older –
If HPV testing is positive, refer for colposcopy with directed cervical biopsies, and sampling of the endocervical canal
If HPV testing is negative, repeat pap smear and HPV co-testing in 3 years

If Preggers and + LSIL = Colposcopy

Question 22

HSIL management

Answer 22

refer for colposcopy

Question 23

What does postcoital (post sexual intercourse) bleeding suggest?

Answer 23

Cervical cancer, which must be ruled out.