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CK GYne > DO of the Cervix and Uterus > Flashcards

DO of the Cervix and Uterus Flashcards

1
Q

______ are fingerlike growths that start on the surface of the cervix or endocervical canal.

These small, fragile growths hang from a stalk and push through the cervical
opening.

A

Cervical polyps

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2
Q

Causes of cervical polyps

A

They may be associated with chronic inflammation, an abnormal response to increased levels of estrogen, or
thrombosed cervical blood vessels.

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3
Q

What is the hx of cervical polyp

A

The history is usually positive for vaginal bleeding, often after intercourse. This bleeding occurs between normal menstrual periods

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4
Q

PE of pts with cervical polyp

A

Speculum examination reveals smooth, red or purple, fingerlike projections from the
cervical canal

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5
Q

Mx of cervical polyp

A

Polyps can be removed by gentle twisting or by tying a surgical string around the base
and cutting it off.

Removal of the polyp’s base is done by electrocautery or with a laser.

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6
Q

A ______is a mucus-filled cyst on the surface of the uterine cervix.

The cervical canal is lined by glandular cells that normally secrete mucus

A

nabothian cyst

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7
Q

PE of Nabothian Cyst

A

Pelvic examination reveals a small, smooth, rounded lump (or collection of lumps)
on the surface of the cervix.

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8
Q

Mx of Nabothian cysts

A

They can be easily cured through electrocautery or cryotherapy. Both procedures can be done in the doctor’s office

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9
Q

The most common finding is mucopurulent cervical discharge and a friable
cervix. This diagnostic finding is confirmed by endocervical bleeding easily induced by passage of a cotton swab through the cervical os

A

Cervicitis

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10
Q

Findings of cervicitis

A

Routine cervical cultures are positive for chlamydia or gonorrhea. WBC and ESR are normal

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11
Q

Mx of Cervicitis

A

Oral azithromycin in a single dose or oral doxycycline BID for 7 days.

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12
Q

The progression from premalignant to invasive cancer has been reported to be approximately ______

A

8–10 years

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13
Q

HPV_________ are the most common

HPV types associated with premalignant and cancerous lesions of the cervix

A

16, 18, 31, 33, and 35

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14
Q

HPV 6 and 11 are the most common HPV types associated with ______

A

benign condyloma acuminata.

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15
Q

RF for Cervical Neoplasia

A

These include early age of intercourse, multiple sexual partners, cigarette smoking,
and immunosuppression. The mediating factor for all these conditions is probably HPV

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16
Q

What cytologic screening methods can be used for cervical neoplasia

A

conventional method

thin-layer, liquid-based cytology

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17
Q

Pap smear should be started at the following ages:
• Age <21: ________
• Age 21: _____

A

no Pap test or screening for HPV, regardless of sexual activity

Start Pap test with cytology alone without HPV testing; the recommendation is the same whether HPV vaccinated or not

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18
Q

The frequency of recommended Pap smear is as follows:

• Age 21–29: _____

A

repeat Pap every 3 years with cytology alone; do not perform HPV testing in this age group

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19
Q

The frequency of recommended Pap smear is as follows:

• Age 30–65:

A

repeat Pap every 3 years with cytology but no HPV testing OR repeat Pap
every 5 years if both cytology and HPV testing (the recommended option in this age
group)

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20
Q

Pap smears should be discontinued:

  • After age 65 if_________
  • Any age if________
A

negative cytology and/or HPV tests for past 10 years AND no history of CIN 2, CIN 3 or cervical carcinoma

total hysterectomy AND no history of cervical neoplasia

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21
Q

Pap Smear Classification

________is the current classification used in the United States.

A

The Bethesda system

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22
Q 
Negative for intraepithelial lesion or malignancy; comments may report 
1
2
3
4
5
A

trichomoniasis, candida, BV, HSV, or atrophy

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23
Q

Pap Smear

________: changes suggestive
of but not adequate to label LSIL

A

ASC-US (atypical squamous cells of undetermined significance)

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24
Q

Pap Smear

_______: biopsy is expected to show histologic findings of HPV, mild dysplasia, or CIN 1

A

LSIL (low-grade squamous intraepithelial lesion)

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25
Q

________: changes suggestive of but not

adequate to label HSIL

A

ASC-H (atypical squamous cells can’t rule out HSIL)

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26
Q

________: biopsy is expected to show histologic findings of moderate–severe dysplasia, CIN 2, CIN 3, or CIS

A

HSIL (high-grade squamous intraepithelial lesion)

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27
Q

Examples of Abnormal endocervical cells (1% of abnormal Pap smears)

1
2
3
4

A

– AGC-NOS (atypical glandular cells, not otherwise specified)
– AGC-neoplastic (atypical glandular cells, can’t rule out neoplasia): changes suggestive
of but not adequate to call AIS or cancer
– AIS (adenocarcinoma in situ)
– Adenocarcinoma

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28
Q

Diagnostic Approach to Abnormal Pap Smears

This is an option for findings of ASC-US in patients of any age, and the preferred option with either ASC-US or LSIL in patients ages 21-24.Repeat the Pap in 12 months.

A

Accelerated repeat Pap.

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29
Q

Mx of repeated pap

– If repeat cytology is negative,____
– If repeat cytology is anything other than negative, _______

A

repeat Pap in another 12 months.

proceed to colposcopy and biopsies

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30
Q

Diagnostic Approach to Abnormal Pap Smears

_______This is the preferred option for findings of ASC-US in patients age
≥25.It is acceptable but not preferred in patients ages 21-24

A

HPV DNA testing.

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31
Q

This is indicated for evaluation of LSIL in patients age ≥25, and all patients with ASC-H and HSIL.

A

Colposcopy

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32
Q

Satisfactory or adequate colposcopy is diagnosed if

A

the entire T-zone is visualized and no lesions disappear into the endocervical canal

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33
Q

All nonpregnant patients undergoing colposcopy which shows metaplastic epithelium entering the endocervical canal will undergo an

A

ECC to rule out endocervical lesions.

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34
Q

If the Pap smear is worse than the histology (suggesting the site ofabnormal Pap smear cells was not biopsied), then a________ is performed

A

cone biopsy

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35
Q

SSx of Invasive Cervical Cancer

A

Patients with invasive cervical cancer can present with postcoital vaginal bleeding.

Other symptoms of cervical cancer include irregular vaginal bleeding and, in advanced
stage, lower extremity pain and edema.

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36
Q

_________ is the third most common gynecologic malignancy with a
mean age at diagnosis of 45 years

A

Cervical carcinoma

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37
Q

Work-up for cervical CA

A

Cervical biopsy.
Metastatic workup
Imaging studies

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38
Q

Patients with these findings are offered adjuvant therapy (radiation therapy and chemotherapy).

A

These include metastatic disease to the lymph nodes, tumor size >4 cm,
poorly differentiated lesions, or positive margins

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39
Q

Mx

Stage Ia1: ______
Stage Ia2:_______

A

Total simple hysterectomy, either vaginal or abdominal

Modified radical hysterectomy

40
Q

Mx

Stage IIB, III, or IV: ________

A

Radiation therapy and chemotherapy for all ages.

41
Q

All patients with invasive cervical cancer should be followed up with Pap smear
________ after treatment, and then ___________

A

every 3 months for 2 years

every 6 months for the subsequent
3 years

42
Q

Patients who have a local recurrence can be treated with ________; if they had
received radiation previously, they might be considered candidates for a _______

A

radiation therapy

pelvic exenteration.

43
Q

Patients with distant metastases should be considered for chemotherapy treatment.
The most active chemotherapeutic agent for cervical cancer is _______

A

cisplatinum

44
Q

Uterine anomalies may result from 3 mechanisms:

Stage 1: ________
Stage 2: ________
Stage 3: ________

A

failure of one or both of the 2 müllerian ducts to form

failure of the 2 ducts to fuse completely

failure of the 2 fused mullerian ducts to dissolve the septum that results from fusion

45
Q

MU¨ LLERIAN ANOMALIES

Failure to Form

A

Hypoplasia/Agenesis

Unicornuate Uterus

46
Q

When one of the müllerian ducts fails to form, a single-horn (banana-shaped) uterus
develops from the healthy müllerian duct. This single-horn uterus may stand alone.

A

Unicornuate Uterus

47
Q

Problem with Unicornuate Uterus

A

a girl may have monthly pain during adolescence because there is no
outlet for the menses from this rudimentary horn

48
Q

There is a risk that a pregnancy will implant in this rudimentary horn, but because of
space limitations, _______

A

90% of such pregnancies rupture

49
Q

A double uterus results from the complete failure of the 2 Müllerian ducts to fuse
together (stage 1 of development).

So each duct develops into a separate uterus, each of which is narrower than a normal uterus and has only a single horn

A

Didelphys Uterus

50
Q

In 67% of cases, a didelphys uterus is associated

A

with 2 vaginas separated by a thin wall

51
Q

Didelphys Uterus Cx

A

Preterm delivery is common if pregnancy occurs in these patients.

52
Q

A ______results from a problem in stage 2 or 3 of uterine development. The
two müllerian ducts fused normally; however, there was a failure in degeneration of
the median septum.

A

septate uterus

53
Q

If this failure was “complete,” a median septum persists in the entire uterus, separating the uterine cavity into______

A

two single-horned uteri that share one cervix

54
Q

If this failure was “partial,” resorption of the lower part of the median septum
occurred in stage 2 but the top of the septum failed to dissolve in stage 3. Thus, there
is a __________

A

single cervix and uterine cavity at the bottom, but at the top that cavity divides
into two distinct horns.

55
Q

This type of uterus is essentially normal in shape with a small midline indentation in the
uterine fundus, which results from failure to dissolve the median septum completely.

A

Arcuate Uterus

56
Q

The daughters of mothers exposed to diethylstilbestrol (DES) during pregnancy are predisposed to ______ and _______

A

uterine abnormalities and clear cell carcinoma of the vagina

57
Q

It is a benign smooth muscle growth of the myometrium. It is the most common
benign uterine tumor. It is 5 times more common in black women than white women.

A

Leiomyoma Uteri

58
Q

The most common location of a leiomyoma is within the wall of the uterus.

A

Intramural.

59
Q

These myomas are located beneath the endometrium and can distort the
uterine cavity. The distorted overlying endometrium may not respond appropriately
to the normal hormonal fluctuations, resulting in unpredictable, often intermenstrual,
bleeding

A

Submucosal.

60
Q

______ is the most common symptom of a submucosal

myoma and can result in anemia

A

Abnormal vaginal bleeding

61
Q

These are located beneath the uterine serosa. As they grow they distort
the external contour of the uterus causing the firm, nontender asymmetry

A

Subserosal.

62
Q

Subserosal myoma

If they are pedunculated, attached to the uterus by a stalk, they can become ____

A

parasitic fibroids

63
Q

Estrogen receptors are increased in leiomyomas resulting in rapid
enlargement during times of high estrogen levels, such as ______

A

pregnancy

64
Q

During times of rapid growth, myomas may outgrow their blood supply,
resulting in ______

A

ischemic degeneration of a fibroid

65
Q

Common myoma degenerations that are

seen include ______, ______ and ______

A

hyaline, calcific, and red degeneration

66
Q

______can cause such extreme, acute pain that the patient requires hospitalization
and narcotics. This is most common during pregnancy.

A

carneous

degeneration,

67
Q

_______is helpful for identifying submucosal
myomas by instilling 5–10 mL of saline into the uterine cavity before visualizing
the uterine cavity with an endovaginal sonogram probe.

A

Saline infusion sonography

68
Q

Submucosal myomas may be identified by visualizing them directly
with ______

A

hysteroscopy

69
Q

Most leiomyomas can be managed

A

conservatively and followed expectantly

with regular pelvic examinations

70
Q

After 3–6 months of_______ with resultant hypoestrogenic state, a 60–70% reduction in size of the fibroids can be expected.

A

GnRH analog therapy,

71
Q

Thus, GnRH analogs cannot be used for definitive cure, but they can be used in
the_______

A

adjuvant setting with surgical therapy

72
Q

This is a surgical procedure performed if the patient desires to maintain fertility. The uterus is incised and the myoma removed through either a laparoscopic
or laparotomy approach

A

Myomectomy

73
Q

If the myomectomy incision entered the endometrial cavity, delivery of any subsequent pregnancy should be by cesarean section because of
i________

A

increased risk of scar rupture in labor

74
Q

This is an invasive radiology procedure in which a catheter is placed into the vessels supplying the myoma.

Microspheres are injected, causing ischemia and necrosis of the myoma.

A

Embolization.

75
Q

If the patient has completed her childbearing, definitive therapy is an

A

abdominal or vaginal hysterectomy.

76
Q

Ectopic endometrial glands and stroma are located within the myometrium of the
uterine wall. The most common presentation is diffuse involvement of the myometrium

A

Adenomyosis

77
Q

The lesion is known as an _______if the involvement is focal, surrounded by a pseudocapsule.

A

adenomyoma

78
Q

Dx of adenomyosis

A

In most cases the diagnosis is made clinically by identifying an enlarged, symmetric,
tender uterus in the absence of pregnancy. The only definitive diagnosis is by histologic
confirmation of the surgically excised tissue

79
Q

PE of adenomyosis

A

The uterus is globular and diffusely up to 2–3 times the normal size.
Tenderness is most common immediately before and during menses

80
Q

Imaging of adenomyosis

A

Ultrasound study or MRI imaging shows a diffusely enlarged uterus with cystic
areas found within the myometrial wall.

81
Q

Mx of adenomyosis

A

Medical treatment includes the levonorgestrel (LNG) intrauterine system
(IUS), which may decrease heavy menstrual bleeding.

Surgery, in the form of hysterectomy, is
the definitive treatment

82
Q

________ is the most common gynecologic malignancy, occurring in 1% of women. The mean age at diagnosis is 61 years

A

Endometrial carcinoma

83
Q

A patient is considered to be in menopause after
1
2

A

3 continuous months of cessation

of menses and elevated gonadotropins.

84
Q

Although the most common cause of postmenopausal bleeding is ______ or _____, the most important diagnosis to rule out is endometrial carcinoma

A

vaginal or

endometrial atrophy

85
Q

The mediating factor for most endometrial carcinomas appears to be ______

A

unopposed estrogen. This results from excessive hyperstimulation of the endometrium without the
stabilizing effect of progesterone

86
Q

RF for endometrial CA

A

These include obesity, hypertension, and diabetes mellitus.

Other risk factors include nulliparity, late menopause, and chronic anovulation conditions, such as PCO disease

87
Q

MC Stage at Dx

A

Spread limited to the uterus (most common stage at diagnosis)

88
Q

Stages of Endometrial CA

A

Stage I: Spread limited to the uterus (most common stage at diagnosis)
Stage II: Extension to the cervix but not outside the uterus
Stage III: Spread adjacent to the uterus
Stage IV: Spread further from the uterus

89
Q

If the endometrial histology sampling reveals atrophy and no evidence of cancer,
it can be assumed the patient is bleeding from atrophy and can be treated with _______

A

hormone replacement therapy

90
Q

With hormone replacement therapy, estrogen and progesterone should be
given to the patient. If estrogen is given alone, the risk of ______

A

endometrial cancer increases

91
Q

The mainstay of treatment of endometrial carcinoma is a

A

total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO), pelvic
and para-aortic lymphadenectomy, and peritoneal washing

92
Q

An evaluation of the postoperative pathology report will classify patients into poor or good prognosis. Patients with poor prognosis should be considered for______

A

radiation therapy

93
Q 
Poor prognostic factors include 
1
2
3
4
A

metastasis to lymph nodes, >50%

myometrial invasion, positive surgical margins, or poorly differentiated histology

94
Q

Postmenopausal patients taking estrogen replacement therapy must be also treated with ______ to prevent unopposed estrogen stimulation, which may lead to endometrial cancer.

A

progestins

95
Q

Reproductive age women who have chronic anovulation, such as_______ should also
be treated with progestins to avoid endometrial hyperplasia from unopposed estrogen

A

PCO syndrome,

CK GYne (9 decks)

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