HPV Flashcards
List risk factors for acquiring aggressive HPV virus.
immunocompromised: HIV, steroids, renal failure, DM
smoking, early coitarche, higher number of partners
Which HPV subtypes cause warts?
6, 11 (most common), also 42, 43, 44
Which HPV subtypes are oncogenic?
16, 18, 31, 33, 45, 52, 58, 35
Choose all correct answers regarding HPV:
a) Cervical cancer is the leading cause of life years lost amongst cancers in the developing world.
b) The proportion of cervical cancers caused by adenocarcinoma vs squamous is rising.
c) Cervical cancer is the most common cancer amongst the Inuit population in Canada
d) Infection with one subtype of HPV is protective against future infection with a different subtype
a) true
b) true
c) true
d) false
Explain the pathogenesis of HPV infection.
Virus enter epithelium though break in skin –> infects basal and parabasal cells –> replicates in nuclei
Cells mature up epithelium filled w/ HPV particles (infectious) –> virus assembly at surface cells
Virus uses host to replicate –> PAPILLOMA projections w/ heaped up cell growth
Choose all correct answers regarding HPV:
a) once cells are infected with HPV virus, lesions can appear within days
b) the virus is cleared by CD4 and 8 cells and macrophages
c) T cells recognizes HPV E3 and E6 proteins on the virus to help clear infected cells
d) older women are more likely to clear an infection because of their mature immune system and cross-reactivity from previous infections
a) false -weeks
b) true
c) true
d) false
Choose all correct answers regarding HPV:
a) if a cervical lesion is seen, a Pap smear is mandatory even if there was a negative pap last year
b) if a pap shows cervical cancer, the patient should be seen in colposcopy within 6 weeks
c) if a pap shows high grade dysplasia, the patient should be seen in colposcopy within 2 months
d) vulvar warts can be seen on infants as old as 24 months as a result of perinatal transmission of HPV
a) false -do a biopsy
b) false -3 weeks
c) false 6/52
d) true
What is the triad of risk factors placing a child at high risk for having acquired recurrent respiratory pappilomatosis?
What are the classic symptoms?
young age of mother <20, vaginal delivery, first born child
hoarseness, weak cry, chronic cough, partial airway obstruction, stridor
What 3 things must be included in a Pap smear report as per the Bethesda Classification?
- adequacy of sample
- presence of normal or abnormal cells
- do results warrant f/u or colposcopy?
Which women in Canada should receive HR-HPV DNA testing for triaging as per the SOGC guideline on HPV?
women > 30yo with ASCUS helps decide whether or not to refer to colpo 5-10% of ASCUS have HR cervical lesions 30-60% of ASCUS have HR-HPV *99% NPV
Compared to cervical cytology, HR-HPV DNA testing has:
a) increased sensitivity and increased specificity
b) decreased sensitivity and decreased specificity
c) increased sensitivity and decreased specificity
d) decreased sensitivity and increased specificity
c
sensitivity 95% vs 84%
specificity 60% vs 85% for CIN2/3
Which of the following are true regarding HPV?
a) With increasing age, prevalence of HPV infection declines
b) With increasing age, High risk subtypes of HPV are more likely to persist
c) incidence of HPV 3 years post-coitarche is 80%
d) LSIL is HPV-DNA+ in >80% of cases
a) true
b) true
c) false 40%
d) true
If a patient receives one dose of the gardasil vaccine and then has a positive pregnancy test, when should she receive the next doses?
Requires 2 more doses, can be done postpartum 12 weeks apart. No need to repeat first dose.
Select all correct answers regarding HPV:
a) for women with persistent HPV infections in monogamous relationships, treating/testing the partner for HR-HPV will decrease the re-infection risk
b) Pap smears are an example of primary prevention
c) women with confirmed HPV genital warts can be treated with acyclovir
d) there is good evidence to recommend smoking cessation to women with diagnosis of HPV
a) false
b) false -infection already present, vaccine is primary
c) false not effective -counsel avoid IC and have new partners vaccinated, tx options include: podophyllotoxin solution, imiquimod cream, TCA, cry/laser for failed topical therapy
d) true
Choose all correct answers regarding HPV:
a) TCA is safe to use in pregnancy to treat external genital warts.
b) laser vaporization of EGW is acceptable first-line tx
c) imiquimod cream is safe to use in pregnancy for treatment of EGW
d) cryotherapy is considered safe in pregnancy
a) true
b) false -only when less aggressive tx has failed
c) false -little data, not approved though probably safe
d) true
