Human papilloma virus infection Flashcards
The human papillomavirus (HPV) is a very common group of viruses that can cause genital warts or cancer. Which of the following is NOT a common risk factors for contracting HPV?
1 - multiple sexual partners
2 - unprotected sex
3 - nulliparity
4 - prolonged infection/ immunosuppression
5 - smoking
6 - prolonged use of COCP > 5 years
7 - multiparty (>3)
8 - low socio economic background
3 - nulliparity
- smoking doubles risk of cervical cancer
If you contract the human papillomavirus (hpv) what happens in most cases?
1 - patient becomes infected and this develops into cervical cancer
2 - patient becomes infected but immune system eliminates virus within months
3 - patient becomes infected but immune system cannot eliminates virus and virus persists
4 - patient becomes infected and then becomes pre-cancerous as immune system did not kill it
2 - patient becomes infected but immune system eliminates virus within months
If you contract the human papillomavirus (hpv) multiple times and the tissues becomes pre-cancerous, does that mean it will automatically become cancerous?
- no
- could become cancerous or just remain with the infection, but not pre-cancerous
Woman who have had persistent human papillomavirus (HPV) can develop cervical intraepithelial neoplasia (CIN) I, which is uncontrolled, abnormal growth of cells or tissues in the body, which can become cancerous. All of the following can happen:
- CIN-I regresses and become normal
- CIN-I persists
- CIN-I progress
- CIN-I become invasive carcinoma
Match the % with what occurs for each of the different things that can occur in a patient with CIN-I?
1 - 1%
2 - 32%
3 - 11%
4 - 57%
1 - 1% = become invasive carcinoma
2 - 32% = persist
3 - 11% = progress
4 - 57% = regress
Woman who have had persistent human papillomavirus (HPV) can develop cervical intraepithelial neoplasia (CIN) II. which is uncontrolled, abnormal growth of cells or tissues in the body, which can become cancerous. All of the following can happen:
- CIN-II regresses and become normal
- CIN-II persists
- CIN-II progress
- CIN-II become invasive carcinoma
Match the % with what occurs for each of the different things that can occur in a patient with CIN-II?
1 - 35%
2 - 22%
3 - 5%
4 - 43%
1 - 35% = persist
2 - 22% = progress
3 - 5% = become invasive carcinoma
4 - 43% = regress
Woman who have had persistent human papillomavirus (HPV) can develop cervical intraepithelial neoplasia (CIN) III. which is uncontrolled, abnormal growth of cells or tissues in the body, which can become cancerous. All of the following can happen:
- CIN-III regresses and become normal
- CIN-III persists
- CIN-III progress
- CIN-III become invasive carcinoma
Match the % with what occurs for each of the different things that can occur in a patient with CIN-III?
1 - 32%
2 - 56%
3 - >12%
1 - 32% = regress
2 - 56% = persist
3 - >12% = become invasive carcinoma = >12%
What is the main form of transmission of human papillomavirus (HPV)?
1 - sex toys
2 - unprotected sexual intercourse
3 - douching
4 - vaginal delivery of baby
2 - unprotected sexual intercourse
The human papillomavirus (hpv) is a small, non-enveloped deoxyribonucleic acid (DNA) virus that infects skin or mucosal cells. How many genes does the HPV contain?
1 - 2
2 - 4
3 - 6
4 - 8
4 - 8
Which 2 forms of the human papillomavirus (HPV) are low risk with the NHS, but can still cause warts and respiratory papillomatosis?
1 - HPV 6 and 18
2 - HPV 6 and 11
3 - HPV 18 and 11
4 - HPV 21 and 18
2 - HPV 6 and 11
- can still lead to cervical cancer, but not as dangerous as 16 and 18
Which 2 forms of the human papillomavirus (HPV) are high risk with the NHS and can lead to cervical head, neck and anogenital cancer?
1 - HPV 16 and 18
2 - HPV 16 and 11
3 - HPV 18 and 11
4 - HPV 21 and 18
1 - HPV 16 and 18
- account for 70% of cervical cancers
- 99% of cervical cancers are because of HPV virus
If you contract the human papillomavirus (HPV) the majority of patients becomes infected but the immune system eliminates virus within months. However, if the infection persists what can this cause?
1 - colorectal cancer
2 - ovarian cancer
3 - squamous intraepithelial lesions (SIL) also called cervical intraepithelial lesions (CIL)
4 - HPV remains dormant until patient is immunocompromised
3 - squamous intraepithelial lesions (SIL) also called cervical intraepithelial lesions (CIL)
During screening for HPV, if someone is high risk for HPV and this is confirmed, what type of sample is taken?
1 - blood sample
2 - swab is taken
3 - liquid based cytology
4 - large Loop Excision of the Transformational Zone
3 - liquid based cytology
- this approach is able to detect early cervical intra-epithelial neoplasia (CIN)
- DOES NOT DIAGNOSE THOUGH AND USED AS A TRIAGE
During screening for HPV, if someone is high risk for HPV and this is confirmed what method needs to be used to diagnose the patient?
1 - blood sample
2 - colposcopy (could include punch biopsy or LLETZ)
3 - liquid based cytology
4 - large Loop Excision of the Transformational Zone (LLETZ)
2 - colposcopy (could include punch biopsy or LLETZ)
What is the main intervention that has significantly dropped the number of HPV cases worldwide?
1 - screening using smear tests
2 - regular blood tests
3 - regular cervical colposcopy
4 - vaccination
4 - vaccination
- up to 99% effective
At what age are girls and boys invited to receive the HPV vaccine?
1 - 9-10
2 - 10-15
3 - 13-14
4 - 16-18
3 - 13-14
- targeted to be given prior to 1st sexualk encounter
- now also offered to gay, bisexual, and other men who have sex with men (GBMSM) to protect against anal, throat and penile cancers.
At what age should women in the UK be invited to receive their smear tests, which would test for cervical cancer and HPV?
1 - >16
2 - >21
3 - >25
4 - >49
3 - >25
- every 3 years between 25-49 y/o
How often should women aged 50-64 be screened for cervical cancer?
1 - annually
2 - every 2 years
3 - every 3 years
4 - every 5 years
4 - every 5 years
Dyskaryosis refers to the change of appearance in cells that cover the surface of the cervix, this is classified as follows:
- cervical intraepithelial neoplasia (CIN) - 1 = mild dyskaryosis
- CIN-II = moderate dyskaryosis
- CIN-III = severe dyskaryosis
If a patient aged 25-49 has a smear test that comes back with no dyskaryosis and negative HPV, when will they have their next smear test?
1 - annually
2 - every 2 years
3 - every 3 years
4 - every 5 years
3 - every 3 years
continue in normal routine
- a 50-64 y/o would return to normal 5 year screening
Dyskaryosis refers to the change of appearance in cells that cover the surface of the cervix, this is classified as follows:
- cervical intraepithelial neoplasia (CIN) - 1 = mild dyskaryosis
- CIN-II = moderate dyskaryosis
- CIN-III = severe dyskaryosis
If a patient aged 25-49 has a smear test that comes back with positive HPV test, but the smear test comes back with no dyskaryosis, when will they have their next smear test?
1 - 12 months
2 - every 2 years
3 - every 3 years
4 - every 5 years
1 - 12 months
- if HPV negative on next smear test at 12 months then patient re-enters normal review pathway
Dyskaryosis refers to the change of appearance in cells that cover the surface of the cervix, this is classified as follows:
- cervical intraepithelial neoplasia (CIN) - 1 = mild dyskaryosis
- CIN-II = moderate dyskaryosis
- CIN-III = severe dyskaryosis
If a patient aged 25-49 has a smear test that comes back with positive HPV test, and the smear test is abnormal with the presence of dyskaryosis, what will be the next step for the patient?
1 - cytology triage
2 - hysteroscopy
3 - colposcopy
4 - bimanual examination
1 - cytology triage
- sample sent to cytology for analysis
- normal cytology = patient reviewed in 12 months
- abnormal cytology = referral for colposcopy and may need Large Loop Excision of the Transformation Zone (LLETZ), which is most common or punch biopsy
Essentially if a patient has a positive test for HPV they should automatically have which 2 of the following regardless of the smear test findings?
1 - cytology triage
2 - colposcopy
3 - additional re-screen in 12 months
4 - hysteroscopy
1 - cytology triage
3 - additional re-screen in 12 months
Of the following, which is likely to need coloposcopy and either a Large Loop Excision of the Transformation Zone (LLETZ), which is most common or punch biopsy?
1 - cervical intraepithelial neoplasia (CIN) - 1 = mild dyskaryosis
2 - CIN-II = moderate dyskaryosis
3 - CIN-III = severe dyskaryosis
4 - all of the above
2 - CIN-II = moderate dyskaryosis
3 - CIN-III = severe dyskaryosis
During a colposcopy a colposcope will be used to provide a magnification view of the cervix. At the same time the doctor can insert a speculum which will allow a further biopsy for analysis. This is assisted using a citric/acetic solution which will then be sprayed onto the cervix. We may see some tissue then become white. Cancerous/pre-cancerous cells are high mitotic replicating cells and glycogen stores so citric acid is taken up causing them to become white. What is the name given to this?
1 - acid-white
2 - acetowhite
3 - alwhite
4 - citric-white
2 - acetowhite
When collecting a cytological sample, does it matter if the swabs as part of the cervical smear are performed 1st?
- yes
- MUST do cytology before swabs, as swabs may disturb the cells
In addition to HPV affecting the cervix, they are also responsible for causing common warts (>150 types). How is HPV transmitted an d cause common warts?
1 - infect T cells that transmits the virus to the epidermis
2 - direct skin to skin contact
3 - oral or vaginal sex
4 - blood or bodily fluids
2 - direct skin to skin contact
Common warts that are caused by HPV begin in which layer of the skin?
1 - stratum spinosum
2 - stratum granulosum
3 - stratum lucidum
4 - stratum basale
4 - stratum basale
- causes proliferation of keritanocytes that causes painful cauliflower looking lesions
Are common warts that are caused by HPV more common in adults or children?
- children
Common warts that are caused by HPV, but do they always require treatmenr?
- no
- typically self limiting
Common warts are caused by HPV. If they require treatment, which of the following is NOT typically offered?
1 - salicylic acid ointment
2 - cryotherapy
3 - surgical removal
4 - all can be offered
3 - surgical removal
