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Women's health trigger > Lecture 14: Cervical Disorders > Flashcards

Lecture 14: Cervical Disorders Flashcards

1
Q

The primary complications of cervicitis include: (2)

A
  • PID
  • Passing infection to newborn during delivery
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2
Q

The main presenting symptom of acute cervicitis is

Typically asymptomatic

A

Discharge

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3
Q

The S/S of acute cervicitis are: (3)

A
  1. Discharge
  2. Vaginal bleeding
  3. Cervical tenderness
  4. Urethritis
  5. Salpingitis
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4
Q

The discharge caused by a gonorrhea/chlamydia infection is usually described as…

A
  • Creamy
  • Thick
  • Purulent
  • Maybe malodorous

Acutely inflamed cervix

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5
Q

The discharged caused by a candidiasis infection is typically described as…

A
  • “Curd-like”
  • Itchy
  • non-malodorous

Adherent

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6
Q

The discharge caused by a trichomonas infection is described as…

A
  • Green
  • Foamy
  • Strawberry petechiae cervix
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7
Q

The discharge caused by a bacterial infection of the cervix is described as

A
  • Thin
  • Gray
  • Fishy odor
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8
Q

The discharge from an HSV infection of the cervix is described as…

A
  • Clear to serous

Vesicular lesions on the base

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9
Q

The main presenting symptom of chronic cervicitis is…

A

Discharge

Less than acute

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10
Q

What colposcopy finding of cervicitis is characteristic of trichomonas?

A

Double hairpin capillaries

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11
Q

What histopathology is characteristic of cervicitis due to HPV?

A
  • Large cells
  • Multinucleated
  • Perinuclear halos
  • Hyperchromasia
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12
Q

HSV and HPV both enlarged cells and have multinucleated cells. However, HSV causing cervicitis has 2 additional features:

A
  • Ground-glass appearance
  • Inclusion bodies
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13
Q

Both bacterial and Trichomonas cervicitis are treated with

A

Nitroimidazoles (metro, tinidazole, secnidazole)

Orally

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14
Q

Who are the high-risk groups for cervicitis?

A
  • Young adults 19-25
  • Previous hx of STIs
  • Inconsistent condom use
  • Substance abuse
  • Multiple partners/high-risk
  • Tx of partners with STIs
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15
Q

Define cervical insufficiency

A

Painless cervical shortening/dilation in the 2nd or 3rd trimester, resulting in preterm birth.

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16
Q

The 4 primary RFs for cervical insufficiency are

A
  • Hx of having it
  • Hx of cervical injury, surgery, or conization
  • DES exposure
  • Anatomic abnormalities
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17
Q

Classic presentation of cervical insufficiency

A

2nd trimester dilation of 2+ cm with minimal contractions

4+ cm might have active contractions or ROM

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18
Q

When can you first check for cervical insufficiency and how?

A

At 14-16 wks via US

No way to check prior!

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19
Q

The 4 types of cervical insufficiency seen on US are

A

T, Y, V, U

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20
Q

The TOC for cervical insufficiency is

A

Cervical cerclage

Purse-like ring of stitch around cervix

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21
Q

Prior to cervical cerclage, you must check for… (2)

A
  • Viable intrauterine pregnancy
  • Cultures of gonorrhea/chlamydia/GBS
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22
Q

The pharmacological adjunct to cervical cerclage for cervical insufficiency is

A

Progesterone

Vaginal/IM/SC, starting at 16wks to 36+.

Can start before cerclage is placed

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23
Q

How do females often realize they have nabothian cysts?

A

Feel a bump when trying to put on cervical cap or diaphragm

Often just found incidentally since asymptomatic.

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24
Q

The tx for nabothian cysts is

A

Nothing

Only drain if theyre huge.

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25
Q

You always treat CIN II and III, except in…

A
  • Pregnant women
  • Do not treat CIN II in adolescents
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26
Q

CIN grading is used to describe…

A

Amt of disordered growth of cervical epithelial lining.

27
Q

The highest peak incidence age range for CIS is…

A

25-35 years

28
Q

Overall, cervical cancer peak incidence occurs around

A

40+ years

29
Q

The Dx of cervical dysplasia is made primarily via

A

Abnormal pap smear

Physical exam is usually normal.

30
Q

Besides high-risk sex and related, the other RFs for cervical dysplasia are

A
  • HPV
  • Immunosuppression
  • Multiparity
  • Long-term OCP use
31
Q

The MC HPV strain overall found in a majority of cervical cancers is

A

HPV 16

Followed by 18

32
Q

T/F: Most women with HPV+ pap smears will go on to develop cervical cancer

A

False

But wary if they smoke!

33
Q

Cervical cancer screening guidelines from 21-65+

A
  • 21-29: Pap Q3y
  • 30-65: Pap Q3y or Pap+HPV Q5y
  • 65+: Stop only if no hx of dysplasia + 3 neg paps or 2 neg pap+HPVs in past 10 yrs.

Guidelines dont apply if hx of cervical ca, HIV, immunodeficient, or DES

34
Q
  • ASC-US
  • ASC-H
  • LGSIL/LSIL
  • HGSIL/LSIL

All describe what system?

Squamous intraepithelial lesions

A

Bethesda system

35
Q

In the Bethesda system, LGSIL corresponds to what CIN? HGSIL/HSIL?

A
  • LSIL corresponds to CIN 1
  • HSIL corresponds to CIN 2 and 3
36
Q

T/F: Atypical Grandular cells are cancerous

A

False

37
Q

What are squamous epithelial cells of the cervix most associated with?

A
  • Adenocarcinoma of the endocervix
  • Endometrium
38
Q

For a patient with ASC-US, the 3 management options are

A
  1. Repeat serial cytology Q6m unil you get 2 normals. (2 abnormals = colposcopy)
  2. Test for high-risk HPV (Colposcopy if positive)
  3. Immediate referral to colposcopy
39
Q

For ASC-H, AGC, LSIL, and HSIL, the preferred next step in management is

A

Colposcopy

40
Q

Endocervical sampling during colposcopy is contraindicated if

A

Pregnant

41
Q

After colposcopy for CIN 1, the management is…

A

2 paps Q6m OR pap+HPV at 6m

Repeat colposcopy if any abnormal.

Switch back to routine screening if 2 smears normal or HPV normal.

42
Q

After colposcopy, the management for CIN II/III, invasive cancer, or abnormal colposcopy is…

A

Surgical therapy

Cryo, laser, LEEP, cone biopsy

43
Q

For an ectocervix-only lesion with satisfactory colposcopy, the surgery options are (3)

A
  • Cryotherapy
  • Laser ablation
  • Superficial LEEP
44
Q

The 3 indications to do deeper LEEPs or conization for the cervix are…

A
  • Endocervical lesion/Ecto with + ECS
  • Unsatisfactory colposcopy
  • Discrepancy between cytology and colposcopy
45
Q

Pros of cryotherapy

A
  • Cheap, easy, no anesthesia
  • Mild SEs
46
Q

The main caveat to cryotherapy for cervical lesions is…

A

It can only do superficial

47
Q

Pros of CO2 laser ablation for cervical lesions

A
  • Precise and versatile
  • Can ablate or assist with cone biopsies

Can cut down to 7mm

48
Q

LEEP is primarily used in CIN…

A

2 and 3

49
Q

Why might we want a LEEP procedure for CIN?

A

Provides a tissue sample for histology

50
Q

What is the main advantage of cold knife conization over LEEP for tissue sampling?

A

No thermal artifact

However, it is an OR only procedure

51
Q

Because LEEP and cold knife conization affect the cervical anatomy drastically, they both increase the risk of…

A

Cervical insufficiency

52
Q

What features of a cervical lesion suggest there is a high chance for recurrence? (4)

A
  • Larger lesion
  • Endocervical gland involvement
  • Positive margins
  • Positive endocervical curettage

Similar rates across all tx modalities

53
Q

How much does treatment of a cervical lesion reduce the risk of cervical cancer by?

A

95%!

But still higher risk than gen pop for 20-25yrs :(

54
Q

Overall, the average age of diagnosis for cervical cancer is…

A

51

55
Q

The majority of cervical cancers are (cell type)

A

Squamous cell carcinomas

70-75%, then 20-25% adenocarcinomas, then mixed

56
Q

The MC symptom of cervical cancer

Early is asymptomatic usually

A

Abnormal vaginal bleeding

57
Q

What are the usual late symptoms of cervical cancer?

A
  • Weakness
  • Wt Loss
  • Anemia
  • unilateral pelvic pain that radiates to hip/thigh
58
Q

Early on in cervical cancer, the cervix appears ?? on physical exam

A

Grossly normal

Ulceration could occur, but usually normal.

59
Q

The terms endophytic and exophytic are used to describe cervical cancer on physical exam and mean….

A
  • Endophytic = barrel-shaped enlargement of cervix
  • Exophytic = friable, bleeding, cauliflower-like lesions
60
Q

What ligaments eventually thicken with parametrial involvement of cervical cancer?

A

Uterosacral ligaments, which fixate the cervix

61
Q

T/F: Cervical cancer can be ruled out via cytology

A

False, biopsy any sus lesion

62
Q

Biopsy of the cervix reveals a CIS, negative colposcopy, but abnormal pap. The next step in evaluation should be

A

Conization

63
Q

A patient’s cervix appears to have invasive cancer just on physical exam. The next step in workup is…

A

Simply biopsy

No need to do conization

64
Q

Overall, the tx for cervical cancer is

A

Radical hysterectomy + lymphadenectomy

Can add chemo and radiation, but not the mainstay.

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