repro 1

Question 1

transformation zone

Answer 1

in childhood - located at the os
changes from stratified squamous keratinising to glandular mucinous endocervical epithelium

during menarche - uterus gets bigger, columnar mucosa everts to it is seen beyond and os and exposed to acidic environment. over the the glandular cells are replaced by squamous cells via metaplasia - these cells are at higher risk to infection by HPV

Question 2

metaplastic cells of the transformation zone are at a higher risk of

Answer 2

infection by HPV

Question 3

childhood transformation zone its located

Answer 3

at the os

Question 4

post menopause transformation zone is located

Answer 4

inside the cervical canal

Question 5

HPV

Answer 5

human papilloma virus
>100 types and 40 infect the genital tract
associated with condyloma, dysplasia and cancer in anogenital tract, oral cavity and respiratory tract in both men and women

Question 6

division of types of HPV

Answer 6

low risk types are 6 and 11

high risk types more likely to lead to cervical cancer - 16,18

Question 7

how does HPV lead to cancer

Answer 7

persistent infection leads to integration of HPV into cell DNA
expression of E6 and E7 viral genes which encode proteins promoting cell cycling
these enhance degradation of p53, inhibiting cell death
E7 binds p21 and prevents its function as a cell cycle inhibitor
E7 inactivates the retinoblastoma gene (Rb) blocking its proliferation-inhibitory function

Question 8

grading of cervical dysplasia (squamous intraepithelial lesion)

Answer 8

CIN 1 - koilocytic atypic and low grade dysplasia involving the basal third of the epithelium
CIN 2 - progressive atypia, expansion of dysplastic cells into the middle third of the epithelium
CIN 3 - diffuse atypia, loss of maturation, and expansion of dysplastic cells to the epithelial surface

Question 9

LSIL

Answer 9

low grade squamous intraepithelial lesion 
CIN1 and/or koilocytes (HPV effect) 
- nuclear enlargement 
- hyperchromasia 
- binucleation 
- cytoplasmic clearing

Question 10

condyloma acuminatum

Answer 10

genital wart
raised cauliflower like exophytic lesion arising in transformation zone or actocervix
usually associated with HPV 6 and 11
low oncogenic potential

Question 11

HSIL

Answer 11

high grade squamous intraepithelial lesion
CIN2 or CIN3
- even more nuclear enlargement so there is an increased nuclear to cytoplasmic ration compared to low grade cells
- hyperchromasia, irregular nuclear borders

Question 12

squamous cell carcinoma

Answer 12

SCC makes up 80% of cervical cancers
most are due to high risk type HPV
macroscopically fungatingg and infiltrative mass
microscopically islands of atypical squamous cells invading into stroma
can spread by LVSI or directly invade adjacent bowel and bladder
over 70% of cervical Ca happen in women who have never had CST or are overdue

Question 13

adenocarcinoma in situ (ACIS) and invasive carcinoma

Answer 13

mostly HPV driven
15% of cervical cancer is adenocarcinoma and develops from ACIS
typical ACIS resembles colon adenoma down the microscope instead of the normal bland mutinous endocervical epithelium

Question 14

treatment of SIL and cervical cancer

Answer 14

L/HSIL may have LLETZ or cone - both surgically remove the affected transformation zone
for invasive tumours may have cone first for staging, then hysterectomy/node dissection/chemo and or radiotherapy

Question 15

cervical screening test

Answer 15

replaced the Pap smear
every 5 years age 25 to 74
cells from the transformation zone are obtained via brush into liquid medium
molecular test for HPV DNA, reflex cytology only if HPV DNA positive

Question 16

advantages for cervical screening test

Answer 16

high negative predictive value than conventional pap, stratifies into high and intermediate HPV types

doesn’t identify women with transient low grade SIL or transient non oncogenic HPV to reduce over treatment

Question 17

colposcopy

Answer 17

if HPV is found that is not high risk

cervix visualised and targeted biopsies are taken of abnormal areas

Question 18

candida

Answer 18

infects vulva, vagina and cervix
vuvlovaginitiss with pruritus, burning and white discharge
treated with topical and oral antifungals

Question 19

trichomonad

Answer 19

trichomonas vaginalis infection is transmitted by sexual contact
asymptomatic or yellow, frothy discharge, dysuria and dyspareunia
large flagellated ovoid protozoan can be seen on the Pap smear

Question 20

HSV

Answer 20

herpes simplex virus
- HSV-2 usually involves genital mucosa
initial infection may be accompanies by systemic symptoms
clinical symptoms only seen in one third
red papules, vessicles, painful ulcers
HSV infection persists indefinitely
becomes reactivated during times of immunosuppression

Question 21

chlamydia and gonorrhoea

Answer 21

sexually transmitted infections
usually take the form of cervicitis
patient may be asymptomatic or have pain, dysuria, discharge and bleeding
both infection may ascend through uterus to cause pelvic inflammatory disease

Question 22

pelvic inflammatory disease

Answer 22

acute complications include 0 peritonitis and bacteraemia, endocarditis, meningitis, suppurative arthritis
other sequelae - infertility and tubal obstruction, increased risk of ectopic pregnancy, intestinal obstruction due to adhesions