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Spring Round II Exams > WH- Cervical/Uterine > Flashcards

WH- Cervical/Uterine Flashcards

1
Q

What age to start screening- Pap smear

A

age 21

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2
Q

Full pap smear includes

A

Cytology AND

HPV

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3
Q

Age 21-29 recommended screen includes

A

Only Cytology every 3 yrs

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4
Q

Age 30-64 screening recommends

A

Both types every 5 yrs

OR
Cytology every 3

OR
HPV every 5

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5
Q

Who is “high risk” and needs Cervical CA screening yearly?

A 
HIV+
Immunocomp
Hx of cervical CA
Hx of CIN 2/3
Exposure to DES in utero
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6
Q

Can stop HPV/Pap at age 65 IF

A 
3 cons negative Cytology tests
2 consecutive Co-test
Has not had CIN2/3 in past 20 yrs
Most recent pap was within 5 yrs
Not high risk
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7
Q

If you are doing a Pap smear and see abnormal Cervical lesion, what should you do?

A

Ignore Pap and instead perform a BIOPSY

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8
Q

ASCUS pap result

“Atypical cells of undetermined significance”

A

If not HPV, d/t STD (chlamydia, HSV, or vulvovaginal atrophy)

If 21-24 YO, Do nothing, repeat Pap in 1 yr

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9
Q

LSIL pap result

“Low grade”

A

usually CIN 1
abundant cytoplastm

If 21-24 YO, Do nothing, repeat Pap in 1 yr

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10
Q

With ASCUS and LSIL pap results, if pt is 24-64 YO

A

Refer to guidlines

Get Colposcopy

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11
Q

HSIL pap results

“High grade”

A

Assume HPV is present

cells hyperchromatic nuclei, no cytoplasm

ALL REFER TO Colposcopy

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12
Q

What makes a Colposcopy sufficient?

A

If you have COMPLETE visualization of the Transition zone

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13
Q

Tx of choice for CIN 2 and 3

A

LEEP: Loop Electrosurgical Excision Procedure

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14
Q

CONTRA to LEEP procedure

A

Suspected invasion
Glandular abnormality
Pregnant

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15
Q

Nabothian cyst- Benign

A

Translucent/yellow
Glandular material is retained- columnar epith covered by Squamous epith

leave them alone, no tx required

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16
Q

Cervical polyp- Benign

A

Post coital bleeding

usually removed via Polypectomy bc they often become symptomatic

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17
Q

Layers of cervix

A

Exocervix: Squamous

Transitional zone: where the two meet, composed of Metaplastic squamous epithelium (rapid turnover)

Endocervix: columnar cells

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18
Q

Where does HPV prefer to hang out?

A

Transitional zone

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19
Q

HPV 16 is most assoc with what type of Cervical CA

A

Squamous cell

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20
Q

HPV 18 is most assoc with what type of Cervical CA

A

Adenocarcinoma

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21
Q

High risk for HPV

A

15-24YO
Multiple sex partners

the virus enters cervical epith thru microtears from intercourse

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22
Q

When to give Gardisil (HPV vaccine)

A

up to age 45

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23
Q

3rd most common GYN CA

A

Cervical CA

Mean age: 48 YO

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24
Q

Squamous cell cervical CA

A

HPV 16

Thankfully, prevalence is falling

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25
Q

Adenocarcinoma cervical CA

A

HPV 18

Bad news bears, prevalence is rising

26
Q

Sx of cervical CA

A

often NONE

Abnormal vaginal bleeding if any

27
Q

What is the only GYN CA that is CLINICALLY staged rather than based on Histology?

A

CERVICAL CA

Figo staging

28
Q

What else do you need to consider ordering with Cervical CA?

A

CXR or CT to r/u Thoracic/chest METs

29
Q

Made of collagen, smooth muscle, and elastin

surrounded by pseudocapsule

A

Uterine fibroids

30
Q

Uterine fibroids are classified by location

A

Submucosal (beneath endometrium): often cause AUB and infertility

Subserosal

Intramural

31
Q

Diagnostic choice for Uterine fibroids

A

Transvaginal US

32
Q

These are 2-3x more common in African American women

A

Uterine fibroids

33
Q

GnRH analog- Depot Lupron

to tx uterine fibroids

A

decreases fibroid size

good for near menopausal women

dont use longer than 6 mo

34
Q

Steroidal (MIRENA) to treat uterine fibroids

NOT for submucosal

A

for long, heavy periods

Mirena, birth control, Nuvaring

35
Q

Tarnexamic acid “Lysteda” to treat uterine fibroids

NOT for submucosal

A

for long heavy periods

use only during menses

this is an oral anti-fibrinolytic

36
Q

What tx is ONLY for submucosal fibroids?

A

Hysteroscopy- preserves Fertility

heated loop resects fibroids

risk of fluid overload- monitor IandOs

37
Q

Myomectomy for tx of fibroids

A

must have C section after this if you have future children

38
Q

Endometrial ablation

A

Have to remove fibroids first b4 doing this to wall

for Menorrhagia (heavy period)

CANT HAVE KIDS after this

39
Q

Uterine Artery Embolization (inject the embolizing agent via catheter)

A

CANT HAVE KIDS in future

only for Small fibroid

(CONTRA if large or many fibroids)

have to stay overnight: iv opioids post procedure

40
Q

Adenomyoma

A

endometrial material grows INTO myometrium (uterus muscle)

41
Q

Hx of previous uterine surgery should clue you into thinking about

A

Adenomyoma

42
Q

How to make a definitive diagnosis of Adenomyoma?

A

Hysterectomy!!! need histology

43
Q

Tx (also the diagnosis) of this Adenomyoma

A

Hysterectomy

44
Q

Premenstrual pelvic pain, relieved by period

A

Endometriosis

45
Q

Endometrial gland/stroma growth OUTSIDE of the endometrial cavity

A

Endometriosis

46
Q

Why is Endometriosis more painful before period

A

Estrogen and Prog stimulate the growth of lesions, but limited by Fibrosis which causes pressure and inflammation

47
Q

“Chocolate cysts” on ovaries

red, petechial lesions

thickness and scarring

A

Endometriosis

48
Q

Laparoscopy is the only way to dx:

A

Endometriosis

49
Q

Goal of tx for Endometriosis

A

STOP PERIOD to interrupt the stimulation of endometrial tissue

*Mirena (progestin) preferred
Birth control
Depot
Excision
Hysterectomy
50
Q

Endometrial hyperplasia

A

Unopposed Estrogen

51
Q

Risk factor for Endometrial hyperplasia

A

Obesity, obesity, obesity

52
Q

Most common sx of Endometrial Hyperplasia

A

Bleeding changes
or
POST MENOPAUSAL bleeding

53
Q

Tx for Endometrial Hyperplasia without Atypia

A

Rely on Prog hormone to help you

Mirena IUD
Provera

54
Q

Tx for Endometrial Hyperplasia with ATypica

A

HYSTERECTOMY is tx of choice d/t increased risk of CA

if still want to have kids, high dose Progesterone

55
Q

1 Most common GYN CA

A

Endometrial CA

56
Q

Type 1 vs Type 2 of Endometrial CA

A

Type 1: d/t unopposed Estrogen, better prognosis

Type 2: seen w endometrial atrophy, poor prognosis

57
Q

Type 1 Endometrial CA subtype

A

ADENOCARCINOMA is most common accounting for 80%

58
Q

Endometrial CA (#1) is most common in what subtype of women

A

Caucasian

and Estrogen is a causative factor

59
Q

If you see Lynch Syndrome/ HNPCC, you should perform Colaris screening to r/o

A

Endometrial CA

60
Q

Tx for Endometrial CA

A

Hysterectomy w Bilateral salpingoophorectomy

61
Q

Possible sx of Endometrial CA

A 
AUB
POST menopause bleeding
Weight loss
Dyspareunia
Abd cramping
Back pain

Spring Round II Exams (10 decks)

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