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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
Adenocarcinoma cervical CA
HPV 18 Bad news bears, prevalence is rising
26
Sx of cervical CA
often NONE | Abnormal vaginal bleeding if any
27
What is the only GYN CA that is CLINICALLY staged rather than based on Histology?
CERVICAL CA Figo staging
28
What else do you need to consider ordering with Cervical CA?
CXR or CT to r/u Thoracic/chest METs
29
Made of collagen, smooth muscle, and elastin surrounded by pseudocapsule
Uterine fibroids
30
Uterine fibroids are classified by location
Submucosal (beneath endometrium): often cause AUB and infertility Subserosal Intramural
31
Diagnostic choice for Uterine fibroids
Transvaginal US
32
These are 2-3x more common in African American women
Uterine fibroids
33
GnRH analog- Depot Lupron to tx uterine fibroids
decreases fibroid size good for near menopausal women dont use longer than 6 mo
34
Steroidal (MIRENA) to treat uterine fibroids | NOT for submucosal
for long, heavy periods Mirena, birth control, Nuvaring
35
Tarnexamic acid "Lysteda" to treat uterine fibroids | NOT for submucosal
for long heavy periods use only during menses this is an oral anti-fibrinolytic
36
What tx is ONLY for submucosal fibroids?
Hysteroscopy- preserves Fertility heated loop resects fibroids risk of fluid overload- monitor IandOs
37
Myomectomy for tx of fibroids
must have C section after this if you have future children
38
Endometrial ablation
Have to remove fibroids first b4 doing this to wall for Menorrhagia (heavy period) CANT HAVE KIDS after this
39
Uterine Artery Embolization (inject the embolizing agent via catheter)
CANT HAVE KIDS in future only for Small fibroid (CONTRA if large or many fibroids) have to stay overnight: iv opioids post procedure
40
Adenomyoma
endometrial material grows INTO myometrium (uterus muscle)
41
Hx of previous uterine surgery should clue you into thinking about
Adenomyoma
42
How to make a definitive diagnosis of Adenomyoma?
Hysterectomy!!! need histology
43
Tx (also the diagnosis) of this Adenomyoma
Hysterectomy
44
Premenstrual pelvic pain, relieved by period
Endometriosis
45
Endometrial gland/stroma growth OUTSIDE of the endometrial cavity
Endometriosis
46
Why is Endometriosis more painful before period
Estrogen and Prog stimulate the growth of lesions, but limited by Fibrosis which causes pressure and inflammation
47
"Chocolate cysts" on ovaries red, petechial lesions thickness and scarring
Endometriosis
48
Laparoscopy is the only way to dx:
Endometriosis
49
Goal of tx for Endometriosis
STOP PERIOD to interrupt the stimulation of endometrial tissue ``` *Mirena (progestin) preferred Birth control Depot Excision Hysterectomy ```
50
Endometrial hyperplasia
Unopposed Estrogen
51
Risk factor for Endometrial hyperplasia
Obesity, obesity, obesity
52
Most common sx of Endometrial Hyperplasia
Bleeding changes or POST MENOPAUSAL bleeding
53
Tx for Endometrial Hyperplasia without Atypia
Rely on Prog hormone to help you Mirena IUD Provera
54
Tx for Endometrial Hyperplasia with ATypica
HYSTERECTOMY is tx of choice d/t increased risk of CA | if still want to have kids, high dose Progesterone
55
#1 Most common GYN CA
Endometrial CA
56
Type 1 vs Type 2 of Endometrial CA
Type 1: d/t unopposed Estrogen, better prognosis Type 2: seen w endometrial atrophy, poor prognosis
57
Type 1 Endometrial CA subtype
ADENOCARCINOMA is most common accounting for 80%
58
Endometrial CA (#1) is most common in what subtype of women
Caucasian and Estrogen is a causative factor
59
If you see Lynch Syndrome/ HNPCC, you should perform Colaris screening to r/o
Endometrial CA
60
Tx for Endometrial CA
Hysterectomy w Bilateral salpingoophorectomy
61
Possible sx of Endometrial CA
``` AUB POST menopause bleeding Weight loss Dyspareunia Abd cramping Back pain ```

Spring Round II Exams (10 decks)

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