cervical

Question 1

what virus and 4 types linked to cervical neoplasia

Answer 1

HPV 16, 18, 31, 33

Question 2

2 HPV types linked to condylomata acuminata

Answer 2

HPV 6 and 11. mainly 11

Question 3

early age sex, early childbearing, blacks, smoking, multiple sex partners, STD hx, low socialeconomic status

Answer 3

cofactors in cervical cancer

Question 4

what part of cervix is 95% of cancer involved

Answer 4

transformation zone

Question 5

what percentage of CIN-3 develop microinvasive and frankly invasive carcinoma

Answer 5

1/3

Question 6

CIN age, CIS age, cervical cancer age

Answer 6

CIN 20s, CIS 25-35 y/o, cervical cancer after age 40

Question 7

HPV 16, 18, 31, 33

Answer 7

virus and 4 types linked to cervical neoplasia

Question 8

HPV 6 and 11

Answer 8

2 HPV types linked to condylomata acuminata; mainly 11

Question 9

HPV most prevalent in squamous cell and adenocarcinoma

Answer 9

squamous: HPV 16
adenocarcinoma: HPV 18

Question 10

gardasil vaccine protects against what types; ages of boys/girls

Answer 10

6, 11(90% of warts), 16, 18(70% cervical cancer). given up to age 26
boys 11-12 and girls 9-26; 3 injections over 6 months

Question 11

which HPV causes 70% of cervical cancer

Answer 11

18

Question 12

what decreases the risk of cervical/vaginal cancer

Answer 12

use of condoms or diaphragm

Question 13

what is neoplasia

Answer 13

abnormal growth of cells

Question 14

what is dysplasia

Answer 14

abnormal development of typically with an excess of immature cells

Question 15

when to start screening

Answer 15

within 3 years of becoming sexually active OR reaching age 21

Question 16

2 initial tests to get for cervical carcinoma

Answer 16

colposcopy with biopsy; and HPV DNA

Question 17

CIN-1, CIN-2, CIN-3, CIS definitions

what percentage of CIN-3 progress to CIS

Answer 17

CIN-1: mild cervical intraepithelial neoplasia
CIN-2: moderate cervical intraepithelial neoplasia
CIN-3: severe cervical intraepithelial neoplasia
CIS: carcinoma in situ
what percentage of CIN-3 progress to CIS: 1/3

Question 18

2 steps in the colposcopy

Answer 18

• schiller test

- paint the cervix with Lugol’s iodine. Cells that do not stain should be biopsied

Question 19

3 aspects of the cervical biopsy

Answer 19

• punch biopsy
• endocervical curettage
• conization for CIN-3 and CIS. Removing the entire transformation zone

Question 20

how to treat pre-invasive CIN

Answer 20

conization

Question 21

how to treat advanced cervical disease

Answer 21

hysterectomy with pelvic lymphadenopathy

Question 22

conization can lead to what

Answer 22

incompetent cervix than a LEEP

Question 23

common signs of cervical cancer

Answer 23

metrorrhagia, postcoital spotting, cervical ulceration

Question 24

what sign may appear after cancer invasion

Answer 24

bloody or purulent, malodorous, non-pruritic discharge

Question 25

cervical cancer screening 21-29 y.o 30-65 y.o over 65 y.o

Answer 25

cervical cancer screening 21-29 y.o: every 3 years Pap smear(cytology) 30-65 y.o: every 3 years Pap smear or every 5 years perform co-testing with pap+HPV over 65 y.o: stop screening if all tests are neg

Question 26

``` definitions ASC-US ASC-H LSIL AGC HSIL ```

Answer 26

ASC-US: atypical squamous cells of undetermined significance ASC-H: atypical squamous cells LSIL: low grade intraepithelial lesion AGC: atypical glandular cells of undetermined significance HSIL: high grade squamous intraepithelial lesion

Question 27

DES exposure risk for what

Answer 27

clear cell cancer

Question 28

``` subtype for: benign with inflammation CIN I CIN II CIN III ```

Answer 28

benign with inflammation: ASC-US and ASC-H CIN I: LSIL CIN II: HSIL CIN III: HSIL

Question 29

4 common infectious cervicitis organisms; most common

Answer 29

**chlamydia, gonococcus, trichomonas, HSV

Question 30

mucopurulent cervicitis

Answer 30

chlamydia more common than gonococcus

Question 31

3 non infectious causes for cervicitis

Answer 31

trauma, radiation exposure, malignancy

Question 32

exam for cervicitis (3)

Answer 32

yellow green mucopurulent discharge, + cervical motion tenderness, friable cervix

Question 33

yellow green mucopurulent discharge, + cervical motion tenderness

Answer 33

cervicitis

Question 34

test for cervicitis

Answer 34

gram stain. chlamydia and gonorrhorea make up 40% of cases.

Question 35

cervicitis tx

Answer 35

chlamydia: azith 1 gm PO dose plus doxy 100mg po BID for 7 days neisseria: ceftriazone 250mg IM plus azith 1 gm PO

Question 36

2 studies for cervical incompetence

Answer 36

bimanual physical exam and vaginal ultrasound

Question 37

cervical incompetence tx

Answer 37

surgical cerclage: using suture to reinforce cervix

Question 38

yellow green mucopurulent discharge, + cervical motion tenderness, friable cervix

Answer 38

cervicitis