Cervix path I

Question 1

what can cause abnormal bleeding that originates from cervix

Answer 1

DUB
endometritis
benign growths (polyps, adenomyoma)
hyperplasia
neoplasias

Question 2

what are the premalignant neoplasms of the cervix

Answer 2

cervical intraepithelial neoplasms

adenocarcinoma in situ

Question 3

what are the cancers of the cervix

Answer 3

invasive SCC

adenocarcinoma

Question 4

when is there eversion of the cervical os and what is this

Answer 4

puberty and pregnancy

when the endocervical epithelium is on external os (exposed to vagina)

Question 5

what will the squamocolumnar junction look like in a post adolescent

Answer 5

squamous metaplasia of the endocervix epithelium creates transition zone

Question 6

when is there inversion of the cervical os and what is it

Answer 6

inversion= transformation zone moves into the endocervical canal and not seen on exam
post menopausal

Question 7

what happens if you add acetic acid to biopsy from cervix and it turns white

Answer 7

HPV infected

Question 8

darker cells on H&E stain means what

Answer 8

more turnover, mitoses, mitochondria etc

Question 9

what is role of lactobacilli in cervix and uterus

Answer 9

produce vaginal pH <4.5

Question 10

what can cause loss of acidocis in cervix

Answer 10

bleeding, intercourse, douching, antibiotics

Question 11

loss of acidosis in cervix can lead to what

Answer 11

loss of normal flora and overgrowth of other bacteria- cervicitis

Question 12

what specific infections can cause cervicitis

Answer 12

gonorrhea
chlamydia
mycoplasma
HSV

Question 13

what can cervicitis cause

Answer 13

abnormal pap because of squamous mucosa changes which result in atypia

Question 14

what is problem with atypia from cervicitis

Answer 14

hard to differentiate atypical squamous cells of uncertain significance from reactive atypical cells that could be dysplasia

Question 15

what will chlamydia cause in men

Answer 15

white discharge with or without pain, swollen painful testicle, epididymis, prostatitis, reactive arthritis, reiters syndrome

Question 16

what will chlamydia cause in women

Answer 16

usually asymptomatic, PID or ectopic pregnancy

Question 17

what can happen to pregnant mother with chlamydia infection

Answer 17

spontaneous abortions, premature birth

Question 18

what can chlamydia cause in neonate birthed from mom who was infected

Answer 18

conjuntivitis, pneumonia, blindess

presents 1 wk post delivery

Question 19

what will cervix looks like if had chlamydia for a while

Answer 19

reddened transformation zone

Question 20

micro of swap from cervix shows inflammatory debris, multinucleated cells with intra-nuclear “Ground glass” viral inclusions

Answer 20

herpes

Question 21

thayer martin

Answer 21

gonorrhea

Question 22

what is a sessile polyp

Answer 22

broad based polyp

Question 23

what is a pedunculated polyp

Answer 23

polyp on a stalk

Question 24

what Sx can an endocervical polyp cause

Answer 24

spotting of blood

Question 25

what is a nabothian cyst

Answer 25

endocervical gland filling with mucus

Question 26

what are host factors for HPV infetion

Answer 26

``` young at first age intercourse multiple sexual partners male partner with multiple partners immunosuppression use of BCPs smoking ```

Question 27

HPV can only infect what cells

Answer 27

immature squamous cells | only can replicate in maturing squamous cells

Question 28

what tumorogenic proteins does HPV code for

Answer 28

viral E6 and viral E7

Question 29

What does E6 do

Answer 29

binds tumor suppressor p53 protein and inactivates it

Question 30

what does E7 do

Answer 30

binds Rb protein preventing it from binding up E2F. free E2F binds promoters like c-myc stimulating cells to enter the cell cycle

Question 31

how can HPV lead to cancer

Answer 31

inserts into DNA | E6 E7 oncoproteins

Question 32

HPV squamous cancer is also seen where in the body

Answer 32

waldeyers ring of oropharynx, anus, penis, vulva and vagina

Question 33

what is synonymous to low grade squamous intraepithelial lesion LSIL

Answer 33

CIN I, mild dysplasia

Question 34

what Cervical Intraepithelial neoplasms are considered high grade squamous intraepithelial lesion HSIL

Answer 34

CIN II III and CINIII/CIS

Question 35

course of action for CIN II or III

Answer 35

biopsy | cone

Question 36

1/3 squamous epithelium has enlarged nuclei, what stage is this

Answer 36

CIN I

Question 37

ki-67 is a marker for what

Answer 37

cell proliferation

Question 38

p16 is what and how does HPV escape it

Answer 38

cell cycle regulator (cyclin kinase inhibitor) | despite high levels, HPV infected cells proliferate because target of p16 (RB) is inactivated by E7

Question 39

90% cervical dysplasia will do what over 2 years

Answer 39

regress

Question 40

abnormal pap requires what follow up

Answer 40

colposcopy and cervical biopsy

Question 41

what are methods to remove dysplastic tissue

Answer 41

cryotherapy electrocautery topical 5-fluoruracil conization

Question 42

what age is recommended to ahve pap

Answer 42

21 or sooner if sexually active

Question 43

at what age are pap smears usually discontinued

Answer 43

65

Question 44

what is a cold cone biopsy

Answer 44

large area is excised for examination

Question 45

why is cone biopsy the best way to definitively check for cancer

Answer 45

glandular cells become neoplastic

Question 46

if there is invasion of the endocervix of cancer what is best step

Answer 46

hysterectomy

Question 47

80% cervical cancer is what type

Answer 47

SCC

Question 48

second most common cervical cancer type

Answer 48

adeno

Question 49

peak incidence of invasive cervical CA

Answer 49

45 y.o