Conditions of cervix, vulva and vagina

Question 1

epithelium of endocervix

Answer 1

columnar mucosal

Question 2

epithelium of ectocervix

Answer 2

squamous

Question 3

name of the area between ecto and endocervix

Answer 3

transition zone

Question 4

what alter position of transition zone

Answer 4

menarche
pregnancy
menopause

Question 5

what is the transition zone predisposed to

Answer 5

malignant change

Question 6

what is cervical erosion

Answer 6

exposure of endocervical mucosal cells to acid environment of vagina causing squamous metaplasia

Question 7

what are nabothian cysts

Answer 7

mucous retention cysts found on cervix - benign and physiological

Question 8

infection of cervix

Answer 8

cervicitis

Question 9

organisms causing cervicitis

Answer 9

chlamydia
herpes
gonococci

Question 10

pathology of cervicitis

Answer 10

sub-epithelial reactive lymphoid follicles present in cervix

Question 11

what can cervicitis lead to

Answer 11

fallopian tube damage

Question 12

how does cervicitis usually present

Answer 12

usually asymptomatic may have discharge

Question 13

what are cervical polyps

Answer 13

localised inflammatory outgrowth - may be ulcerated

Question 14

cervical polyps are pre-malignant/benign

Answer 14

benign

Question 15

presentation of cervical polyps

Answer 15

post-coital bleeding

discharge

Question 16

management of cervical polyps

Answer 16

pre-menopause - nothing

post-menopause - TVS and hysteroscopy to exclude uterine polyps

Question 17

what is the pre-invasive phase of cervical cancer

Answer 17

cervical intraepithelial neoplasia

Question 18

what are the 2 high risk viruses associated with cervical disease

Answer 18

HPV 16 and 18

Question 19

risk factors for CIN

Answer 19

many sexual partners (increased HPV exposure)
vulnerability of SC junction in early reproductive life
long term use of oral contraceptives
non-use of barrier methods
smoking
immunosuppression

Question 20

what histological change is present in CIN

Answer 20

koilocytosis - presence of koilocytes (abnormal squamous cells)
immature basal cells
nuclear abnormalities
excess mitotic activity

Question 21

how can koilocytes be detected

Answer 21

smear

Question 22

where does CIN occur

Answer 22

transition zone

Question 23

CNI histology

Answer 23

basal 1/3 of epithelium occupied by abnormal cells

Question 24

CNII histology

Answer 24

abnormal cells extend to middle 1/3

Question 25

CNIII histology

Answer 25

abnormal cells occupy full thickness of epithelium

Question 26

most common cervical cancer

Answer 26

squamous

Question 27

age group affected by squamous cervical cancer

Answer 27

younger women

Question 28

what does squamous carcinoma develop from

Answer 28

CIN (most cases are preventable by screening )

Question 29

stage 1A1

Answer 29

depth <3mm, width <7mm

Question 30

stage 1A2

Answer 30

depth <5mm, width <7mm

Question 31

stage 1B

Answer 31

confined to cefvix

Question 32

stage 2

Answer 32

spread to adjacent organs (vagina, uterus etc)

Question 33

stage 3

Answer 33

involvement with pelvic wall

Question 34

stage 4

Answer 34

distant metastases/bladder/bowel involvement

Question 35

presentation of cervical cancer

Answer 35

``` none at early stages abnormal bleeding (post coital, post menopausal) brown/blood stained mucosal discharge contact bleeding pelvic pain haematuria UTI ```

Question 36

what lymph nodes do cervical cancers spread to

Answer 36

pelvic | para-aortic

Question 37

lymph node spread is early/late

Answer 37

early

Question 38

haematogenous spread is early/late

Answer 38

late

Question 39

distant sites of metastasis

Answer 39

liver lungs bone

Question 40

pre-invasive form of endocervical adenocarcinoma

Answer 40

cervical glandular intraepithelial neoplasia

Question 41

what has worse prognosis, squamous or adenocarcinoma of cervix

Answer 41

adenocarcinoma

Question 42

what are other HPV associated neoplastic diseases

Answer 42

vulvar intraepithelial neoplasia (VIN) vaginal intraepithelial neoplasia (VaIN) anal intraepithelial neoplasia (AIN)

Question 43

VIN has greater risk of progression in younger/older women

Answer 43

older

Question 44

who gets vulvar invasive squamous carcinoma

Answer 44

elderly women

Question 45

how does vulvar carcinoma present

Answer 45

ulcer | exophytic mass

Question 46

where does vulvar carcinoma spread to

Answer 46

inguinal lymph nodes

Question 47

treatment for vulval cancer

Answer 47

radical vulvectomy | inguinal lymphadenectomy

Question 48

crusting vulvar rash

Answer 48

vulvar paget's disease

Question 49

what is pagets disease of vulva

Answer 49

tumour cells in epidermis (containing mucin) | tumour arising from sweat gland in skin

Question 50

who gets vaginal cancer

Answer 50

elderly