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Lecture 14: Cervical Disorders Flashcards

1
Q

The primary complications of cervicitis include: (2)

A
  • PID
  • Passing infection to newborn during delivery
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2
Q

The main presenting symptom of acute cervicitis is

Typically asymptomatic

A

Discharge

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3
Q

The S/S of acute cervicitis are: (5)

A
  1. Discharge
  2. Vaginal bleeding
  3. Cervical tenderness
  4. Urethritis
  5. Salpingitis
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4
Q

The discharge caused by a gonorrhea/chlamydia infection is usually described as…

A
  • Creamy
  • Thick
  • Purulent
  • Maybe malodorous

Acutely inflamed cervix

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5
Q

The discharged caused by a candidiasis infection is typically described as…

A
  • “Curd-like”
  • Itchy
  • non-malodorous

Adherent, Cottage Cheese Candidiasis

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6
Q

The discharge caused by a trichomonas infection is described as…

A
  • Green
  • Foamy
  • Strawberry petechiae cervix

Trip to the Strawberry farm to see the Green Strawberries

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7
Q

The discharge caused by a bacterial infection of the cervix is described as

A
  • Thin
  • Gray
  • Fishy odor
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8
Q

The discharge from an HSV infection of the cervix is described as…

A
  • Clear to serous

Vesicular lesions on the base

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9
Q

The main presenting symptom of chronic cervicitis is…

A

Discharge

Less than acute

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10
Q

What colposcopy finding of cervicitis is characteristic of trichomonas?

A

Double hairpin capillaries

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11
Q

What histopathology is characteristic of cervicitis due to HPV?

A
  • Large cells
  • Multinucleated
  • Perinuclear halos
  • Hyperchromasia
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12
Q

HSV and HPV both have enlarged cells and have multinucleated cells. However, HSV causing cervicitis has 2 additional features:

A
  • Ground-glass appearance
  • Inclusion bodies

HSV causes grouped vesicles too, so lots of bodies everywhere

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13
Q

Both bacterial and Trichomonas cervicitis are treated with

A

Nitroimidazoles (metro, tinidazole, secnidazole)

Orally

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14
Q

Who are the high-risk groups for cervicitis?

A
  • Young adults 19-25
  • Previous hx of STIs
  • Inconsistent condom use
  • Substance abuse
  • Multiple partners/high-risk
  • Tx of partners with STIs
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15
Q

Define cervical insufficiency

A

Painless cervical shortening/dilation in the 2nd or 3rd trimester, resulting in preterm birth.

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16
Q

The 4 primary RFs for cervical insufficiency are

A
  • Hx of having it
  • Hx of cervical injury, surgery, or conization
  • DES exposure
  • Anatomic abnormalities
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17
Q

Classic presentation of cervical insufficiency

A

2nd trimester dilation of 2+ cm with minimal contractions

4+ cm might have active contractions or ROM

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18
Q

When can you first check for cervical insufficiency and how?

A

At 14-16 wks via US

No way to check prior!

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19
Q

The 4 types of cervical insufficiency seen on US are

A

T, Y, V, U

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20
Q

The TOC for cervical insufficiency is

A

Cervical cerclage

Purse-like ring of stitch around cervix

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21
Q

Prior to cervical cerclage, you must check for… (2)

A
  • Viable intrauterine pregnancy
  • Cultures of gonorrhea/chlamydia/GBS
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22
Q

The pharmacological adjunct to cervical cerclage for cervical insufficiency is

A

Progesterone

Vaginal/IM/SC, starting at 16wks to 36+.

Can start before cerclage is placed

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23
Q

How do females often realize they have nabothian cysts?

A

Feel a bump when trying to put on cervical cap or diaphragm

Often just found incidentally since asymptomatic.

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24
Q

The tx for nabothian cysts is

A

Nothing

Only drain if theyre huge.

Nubs on the Cervix are Nothing
Nabothian Cysts No (tx)

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25
You always treat CIN II and III, except in...
* Pregnant women * Do not treat CIN II in adolescents
26
CIN grading is used to describe...
Amt of disordered growth of **cervical epithelial lining.**
27
The highest peak incidence age range for CIS is...
25-35 years
28
Overall, cervical cancer peak incidence occurs around
40+ years
29
The Dx of cervical dysplasia is made primarily via
Abnormal pap smear | Physical exam is usually normal.
30
Besides high-risk sex and related, the other RFs for cervical dysplasia are
* HPV * Immunosuppression * Multiparity * Long-term OCP use
31
The MC HPV strain overall found in a majority of cervical cancers is
HPV 16 | Followed by 18
32
T/F: Most women with HPV+ pap smears will go on to develop cervical cancer
False | But wary if they smoke!
33
Cervical cancer screening guidelines from 21-65+
* 21-29: Pap Q3y * 30-65: Pap Q3y or Pap+HPV Q5y * 65+: Stop only if no hx of dysplasia + 3 neg paps or 2 neg pap+HPVs in past 10 yrs. | Guidelines dont apply if hx of cervical ca, HIV, immunodeficient, or DES
34
* ASC-US * ASC-H * LGSIL/LSIL * HGSIL/LSIL All describe what system? | Squamous intraepithelial lesions
Bethesda system
35
In the Bethesda system, LGSIL corresponds to what CIN? HGSIL/HSIL?
* LSIL corresponds to CIN 1 * HSIL corresponds to CIN 2 and 3
36
T/F: Atypical Grandular cells are cancerous
False
37
What are squamous epithelial cells of the cervix most associated with?
* Adenocarcinoma of the endocervix * Endometrium
38
For a patient with **ASC-US**, the 3 management options are
1. Repeat serial cytology Q6m unil you get 2 normals. (2 abnormals = colposcopy) 2. Test for high-risk HPV (Colposcopy if positive) 3. Immediate referral to colposcopy
39
For ASC-H, AGC, LSIL, and HSIL, the preferred next step in management is
Colposcopy | aka anything besides ASC-US
40
Endocervical sampling during colposcopy is contraindicated if
Pregnant
41
After colposcopy for CIN 1, the management is...
2 paps Q6m OR pap+HPV at 6m | Repeat colposcopy if any abnormal. ## Footnote Switch back to routine screening if 2 smears normal or HPV normal.
42
After colposcopy, the management for CIN II/III, invasive cancer, or abnormal colposcopy is...
Surgical therapy | Cryo, laser, LEEP, cone biopsy
43
For an **ectocervix-only lesion with satisfactory colposcopy**, the surgery options are (3)
* Cryotherapy * Laser ablation * Superficial LEEP
44
The 3 indications to do deeper LEEPs or conization for the cervix are...
* **Endocervical lesion**/Ecto with + ECS * Unsatisfactory colposcopy * Discrepancy between cytology and colposcopy
45
Pros of cryotherapy
* Cheap, easy, no anesthesia * Mild SEs
46
The main caveat to cryotherapy for cervical lesions is...
It can only do superficial
47
Pros of CO2 laser ablation for cervical lesions
* Precise and versatile * Can ablate or assist with cone biopsies | Can cut down to 7mm
48
LEEP is primarily used in CIN...
2 and 3
49
Why might we want a LEEP procedure for CIN?
Provides a tissue sample for histology
50
What is the main advantage of cold knife conization over LEEP for tissue sampling?
No thermal artifact | However, it is an OR only procedure
51
Because LEEP and cold knife conization affect the cervical anatomy drastically, they both increase the risk of...
Cervical insufficiency
52
What features of a cervical lesion suggest there is a high chance for recurrence? (4)
* Larger lesion * Endocervical gland involvement * Positive margins * Positive endocervical curettage | Similar rates across all tx modalities
53
How much does treatment of a cervical lesion reduce the risk of cervical cancer by?
95%! | But still higher risk than gen pop for 20-25yrs :(
54
Overall, the average age of diagnosis for cervical cancer is...
51
55
The majority of cervical cancers are (cell type)
Squamous cell carcinomas | 70-75%, then 20-25% adenocarcinomas, then mixed
56
The MC symptom of cervical cancer | Early is asymptomatic usually
Abnormal vaginal bleeding
57
What are the usual late symptoms of cervical cancer?
* Weakness * Wt Loss * Anemia * **unilateral** pelvic pain that radiates to hip/thigh
58
Early on in cervical cancer, the cervix appears ?? on physical exam
Grossly normal | Ulceration could occur, but usually normal.
59
The terms endophytic and exophytic are used to describe cervical cancer on physical exam and mean....
* Endophytic = barrel-shaped enlargement of cervix * Exophytic = friable, bleeding, cauliflower-like lesions | Exophytic = exploding (in my mind)
60
What ligaments eventually thicken with parametrial involvement of cervical cancer?
Uterosacral ligaments, which fixate the cervix
61
T/F: Cervical cancer can be ruled out via cytology
False, biopsy any sus lesion
62
Biopsy of the cervix reveals a CIS, negative colposcopy, but abnormal pap. The next step in evaluation should be
Conization
63
A patient's cervix appears to have invasive cancer just on physical exam. The next step in workup is...
Simply biopsy | No need to do conization
64
Overall, the tx for cervical cancer is
Radical hysterectomy + lymphadenectomy | Can add chemo and radiation, but not the mainstay.

Women's Health (15 decks)

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