Lecture 8- PapSmear/ Vulvovaginitis

Question 1

What is when cells are scraped from the cervix and examined under a microscope to check for cancer or other problems ?

Answer 1

Pap smear

Question 2

What age should women get a pap smear?

Answer 2

21 and older

Question 3

Do women with a total hysterectomy need a pap smear?

Answer 3

No as long as it wasn’t done as treatment for cervical pre-CA or CA

Question 4

Is a Pap Smear a diagnostic test?

Answer 4

No- it is only screening

Question 5

What is a diagnostic test to get a tissue biopsy to confirm the findings of the pap smear?

Answer 5

Colposcopy

Question 6

Testing for what other conditions can also be obtained if the Pap is liquid based?

Answer 6

Gonorrhea and chlamydia

Question 7

When can paps normally be stopped?

Answer 7

After age 65 with a normal history

Question 8

Most HPV infections clear the immune system within how many months?

Answer 8

24-36 months

Question 9

how many subtype of HPV are there?

Answer 9

More than 100

Question 10

What are the 2 most high risk strains of HPV?

Answer 10

16 and 18 cause 2/3 of cervical cancer

Question 11

how long does it take for invasive cervical CA to develop after detection of a precancerous state (CIN2/3)?

Answer 11

average of 10 years

Question 12

What can increase the risk of getting HPV?

Answer 12

Multiple sexual partners
Engaging in intercourse at a young age
Multiparity
Immunodeficiency 
Smoking

Question 13

What does ASC-US stand for?

Answer 13

Atypical squamous cells of undetermined significance

Question 14

what is the advantage of testing for HPV over 30?

Answer 14

Immune system isn’t as robust, most susceptible to infection

Question 15

What does the HPV vaccine have?

Answer 15

viral like particles which lack viral genetic

material and are non-infectious.

Question 16

What does CIN stand for?

Answer 16

Cervical intraepithelial neoplasia

Question 17

What 2 strains are most commonly associated with genital warts?

Answer 17

Types 6 and 11

Question 18

What are encapsulated HPV virons expressed as morphologically?

Answer 18

koilocytes

Question 19

What are the two types of cervical epithelium?

Answer 19

Columnar (glandular)

Stratified non-keratinizing squamous epithelium

Question 20

Where do most neoplasms arise?

Answer 20

Squamocolumnar Junction (SCJ)

Question 21

What is the are b/w the original SCJ and teh active SCJ (area of squamous metaplasia)

Answer 21

Transformation Zone (TZ), area most vulnerable to oncogenic changes

Question 22

What is a cyst that happens when glands within the columnar epithelium becomes trapped causing these cysts.

Answer 22

Nabothian Cysts

Question 23

What does LGSIL stand for?

Answer 23

Low grade squamous interepithelial lesions

Question 24

what determines the grade and extent of the lesion

Answer 24

colpo (coloposcopy)

Question 25

What are options for abnormal pap results?

Answer 25

Repeat Pap in 6 months (for low grade) HPV testing (already done with reflexive testing) Colposcopy (most common( Endocervical curretage (ECC)

Question 26

If there is a ASCUSC with negative HPV what should you do?

Answer 26

Repeat Pap in 1 year

Question 27

Where are glandular cells located?

Answer 27

Endocervical canal

Question 28

What do AGC stand for?

Answer 28

Atypical glandular cells

Question 29

What could AGC indicate?

Answer 29

Uterine, fallopian tube, glandular cancers | or could be CIN (mis-identified)

Question 30

What should be done after an AGC comes back?

Answer 30

Colpo | Endocervical sampling

Question 31

What are excisional treatments for CIN? (most common)

Answer 31

Cold-knife cone LEEP LLETZ (laser conization and electrosurgical needle conization)

Question 32

WHat are some ablation techniques for CIN? (not as common)

Answer 32

cryotherphy Laser ablation Electrofulguration and cold coagulation

Question 33

After treatment for noninvasive abnormalities how often should a Pap be done?

Answer 33

Every 6 months for 2 years

Question 34

What are the two major types of cervical cancer?

Answer 34

Squamous cell and adenocarcinoma

Question 35

What is the most common form of cervical cancer?

Answer 35

Squamous cell

Question 36

What is the good bacteria in the vagina? Formed after puberty.

Answer 36

Lactobacilli

Question 37

What do lactobaccili break down glycogen to to keep the vagina acidic?

Answer 37

lactic acid

Question 38

What give vaginal secretions a white to off-white color?

Answer 38

Exfoliated squamous cells

Question 39

What is a polymicrobial infection characterized by a lack of H2O2 producing lactobacilli and an overgrowth of facultative anaerobic organisms.

Answer 39

Bacterial vaginosis (BV)

Question 40

What are common symptoms of bacterial vaginosis (BV)?

Answer 40

discharge, odor that gets worse after intercourse

Question 41

What will the discharge smell like with bacterial vaginosis (BV)?

Answer 41

musty of fishy odor because of bacteria producing amines

Question 42

What is a way to test for BV?

Answer 42

Drop KOH on swab with vaginal discharge and will have fishy smell.

Question 43

what does the discharge look like with BV?

Answer 43

thin, homogenous, white adherent discharge

Question 44

What type cells are present on microscopic appearance with BV?

Answer 44

Clue cells

Question 45

How do you treat BV?

Answer 45

Oral or topical metronidazole (flagil) or oral or topical clindamycin

Question 46

What form of metronidazole should you give if the person is going to drink?

Answer 46

Topical form

Question 47

What is an infection caused by ubiquitous airborne fungi, approximately 90% of these infections

Answer 47

Yeast infection (candidiasis)

Question 48

What will the pH be like with a yeast infection?

Answer 48

Normal (lactobacilli aren't disrupted)

Question 49

What are common symptoms of a yeast infection?

Answer 49

Itching, burning, irritation, thick, white discharge

Question 50

What does the discharge look like with yeast infection?

Answer 50

Thick, white cottage cheese like

Question 51

What will the vulva and vaginal tissues look like with a yeast infection?

Answer 51

Bright red in color

Question 52

What is the microscopic appearance of a yeast infection?

Answer 52

Hyphae and buds (apply KOH and look at under 10x power)

Question 53

How do you treat a yeast infection?

Answer 53

``` Topical antifungals (micronazole, clotrimazole, terconazole, etc.) Oral fluconazole (only one pill, one dose) -STD lecture: butocanzole or fluconazole ```

Question 54

What is flagellate protozoan that lives only in the vagina, Skene ducts, and male or female urethra?

Answer 54

Trichomonas Vulvovaginitis (trich)

Question 55

What is the pH with trich?

Answer 55

Greater than 4.5

Question 56

What is the most common symptom with trich?

Answer 56

Frothy discharge (gray-green)

Question 57

What will the cervix look like with trich?

Answer 57

Strawberry cervix

Question 58

What is the microscopic appearance with trich?

Answer 58

Flagellated organisms present (look at 40x) | move independently

Question 59

What is the treatment for trich?

Answer 59

Metronidazole or Tinidazole

Question 60

What is Atrophy of the vaginal epithelium due to diminished estrogen levels?

Answer 60

Atrophic vaginitis

Question 61

What is a vaginitis that occurs with a dry vagina?

Answer 61

Atrophic vaginitis.

Question 62

How do you treat atrophic vaginitis?

Answer 62

Topical estrogen therapy

Question 63

What is a vaginitis that is characterized by purulent discharge, exfoliation of epithelial cells and vulvovaginal burning and erythema?Generally seen in peri and postmenopausal women

Answer 63

Desquamative inflammatory vaginitis

Question 64

How do you treat desquamative inflammatory vaginitis?

Answer 64

Clindamycin cream 2% applied for 14 days