Menopause and Pap Smear Flashcards Preview

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Flashcards in Menopause and Pap Smear Deck (25):
1

Pap Smear

Normal = negative for intraepithelial neoplasia
Atypical Squamous Cells of Undetermined Significance
ASC - H
Low-grade squamous intraepithelial lesion
High-grade squamous intraepithelial lesion
Squamous Cell Carcinoma
Atypical Glandular Cells
AGC - favor neoplasia
Endocervical adenocarcinoma in situ

2

Screening Recommendations

Annual at age 21, before 21 if pregnancy or other
>30 yrs with normal annual paps, every 3 years
- periodic screening if neoplasia high risk

3

High Risk Factors

Multiple Partners, early age intercourse, partner had multiple partners, HPV, HSV, HIV, STDs, smoker, drugs

4

Dysplasia

CIN 1 - mild dysplasia
CIN 2 - moderate dysplasia
CIN 3 - severe dysplasia
CIS - carcinoma in situ

5

HPV

> 100 types, lots of oncogenes
- All grades of CIN and invasive cervical cancer contain HPV DNA
- Peak age 14-24

6

Koilocytosis

cellular change from HPV --> perinuclear cavitation and nuclear atypia

7

Squamous Cell Carcinoma

most common, often HPV 16

8

Adenocarcinoma

2nd most common, HPV 18 and 45

9

HPV infection is atypical

NOT bloodborne, no viremic phase
- immunoevasive nature limits host immune response

10

Colposcopy

examination of cervix, vagina, vulva with magnifying instrument at 10-16x
- Acetowhite epithelium results from piling up of cells with increased nuclear-cytoplasmic ratio
- Mosaic pattern from neovascularization
- Punctation from perpendicular capillaries

11

Colposcopy criteria

1. Sharpness of peripheral margin
2. Color of acetowhite staining
3. Type of vascular pattern
4. Iodine staining reaction (mustard yellow)
5. Adequate visualization of squamocolumnar junction

12

Dysplasia Treatment

Superficial techniques can be used if:
- entire SCJ visualized, biopsy consistent with pap, endocervical curettage negative, no suspicion of occult invasion
Other techniques
- cone biopsy -> can't see SCJ, CIN 2-3
- hysterectomy

13

Atypical Glandular Cells

atypical enometrial cells -> EMBX
>35 years or abnormal bleeding -> EMBX

14

LSIL

No CIN/cancer -> cytology and coloposcopy

15

HSIL

No CIN/CIN 1 Bx ->
- no change = diagnostic excision
- change = manage per guidelines

16

HPV Vaccinations

HPV 6, 11, 16, 18
- recommended for girls age 11-12

17

Perimenopause

time before, during, after menopause (transition)
- uneventful or major symptoms
- irregular menses for about 4 years

18

Menopause

permanent cessation of menses after cessation of ovarian function
- amenorrhea in presence of signs of hypoestrogenemia and FHS >40

19

Postmenopausal

more than 1/3 of woman's life!
CONCERNS:
- osteoporosis, skin, mood, hot flashes, CVD, sex, vaginal atrophy, incontinence, HRT

20

Hormonal changes

- follicles decrease, inhibin falls, FSH rises -> estradiol level decline -> endometrial development fails -> abscence of menses
- progesterone production ceases -> unopposed estrogen --> increased endometrial cancer early in menopause
- Androgens production decreases from both ovaries and adrenals -> libido?

21

Physiologic Changes

1. Body mass -> weight and fat increase, CVD risk?
2. Decreased Collagen -> thinning skin, tooth loss, atrophic vagina, poor uterovaginal support
3. Hot Flashes -> pathognomonic for menopause, directly related to estrogen levels, GnRH pulses from hypothalamus
- Other symptoms - depression, libido, loss of youth, headaches, amenorrhea

22

Abnormal uterine bleeding

>50% of women (perimenopausal)
- RULE OUT PREGNANCY!!!!!

23

Osteoporosis

post-menopause bone density decreases 1-2% per year
- age 60 -> 25% spinal compression
- age 80 -> 20% hip fracture, 15% die in 6 months
Tx = HRT, bisphosphanates, calcitonin, SERMs, calcium, Vit D

24

Hormone Replacement Therapy

Indications -> hot flashes, vaginal atrophy, osteoporosis, high risk
Contraindications -> pregnant, undiagnosed vaginal bleeding, active VTE, GB disease, liver disease

25

Osteoporosis Risk Factors

White/Asian, low weight/height, early menopause, fam hx, low Ca, low Vit D, high caffeine, high alcohol, high protein, cigs, diabetes, hyperthyroidism, Cushings