Flashcards in Pap smear Deck (50):
1
42 y.o G2P2 with LMP one week ago. tubal ligation as birth control. annual exam
hypothyroid, 22pack year, +FMH breast CA
no mammogram, last PAP 5 yrs prior
2 c sections for LGA babies
+gestational DM
+vaginal discharge on exam
next step?
wet prep
KOH
pap
2
if pap shows atypical squamous cells high grade
next step?
colposcopy and Bx
3
Sx bacterial vaginosis
odor
no inflammation or itching
4
risk factors bacterial vaginosis
sexual activity, douching
5
what causes bacterial vaginosis
overgrowth of anaerobic bacteria- gardnerella
6
What is Amsel criteria
3 of following:
-homogenous white to gray discharge
-pH >4.5
- + whiff test with KOH
- clue cells on wet mount
7
pregnancy risks of bacterial vaginosis
preterm
PROM
amniotic fluid infection
chorioamnionitis
post partum endometritis
8
bacterial vaginosis Tx
metronidazole
clindamycin
tindazole
9
Tx asymptomatic patient with bacterial vaginosis
not recommended but most people Tx
10
yeast on wet mount
pseudohyphae
11
Sx yeast
itching, red cervix
12
bubbly discharge of vaginal fluid
trichomonas
13
koilocyte
HPV
14
what do you look for in cells on pap smear
increased nuclear to cytoplasmic ratio
abnormal cell structure
koilocyte indication
15
cervical cancer associated with
sex
(precursors: HPV etc)
16
most common sexually transmitted infection
HPV
17
how many types HPV sexually transmitted
40 types
18
how is HPV Dx
DNA hybrid testing
19
clinical infection of HPV
warty growths- condylomata accuminata (6 and 11)
on vulva, vagina, cervix, urethra, perianal
20
HPV asociated with what genital neoplasias
cervical, vaginal, vulvar CA
21
HPV infection normal course
spontaneously clears within 2 years
22
high risk HPV
16 18 30
23
what is ASCUS
atypical squamous cells of udetermined significance
24
What is ASC-H
atypical squamous cells, high grade
25
what is AGUS
atypical glandular cells of undetermined significance (endocervical cells)
26
what is LSIL
low grade squamous intraepithelial lesion
27
HSIL
high grade squamous intraepithelial lesion
28
work up of abnormal pap
age dependent degree abnormality
29
risk factors for abnormal pap
no recent pap
smoking
age of 1st intercourse
number of patients
HIV or any other reason to be immunocompromised
30
how does smoking increase risk cervical cancer
destroys epithelial cells
31
what is colposcopy
looking at cervix with microscope and usually take biopsy
32
biopsy can tell you what about cervix pathology
CIN I II III and invasive
33
what is CIN I
mild dysplasia
34
what is CIN II
moderate dysplasia
35
what is CIN III
severe dysplasia, carcinoma in situ
36
what occurs in CIN I prognosis
70% regress
37
what occurs in CIN II prognosis
30% regress, 30% stay same, 30-40% progress
38
Tx CIN II
excise usually
39
how does cervical cancer spread
lymph nodes
40
radical hysterecotmy includes what part of vagina
top third
41
what are indications for conization
CIN II III
endocervical disease on colposcopy
inadequate colposcopy
depth on invasion
42
contributing factor to cervical cancer death
lack of screening
43
highgest incidence cervical CA
30-50
44
screening for ages 21-29
cytology every 3 years
HPV testing not used as screen
45
screening for ages 30-64
cytology and HPV testing (co testing) every 5 years
46
reason for cotesting
increased detection CIN3
enhances detection adenocarcinoma
47
normal pap with HPV high risk positive what is next step
colposcopy
48
when to stop screening in women
age 65 with negative screening before
3 consecutive neg paps or 2 consecutive neg HPV tests
49
When not to stop screening at age 65
history CIN 2 or 3
change of partners
50