Pap Smear, Cervical Dysplasia, Cervical Cancer (Wootton)

Question 1

What HPV types cause the majority of cancers?

Which ones are responsible for 70% of cervical cancers?

Which types are associated with genital warts and with low grade lesions?

Answer 1

1) 16,18, 31 and 45
2) 16 and 18
3) 6 and 11

Question 2

What are common risk factors for cervical neoplasia?

Answer 2

High parity
Multiple sexual partners
Organ transplant
DES exposure
Smoking

H MODS

Question 3

What populations should not have a pap smear done?

Answer 3

1) Under 21

2) After hysterectomy

Question 4

What is the pap smear guideline for patients ages 21-29 that had an initial normal test?

Answer 4

Cytology alone every 3 years

Question 5

What is the pap smear guideline for patients ages 30-65?

Answer 5

HPV and cytology co-testing every 5 years

Question 6

What is the pap smear guideline for patients ages 65 and older?

Answer 6

No screening following adequate negative prior screening

Question 7

Low grade squamous intraepithelial lesion correlates with?

High grade squamous intraepithelial lesion correlates with?

Answer 7

1) CIN 1

2) CIN 2, CIN 3, and Carcinoma in situ

Question 8

Adenocarcinoma is associated with what type of cells?

Answer 8

Glandular cells

Question 9

What is gold standard for diagnosis and treatment planning with low grade and high grade intraepithelial lesion findings?

Answer 9

Colposcopy with directed biopsy

Question 10

With a colposcopy, the cervix is washed with a 3% acetic acid which dehydrates cell and large nuclei of abnormal cells turn what color?

Answer 10

White (acetowhite changes)

Question 11

With a colposcopy, what findings are you looking for?

Answer 11

1) Punctuations
2) Acetowhite changes
3) Mosaicism
4) Abnormal vessels
5) Masses

PAMAM

Question 12

What are some ablative (destroy cervical tissue) treatment options?

What are some excisional treatment options?

Answer 12

1) Cryotherapy and laser ablation

2) Cold knife cone and Loop electrode excisional procedure (LEEP)

Question 13

A cold knife cone excisional technique is done when __1__ is positive.

Excisional techniques are also done when there is unsatisfactory __2__ or if there is a substantial discrepancy between __3__ and __3__.

Answer 13

1) Endocervical curettage
2) Colposcopy
3) Pap and biopsy (ie High grade pap and negative colposcopy)

Question 14

What is there an increased risk of with excisional procedures?

Answer 14

Preterm premature rupture of membranes (PPROM)

Question 15

What type of cancer makes up 80% of cervical cancer cases?

What type makes up 15% of cases?

Answer 15

1) Squamous cell carcinomas

2) Adenocarcinoma

Question 16

What symptoms point toward cervical cancer?

Answer 16

1) Watery vaginal bleeding
2) Intermittent spotting
3) Postcoital bleeding

WIP

Question 17

How does cervical cancer spread?

Answer 17

Direct invasion and lymphatic spread

Question 18

What are methods of prevention of cervical cancer?

Answer 18

1) Use of barrier protection

2) Vaccination with HPV vaccine

Question 19

What is the injection series for the HPV vaccine?

Answer 19

1) First dose
2) Second dose 2 months later
3) Third dose 6 months from the first

Question 20

Who is the HPV vaccine recommended for?

Answer 20

All girls and boys ages 9-26

*As of 2018 can use in men women 27-45

Question 21

Can the HPV vaccine be given to men and women ages 27-45?

Answer 21

Yes

Question 22

Can the vaccine be used in pregnant women?

Is it safe in breastfeeding?

Answer 22

1) No

2) Yes

Question 23

Can you receive the HPV vaccine if you already had an abnormal pap?

Answer 23

Yes

Question 24

The 4 strain Gardasil vaccine protects against?

Answer 24

HPV 6, 11, 16 and 18

Question 25

The 9 strain Gardasil vaccine protects against?

Answer 25

HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58

Question 26

Cervarix which is no longer available in the US is FDA approved for what population?

It protects against?

Answer 26

1) Girls ages 9-25

2) HPV 16 and 18

Question 27

What side effects are commonly seen with the HPV vaccine?

Answer 27

1) Dizziness
2) Injection site reactions (pain, swelling and redness)
3) Headache