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Chapter 41: Gynecology

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Concerning human papillomavirus (HPV) vaccination, which of the following is FALSE?

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A. Two HPV vaccines have been developed and approved by the U.S. Food and Drug Administration (FDA).

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B. Both vaccines generate high concentrations of neutralizing antibodies to HPV L1 protein.

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C. Prospective randomized clinical trials have demonstrated that vaccination prevents nearly 100% of HPV subtype-specific precancerous cell changes.

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D. HPV immunizations prevents 90% of all cervical cancers.

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Answer: D

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Two human papillomavirus (HPV) vaccines have been developed and approved by the U.S. Food and Drug Administration (FDA). Vaccination generates high concentrations of neutralizing antibodies to HPV L1 protein, the antigen in both vaccines. Several randomized clinical trials involving approximately 35,000 young women have shown that both Gardasil and Cervarix prevent nearly 100% of the HPV subtype-specific precancerous cervical cell changes for up to 4 years after vaccination among women who were not infected at the time of vaccination. Cervical cancer screening continues to play an important role in detection and treatment of cervical intraepithelial neoplasia (CIN) II/III and prevention of cervical cancer in these high-risk patients. Cervical cancer screening continues to be of great importance since HPV immunization will not prevent approximately 25 to 30% of cervical cancers in HPV-naïve women and does not protect against the development of cancer in women already infected with carcinogenic HPV types. (See Schwartz 10th ed., pp. 1681–1682.)

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Concerning uterine leiomyomas, all of the following are true EXCEPT

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A. Most common pelvic tumor.

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B. Has a racial predilection.

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C. Classified according to anatomic location.

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D. Rarely necessitates hysterectomy.

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Answer: D

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Leiomyomas, also known colloquially as fibroids, are the most common female pelvic tumor and occur in response to growth of the uterine smooth muscle cells (myometrium). They are common in the reproductive years, and by age 50, at least 60% of white and up to 80% of black women are (or have been) affected. Leiomyomas are described according to their anatomic location (Fig. 41-1) as intramural, subserosal, submucosal, pedunculated, cervical, and rarely ectopic. Most are asymptomatic; however, abnormal uterine bleeding caused by leiomyomas is the most common indication for hysterectomy in the United States. (See Schwartz 10th ed., Figure 41-9, pp. 1683–1684.)

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Fig. 41-1. Types of uterine myomas.

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Which of the following concerning endometriosis is FALSE?

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A. More common in infertile women.

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