lab med lecture 20

- HPV vaccination

- screening

what is the reason we have a low rate of cervical cancer here in the US

HPV

what is cervical cancer due to

sexual activity

how is HPV transmitted

none, they are asymptomatic

what are symptoms that someone would present with when diagnosed with HPV

- 16

- 18

- 31

- 33

which HPV strands lead to cervical cancer

- 6

- 11

which HPV strands cause genital warts

true

true or false:

your body often clears HPV naturally within 1-2 years

- HPV infects epithelilal cells in lining

- infection presents

- HPV inactivates tumor supression genes

- cells experience uncontrolled growth

- precancerous cells develop

- cervical cancer develops

how does cervical cancer develop

21

what age do you start screening for cervical cancer

every 3 years

how often should you pap smear screen people from age 21-29

every 5 years and 3 years for pap smear

how often should you screen for cervical cancer from age 30-65

Pap smear

what is the screening method for cervical cancer

vaginal swab

what is the screening method for HPV

- females <25

- men who have sex with men

- patients with HIV

- individuals entering correctional facilities

who is considered high risk for getting an STI

usually present as asymptomatic and it can lead to serious complications

what is so scary about STIs

- women older than 25 and sexually active

- women less than 25 and sexually active

- men who have sex with women only

- men who have sex with men

who should you screen for STIs

if they are at risk

when is the time you would screen women older than 25 and sexually active

only if they are high risk

when should you screen men who have sex with women only

HIV

what screening should you do anually if its a man having sex with a man

- painful urination

- genital sores

- unusual discharge

- pain during sex

- fever, rash, swollen lymph nodes

what kind of symptoms should cue you to screen for STI

- urine test

- blood test

- swab test

how can you screen for STI

The patient needs additional

testing to rule out latent TB

A 37-year-old male presents to the clinic after returning home from travels in Bangladesh. He had

been working in the homeless shelter and is now concerned after having learned about a rampant

tuberculosis outbreak there. He is asymptomatic but is still concerned he might have contracted TB.

You obtain a chest x-ray and a CBC. The bloodwork is normal. The chest x-ray is as below. Which of

the following is true?

TB

infection of the respiratory system or other organs with myobacterium tuberculosis, acid fast bacilli

TB

leading cause of death from an infectious agent worldwide

- close contact to someone with it

- crowded conditions

- immunosupression

what are risk factors for getting TB

- Immediate clearance

- Primary disease

- Latent Infection

- Reactivation

what are the four outcomes that could present with inhalation of myobacterium tuberculosis

- prolonged fever

- cough, chest pain, hemoptosis

- fevers, chills

- weight loss

what are clinical presentations for TB

true

true or false

Patient is asymptomatic

and NOT contagious with

latent TB

NO

will latent TB have imaging findings

false

true or false

someone with latent TB can spread it

Both A and B (TST

and Quantiferon Gold (IGRA)

Which of the following lab tests can help

establish the diagnosis of latent TB?

- Tuberculin Skin Test (TST)

- Interferon-gamma release assay (IGRA) AKA

Quantiferon Gold

what are tests you can do to screen for TB

inject a TB antigen inttradermally and watch for any reaction within 48072 hours

how does the PPD test work

a red bump over injection site

what is considered a positive TB test

4

which hypersensitive reaction is TB

positive for TB

what does it mean if the TB lump is >15 mm

positive test but could be someone who's at higher risk or was previously exposed

what does it mean if the TB lump is >10 mm

positive test but could be an immunosupressed person bc their immune system isnt as strong to make a higher response

what does it mean if the TB lump is >5 mm

IGRA

this test is a one time blood draw that is not affected by prior BCG vaccination compared to TST

- Patients who will not return for TST reading

(IVDU, homelessness)

- Those with previous BCG vaccination

- Those likely to have TB infection

who would you want to get a IGRA on

- high cost

- high rates of false results

what are some disadvantages to IGRA

Improper reading, cross reaction with an atypical

(Mycobacterium avium complex), test within 2-10

years of BCG vaccination

what would cause a false positive on a PPD test

Anergy (HIV, sarcoidosis, etc), faulty application,

acute TB (takes 2-10 weeks to convert), malignancy

what would cause a false negative on a PPD test

Obtain a chest x-ray

Your patient has a positive IGRA. What is your

next step?

Obtain a chest x-ray

Your patient has a positive PPD. What is your

next step?

get a chest xray

what do you do if your have a positive ppd OR igra

- positive tst or igra AND

- no symptoms of infections AND

- no imaging finding of active infection

how can you diagnose latent TB

colon polyps

Discrete mass lesions that protrude into

the intestinal lumen

asymptomatic

what is the clinical manifestation of clinical polyps

some of them are neoplastic so if you dont know or catch it over 10 years it can become cancer

why can it be bad that colon polyps are asymptomatic

screening early

how can you avoid malignant transformation of a colon polyp

45 years old

when should you start screening for colon cancer screening

colonoscopy

what is the gold standard for screening and diagnosing colon cancer

every 10 years

how often should you do a colonoscopy if its normal

- stool test

- colonoscopy

what are 2 ways we can screen for colon cancer

gFOBT

Screening test used to identify hidden (occult) blood in stool

gFOBT

Test identifies presence of hemoglobin in stool by turning

guaiac reagent purple-blue

- GI bleed

- colon cancer

what is gFOBT used to evaluate for

- Red meat

- Peroxidase-rich veggies/fruits: Turnips, banana, horseradish, etc

- Drugs (anticoagulants, aspirin, colchicine, iron, NSAIDS,

steroids)

what can cause a false positive for gFOBT

vitamin C

what can cause a false negative for gFOBT

FIT

Highly sensitive stool occult blood test that uses antibodies

that bind to human hemoglobin

FIT

Highly specific to human blood; less false positives than

gFOBT

FIT

this test Doesn't detect "non-blood" markers that can be present in early-stage or non-bleeding cancers (not all polyps bleed)

FIT and DNA testing

which test can detect blood and genetic mutations

FIT and DNA testing

this test is More sensitive than FIT alone; superior at detecting early- stage cancer and non-bleeding precancerous polyps

FIT

Sensitive stool tests that checks for presence of Hgb. Use for patients unable or unwilling to undergo colonoscopy. Must be done annually. If positive -> COLONOSCOPY

FIT-DNA

"Cologuard", highly sensitive stool test. Evaluates for Hgb + DNA mutation/methylation. Performed q 1-3 years. More sensitive but less specific than FIT. If positive -> COLONOSCOPY