Concerning human papillomavirus (HPV) vaccination, which of the following is FALSE?
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 Ll 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-na'ive women and does not protect against the development of cancer in women already infected with carcinogenic HPV types.
Concerning uterine leiomyomas, all of the following are true EXCEPT:
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. below) as intramural, sub serosal, 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.
Types of uterine myomas.
Which of the following concerning endometriosis is FALSE?
Endometriosis is especially prevalent in patients suffering from chronic pelvic pain (80%) and infertility (20-50%). The pathophysiology of endometriosis is poorly understood; etiologic theories explaining dissemination of endometrial glands include retrograde menstruation, lymphatic and vascular spread of endometrial glands, and coelomic metaplasia. Endometriosis commonly involves the ovaries, pelvic peritoneal surfaces, and uterosacral ligaments. Other possible sites include the rectovaginal septum, sigmoid colon, intraperitoneal organs, retroperitoneal space, ureters, incisional scars, umbilicus, and even the thoracic cavity. Endometriosis can also cause increases in serum cancer antigen 125 (CA-125).
Pregnancy-related surgical conditions include all of the following EXCEPT:
Trauma-related hypovolemia may be compounded by pregnancy-induced decreases in systemic vascular resistance. Gastric motility is decreased, increasing the risk of aspiration. Several coagulation factors are also increased in pregnancy, increasing the likelihood for thromboembolic events. It should also be recognized that the fetus will be impacted significantly by maternal hypotension, as blood may be shunted away from the uterus. Only the third-trimester fetus has any ability to autoregulate in the context of decreased uterine blood flow and oxygen delivery.
Typical indications for cesarean delivery include all of the following EXCEPT:
Typical indications for cesarean delivery include nonreassuring fetal status, breech or other malpresentations, triplet and higher order gestations, cephalopelvic disproportion, failure to progress, placenta previa, and active genital herpes.
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