11 - Female Reproductive System, Breast and Skin Flashcards
Three examples of developmental abnormalities of female reproductive system?
- agenesis of vagina
- agenesis of uterus
- abnormality of uterus
Define the difference btwn true hermaphroditism, male and female pseudohermaphroditism
True: person has both male and female gonads (hormone makers)
Male pseudo: genotypically male, phenotypically female
Female pseudo: genotypically female, phenotypically male
What are the 2 pathogenic and 5 anatomic classifications
Pathogenic:
1. descending infections (TB, hematogenouos)
2. Ascending infection (STI)
Anatomic classification:
1. salpingitis: fallopian tube
2. endometritis: endometrium
3. cervicitis: cervix
4. vaginitis: vagina
5. vulvitis: vulva
What are the main characteristics of diseases caused by genital herpes (3)? Why is it important?
- majority are asymptomatic
- vesicle rupture can lead to ulcerations
- no cure, virus remains dormant in neural ganglion
Important because don’t want vaginal delivery if active lesions
What are the main characteristics of diseases caused by HPV (3)?
- labial, vaginal, and cervical warts (condyloma)
- certain types associated with carcinoma
- condyloma acuminatum: anogenital warts, usually caused by HPV 6,11 and transmitted through skin contact
Describe bacteria and diseases caused by chlamydia, gonorrhea, and syphilis
Chlamydia:
- chlamydia trachomatis
- causes urethritis, cervicitis with discharge, and PID
Gonorrhea:
- neisseria gonorrheae
- causes urethritis, cervicitis with discharge, and PID
Syphilis:
- treponema pallidum
- causes vulvar ulcers
Characteristics of PID? What are 3 other diseases it can cause and 3 complications?
- infection of reproductive tract, usually secondary to an ascending infection of STI
Causes: salpingitis, tubo-ovarian abscess, peritonitis
Complications: infertility, ectopic pregnancy, spread of infection
What are the three main infectious and non-infectious causes of vaginitis
Infectious:
1. bacterial vaginosis (bacteria, not STI)
2. candidiasis (fungus, not STI)
3. Trichomonas (trichomonas vaginalis, STI)
Non-infectious:
1. atrophic vaginitis
2. foreign body
3. allergen or irritant
What is endometriosis characterized by (2)? Pathogenesis? What’s a specific example
Characterized by:
- when endometrial tissue, which is normally lines the inside of the uterus, is found on the outside of the uterus
- benign condition that may cause pain and infertility
Pathogenesis:
- retrograde menstrual flow theory
- traumatic implantation
- embryonic rests (part of embryonic tissue remains after embryonic development period)
Example: **Ovarian endometriosis **-> ovarian cyst
What is endometrial hyperplasia?
thickening of endometrial mucosa due to hormonal imbalances
What are the 5 main steps of the anovulatory cycle? What are the functional and organic causes? What disease is this cycle relevant to?
- no ovulation
- no progesterone secretion
- unopposed estrogenic stimulation
- proliferation
- endometrial hyperplasia
Functional: puberty, anorexia, anxiety, nervosa, bulima, athletes
Organic: excess estrogen
Endometrial Hyperplasia
Describe characteristics of vulva (4) carcinoma and vaginal carcinoma (2)
Vulva
- squamous cell carcinoma
- raised wart-like or ulcerated regions
- may result in leukoplakia or erythroplakia
- biopsy to assess, surgical excision w/ or w/o adjuvant therapy to treat
Vagina
- squamous cell carcinoma
- clear cell carcinoma due to women born to mothers on DES during pregnancy
What are 4 characteristics of carcinoma of cervix?
- cause is unknown
- most commonly squamous cell carcinoma
- occurs at transition zone of exocervic and endocervix
- cells may shed into vagina (hence pap test)
What are 2 risk factors of carcinoma of cervix?
- sexual intercourse at young age/multiple partners/HPV infections type 16 and 18
- Environmental factors (tobacco)
What type of neoplasm is cervical intra-epithelial neoplasia (CIN) associated with? What does CIN I, II, III mean in terms of severity?
Carcinoma of cervix
CIN I = mild
CIN II = moderate
CIN III = severe
Describe leiomyoma (3) and leiomyeosarcoma (2)
Leiomyoma:
- benign neoplasm of uterus derived from smooth muscle of uterus wall
- response to estrogen, usually asymptomatic
- may produce symptoms due to bleeding
Leiomyosarcoma:
- malignant neoplasm derived from smooth muscle in uterus wall
- very rare
What is endometrial adenocarcinoma? What is a risk factor? Diagnosis and treatment?
Malignant neoplasm derived from epithelial cells in endometrium
Risk factors are related to increased estrogen
Diagnosis: endometrial biopsy, dilation, curettage
Treatment: hysterectomy (surgical removal of uterus) with or without adjuvant therapy
Name an example of a disease with ovarian cysts and state 4 characteristics
Polycystic ovary syndrome
1. multiple cysts in both ovaries
2. presents with menstrual irregularities
3. patients don’t ovulate
4. cause of infertility
What are the three major ovarian neoplasm groups? Pathogenesis (3)?
Three Major Groups:
1. surface epithelial tumors
2. Germ cell tumors
3. Sex Cord stromal tumors
Pathogenesis
1. after ovulation, ovarian surface epithelium ruptures
2. heals by proliferation
3. proliferative surface epithelial cells have increased risk of transformation
What are the three main surface epithelial tumors? Describe their characteristics and whether they’re generally benign or malignant
Serous epithelial tumors
- typically cystic and filled with clear fluid
- 30% benign 60% malignant
Mucinous epithelial tumors
- typically cystic and filled with vicsous fluid
- more likely to be benign compared to serous
Endometriod epithelial tumors
- typically solid
- usually malignant
Characteristics of teratoma (4)?
- aka dermoid cyst, often cystic and contains hair + sebaceous material
- may contain teeth and bone cartilage
- benign but should be resected to avoid malignant transformation
- immature teratomas contain immature neural tissue and may behave malignantly
What disease is a risk of excess estrogen
Endometrial carcinoma
Where do ovarian sex cord neoplasms originate from? What are the 4 types?
Originates from ovarian stromal cells
- Fibroma: benign neoplasm of fibroblasts
- thecoma: benign neoplasm of theca cells, can produce estrogen
- Granulosa cell tumor: benign or malignant neoplasm of granulosa cell, can produce estrogen
- Sertoli-leydig cell tumor: secretes androgens -> virilization
What are 4 factors leading to infertile pregancies?
Ovum related:
- immature ovum, incomplete meiotic division
Sperm related:
- azospermia (no sperm)
- oligospermia (low sperm)
- immotile sperm
Genital organ factors:
- PID
- Asherman’s syndrome: scar tissue in uterus or cervix
Systemic Factors:
- immune mechanisms
Describe ectopic pregnancy and why it’s dangerous (3)?
- implantation of fertilzied ovum outside of uterine cavity, usually in the fallopian tube
- adhesions prevent normal passage of zygote so it implants and penetrates in the fallopian tube
- may erode through wall and rupture, leading to massive blood loss
Difference btwn placenta accreta and previa?
Accreta:
- abnormally deep peneration of placental villi into uterus wall
- risk of retaining placenta after delivery and post-partum hemorrhage
Previa:
- abnormal placental implantation site in lower uterine segment
- prone to bleeding and risk of premature delivery
What is the difference btwn complete, incomplete, missed, threatened, and inevitable abortion?
Complete: fetus and placenta expelled, normal function
Incomplete: retention of some fetal and placental material
Missed: death of fetus in uterus, expelled weaks later
Threatened: cervix closed, spotting blood, fetus still in uterus
Inevitable: cervix is dilated, but products of conception not expeleld
What are gestational trophoblastic diseases? What are the two cell types? Name a benign and malignant GTD.
Group of abnormalities of placentation resulting in tumor-like changes or malignant transformation
Cytotrophoblasts and synctiotrophoblasts which proliferate in GTD
Benign: hydatid mole
Malignant: choriocarcinoma
What are some characteristics of hydatid form moles? Difference btwn complete and incomplete moles?
- trophoblastic proliferation, degeneration of chorionic villi
- features enlarged uterus with no fetal movement, looks like cluster of grapes on ultrasound
Complete mole:
- more common, no fetus (empty ovum), abnormal fertilization (all chromosomes from one parent, but normal amount)
Incomplete mole:
- some fetal parts in ovum, abnormal fertilization (abnormal number of chromosomes)
Characteristics of choriocarcinoma?
rare highly malignant tumor of gestational trophoblasts, arises from pre-existing complete mole
What is the difference btwn preeclampsia and eclampsia? What disease do they describe?
Preeclampsia:
- triad: HTN, edema, proteinuria
- typically occurs in third trimester
- can lead to eclampsia
Eclampsia:
- triad + seizure, life threatning to both mother and baby
- requires treatment of seizure before delivering baby
Toxemia of pregnancy
What is mastitis? Difference btwn acute and chronic mastitis?
Mastitis = inflammation of breast
Acute:
- warm, red, edema, painful
- bacterial infection through milk ducts and breastfeeding
- may develop abscess
Chronic: mimics breast cancer, requires biopsy
Describe fibrocystic change. What are some clinical features? Pathological findings?
Benign change in bobs due to hormones and age
Clinical findings: pain, nodularity, sensitivity on palpation
Pathological findings:
- fibrosis on intralobular stroma
- cystic dilation of epithelial ducts
- epithelial hyperplasia
Describe gynecomastia
Increased proliferation of excretory ducts and stroma, leading to enlarged man breasts, usually due to hormonal changes
Name a benign breast neoplasm and what causes it to occur
Fibroadenema
- Proliferation of stromal elements (fibro) and epithelial elements (adenoma)
- Believed to be abnormal exaggerated response of breast to hormones (puberty, pregnancy)
Name a malignant breast neoplasm and what causes it to occur
Breast cancer, most common type is ductal carcinoma
- hormonal, environmental, and genetic influences (e.g. familial breast cancers = mutation in BRCA-1 and BRCA-2 tumor suppressor genes)
What are some non-modifiable and modifiable risk factors of breast cancer?
Non-modifiable:
- age, race, female sex
- genetic predisposition, personal history
- hormones
- dense breasts
Modifiable:
- alcohol intake
- smoking
- maintaining healthy body weight
- breastfeeding
- hormone replacement therapy
- radiation exposure (unnecessary)
Describe the three types of external skin injuries
Mechanical:
- blunt force
- sharp force
Electrical:
- inadequately isolated electrical wiring/lightening
- can cause burns
- can interfere with heart conduction
Radiation injury
- non-ionizing (UV)
- ionizing
Describe the 4 degrees of burn
First degree: epidermis only, erythema, swelling, pain
Second degree: involves dermis, superficial or deep partial thickness, blisters/pain
Third degree: full thickness dermis, charred and black, no pain
Fourth degree: underlying soft tissue, muscle and bone
Describe eczema and urticaria
Eczema
- chronic inflammatory disorder characterized by red, dry, scaly. itchy skin
- type I HSR
- often associated with asthma and allergic rhinitis
Urticaria (hives, welts, wheals)
- acute, transient, intensely itchy red raised plaques
- mast cell degranulation
- allerigic triggers (meds, food, bite) and non-allergic triggers (infections, cold temperature)
What is seborrheic dermatitis
- chronic relapsing mild dermatitis
- infants -> cradle cap
- severity varies
What is psoriasis
Papules and patches covered by scale extensor surfaces (elbows, knees)
What are the 4 types of skin neoplasms?
- epithelial (basal cell carcinoma, squamous cell carcinoma)
- melanocytic (nevus/mole, melanoma)
- dermal connective tissue
- metastasis
Describe basal and squamous cell carcinoma
Basal:
- good prognosis, doesn’t metastasize
- nodule with red thread-like veins
Squamous:
- good prognosis, <2% metastasize
- firm, scaly nodules
Describe nevus and melanoma
Nevus: benign neoplasm of melanocyte
Melanoma: malignant neoplasm of melanocyte
- refer to the ABC’s:
- Asymmetry
- Border irregularity
- Colour irregularity
- Diameter > 6 mm
- Evolution (shape, colour, size, etc.)
