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Endo/Repro II Test 1 > 9. Robbins: Chapter 22 Vulva, Vagina and Cervix > Flashcards

9. Robbins: Chapter 22 Vulva, Vagina and Cervix Flashcards

1
Q

Embryologically, how are fallopian tubes formed?

A

Upper portions of mullerian ducts do not fuse.

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2
Q

When the LOWER portion of the mullerian ducts fuse, what does this form?

A
  1. uterus
  2. cervix
  3. upper vagina
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3
Q
  • Endometriosis is a _______-derived lesion
A

Mullerian

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4
Q

Persistance of the mesonephric ducts form what?

A
  1. Gartner duct cysts = Epithelial inclusions in the cervix and vagina t
  2. Paratubal cysts = Epithelial inclusions next to the ovaries, tubes, and uterus;
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5
Q

What type of epithelium lines the female genital tract and the surface of the ovary?

A

Coelomic epithelium (mesothelium)

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6
Q

Buzzwords for the following common CURABLE STIs (include types in discharge, if possible)

  1. Chlamydia trachomatis
  2. Neisseria gonorrhea
  3. Trichomonas vaginalis
  4. Gardnerella vaginalis
  5. Ureaplasma urealyticum, mycoplasma hominis
A
  1. Chlamydia trachomatis =
    1. pelvic inflammatory disease;
    2. Serous discharge
  2. Neisseria gonorrhea =
    1. Pelvic inflammatory disease (most serious complication of gonorrhea in women);
    2. Purulent discharge
    3. Gram (-) diplococci within neutrophils (PMNs)
  3. Trichomonas vaginalis
    1. Large, ovoid protozoa w flagella;
    2. Yellow, frothy discharge;
    3. “Strawberry cervix”
  4. Gardnerella vaginalis
    1. Gram (-) baccili
    2. Main cause of bacterial vaginosis
    3. Thin grey/green fishy discharge
  5. Ureaplasma urealyticum, mycoplasma hominis
    1. Seen in pre-term deliveries
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7
Q

Which infections of the female genital tract cause:

  1. Discomfort, without serious complications
  2. Infertility
  3. Occur if bb is delivered pre-term
A
  1. Candida, Trichomonas, Gardnerella
  2. Gonorrhea and chylamydia
  3. Ureaplasma urityiculum and mycoplasma homonis
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8
Q

Herpes Simplex Virus (HSV)

  • Commonly involves: _______
  • _____ => oropharyngeal infection
  • _____ => infection in the genital mucos and skin.
A
  • Cervix > vagina > vulva
  • HSV1 => oropharyngeal infection
  • HSV2 => infection of the genital mucosa and skin
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9
Q

How does HSV (herpes simplex virus) present?

A
  1. Lesions on cervix > vagina > vulva
    1. 1/3 of newly infected females show painful red papules 3-7 days after infection with fever, malaise, and tender inguinal lymph nodes
    2. => vesicles
    3. => coalesce into painful ulcers
      1. ​If on cervix or vagina: + purulent discharge & pain
      2. If on vulva: easily seen
      3. If next to urethra: dysuria
    4. => spontaneously in 1-3 weeks
    5. => however, infection remains latent in lumbosacral ganglia
    6. => reactivated due to stress, trauma, UV light, hormonal changes (skin & mucosal lesions
  2. Purulent discharge
  3. Pelvic pain
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10
Q

ALL males with HSV are _____.

A

Symptomatic

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11
Q

HSV

  • Contains what intranuclear inclusions?
  • Morphology?
A
  • Cowdry bodies
  • Morphology
    1. Ulcer is often biopsied
    2. Desquamated (peeling) of epithelium with acute inflammation at the ulcer bed
    3. Multinucleated squamous cells
    4. “Ground glass” eosinophilic to basophilic viral inclusions (viral cytopathic effect)
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12
Q

Recurrences of HSV is MUCH more common in who?

A

Immunocompromised → meningitis, hepatitis, pneumonitis

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13
Q

Detection of anti-HSV antibodies to (Smith antigen) in the serum = _______

A

recurrent/latent infection

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14
Q
  1. _______ have higher susceptibility to HSV
  2. Previous infection with HSV-1 ___ risk of infection with HSV-2
  3. HSV-2 infection enhances acquisition and transmission of ____
A
  • Females
  • ↓
  • HIV-1
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15
Q

HSV1 is a major cause of what in the US?

A
  1. Corneal blindness
  2. Fatal sporadic encephalitis
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16
Q

HSV-2 infection in the neonate may be mild, but more commonly what course does it follow and what’s affected?

A
  • More commonly is fulminating
  • Generalized LAD, splenomegaly, and necrotic foci throught the lungs, liver, adrenals and CNS
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17
Q

What can be used to ID herpes simplex virus (HSV)?

A
  1. Tzank smear, look for cytopathic effect (multinucleation).
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18
Q

What is the gravest consequence of HSV infection?

A

Transmission to the neonate during birth (active and primary/initial infection) is assoc. w/ high mortality rate

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19
Q

What is Molluscum contagiosum virus?

Which type is most often prevelent and sexually transmitted?

A
  • Poxvirus of the skin and mucus membranes with 4 subtypes
  • Most prevelant = MCV1
  • Most sexually trasnmitted = MCV2
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20
Q

What family of viruses is Molluscum contagiosum; what is unique about its replication?

A
  • Poxvirus; linear dsDNA virus
  • ONLY DNA virus to replicate in the cytoplasm
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21
Q

What is the characteristic appearance of the papules seen w/ Molluscum contagiosum infection?

A
  1. Pearly, dome-shaped w/ dimpled umbilicated center
  2. Central waxy core has cells w/ cytoplasmic viral inclusion bodies (Guarnieri bodies)
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22
Q

How is Molluscum contagiosum (poxvirus) diagnosed in children (2-12) and adults?

A
  • Children (2-12 years old): Direct contact or shared items (towels) and is most common on the trunk, arms & legs. Think of sexual abuse if seen in genitals in kids.
  • Adults: sexually transmitted and seen on genitals, lower abdomen, buttocks, inner thighs
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23
Q

Vulvovaginal candidiasis is common in who?

A
  1. T2DM**
  2. Pregnant
  3. ABX
  4. Defects in NADPH or MPO
  5. Burn patients or indwelling cartheter
  6. Neutroptenia/TH17 defects
  7. HIV
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24
Q

Which sign’s and sx’s are common to Candida vaginitis?

A
  1. Yeast infection (not a STI)
    1. Thick, curd like discharge (“cottage cheese-like”)
    2. Intense itching, erythema, swelling
  2. If severe=> ulcerate
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25
Q

What is the characteristic morphology of Candida?

A

Pseudohyphae and budding yeast

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26
Q

How is the diagnosis of Candida vaginitis made; which stain and what’s seen?

A
    1. Inspection
    1. KOH wet mount: pseudospores or filamentous fungal hyphae
  • 3. Pap smear
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27
Q

What is the most common curable STI?

A

Trichomonas vaginalis

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28
Q

Trichomonas vaginalis

  • Symptoms?
  • Diagnosis?
A
  1. Sx
    1. Yellow, frothy discharge
    2. Strawberry cervix => dilation of cervical vessels (colpscopic appearance)
    3. Dyuria/dysparenia (pain during sex)
  2. Diagnosis
    1. Methylene blue wet mount: motile trophozoites with corkscew motility
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29
Q

What is the main cause of bacerial vaginosis/vaginitis?

A

Gardnerella vaginalis (Gram - baccilis)

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30
Q

What is the typical presentation of Gardnerella vaginalis?

A
  1. Present w/ thin, green-GRAY, discharge w/ fishy smell
  2. If pregnant, can cause premature labor*
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31
Q

What will a pap smear of pt with Gardnerella vaginalis show?

A

Superficial and intermediate squamous cells covered with shaggy coating of coccobacilli (clue cells)

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32
Q

Which test for Gardnerella vaginalis will enhance the fishy odor?

A

Amine whiff test: mix discharge w/ 10% KOH

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33
Q

Ureaplasma urealyticum & Mycoplasma hominis

  • Symptoms
  • Morphology
A
  • Sx
      1. Vagininitis/cervicitis
  • Morphology
    • Fried egg appearance
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34
Q

What 2 STIs cause Pelvic Inflammatory Disease (infection that begins in the vulva/vagina => upward involve most female genital system, causing pelvic pain, adnexal tenderness, fever and vaginal discharge).

A
  1. Chlamydia trachomitis (serotypes D-K)
  2. Neisseria gonorrheae
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35
Q

What is symptom is common between [N. gonorhheae and C. trachomatis]?

A

BOTH are often ASYMPTOMATIC in women

36
Q

Most common STI in the world

A

Chlamydia trachomatis

37
Q

Chlamydia trachomatis

  • Type of bacteria
  • Presentation
  • Diagnosis
A
  • Gram (-) obligate intracellar bacteria
  • Sx
    • Usually asymptomatic (50%)
    • Mucopurulent/serous discharge (containing mainly neutrophils)
    • PID
  • Diagnose: Nucleic Acid Amplification Test (NAAT)
38
Q

What are the 2 forms that Chlamydia trachomatis exists in during its life cycle and characteristic of each?

A
  1. - Elementary body = infectious, inactive form, that is taken up by the host cell
    • Reticulate body = active form, uses host ATP and AA’s to replicate
39
Q

What is PID?

A
  1. Infection that begins in the vulva or vagina and spreads upward to involve most of the structures of the female genital system.
  2. Fever, pelvic RUQ pain, adnexel tenderness and vaginal discharge
40
Q

Pelvic inflammatory disease that occurs after [spontaneous/induced abortions] and [normal/abnormal deliveries] are referred to as what; most commonly caused by what organisms?

A
    • Puerperal infections -* infections that occur after childbirth/abortions
  • Typically polymicrobial: staphylococci, streptococci, coliforms, and Clostridium perfringens
41
Q

How does PID causes by gonococcal infections differ from that caused by staphylococcis, streptococci, and other puerperal invaders; which is more often assoc. w/ bacteremia?

A

- Gonococcal shows marked acute inflammation of mucosal surfaces; spread upward to involve fallopian tubes (acute supportive salpingitis) and tubo-ovarian region, but spares the endometrium.

- Puerperal invaders have less mucosal involvement and more inflammation of deeper layers; spread via lymph and veins; bacteremia is a more frequent complication

42
Q

Which part of the female genital tract does Gonococcal infections usually not affect?

A

Endometrium

43
Q

What are the acute vs. chronic complications which may arise from PID?

A

Acute =

  • Peritonitis and bacteremia —-> [endocarditis, meningitis, and suppurative arthritis]
  • Chronic =
  1. Infertility and tubal obstruction, ectopic preg., pelvic pain, and intestinal obstruction
  2. Fitz-Hugh Curtis syndrome
44
Q

What is a rare complication of PID that occurs almost exlusively in women?

A

Fitz-High Curtis Syndrome = inflammation of the liver capsule the creates adhesion, most often due to Gonorrhea.

45
Q

STIs that form Ulcers

A
  1. Granuloma inguinale
  2. Chancroid
  3. Chlamydia serovars L1-L3 => lymphogranuloma venereum
  4. Treponema pallidum (syphilis)
46
Q

Lymphogranuloma venereum is caused by what organism?

A

L1-3 serotypes of Chalmydia trachomatis

47
Q

Lymphogranuloma venereum is endemic where?

Sporadic where?

A
  1. Endemic = Parts of Asia, Africaa, the Caribbean, and S. America
  2. Sporadic = US/Western Europe
48
Q

How is Lymphogranuloma Venereum diagnosed in active and chronic cases?

A
  • Active = organism is seen in biopsy or smears of exudate
  • Chronc cases = Ab to chylamdia L1-3
49
Q

Presentation of Lymphogranuloma venereum

A
  1. Begins as painless ulcer at the site of contact
  2. => progresses to painful swollen lymph nodes
  3. => leading to genital elephantiasis in late stage
50
Q

What is the leading cause of preventable infectious blindness?

A

Trachoma, caused by chlamydia (types A, B, Ba, and C)

51
Q

Which organism is responsible for causing chancroid (soft chancre) in both males and females; what is its morphology and gram stain?

A

Haemophilus ducreyi = Gram (-) coccobacillus

52
Q

Where is Haemophilus ducreyi (=> chancroids) seen most commonly?

A
  • Most common cause of genital ulcers in Africa and SE Asia
53
Q

Who is Haemophilus ducreyi (=> soft chancroids) most commonly seen in?

A
  1. lower SES
  2. Men who have frequent sex with prostitutes
54
Q

Where do most ulcers associated w/ H. ducreyi develop in females; are they painful or painless?

Other SX:

A
  1. Begins: PAINFUL erythematous papule on vagina or periurethral area
  2. Erodes over a a few days to make an
    1. => multiple, non-indurated, painful ulcer (chancroid)
  3. Within 1-2 weeks, 50% pts get enlarged, tender regional LN (buboes)
  4. *Haemophilus ducreyi (it’s so painful, you “do cry”)
55
Q

How does the H. ducreyi ulcer (chancroid) differ from that of syphillis; what is seen morphologically at the base of the ulcer?

A
  • Chancroids => multiple non-indurated painful ulcers ; base will have a yellow-grey exudate
  • Syphillus => single, hard, indurated painful ulcers
56
Q

Microscopically how does the ulcer of chancroid (H. ducreyi) appear?

A
  1. Superficial zone of neutrophilic debris + fibrin
  2. Underneath => granulation tissue with areas of necrosis and thrombosed vessels
57
Q

Haemophilus ducreyi (painful chancroids)

  • Causes painful, genital ulcers in Africa and SE Asia, where it probably serves as an important cofactor for ________
  • Why are they often underdiagnosed?
A
  • HIV
  • Hard to grow in culture and PCR-based tests are not always available
58
Q

Which organism is associated with granuloma inguinale (donovanosis) in both males and females; what is its gram stain and morphology?

A
  • Klebsiella granulomatis = Encapsulated_, gram (-) coccobacillus_
59
Q

Granuloma Inguinale

  • Endemic
  • Uncommon
A
  • Endemic = Rural areas in some deloping country
  • Uncommon = US/Western Europe
60
Q

What are Granuloma Inguinale?

A

Soft, painless genital ulcers of the pharynx/oral mucosa without lymphadopathy.

  • base: granulation like tissue.
61
Q

How does the lesion of granuloma inguinale begin and how does it progress over time?

A
  1. Raised papular lesion on moist stratified squamous epithelium of genitals
  2. => Soft painless ulcer with granulation tissue at the base.
62
Q

Untreated Granuloma Inguinale

A
  • Scarring => lymphatic obstruction => lymphedema => elephantiasis of the external genetalia
63
Q

ID Granuloma Inguinale

A
  1. Giemsa-stain: MO with encapsulated coccobacilli (Donovan bodies)
  2. Wartharin - Starry Silver stains can also be used
64
Q

What is one major difference about the pathogenesis of H. ducreyi and K. granulomatis?

A
  • H. ducreyi often has regional LN involvement; become large and tender
  • - K. granulomatis typically spares the regional LN’s
65
Q

What is the microaerophilic spirochete that causes syphillis?

A

T. pallidum

66
Q

T. Pallidum

Type of bacetria

A

Flagellated, Gram (-), slender corkscrew-shaped (or spiral) spirochete

67
Q

T. pallidum

  • Pathogenesis (in all stages)
  • is too slender to be gram stained so what is used for visualization?
A
  • Proliferative endarteritis of small vessels surrounded by plasma cells
  • Cant gram-stain, so Dark field micrscopy (Silver stain) and immunofluorescence techniques
68
Q

How are the following ID’d

  1. Granuloma inguinale
  2. Chancroid
  3. Chlamydia serovars L1-L3 => lymphogranuloma venereum
  4. Treponema pallidum (syphilis)
A
  1. Granuloma inguinale
  2. Chancroid
  3. Chlamydia serovars L1-L3 => lymphogranuloma venereum
  4. Treponema pallidum (syphilis):
    1. Darkfield microscopy (silver stain) or immunoflurouecnce (bc cant gramstain/culture)
69
Q

Primary syphillis occurs about 3 weeks after infection and is characterized by what?

A

Single, painless, non-tender chancre (wart) at the cervix, vaginal wall, or anus

  • indurated edge; contagious; heals spontaneously 3-6 weeks but progresses because painless and is typically left untreated
70
Q

2-10 weeks after untreated primary syphilis the pt enters 2nd stage of syphillis which is characterized by what?

A
    • Maculopapular (copper-colored rash) on palms and soles of feet
    • Condyloma lata = flat wart like perianal and mucous membrane lesions that are very infectious
    • Mild fever + LAD + malaise + weight loss = common
    • Asymptomatic neurosyphillis may develop
71
Q

How long is the typical latent period between secondary syphillis and tertiary syphillis?

A

5+ years without clinical sx

72
Q

What are the main manifestations of tertiary syphillis that may occur alone or in combination?

A
  1. Benign tertiary syphillis (aka gummas): soft growths with necrotic centers
  2. Cardiovascular syphillis
  3. Neurosyphillis
73
Q

What is the characteristic finding of benign tertiary syphillis and what are the signs/sx’s?

A
  • Gummas in bone, skin, and mucous membranes of upper airway and mouth = nodular lesions
  • Skeletal involvement causes pain, tenderness, and swelling + pathologic fractures
  • Skin/mucous membranes w/ nodular or, rarely, destructive, ulcerative lesions
74
Q

What is seen on histological examination of a gumma associated with tertiary syphillis?

A

Centers of coagulated, necrotic material and marginscomposed of plump, palisading macrophages and fibroblasts surrounded by large numbers of mononuclear leukocytes, mainly plasma cells

75
Q

The later manifestations of congenital syphillis inculde what distinct triad?

A
    • Interstital keratitis
    • Hutchinson teeth
    • CN VIII deafness
76
Q

N. Gonrrhea

  • bacterial characteristics
  • ID
A
  • Phagocytosed gram (-) diplococci within neutrophils/PMNs (intracellular)
  • Thayer-Martin Agar
77
Q

HPV

  • Presentation
  • Causes cancer where?
  • Infects what cells?
  • Cells infected with HPV are called?
  • ID’d how?
A
  • Multiple warty lesions on the perineum and around the anus in low-risk types 6 and 11
  • Cervix squamous cell carcinoma>>>> vagina > vulva
  • Basal keratinocytes (stem cells) of genital mucosal epithelium and delivers genome to nucleus
  • Squamous cells with koilocytosis = krinkled nucleus with clear area around it that looks like a raisin d/t E5 promotes viral replication
78
Q

With STD can cause cervical dysplasia and cancer; as well as vuvlvar and vaginal cancer in females?

Name the precursor lesions

A

HPV

  • Vulva = vulvar intraepithelial neoplasia (VIN)
  • Vagina = VaIN
  • Cervix = CIN
79
Q

HPV and herpes virus are associated with what type of inflammatory response?

A

Cytopathic-cytoproliferative reactions

80
Q

Candidias occurs due to what?

A

Change in local flora (microbiome) of the vagina; usually lactinobacillus

81
Q

Name the infection:

  1. Intranuclear basophilic “owl eye” inclusions
  2. Corkscrew shaped bacteria (spirochetes)
  3. Elementary and reticulate bodies
  4. Ground glass intranuclear inclusions
  5. Squamous cells with koilocytosis
A
  1. asdasd
  2. asd
  3. sd
  4. HSV
  5. HPV
82
Q

Are the following lesions single or multiple

  1. Chancroids
  2. HSV
  3. Candidiasis
  4. Granumoma inguinale
  5. Syphillis
  6. Secondary syphillus
  7. Lymphogranuloma venereum
A
  1. Chancroids = single (non-granulomatous)
  2. HSV = multiple
  3. Candidiasis = single
  4. Granumoma inguinale = single (granulomatous)
  5. Syphillis = single (non-granulomatous)
  6. Secondary syphillus = multiple
  7. Lymphogranuloma venereum = single (granulomatous)
83
Q

Which HPV strains have the highest risk of causing genital cancer??

A

16 and 18

84
Q

What is the mechanism of HPV?

HPV 6 inhibits p53 => continous replication

HPV7 inhibits p21 and RB

A
  • HPV 6 inhibits p53 => continous replication
  • HPV7 inhibits p21 and RB
    • inhibition of p21 => increased expression of CDK4/cyclin D => inhibits RB-E2F
    • Inhibition of RB-E2F
  • => immortilization; increased cell proliferation; genomic instability
85
Q
A

Endo/Repro II Test 1 (23 decks)

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