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ENRP Exam 1 > Female GU Pathology > Flashcards

Female GU Pathology Flashcards

1
Q

from what embryonic tissue is the upper third of the vagina, the cervix, fallopian tubes, and uterus derived?

A

paramesonephric duct (mullerian duct)

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2
Q

What is Mayer-Rokitansky-Hauser syndrome

A

Normal external genitalia, chromosomal and ovary function BUT

underdeveloped/absent vagina and uterus

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3
Q

How can antibiotic use predispose a woman to infection

A

destruction of normal flora shifts commensal bacteria populations which maintain the normal physiology of vagina. this may make vagina more susceptible to colonization

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4
Q

Is HSV-2 infection more common in men or women?

A

Women

also more common in non-hispanic blacks

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5
Q

list the parts of the female GU tract in order of frequency of HSV infection

A

Cervix, Vagina, Vulva

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6
Q

you suspect a patient of having herpes, what test is likely to confirm that suspicion

A

Tzanck Smear

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7
Q

You and your wife are having a mutherfucking gin and tonic down in the minican and swinging with locals. 5-7 days after you get back, you develop a fever, tender lymph nodes and your wife has red papules on her vulva. What infection did she likely pick up in the minican

A

Herpes

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8
Q

what is the prognosis of vertical transmission of HSV

A

high mortality, poor prognosis

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9
Q

What does HHV-8 cause

A

Kaposi Sarcoma

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10
Q

In congenital CMV, 95% of the patients are asymptomatic but in the case of primary maternal infection, that disease develops and what does it resemble

A

Cytomegalic inclusion disease which resembles

erythroblastosis fetalis

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11
Q

In the case of a neonate who was infected with CMV and developed cytomegalic inclusion disease, what does the disease process look like.

A 
Intrauterine Growth Restriction
Jaundice
hepatosplenomegaly 
anemia 
bleeding

also have microcephaly

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12
Q

what are the two forms chlamydia exists in

A

elementary body - infectious, inactive form
reticular body - metabolically active

Most common bacterial STI in the world

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13
Q

What is the serotype of chlamydia associated with urogenital and conjunctivitis

A

D-H

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14
Q

what is the serotype of chlamydia associated with lymphogranuloma venereum serotypes

A

L1, L2, L3

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15
Q

What is the serotype of chlamydia associated with ocular infections in children/trachoma

A

A, B, C

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16
Q

What is the best test to use for chlamydia infection

A

Nucleic Acid Amplification Test (NAAT)

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17
Q

What is a complication of PID that is characterized by peritonitis and peri-hepatitis. SX include URQ pain, Fever, chills, malaise and maybe adhesions? (slide 41)

A

Fitz-Hugh-Curtis Syndrome

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18
Q

if someone describes a non-tender chancre on their vulva or scrotum. and show endarteritis on histology, what organism has likely infected them

A

Treponema Pallidum (syphilis)

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19
Q

A 24 year old man presents to the free clinic on an LGBTQ free screening day. His history seems normal, he is sexually active but only with a couple of people. During the interview, you notice and ulcer on the back of his hand. When you ask about it, he says it doesn’t hurt. What infection should you be thinking of

A

Syphilis

included because he made a point that ulcers can appear anywhere on the body. This would be epidermal syphilis

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20
Q

Describe Chancroid disease

A

Caused by Haemophilus ducreyi (look out in tropics)
Painful!
yellow/gray exudate
buboes can erode -> chronic draining ulcers

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21
Q

Describe Granuloma Inguinale

A

Cause by Klebsiella granulomatis
painless ulcers
Rare in the west
Untreated -> elephantiasis

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22
Q

describe lymphogranuloma venereum

A

L serotypes
starts as small papule on genital mucosa or skin
2-6 weeks draining swollen nodes

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23
Q

A woman presents with vulvovaginal pruritus,, erythema, and swelling in her hooha. She also describes cottage cheese like discharge. On pap smear you notice pseudohyphae. what is the organism she is infected with

A

Vulvovaginal candidiasis

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24
Q

What are the hallmarks of trichomonas vaginalis

A 
Large flagellated ovoid protozoan
frothy yellow discharge 
dysuria
dyspareunia 
strawberry cervix
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25
What is the most common cause of bacterial vaginosis
Garderella Vagnialis gives you dat fish puss, treat with metronidazole
26
What is the classic tetrad of congenital toxoplasmosis
Cerebral Calcifications Micro or hydrocephalus Chorioretinitis Convulsions
27
What is a complication of listeria in pregnancy
can lead to SAB, stillbirth, or neonatal sepsis due to chorioamnionitis
28
Parvo B19 can cause what disease in immunocompetent children
fifths disease
29
What are adverse outcomes of parvo B19 infection in seronegative women
SAB (second trimester) Stillbirth Hydrops Congenital anemia
30
What is lichen sclerosis
smooth white plaque or macules that coalesce into a surface that resembles parchment occurs in all ages but most common in postmenopausal women increases chance of squamous cell carcinoma
31
describe squamous cell hyperplasia
nonspecific localized, well circumscribed area of lichenification resulting from repeated itching and scratching not considered premalignant
32
What is condyloma cuminatum
genital warts solitary but more likely multifocal from HPV 6 and 11 (low risk)
33
What is condyloma latum
painless superficial lesions to skin and mucosa | associated with secondary syphilis (2-10 weeks after primary chancre)
34
What are the two types of squamous neoplasia of the vulva and their associated
A. HPV related - Classic VIN | B. Non HPV related - differentiated VIN
35
What are the two tumor types of the vulva that have counterparts in the breasticles
Papillary hidradenoma | extramammary paget disease
36
how does extramammary Paget disease presetn
pruritic, red, crusted, map-like area on Labia Majora | distinctive intraepithelial proliferation of cells
37
What is the treatment for vulvar paget disease
wide local excision | if malignancy does develop, prognosis is poor
38
What are gartner duct cysts
cysts on the walls of vagina left over from wolffian duct rests
39
If a young female presents with a vaginal tumor composed of malignant embryonal rhabdomyoblasts, what is the diagnosis
Embryonal Rhabdomyosarcoma
40
what is the predominant protective bacterium in the vagina
Lactobacilli
41
What are the high risk and the low risk HPV strains
High Risk - 16, 18 Low risk - 6, 11
42
What are the two proteins associated with the high risk strains of HPV that lead to cancer
E6 - p53 degradation E7 - RB inactivation
43
What percent of HPV infections are cleared by a normal immune system in 24 months
90%
44
Describe Low Grade Squamous Intraepithelial Lesions
- high level of viral replication - not treated like premalignant lesion - 80% associated with serotype HPV-16 - does NOT progress directly to invasive carcinoma
45
Describe High Grade Squamous Intraepithelial Lesions
- low replication but high proliferation - Irreversible derangements - high risk progression to SCC
46
what is the average age of cervical carcinoma and what type of carcinoma is present
45-50 SCC
47
what endometrial characteristics could be used to determine that the woman is in day 1-5 (menstrual phase) of their cycle
- Dissolution of corpus luteum | - functionalis layer degenerates/sheds
48
what endometrial characteristics could be used to determine that the woman is in the proliferative phase of her cycle
- rapid growth of glands and stroma | - glands are straight tubular structures
49
What is the key histologic feature of they secretory phase
subnuclear vacuoles
50
What are histologic features of the 21-22 day phase of the secretory phase
Prominent spiral arterioles Increased ground substance and edema Cytoplasmic eosinophilia
51
what is the most common cause of dysfunctional uterine bleeding
Anovulatory cycle other causes include MEtabolic disorders ovarian lesions endocrine disorders
52
Failure of what process would cause in excessive endometrial stimulations by estrogen that is unopposed by progesterone
Ovulation
53
Name some of the disorders that are associated with endometritis
``` Chronic pelvic inflammatory disease Retained gestational tissue intrauterine contraceptive devices TB No cause 15% ```
54
Describe endometriosis
presence of ectopic endometrial tissue outside of uterus. This leads to infertility, dysmenorrhea, dyspareunia, pelvic pain
55
What are the locations of ectopic endometrial tissue in endometriosis
Ovaries Uterine ligaments Rectovaginal septum Rectouterine pouch
56
What is adenomyosis
presence of endometrial tissue within the myometrium
57
What are the 4 theories of endometriosis
1. Regurgitation theory 2. Benign metastasis theory 3. Metaplastic theory 4. Extrauterine stem/progenitor cell theory
58
What are conditions that cause increased estrogen
``` anovulation obesity menopause prolonged administration of estrogenic substances PCOS tumors ```
59
Inactivation of what gene in endometrial hyperplasia is common
PTEN
60
What is cowden syndrome
germline PTEN mutation and high incidence of endometrial and breast cancer
61
loss of PTEN leads to secondary activation of what pathway
PI3K/AKT
62
What is the cardinal feature of typical hyperplasia
increased gland to stroma ratio | rarely progress to cancer
63
Describe Atypical hyperplasia
AKA EIN Complex patterns of proliferating glands displaying nuclear atypia Glands back to back and branching Conspicuous nuclei overlap with well differentiated cancer
64
What is the most common invasive cancer of the female genital tract and what is the peak age
Endometrial carcinoma peak age is 55-65
65
Describe type 1 - endometrioid endometrial carcinoma
most common type of endometrial carcinoma - Well differentiated - obesity - Diabetes - HTN - Unopposed estrogen
66
What is the main morphology of type II endometrial carcinoma
serous (compared to type I endometrioid) - pts are older and it is more aggressive - associated with TP53
67
What are mixed mullerian tumors
endometrial adenocarcinomas with a malignant mesenchymal component
68
Define carcinosarcoma
malignant glandular and mesenchymal elements
69
what are the two types of stromal tumors
adenosarcoma = benign glands and malignant stroma | pure stromal tumors = B-9 vs stromal sarcoma
70
what are microscopic features of leiomyoma
bundles of smooth muscle cells uniform in size and shape, oval nucleus rare mitoses can degenerate
71
How does most leiomyosarcoma come to be
arise from myometrium or stromal precursor cells, NOT from leiomyoma more than half metastasize
72
what are key features of leiomyosarcoma on histo
nuclear atypia mitotic index is >10 zonal necrosis mets to lungs
73
What infectious agent is most likely to attack fallopian tubes
N. gonorrhea 60% | rest is chlamydia
74
how common are adenocarcinomas of the fallopian tubes?
super rare Post menopausal caucasians sinister disease with 40% dead to 5 yrs
75
When does a cystic follicle become a follicle cyst
when it grows from <2 cm to greater
76
Describe PCOS
multiple ovarian cysts combined with - hyperandrogenism - menstrual irregularity - Chronic Anovulation - decreased fertility
77
What are common comorbidities with PCOS
Obesity T2DM Premature Atherosclerosis
78
Why do ovarian tumors account for a disproportionate high number of deaths from female GU cancer
metastasis by the time of diagnosis
79
what are the most common symptoms of ovarian tumors
Abdominal pain/distention urinary and gastrointestinal tract symptoms vaginal bleeding
80
From what tissue do most primary ovarian neoplasms arise
Mullerian Epithelium
81
What are the three types of epithelial ovarian neoplasms
Serous Mucinous Endometrioid
82
How do mucinous epithelial ovarian tumors differ from the serous types
Surface of ovary is rarely involved | Mutation of KRAS is consistent mutation
83
How can specialized teratomas cause problems
they can be fully functional differentiated tissues that can cause hypersecretion of a hormone
84
If someone has a dysgerminoma and during testing you find elevated levels of HCG. what type of cell would you be expected to find on histology
syncytiotrophoblastic cells tumor associated with gonadal dysgenesis
85
What are the germ cell tumors
Teratomas - mature, immature, specialized Dysgerminoma Yolk sac Choriocarcinoma *he says focus on key concepts boxes and morphology in robbins
86
How does an adult granulosa cell tumor present
``` DUB Endometrial hyperplasia Endometrial Carcinoma Proliferative breast disease Masculinization if androgens ```
87
how would a juvenile granulosa cell tumor present clinically
Precocious puberty Early breasts early menarche pubic or underarm hair Pseudohermaphroditism if androgen
88
What are the two associations with fibromas
ascites | basal cell nevus syndrome
89
What are the hallmarks of sertoli-leydig cell tumors
masculinization or defeminization
90
What is the definition of spontaneous abortion
pregnancy loss prior to 20 weeks
91
what are the main causes of spontaneous abortion
fetal chromosomal abnormalities maternal endocrine factors physical defects in the uterus infections
92
What is the predisposing condition of 35-50% with ectopic pregnancy
chronic salpingitis secondary to PID
93
What are the 2 pathways associated with infection
Ascending infection | hematogenous spread
94
What is placenta previa
placenta covering cervical opening which can cause bleeding
95
what causes placenta accretia
partial or complete absence of the decidua
96
what is the triad of preeclampsia
HTN edema proteinuria
97
describe the pathology of preeclampsia
failure of the remodeling of the maternal endothelial cells with placental endothelial cells so when more blood is demanded the placenta becomes ischemic
98
What are the halmarks of HELLP
Hemolysis Elevated Liver Enzymes Low platelets
99
what makes a complete mole
sperm fertilizes an empty ovum or 2 sperm fertilize one empty ovum
100
what makes a partial mole
2 sperm fertilize a normal ovum
101
which type of mole is likely to develop into carcinoma
complete mole partial mole has NO risk
102
What is the clinical presentation of a gestational choriocarcinoma
Irregular vaginal bleeding Enlarged uterus May present with mets hCG very high

ENRP Exam 1 (20 decks)

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