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Clinical Pathology > Gynae and breast pathology > Flashcards

Gynae and breast pathology Flashcards

1
Q

what is dysplasia?

A

earliest morphological manifestation of multistage process of neoplasia
in situ disease

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2
Q

low risk HPV viruses

A

genital warts

6 and 11

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3
Q

high risk HPV viruses

A

16 and 18

high grade pre-invasive and invasive disease

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4
Q

which strains does Gardasil work on

A

6, 11, 16, 18

used since 2012

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5
Q

which strains does Cervarix work on

A

16 and 18

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6
Q

what does p53 do?

A

mediates apoptosis in response to DNA damage

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7
Q

what does RB1 do?

A

tumour suppressor gene - controls G1/S in cell cycle

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8
Q

how does HPV cause cancer

A

upregulates E6 and E7 which deactivate p53 and RB1

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9
Q

is warty VIN related to HPV

A

yes

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10
Q

who gets warty VIN

A

younger people

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11
Q

is warty VIN graded?

A

yes 1-3

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12
Q

who gets differentiated VIN

A

older people

occurs in chronic dermatoses esp. lichen sclerosus

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13
Q

VIN is more likely to invade in who?

A

immunocompromised

post menopausal women

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14
Q

what percent of VIN progress to invasive Ca if left untreated?

A

87%

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15
Q

what is the most common vulval cancer?

A

squamous cell carcinoma

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16
Q

who gets squamous cell carcinoma associated with VIN?

A

<60
HPV +ve
associated lower genital tract neoplasia - CIN

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17
Q

who gets SCC associated with inflammatory dermatoses?

A

age >70

lichen sclerosus

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18
Q

what does vulval cell carcinoma look like

A

eroded plaque or ulcer

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19
Q

where does SCC of vulva spread to?

A

vagina and distal urethra
ipsilateral inguinal LNs
contralateral inguinal LNs, deep iliofemoral LNs

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20
Q

what is the overall 5 year survival for SCC of vulva

A

70%

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21
Q

which system is used for staging gynae cancers

A

FIGO

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22
Q

what is the transformation zone?

A

physiological area of squamous metaplasia

where CIN happens

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23
Q

what happens to the transformation zone after menopause?

A

it moves up the cervical canal

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24
Q

what is cervical intraepithelial neoplasia?

A

pre-invasive stage of SCC

graded according to increasing abnormality

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25
Q

what percentage of CIN I progresses to invasion

A

1%

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26
Q

what percentage of CIN III progresses to invasion

A

20-70%

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27
Q

what age groups are screened for cervical cancer

A

25-49 3 yearly

50-64 5 yearly

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28
Q

what is LLETZ

A

large loop excision of the transformation zone

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29
Q

what are the risk factors for cervical SCC

A 
high risk HPV 
multiple sexual partners 
young age at first intercourse 
high parity 
low IMD
smoking 
immunosuppression
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30
Q

what is cervical adenocarcinoma

A

presentation and spread same of SCC
high risk HPV
precursor is cervical glandular interepithelial CGIN

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31
Q

how to SCC spread

A

pelvic and para-aortic lymph nodes

via blood to lungs, bone etc

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32
Q

what is endometriosis

A

ectopic endometrium > bleeding into tissues > fibrosis

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33
Q

symptoms of endometriosis

A 
dysmenorrhoea
dyspareunia 
pelvic pain 
subfertility 
pain on passing stool 
dysuria
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34
Q

treatment of endometriosis

A

medical - COCP, GnRH agonists, progesterone antagonists

surgical - ablation

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35
Q

what are endometrial polyps?

A

sessile/polypoid oestrogen dependent uterine overgrowths

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36
Q

what is endometrial hyperplasia

A

excessive endometrial proliferation

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37
Q

symptoms of endometrial hyperplasia

A

abnormal bleeding

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38
Q

malignant progression of hyperplasia

A

normal > non-atypical hyperplasia > atypical hyperplasia EIN > endometrioid adenocarcinoma

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39
Q

what is type 1 endometrial adenocarcinoma

A

endometrioid
pre or perimenopausal
PTEN, Kras mutations
grades 1, 2, 3

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40
Q

what is type 2 endometrial adenocarcinoma

A

serous
postmenopausal
P53 mutation
grade 3

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41
Q

what is polycystic ovary syndrome?

A

endocrine disorder, hyperandrogenism, menstrual abnormalities, polycystic ovaries

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42
Q

what would you see on a fasting biochemical screen with PCOS

A

decrease FSH, increase LH, increase testosterone, increase DHEAS

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43
Q

with what criteria do you diagnose PCOS

A

rotterdam
2/3 PCO
hyperandrogenism
irregular periods

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44
Q

name the 3 origins of ovarian neoplasms

A

surface epithelial tumours
serous, mucinous, endometriod, transitional cell, clear cell
germ cell tumours - teratomas, yolk sac tumours, embryonal carcinoma dysgerminomas
sex-cord stromal tumours - granulosa cell, thecomas, sertoli-leydig cell tumours

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45
Q

what are the most common ovarian cancers

A

epithelial tumours - carcinomas

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46
Q

what are the 3 main types of ovarian carcinomas

A

serous - tubal
mucinous - endocervical
endometrioid - endometrium

47
Q

what is a teratoma?

A

differentiation towards multiple germ cell layers

48
Q

what are yolk sac tumours?

A

differentiation towards extraembryonic yolk sac

49
Q

what are choriocarcinomas?

A

differentiation - placenta, malignant, often unresponsive

50
Q

what are sex cord stromal tumours

A

arise from ovarian stroma which was derived from the sex cord of embryonic gonad

51
Q

risk factors for ovarian cancer

A

FH, age, PMH breast cancer, smoking, oestrogen HRT, lynch II syndrome, obesity, nullparity

52
Q

protective factors for ovarian cancer

A

OCP, breastfeeding, hysterectomy

53
Q

what is the most common met of ovarian cancer

A

Mullerian tumours - uterus, fallopian tube, pelvic perineum, contralateral ovary

54
Q

where do non-mullerian tumours spread by lymph/ blood

A

GI tract, breast, melanoma, kidney and lung

55
Q

what is a leiomyomata

A

benign smooth muscle tumours of the myometrium

56
Q

what is the age range for the breast screening programme?

A

50-70

57
Q

what is fibrocystic disease

A

at least 50% women
a contellation of different benign changes seen in the breast including apocrine change, usual type ductal hyperplasia and sclerosing adenosis

58
Q

what is fibroadenoma

A

women 10-40 years
found as lump
not fixed does not cause skin dimpling
benign

59
Q

triple assessment

A

radiology
histology
clinical impression

60
Q

risk factors of breast cancer

A 
oestrogens 
early menarche
late menopause
obesity in post menopausal women 
alcohol 
COCP 
HRT
61
Q

treatment for high grade ductal carcinoma in situ

A

surgical excision

62
Q

what is DCIS

A

stage of cancer before it invades

pure DCIS cannot produce a metastasis

63
Q

most common breast cancer

A

ductal carcinoma

64
Q

what should be done if lymph node involvement

A

axillary clearance

65
Q

infections that can be transmitted from mother to baby in utero

A 
CMV
parvovirus 
toxoplasmosis 
syphilis 
VZV 
Rubella 
Zika
66
Q

neonatal infections acquired when passing through birth canal

A 
group B strep 
HSV
Gonorrhoea 
Chlamydia 
HIV 
Hep B virus
67
Q

what is asymptomatic bacteriuria

A

symptomatic UTI in pregancy preceeds it
if untreated 30% = pyelonephritis
samples containing >105 of same organism

68
Q

which antimicrobials are considered safe in pregnancy

A

penicillins, cephalosporins

69
Q

which antimicrobials are considered unsafe in preganancy?

A

chloramphenicol, tetracycline, fluoroquinolones, trimethoprim- sulphamethoxazole

70
Q

what is chorioamnionitis

A

inflammation of umbilical cord, amniotic membranes, placenta

71
Q

what are the risk factors for intra-amniotic infections

A

amniocentesis, cordocentesis, cervical cerclage multiple vaginal exams

72
Q

causative agents of intraamniotic infections

A

group B strep
enterococci
e.coli

73
Q

what is puerperal endometritis

A

infection of the womb during puerperium

74
Q

risk factor for puerperal endometritis

A

caesarean section
prolonged labour
prolonged rupture of membranes
multiple vaginal exams

75
Q

clinical features of puerperal endometritis

A 
fever 
uterine tenderness 
foul-smelling lochia 
increased WCC
malaise, abdopain
76
Q

causative agents of puerperal endometritis

A

e. coli
b- haemolytic strep
anaerobes

77
Q

treatment of puerperal endometritis

A

broad-spectrum IV antimicrobials

78
Q

what is early onset sepsis

A

major cause of mortality and morbidity in neonates

79
Q

what causes EOS

A

organisms from genital tract

80
Q

URTI in children

A

common cold
tonsillitis
otitis media

81
Q

cause of sore throat

A

viral

group A strep 20-30%

82
Q

main cause of otitis media

A

s. pneumoniae

83
Q

LRTIs in children

A

pneumonia
acute bronchitis
bronchiolitis

84
Q

main cause of acute respiratory infections in children

A

RSV

85
Q

what is bronchiolitis

A

viral illness characterised by fever, nasal discharge, dry wheezy cough
fine crackles on inspiration and/or high pitched expiratory wheeze

86
Q

most common cause of pneumonia in newborns

A

group B strep

87
Q

most common cause of pneumonia in 1-3 months

A

chylamydia

RSV

88
Q

most common cause of pneumonia in 3-12 months

A

RSV

s. pneumoniae

89
Q

most common cause of pneumonia in 2-5 years

A

resp viruses

s. pneumoniae

90
Q

most common cause of pneumonia in 5-18 years

A

M. pneumoniae

S. Pneumoniae

91
Q

clinical picture of pneumonia

A 
acute febrile illness
breathlessness
irritability 
sleeplessness 
cough, chest or abdo pain 
audible wheezing - rare
92
Q

what is pertussis

A

3 stages
catarrhal phase - cold-like
paroxysmal phase - typical whooping sound, vomiting, no fever 2-6 weeks
convalescent phase

93
Q

what is pertussis caused by

A

B. pertussis

94
Q

how is pertussis transmitted

A

resp droplets

95
Q

presentation of meningitis

A

fever, irritability, lethargy, poor feeding, high pitched cry, bulging AF, convulsions, opisthotonus

96
Q

most common cause of bacterial meningitis in neonates

A

s. algalacticae

e. coli, L. monocytogenes

97
Q

most common cause of bacterial meningitis in children

A

s. pneumoniae

n. meningitidis

98
Q

most common cause of viral meningitis in neonates

A

enteroviruses

99
Q

most common cause of UTI in children

A

E. coli, proteus, Klebsiella, Enterococcus, staphylococcus

100
Q

causative agent of impetigo

A

s. aureus, s. pyogenes

101
Q

treatment of impetigo

A

topical antibiotics or flucloxacillin

102
Q

causes of scarlet fever

A

group A beta haemolytic streptococcus

103
Q

symptoms of scarlet fever

A 
fever 
headache 
sore throat 
unwell 
rash 
sandpaper skin 
strawberry tongue
104
Q

treatment scarlet fever

A

penicillin 10 days

105
Q

what is measles

A

acute viral infection characterized by fever, coryza, conjunctivitis, maculopapular rash and Koplik spots

106
Q

how is measles transmitted

A

direct contact with infectious droplets or less commonly by airborne spread

107
Q

incubation period of measles

A

10-12 days

108
Q

when is measles communicable

A

4 days before to 4 days after rash

109
Q

what is rubella

A

mild febrile viral illness

110
Q

how is rubella transmiteed

A

infected nasopharyngeal secretions

111
Q

incubation period of rubella

A

16-18 days

112
Q

communicable periord of rubella

A

5 days before rash - 5 days after rash onset

113
Q

chicken pox cause

A

VZV

Clinical Pathology (8 decks)

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