Gynae and breast pathology Flashcards
1
Q
what is dysplasia?
A
earliest morphological manifestation of multistage process of neoplasia
in situ disease
2
Q
low risk HPV viruses
A
genital warts
6 and 11
3
Q
high risk HPV viruses
A
16 and 18
high grade pre-invasive and invasive disease
4
Q
which strains does Gardasil work on
A
6, 11, 16, 18
used since 2012
5
Q
which strains does Cervarix work on
A
16 and 18
6
Q
what does p53 do?
A
mediates apoptosis in response to DNA damage
7
Q
what does RB1 do?
A
tumour suppressor gene - controls G1/S in cell cycle
8
Q
how does HPV cause cancer
A
upregulates E6 and E7 which deactivate p53 and RB1
9
Q
is warty VIN related to HPV
A
yes
10
Q
who gets warty VIN
A
younger people
11
Q
is warty VIN graded?
A
yes 1-3
12
Q
who gets differentiated VIN
A
older people
occurs in chronic dermatoses esp. lichen sclerosus
13
Q
VIN is more likely to invade in who?
A
immunocompromised
post menopausal women
14
Q
what percent of VIN progress to invasive Ca if left untreated?
A
87%
15
Q
what is the most common vulval cancer?
A
squamous cell carcinoma
16
Q
who gets squamous cell carcinoma associated with VIN?
A
<60
HPV +ve
associated lower genital tract neoplasia - CIN
17
Q
who gets SCC associated with inflammatory dermatoses?
A
age >70
lichen sclerosus
18
Q
what does vulval cell carcinoma look like
A
eroded plaque or ulcer
19
Q
where does SCC of vulva spread to?
A
vagina and distal urethra
ipsilateral inguinal LNs
contralateral inguinal LNs, deep iliofemoral LNs
20
Q
what is the overall 5 year survival for SCC of vulva
A
70%
21
Q
which system is used for staging gynae cancers
A
FIGO
22
Q
what is the transformation zone?
A
physiological area of squamous metaplasia
where CIN happens
23
Q
what happens to the transformation zone after menopause?
A
it moves up the cervical canal
24
Q
what is cervical intraepithelial neoplasia?
A
pre-invasive stage of SCC
graded according to increasing abnormality
25
what percentage of CIN I progresses to invasion
1%
26
what percentage of CIN III progresses to invasion
20-70%
27
what age groups are screened for cervical cancer
25-49 3 yearly
| 50-64 5 yearly
28
what is LLETZ
large loop excision of the transformation zone
29
what are the risk factors for cervical SCC
```
high risk HPV
multiple sexual partners
young age at first intercourse
high parity
low IMD
smoking
immunosuppression
```
30
what is cervical adenocarcinoma
presentation and spread same of SCC
high risk HPV
precursor is cervical glandular interepithelial CGIN
31
how to SCC spread
pelvic and para-aortic lymph nodes
| via blood to lungs, bone etc
32
what is endometriosis
ectopic endometrium > bleeding into tissues > fibrosis
33
symptoms of endometriosis
```
dysmenorrhoea
dyspareunia
pelvic pain
subfertility
pain on passing stool
dysuria
```
34
treatment of endometriosis
medical - COCP, GnRH agonists, progesterone antagonists
| surgical - ablation
35
what are endometrial polyps?
sessile/polypoid oestrogen dependent uterine overgrowths
36
what is endometrial hyperplasia
excessive endometrial proliferation
37
symptoms of endometrial hyperplasia
abnormal bleeding
38
malignant progression of hyperplasia
normal > non-atypical hyperplasia > atypical hyperplasia EIN > endometrioid adenocarcinoma
39
what is type 1 endometrial adenocarcinoma
endometrioid
pre or perimenopausal
PTEN, Kras mutations
grades 1, 2, 3
40
what is type 2 endometrial adenocarcinoma
serous
postmenopausal
P53 mutation
grade 3
41
what is polycystic ovary syndrome?
endocrine disorder, hyperandrogenism, menstrual abnormalities, polycystic ovaries
42
what would you see on a fasting biochemical screen with PCOS
decrease FSH, increase LH, increase testosterone, increase DHEAS
43
with what criteria do you diagnose PCOS
rotterdam
2/3 PCO
hyperandrogenism
irregular periods
44
name the 3 origins of ovarian neoplasms
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
45
what are the most common ovarian cancers
epithelial tumours - carcinomas
46
what are the 3 main types of ovarian carcinomas
serous - tubal
mucinous - endocervical
endometrioid - endometrium
47
what is a teratoma?
differentiation towards multiple germ cell layers
48
what are yolk sac tumours?
differentiation towards extraembryonic yolk sac
49
what are choriocarcinomas?
differentiation - placenta, malignant, often unresponsive
50
what are sex cord stromal tumours
arise from ovarian stroma which was derived from the sex cord of embryonic gonad
51
risk factors for ovarian cancer
FH, age, PMH breast cancer, smoking, oestrogen HRT, lynch II syndrome, obesity, nullparity
52
protective factors for ovarian cancer
OCP, breastfeeding, hysterectomy
53
what is the most common met of ovarian cancer
Mullerian tumours - uterus, fallopian tube, pelvic perineum, contralateral ovary
54
where do non-mullerian tumours spread by lymph/ blood
GI tract, breast, melanoma, kidney and lung
55
what is a leiomyomata
benign smooth muscle tumours of the myometrium
56
what is the age range for the breast screening programme?
50-70
57
what is fibrocystic disease
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
what is fibroadenoma
women 10-40 years
found as lump
not fixed does not cause skin dimpling
benign
59
triple assessment
radiology
histology
clinical impression
60
risk factors of breast cancer
```
oestrogens
early menarche
late menopause
obesity in post menopausal women
alcohol
COCP
HRT
```
61
treatment for high grade ductal carcinoma in situ
surgical excision
62
what is DCIS
stage of cancer before it invades
| pure DCIS cannot produce a metastasis
63
most common breast cancer
ductal carcinoma
64
what should be done if lymph node involvement
axillary clearance
65
infections that can be transmitted from mother to baby in utero
```
CMV
parvovirus
toxoplasmosis
syphilis
VZV
Rubella
Zika
```
66
neonatal infections acquired when passing through birth canal
```
group B strep
HSV
Gonorrhoea
Chlamydia
HIV
Hep B virus
```
67
what is asymptomatic bacteriuria
symptomatic UTI in pregancy preceeds it
if untreated 30% = pyelonephritis
samples containing >105 of same organism
68
which antimicrobials are considered safe in pregnancy
penicillins, cephalosporins
69
which antimicrobials are considered unsafe in preganancy?
chloramphenicol, tetracycline, fluoroquinolones, trimethoprim- sulphamethoxazole
70
what is chorioamnionitis
inflammation of umbilical cord, amniotic membranes, placenta
71
what are the risk factors for intra-amniotic infections
amniocentesis, cordocentesis, cervical cerclage multiple vaginal exams
72
causative agents of intraamniotic infections
group B strep
enterococci
e.coli
73
what is puerperal endometritis
infection of the womb during puerperium
74
risk factor for puerperal endometritis
caesarean section
prolonged labour
prolonged rupture of membranes
multiple vaginal exams
75
clinical features of puerperal endometritis
```
fever
uterine tenderness
foul-smelling lochia
increased WCC
malaise, abdopain
```
76
causative agents of puerperal endometritis
e. coli
b- haemolytic strep
anaerobes
77
treatment of puerperal endometritis
broad-spectrum IV antimicrobials
78
what is early onset sepsis
major cause of mortality and morbidity in neonates
79
what causes EOS
organisms from genital tract
80
URTI in children
common cold
tonsillitis
otitis media
81
cause of sore throat
viral
| group A strep 20-30%
82
main cause of otitis media
s. pneumoniae
83
LRTIs in children
pneumonia
acute bronchitis
bronchiolitis
84
main cause of acute respiratory infections in children
RSV
85
what is bronchiolitis
viral illness characterised by fever, nasal discharge, dry wheezy cough
fine crackles on inspiration and/or high pitched expiratory wheeze
86
most common cause of pneumonia in newborns
group B strep
87
most common cause of pneumonia in 1-3 months
chylamydia
| RSV
88
most common cause of pneumonia in 3-12 months
RSV
| s. pneumoniae
89
most common cause of pneumonia in 2-5 years
resp viruses
| s. pneumoniae
90
most common cause of pneumonia in 5-18 years
M. pneumoniae
| S. Pneumoniae
91
clinical picture of pneumonia
```
acute febrile illness
breathlessness
irritability
sleeplessness
cough, chest or abdo pain
audible wheezing - rare
```
92
what is pertussis
3 stages
catarrhal phase - cold-like
paroxysmal phase - typical whooping sound, vomiting, no fever 2-6 weeks
convalescent phase
93
what is pertussis caused by
B. pertussis
94
how is pertussis transmitted
resp droplets
95
presentation of meningitis
fever, irritability, lethargy, poor feeding, high pitched cry, bulging AF, convulsions, opisthotonus
96
most common cause of bacterial meningitis in neonates
s. algalacticae
| e. coli, L. monocytogenes
97
most common cause of bacterial meningitis in children
s. pneumoniae
| n. meningitidis
98
most common cause of viral meningitis in neonates
enteroviruses
99
most common cause of UTI in children
E. coli, proteus, Klebsiella, Enterococcus, staphylococcus
100
causative agent of impetigo
s. aureus, s. pyogenes
101
treatment of impetigo
topical antibiotics or flucloxacillin
102
causes of scarlet fever
group A beta haemolytic streptococcus
103
symptoms of scarlet fever
```
fever
headache
sore throat
unwell
rash
sandpaper skin
strawberry tongue
```
104
treatment scarlet fever
penicillin 10 days
105
what is measles
acute viral infection characterized by fever, coryza, conjunctivitis, maculopapular rash and Koplik spots
106
how is measles transmitted
direct contact with infectious droplets or less commonly by airborne spread
107
incubation period of measles
10-12 days
108
when is measles communicable
4 days before to 4 days after rash
109
what is rubella
mild febrile viral illness
110
how is rubella transmiteed
infected nasopharyngeal secretions
111
incubation period of rubella
16-18 days
112
communicable periord of rubella
5 days before rash - 5 days after rash onset
113
chicken pox cause
VZV
