Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y2 Clinical Pathology > Gynaecological and Breast Pathology > Flashcards

Gynaecological and Breast Pathology Flashcards

1
Q

What is screening

A

The process of identifying people who appear healthy but may be at an increased risk of disease or condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the main aim of breast screening

A

To reduce mortality from breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who is screened in the breast screening programme

A

50-70 years
Invited every 3 years
Mammography main tool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the breast triple assessment

A 
Clinical examination (history, physical)
Radiological examination (ultrasound, mammography)
Pathological examination (core cut biopsy, FNAC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How are the areas of breast triple assessment scored

A 
P1, R1, B1: Normal
P2, R2, B2: benign lesion
P3, R3, B3: Atypical
P4, R4, B4: Atypical, prob-malignant
P5, R5, B5: malignant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Who are the members of the breast MDT

A 
Surgeons
Oncologists
Radiologists
Pathologists
Specialist nursing team
Research nurses
Genetic counsellors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the synonyms of fibrocystic change

A 
Fibrocystic disease
Fibrous mastopathy
Mammary dysplasia
Schimmelbusch's disease
Chronic cystic mastitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is fibrocystic change

A

Generally affects pre-menopausal women
Usually B/L and multifocal
Risk of FCC development is increased in women with hyperestogenism
No increased risk of subsequent carcinoma development
A constellation of benign, hormonally mediated breast changes including cyst formation, stroll fibrosis and mild epithelial hyperplasia without atypic
Symptoms cease 1-2 years following menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does fibrocystic change present

A

Lumpy, premenstrually painful breasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is fibroadenoma

A

Common
Women 20-30 years
More common in Afro-caribbean women
Mobile, painless, well defined breast lump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How are fibroadenoma’s treated

A

Surgical excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is DCIS

A

Ductal carcinoma in situ
A malignant clonal proliferation of cells within breast parenchymal structures
No evidence of invasion
A precursor of invasive carcinoma
Most commonly identified as microcalifications on screening
Pure DCIS cannot produce metastasis
Can progress to invasion if left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risk factors for breast cancer

A

Linked to oestrogen
Increased with early menarche, late menopause, obesity in postmenopausal women, OCP’s and normal therapy for menopause, alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should a path report tell about malignancy

A 
In situ or invasive
Type
Grade
Size
Vascular invasion
Nodal status
Relationship to margins
Molecular marker status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the main types of breast carcinoma

A 
Ductal (75%)
Lobular (12%)
Tubular/cribriform (3%)
Medullary (3%)
Mucoid (2%)
Metaplastic (1%)
Others (4%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the key prognostic factors

A

Tumour grade
Tumour size
Nodal status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the Nottingham Prognostic index

A

Grade + nodal status + 0.2 x tumour size

  1. 4 or less : good (80%+ 16 year survival)
  2. 41-5.4: moderate (46%)
  3. 41 +: poor (10%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is CIN

A

Cervical intraepithelial neoplasia
Dysplasia
Leads to squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is CGIN

A

cervical glandular intraepithelial neoplasia
Dysplasia
Leads to adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is VIN

A

Vulval intraepithelial neoplasia

Dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is VaIN

A

Vaginal intraepithelial neoplasia

Dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is AIN

A

Anal intraepithelial neoplasia

Dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is dysplasia

A

Earliest morphological manifestation of multistage process of neoplasia
Cytological features of malignancy but no invasion
Removal is curative, if left then significant chance of developing invasive malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the results of low risk HPV

A

Types: 6, 11
Lower genital tract warts (condylomata: benign squamous neoplasms), low grade INs
Very rare in malignant lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the results of high risk HPV

A

Types: 16, 18, 31, 33

High grade INs and invasive carcinomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the HPV vaccines

A

Gardasil (HPV 6,11, 16,18)

Cervarix (HPV 16, 18)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What part of the cervix is vulnerable to the oncogenic effects of HPV

A

Transformation zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the characteristics of CIN I

A

Regression 60%
Persistence 30%
Progression to CIN III 10%
Progression to invasion 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the characteristics of CIN II

A

Regression 40%
Persistence 40%
Progression to CIN III 20%
Progression to invasion 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the characteristics of CIN III

A

Regression 33%
Persistence ~56%
Progression to invasion 20-70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What makes a good screening test

A 
High sensitivity and specificity
Not harmful
Not too expensive
Acceptable to population
Define pre-invasive stage long enough to allow intervention
Simple successful treatment
Not a test for cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How are smear tests triaged

A

HPV triage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is LLETZ

A

Large loop excision of the transformation zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the FIGO staging of cervical carcinoma

A

I: Confined to cervix
II: Invades beyond uterus, not to pelvic side wall
III: Extends to pelvic wall, lower 1/3 vagina, hydronephrosis
IV: Invades bladder or rectum or outside pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the treatments for each stage of cervical carcinoma

A

IA1, IA2: No need for radical treatment, complete excision with LLETZ
IB, IIA, IIB: Consider radical therapy with surgery or chemo or radiotherapy
III, IV: Consider palliative care, chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the characteristics of Vulval squamous cell carcinoma

A 
Associated with VIN
Associated with inflammatory dermatoses
Eroded plaque or ulcer
Spreads locally to involve:
-Vagina and distal urethra
-Ipsilateral inguinal LNs
Contralateral inguinal LNs, deep iliofemoral LNs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is endometriosis

A

Presence of endometrial tissue at sites other than the endometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How do patients with endometriosis present

A 
25% asymptomatic
Dysmenorrhoea
Dyspareunia
Pelvic pain
Subfertility
Pain on passing stool
Dysuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How is endometriosis diagnosed

A

Laparoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How is endometriosis treated

A

Medically (COCP, GnRH agonists/antagonists, progesterone antagonists)
Surgically (ablation/ TAH-BSO)

41
Q

What are some linked issues with endometriosis

A

Ectopic pregnancy
Ovarian cancer
IBD

42
Q

What is endometritis

A

Inflammation of the endometrium

43
Q

How do patients with endometritis present

A 
Abdominal/pelvic pain
Pyrexia
Discharge
Dysuria
Abnormal vaginal bleeding
44
Q

How is endometritis diagnosed

A

Biochemistry/microbiology

USS

45
Q

How is endometritis treated

A

Analgesia
Antibiotics
Remove cause

46
Q

How do patients with endometrial polyps present

A

Often asymptomatic
Intermenstrual/ post menopausal bleeding
Menorrhagia
Dysmenorrhoea

47
Q

How is endometrial polyps diagnosed

A

USS

Hysteroscopy

48
Q

How is endometrial polyps treated

A

medical (P4/GnRH agonists), surgical (curettage)

49
Q

What is endometrial hyperplasia

A

Excessive endometrial proliferation

50
Q

What are the risk factors for endometrial hyperplasia

A 
Obesity
Exogenous E2
PCOS
E2-producing tumours
Tamoxifen
HNPCC (PTEN mutations)
51
Q

What are the types of endometrial hyperplasia

A

simple non-atypical, simple atypical

Complex non-atypical, complex atypical

52
Q

What is the history for endometrial hyperplasia

A

Abnormal bleeding

53
Q

How is endometrial hyperplasia diagnosed

A

USS
Hysteroscopy
Biopsy

54
Q

How is endometrial hyperplasia diagnosed

A

Medical (IUS,P4)

Surgical (TAH)

55
Q

What is the prognosis for endometrial hyperplasia

A

Endometrial adenocarcinoma

or regression

56
Q

What is the malignant progression of hyperplasia

A

Normal - Non-atypical hyperplasia - Atypical hyperplasia - Endometrioid adenocarcinoma

57
Q

What is polycystic ovary syndrome

A

Endocrine disorder
Hyperandrogenism
Menstrual abnormalities
Polycystic ovaries

58
Q

How is PCOS investigated

A

USS
Fasting biochemical screen (↓FSH, ↑LH, ↑testosterone, ↑DHEAS)
OGTT

59
Q

How is PCOS treated

A

Lifestyle (weight loss)
Medical (metformin, OCP, clomiphene)
Surgical (ovarian drilling)

60
Q

What are linked issues with PCOS

A

Infertility
Endometrial hyperplasia
Adenocarcinoma

61
Q

What is endometrial adenocarcinoma history

A

PMB/IMB, pain if late

62
Q

How is endometrial adenocarcinoma investigated

A

USS
Biopsy
Hysteroscopy

63
Q

How is endometrial adenocarcinoma treated

A

Medical (P4)
Surgery (TAH-BSO)
Adjuvant therapy (chemo-radiotherapy)

64
Q

What is the prognosis for endometrial adenocarcinoma

A

Stage 1: 90% 5 yr survival

Stage 2-3: <50% 5 yr survival

65
Q

What are epithelial tumours

A 
Most common group of ovarian neoplasms
3 major carcinoma histological types:
Serous (tubal)
Mucinous (endocervical)
Endometrioid (endometrium)
Each type contains benign/ borderline/ malignant variants
66
Q

How are the benign epithelial tumours classes

A

Based on components
Cystic (cystadenomas)
Fibrous (adenofibromas)
Cystic and fibrous (cystadenofibromas)

67
Q

How are malignant epithelial tumours named

A

Cystadenocarcinoma

68
Q

What are germ cell tumours

A

15-20% of all ovarian tumours
Types:
Germinomatous:
- Dysgerminomas (malignant, chemosensitive)
Non-germinatous:
-Teratomas (differentiation towards multiple germ layers)
-Yolk sac tumours (differentiation towards extra embryonic yolk sac, malignant, chemosensitive)
-Choriocarcinomas (differentiation- placenta, malignant, often unresponsive

69
Q

How are germ cell tumours treated

A

Surgical
Chemo
Radiotherapy

70
Q

What are sex cord stroll tumours

A

Can generate cells from the opposite sex:
Thecoma/fibrothecoma/fibroma:
-Benign thecomas and fibrothecomas produce E2, fibromas hormonally inactive
-Comprised of spindle cells
-Meig’s syndrome:ovarian tumour, right sided hydrothorax, ascites
Granulosa cell tumours:
-low grade malignant, produces E2
Sertoli-Leydig cell tumours:
-Produce androgens, 10-25% malignant

71
Q

What is ovarian cancer risk factors

A

: FH, ↑age, PMH breast cancer, smoking,

E2-only HRT, Lynch II syndrome, obesity, nulliparity

72
Q

What are protective factors for ovarian cancer

A

OCP, breastfeeding, hysterectomy

73
Q

What are the ways ovarian cancer patients present

A

Non-specific symptoms:

  • Pain
  • Bloating
  • Weight loss
  • PV bleeding
  • Urinary frequency
  • Anorexia
74
Q

What are the treatments of ovarian cancer

A

Stage <1C epithelial tumours  TAH/BSO, omentectomy, appendectomy, lymphadenectomy & adjuvant chemo - chemo only in sensitive GCTs

75
Q

What are leiomyoma

A

Uterine fibroids

Benign smooth muscle tumours of the myometrium

76
Q

What is the history of leiomyoma

A

Often asymptomatic menorrhagia

Subfertility/pregnancy problems

77
Q

How is leiomyoma diagnosed

A

Bimanual examination

USS

78
Q

How is leiomyoma treated

A

Medical (IUS/NSAIDs/OCP/P4/Fe2+); non-medical (artery embolization, ablation, TAH)

79
Q

What can happen as a result of infection in pregnancy

A
  • miscarriage
  • congenital anomalies
  • fetal hydrops
  • fetal death
  • preterm delivery
  • preterm rupture of the membranes
80
Q

What is the key message to give mothers during antenatal counselling to avoid infections

A

Avoid exposure to infection during pregnancy

Get vaccinations so maternal antibodies can cross the placenta and give passive immunity to the foetus

81
Q

What should the mother be screened for early stage in pregnancy

A

Hepatitis B

HIV

82
Q

What are the in utero infections which can be transmitted from mother to baby

A 
TORCH
Toxoplasmosis
Others (syphilis, HIV, Coxsackie virus, Hep B, Varicella-zoster)
Rubella
Cytomegalovirus disease
Herpes simplex disease
83
Q

What are the potential foetal consequences of TORCH infections

A 
Abortion
Stillbirth
Prematurity
IUGR
Congenital malformations (microcephaly, intracranial calcifications)
84
Q

What are the managements of intra-amniotic infections

A

Intrapartum antimicrobials and delivery of the foetus

Antimicrobials should be administered at the time of diagnosis not after delivery

85
Q

What are the clinical features of puerperal endometritis

A 
Fever (38.5C  in first 24 h post delivery or >38.0 for 4 hours, 24 h+ after delivery), no other apparent cause identified
Uterine tenderness
Purulent, foul-smelling lochia
Increased white cell count
General malaise, abdominal pain
86
Q

What is early onset neonatal sepsis

A

Within 72 hours
A major cause of mortality and morbidity in new-born babies
High mortality, particularly in premature and low birth weight babies
Death in 1 in 4 babies who develop it, even when given antibiotics

87
Q

What is the most common bacterial infection

A

Streptococcal pneumoniae

88
Q

What are the upper respiratory tract infections in children

A

Common cold
Acute tonsillitis
Acute otitis media

89
Q

What is a sore throat

A

Any various inflammations of the tonsils, pharynx, or larynx characterised by pain in swallowing

90
Q

What causes a sore throat

A

Viral (70-80%)

Group A beta-haemolytic streptococcus (20-30%)

91
Q

How does a patient with otitis media present

A 
Unusual irritability
Difficulty sleeping
Tugging or pulling at one or both ears
Fever
Fluid draining from the ear
Loss of balance
Unresponsiveness to quiet sound or other signs of hearing difficulty
92
Q

What is otitis media

A

Inflammation of middle ear

93
Q

What are the Lower respiratory tract infections

A

Pneumonia
Acute bronchitis
Bronchiolitis

94
Q

What is bronchiolitis

A

Inflammation of bronchioles/small airways in children younger than 2 years
A seasonal viral illness characterised by fever, nasal discharge and dry, wheezy cough.
On examination there are fine inspiratory crackles and/ or high-pitched expiratory wheeze

95
Q

What are the causes of bronchiolitis

A 
Respiratory Syncytial Virus (RSV) 
Metapneumovirus 
Adenovirus
Para-influenza virus 
Influenza 
Rhinovirus
96
Q

What is the clinical picture of LRTI

A

Acute febrile illness, possibly preceded by typical viral URTI
Breathlessness
Irritability
Poor feeding
Sleeplessness
Cough, chest, abdominal pain in older patients
Audible wheezing is rare but can occur

97
Q

How does meningitis present in children

A 
Fever
Irritability
Lethargy
Poor feeding
High pitched cry
Bulging AF
Convulsions
Opisthotonus
98
Q

How does meningococcemia present

A 
Fever 
Non-specific malaise
Lethargy
Vomiting 
Meningism
Resp distress
Irritability 
Seizures
Maculopapular rash common early in disease
Petechial rash seen in 50-60%
99
Q

What are the symptoms of UTI

A

Older children:
Dysuria, frequency, urgency, small-volume voids, lower abdominal pain
Younger children:
Nonspecific symptoms
Fever, irritability, vomiting, poor appetite

Y2 Clinical Pathology (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions