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Year 2: Clinical Pathology > Gynaecological Pathology > Flashcards

Gynaecological Pathology Flashcards

1
Q

VIN

A

Vuval interepithelial neoplasm

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2
Q

CIN

A

Cervical interepithelial neoplasm

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3
Q

Dysplasia

A

early manisfestation of neoplasm. Insitu/ non invasive disease. Cytology of malignancy but no mets.

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4
Q

Cytology of neoplasms

A

big dark blue nuclei

Cells organised differently eg. horizontally rather then vertically

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5
Q

HPV

Virus Type

A

Human papilloma virus - double stranded DNA

Different subtypes in different tissues + low/ high oncogenic risk

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6
Q

Types of HVP included in the vaccinations

A

16 and 18 in cervarix = 70% of cancers

16,18, 6 and 11 in Gardasil = include low grade warts also

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7
Q

HVP mode of action - proteins E6 (p53) and E7 (RB1)

A

Up regulates Proetins:
E6 –> inactivates P53 - responsible for control of cell apoptosis of damaged DNA
E7 –> Binds to product of tumour suppressor gene RB1 = uncontrolled cell proliferation

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8
Q

Types of benign VIN (2) one caused by HPV and one not

A

1) Classical/warty/ baseloid presentation = Genital warts or condyloma acumination. Caused by HPV
2) Differentiated - not graded not caused by HPV. Chronic dermatoses (lichen sclerosis)

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9
Q

Spread of squamous cell carcinoma of the vulval

A

An eroded plaque or ulceration spreads locally in the vagina
Ipsilateral inguinal LN
counterlater deep femoral LN

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10
Q

Staging for Vulval squamous cell carcinoma

A

FIGO

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11
Q

Paget’s disease –> into what cancer?

A

eczema like patches on the vulva in over 80 years old

Can developing into adenocarcinoma

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12
Q

Change in Cervical mucosa during puberty (menarch)

A

Increase in Oestrogen = eversion of columnar epithelium (squamous cell metaplasia = transformational zone forms

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13
Q

Change in cervical mucosa during menopause

A

Drop in oestrogen = inversion. Squamous cells return to the cervix. Squamocolumnar junction at the external os again.

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14
Q

Cervical cytology is measurable between which ages

A

Menarch and menopause - when the squamocolumnar junction is descended and the transitional zone is swabable

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15
Q

Cervical screening - what for?

A

Pre invasive CIN not malignancy

Then HPV testing (boarder line nuclear change)

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16
Q

Cervical screening - ages and frequency

A

25-49 = 3 yearly
50-64 = 5 yearly
If all is normal

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17
Q

Further investigation of CIN (3)

A

Colposcopy - exam of cervix with acetic acid it highlight abnormal epithelium
Large Loop excision of transformation zone (LLETZ) = biospy
Analysis by histopathologies to further treatement

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18
Q

Two Types of malignant CIN

  • risk
  • symptoms
  • spread
A

1) Cervical Squamous cell carcinoma. Causes = high risk HPV, many sexual partners and smoking. Ulcers, discharge and bleeding
2) Cervical adenocarcinomas = high risk HPV. Developing in CGIN (glandular). Spread pelvic wall, vagina, bladder and rectum. Mets in bone and lungs

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19
Q

Endometriosis

  • classification
  • progression
  • symptoms (5)
  • Treat (3)
A

Acquired inflame growth disorder.

Ectopic endometrium –> bleed –> fibrosis

non OR dysmenorrhoea, dyspareunia, pain, dysuria

Oral contraceptive pill, Progesterone, gonadorelin releasing Hormone

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20
Q

OCP

A

Oral contraceptive Pill

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21
Q

Endometritis

  • What
  • symptoms (5)
  • Treat
A

Inflammation of endometrium - infection

Ab pain, pyrexia, dysuria, vaginal bleeds. USS of lymphocytes

Antibiotics

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22
Q

Endometrial polyps

  • What
  • Symptoms (3)
  • Treat
A

Sessile or polypoid oestrogen dependent growths

intermenstrual bleeds, heavy menstartion OR dysmenorrhagia

Gonadarelin releasing hormone OR surgery

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23
Q

Leiomyoma (uterine Fibroids)

  • What + hormones?
  • Symptoms (3)
  • Treat (4)
A

Myometrium benign growth - eostrogen and progesterone dependant

Menometorrhagia (aneamia), subfertility and pressure symptoms

NSAIDS, progesterone, iron supplements and contraception (coil or OCP)

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24
Q

Endometrial hyperplasia

  • What + hormones?
  • Symptoms
  • Treat (2)
  • progression?
A

excessive endometrial proliferation - high E low P

Abnormal bleeds

Progesterone or surgery

Risk of adenocarcinoma

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25
Two types of endometrial carcinomas
Type 1 - pre menopausal | Type 2 - post menopausal (serious)
26
Most common cancer of female genital tract
Endometrial adenocarcinoma
27
Staging of endometrial adenocarcinoma
FIGO
28
Symptoms + treat of adenocarcinoma
Abnormal bleeds, USS, biopsy Hysterectomy or chemo or radio
29
Polycystic ovary syndrome - Acquired metabolic disorder? - Types of hormones affected - Impact
Endocrine disorder - hypogonadism menstrual abnormal, infertility, edometrial hyperplasia/ adenomcarcinoma
30
Measurements (hormones) for polycystic ovary
USS Raised blood LH and testosterone Decreased FSH
31
Treatment for polycystic ovaries (3)
Weight loss, metformin or ovary drilling
32
Gonadal Failure causes | Hyper (6) and hypo (4)
Hyper - congenital: turners (XO), Klinerfelters (XXY) - acquired: infection, surgery, chemo and drugs Hypo Sheehan syndrome, pituitary tumours, brain injury or polycystic ovaries
33
Presentation (hormones) and Treatment of Gonadal failure
Amenorrhoea or absent menarche = delayed puberty Low sex hormones but high LH and FSH Diagnose with karyotype of hormone profile Hormonal therapy
34
Risk factors (6) VS protective factors (3) for Ovarian neoplasm
Risk = high FH, age, breast cancer, smoking, lynch syndrome, obesity Protective = breastfeeding, hysterectomy, OCP
35
Symptoms of Ovarian neoplasm (6)
``` Nonspecific pain Bloating Anorexia and weight loss Irregular bleeds urinary frequency ```
36
5 year survival of ovarian neoplasm
43%
37
Types of Ovarian neoplasm (3) and % of total
Surface epithelial 90% Germ cell 10% Sex cord = very rare
38
Benign surface epithelial tumours
= Fibromas
39
Malignant Surface epithelial tumours
Cystadenocarcinomas
40
Dusgerminomas (malignant)
differentiation of oogocyte
41
Yolk sac vs Choriocarcinomas
BOTH: malignant non germinomatous germ cell tumours Yolk sac - differentiated to yolk sac + responsive to chemo Chorio = differentiated towards placenta + unresponsive to chemo
42
Sex cord tumours that are Inactive Produce E2 Produce adrogens
``` Inactive = Fibroma E2 = Granulomas (malignant) Adrogens = Sertoli leydig cell tumours (10% malignant) ```
43
Most common Mets in ovaries
'Mulleriam' from uterus, fallopian tube or contralateral ovary
44
Age for Mammography breast screening
47-73 years old every 3 years
45
Mammogram (USS) - what it picks up
Mass that is not palpable high density area = calcification Pre - invasive tumour - Ductile carcinoma in situ (DCIS)
46
Triple diagnosis
Mammogram, palpation and biopsy
47
Palpation - try to determine
mobility, size, boarders of mass
48
Types of Biopsy (3)
fine needle cell aspiration ultrasound/ stereotactic guided core biopsy Freehand biopsy
49
Peuperal Mastitis Or mamitis - cause (bacteria) - symptoms
Inflammation of breast tissue due to infection Staph A or Staph epidermis Pain, swelling, red, abcess
50
Benign Breast tumours (2) - Changes - Type of mass
1) Fibrocystic disease (B2) Apocrine cell metaplasia, Ductal hyperplasia and sclerosing adenois = lump and pain. Can disrupt menstrual cycle 2) Fibroadenoma (B2) Most common in adolescences. Fixed round mass with no skin dimpling eg. Phyllodes tumour
51
Risks (7) VS protective factors for Breast Cancer (1)
RISK = high Oestradiol, early menarche or late menopause, obesity, alcohol intake, hormone treatments, genes Protective = childbearing
52
HER measure and what it signifies
Human epidermal growth factor on surface of tumour cells Positive HER = fast growth
53
ER and PR
Oestrogen and Progesterone receptors on the surface of tumour cells Positive ER and PR = active tumour
54
Types of Breast Malignancy (5 + others)
DCIS - grade 5a = non invasive Ductal carcinoma - grade 5b some DCIS cells. Express ER, PR and HER Lobular Tubular Medullary Other
55
Treatment for breast cancer (5 - increase severity/ lack of responsiveness)
Wide local excision with localisation wire Sentinal node biopsy Mammectomy Radio/ chemo
56
Nottingham prognostic index Results?
Grade + nodal score + 0.2 x tumour size Nodal score: more nodes = higher socre Results <3.4 = good prognosis 5.4 + = poor prognosis
57
Effect of Infections in pregnancy
``` Resistance NOT affected Can be more severe Miscarriage Congential abnormalities Pretern delivery Featal death ```
58
Infections transmitted from mother to featus during pregnancy (haemarogenous) or delivery through birth canal (direct touch) = TORCH
Toxoplasmosis (toxoplasma gondii parasite in animal poo, uncooked meat) Other viruses (HIV, Hep B, Syphilis, varicella zoster, parovirus) Rubella Cytomegalovirus Herpes Simplex
59
UTIs in pregnancy - risks - Measuring - If group B strep
high risk of Pyelonephritis, preterm delivery and low birth rate Midstream urine cultures to find asymptomatic bacteriuria Group B strep = fetal sepsis
60
AntiBs harmful to foetus (3)
Chloramphenicol, Teracycline, Fluoroquinolones (ciprofloxacin)
61
AntiBs Safe in pregnancy (2 - groups)
Penicillin, Cephalosporins
62
Grey Baby syndrome Due to? Feotus born with?
Due to chloramphenical toxicity Grey skin, hypotension, cyanosis, hypothermia and cardiac/ Resp distress
63
Intra-amniotic infections Causes and Risk factors
Preterm deliver and rupture of membranes Group B streph, Ecoli (ascend from the vagina) Risk = amniocentesis, cordocentesis and vaginal exams
64
Intra-amniotic infections signs and treatment
Purulent foul smelling amniotic fluid. ``` Baby = AntiBs on delivery Mother = AntiBs on diagnosis ```
65
Puerperal endometritis Risks and causes
Risk = ceasarean section, prolong labour, rupturing of membranes Causes = Ecoli, Beta heamolytic strep, anaerobes
66
Puerperal endometritis Present and treat
Present = fever post deliver, uterine tenderness, foul smelling vaginal discharge --> sepsis Broad spectrum antiBS
67
Neonatal sepsis - % of feotal deaths
15%
68
Early onset sepsis
within 72 hours of birth. Group B strep, Ecoli from maternal tract. highest mortality
69
Late onset
7 days into life | Coagulase-negative staphylococci
70
Cause of children being high risk of infection (3)
1) more physical contact 2) behaviours - hands in mouth 3) Immature immune system
71
Pneumonia in childhood causes
newborn = GBS, gram negative organisms and TORCH < 12 months = RSV <5 years = respiratory viruses
72
Bronchiolitis Age Types Sympt
Common in children under 2 years Seasonal viral Cold like, fever, loss of appetite, difficulty breathing
73
Whooping Cough or Pertussis = 3 stages
1) Cold like symptoms (>3 weeks) 2) Gasping/ classical whooping cough, vomiting and cyanosis (6 weeks) 3) subside = Convalescent phase
74
Meningitis cause in childhood | Neonates - 1 month - <1 year
Neonates = GBS, Ecoli 1 month - 5 years = Strep pneumonia <1 year with infected CNS (viral) = enterovirus, HSV, Influenza
75
Urine sample from children
Suprapubic aspiration (of bladder)
76
Menigococcemia - incidence - sympts (6) - complications (3)
< 4 years Fever, malaise, petechial rash, vomiting, resp distress and seizures Deafness, neurological and amputations
77
Scarlet Fever (SF) Vs Measles (M) Vs Rubella (R) causes
SF = Group A beta heamolytic strep M = Virus R = Viral
78
SF vs M vs R - symptoms Type of rash and where
ALL = fever and rash SF = headaches, sore throat, strawberry tongue, desquamination (scaly skin) + Circumoral rash (whole body) M = conjunctivitis and maculopapular rash (hairline - trunk) R = Pink maculopapular rash face --> down
79
SF vs M vs R management
SF = Penicillin immediately M = 4 days pre and post rash = public health emergency (communicable) R = Communicable 5 days pre and 7 days post rash

Year 2: Clinical Pathology (10 decks)

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