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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
Q

Two types of endometrial carcinomas

A

Type 1 - pre menopausal

Type 2 - post menopausal (serious)

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26
Q

Most common cancer of female genital tract

A

Endometrial adenocarcinoma

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27
Q

Staging of endometrial adenocarcinoma

A

FIGO

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28
Q

Symptoms + treat of adenocarcinoma

A

Abnormal bleeds, USS, biopsy

Hysterectomy or chemo or radio

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29
Q

Polycystic ovary syndrome - Acquired metabolic disorder?

  • Types of hormones affected
  • Impact
A

Endocrine disorder - hypogonadism

menstrual abnormal, infertility, edometrial hyperplasia/ adenomcarcinoma

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30
Q

Measurements (hormones) for polycystic ovary

A

USS
Raised blood LH and testosterone
Decreased FSH

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31
Q

Treatment for polycystic ovaries (3)

A

Weight loss, metformin or ovary drilling

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32
Q

Gonadal Failure causes

Hyper (6) and hypo (4)

A

Hyper

  • congenital: turners (XO), Klinerfelters (XXY)
  • acquired: infection, surgery, chemo and drugs

Hypo
Sheehan syndrome, pituitary tumours, brain injury or polycystic ovaries

33
Q

Presentation (hormones) and Treatment of Gonadal failure

A

Amenorrhoea or absent menarche = delayed puberty
Low sex hormones but high LH and FSH

Diagnose with karyotype of hormone profile

Hormonal therapy

34
Q

Risk factors (6) VS protective factors (3) for Ovarian neoplasm

A

Risk = high FH, age, breast cancer, smoking, lynch syndrome, obesity

Protective = breastfeeding, hysterectomy, OCP

35
Q

Symptoms of Ovarian neoplasm (6)

A 
Nonspecific pain
Bloating
Anorexia and weight loss
Irregular bleeds
urinary frequency
36
Q

5 year survival of ovarian neoplasm

A

43%

37
Q

Types of Ovarian neoplasm (3) and % of total

A

Surface epithelial 90%
Germ cell 10%
Sex cord = very rare

38
Q

Benign surface epithelial tumours

A

= Fibromas

39
Q

Malignant Surface epithelial tumours

A

Cystadenocarcinomas

40
Q

Dusgerminomas (malignant)

A

differentiation of oogocyte

41
Q

Yolk sac vs Choriocarcinomas

A

BOTH: malignant non germinomatous germ cell tumours

Yolk sac - differentiated to yolk sac + responsive to chemo

Chorio = differentiated towards placenta + unresponsive to chemo

42
Q

Sex cord tumours that are
Inactive
Produce E2
Produce adrogens

A 
Inactive = Fibroma
E2 = Granulomas (malignant)
Adrogens = Sertoli leydig cell tumours (10% malignant)
43
Q

Most common Mets in ovaries

A

‘Mulleriam’ from uterus, fallopian tube or contralateral ovary

44
Q

Age for Mammography breast screening

A

47-73 years old every 3 years

45
Q

Mammogram (USS) - what it picks up

A

Mass that is not palpable
high density area = calcification
Pre - invasive tumour - Ductile carcinoma in situ (DCIS)

46
Q

Triple diagnosis

A

Mammogram, palpation and biopsy

47
Q

Palpation - try to determine

A

mobility, size, boarders of mass

48
Q

Types of Biopsy (3)

A

fine needle cell aspiration
ultrasound/ stereotactic guided core biopsy
Freehand biopsy

49
Q

Peuperal Mastitis Or mamitis

  • cause (bacteria)
  • symptoms
A

Inflammation of breast tissue due to infection

Staph A or Staph epidermis

Pain, swelling, red, abcess

50
Q

Benign Breast tumours (2)

  • Changes
  • Type of mass
A

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
Q

Risks (7) VS protective factors for Breast Cancer (1)

A

RISK = high Oestradiol, early menarche or late menopause, obesity, alcohol intake, hormone treatments, genes

Protective = childbearing

52
Q

HER measure and what it signifies

A

Human epidermal growth factor on surface of tumour cells

Positive HER = fast growth

53
Q

ER and PR

A

Oestrogen and Progesterone receptors on the surface of tumour cells

Positive ER and PR = active tumour

54
Q

Types of Breast Malignancy (5 + others)

A

DCIS - grade 5a = non invasive
Ductal carcinoma - grade 5b some DCIS cells. Express ER, PR and HER

Lobular
Tubular
Medullary
Other

55
Q

Treatment for breast cancer (5 - increase severity/ lack of responsiveness)

A

Wide local excision with localisation wire
Sentinal node biopsy
Mammectomy
Radio/ chemo

56
Q

Nottingham prognostic index

Results?

A

Grade + nodal score + 0.2 x tumour size

Nodal score: more nodes = higher socre

Results
<3.4 = good prognosis
5.4 + = poor prognosis

57
Q

Effect of Infections in pregnancy

A 
Resistance NOT affected
Can be more severe
Miscarriage
Congential abnormalities
Pretern delivery
Featal death
58
Q

Infections transmitted from mother to featus during pregnancy (haemarogenous) or delivery through birth canal (direct touch) = TORCH

A

Toxoplasmosis (toxoplasma gondii parasite in animal poo, uncooked meat)

Other viruses (HIV, Hep B, Syphilis, varicella zoster, parovirus)

Rubella

Cytomegalovirus

Herpes Simplex

59
Q

UTIs in pregnancy

  • risks
  • Measuring
  • If group B strep
A

high risk of Pyelonephritis, preterm delivery and low birth rate

Midstream urine cultures to find asymptomatic bacteriuria

Group B strep = fetal sepsis

60
Q

AntiBs harmful to foetus (3)

A

Chloramphenicol, Teracycline, Fluoroquinolones (ciprofloxacin)

61
Q

AntiBs Safe in pregnancy (2 - groups)

A

Penicillin, Cephalosporins

62
Q

Grey Baby syndrome

Due to?

Feotus born with?

A

Due to chloramphenical toxicity

Grey skin, hypotension, cyanosis, hypothermia and cardiac/ Resp distress

63
Q

Intra-amniotic infections

Causes and Risk factors

A

Preterm deliver and rupture of membranes Group B streph, Ecoli (ascend from the vagina)

Risk = amniocentesis, cordocentesis and vaginal exams

64
Q

Intra-amniotic infections signs and treatment

A

Purulent foul smelling amniotic fluid.

Baby = AntiBs on delivery
Mother = AntiBs on diagnosis
65
Q

Puerperal endometritis

Risks and causes

A

Risk = ceasarean section, prolong labour, rupturing of membranes

Causes = Ecoli, Beta heamolytic strep, anaerobes

66
Q

Puerperal endometritis

Present and treat

A

Present = fever post deliver, uterine tenderness, foul smelling vaginal discharge –> sepsis

Broad spectrum antiBS

67
Q

Neonatal sepsis - % of feotal deaths

A

15%

68
Q

Early onset sepsis

A

within 72 hours of birth.
Group B strep, Ecoli from maternal tract.
highest mortality

69
Q

Late onset

A

7 days into life

Coagulase-negative staphylococci

70
Q

Cause of children being high risk of infection (3)

A

1) more physical contact
2) behaviours - hands in mouth
3) Immature immune system

71
Q

Pneumonia in childhood causes

A

newborn = GBS, gram negative organisms and TORCH
< 12 months = RSV
<5 years = respiratory viruses

72
Q

Bronchiolitis
Age
Types
Sympt

A

Common in children under 2 years
Seasonal viral
Cold like, fever, loss of appetite, difficulty breathing

73
Q

Whooping Cough or Pertussis = 3 stages

A

1) Cold like symptoms (>3 weeks)
2) Gasping/ classical whooping cough, vomiting and cyanosis (6 weeks)
3) subside = Convalescent phase

74
Q

Meningitis cause in childhood

Neonates - 1 month - <1 year

A

Neonates = GBS, Ecoli
1 month - 5 years = Strep pneumonia
<1 year with infected CNS (viral) = enterovirus, HSV, Influenza

75
Q

Urine sample from children

A

Suprapubic aspiration (of bladder)

76
Q

Menigococcemia

  • incidence
  • sympts (6)
  • complications (3)
A

< 4 years
Fever, malaise, petechial rash, vomiting, resp distress and seizures
Deafness, neurological and amputations

77
Q

Scarlet Fever (SF) Vs Measles (M) Vs Rubella (R) causes

A

SF = Group A beta heamolytic strep

M = Virus

R = Viral

78
Q

SF vs M vs R - symptoms

Type of rash and where

A

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
Q

SF vs M vs R management

A

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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