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Endo/Repro > Introduction to the Female Genital Tract (Embryo, Anatomy, STI) > Flashcards

Introduction to the Female Genital Tract (Embryo, Anatomy, STI) Flashcards

1
Q

What is the female reproductive system derived from?

A
  1. Mesoderm
  2. Primordial germ cells
  3. Coelomic epithelium
  4. Mesenchyme
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2
Q

What are the three main groups of the female reproductive system?

A
  • Gonads
  • Reproductive ducts
  • External genitalia
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3
Q

When does the uterus form?

A
  • During Müllerian organogenesis accompanied by the development of the upper third of the vagina, cervix, and both fallopian tubes
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4
Q

Which duct is the ovary derived from?

A
  • Mesonephric duct (Wolffian duct)

- Mesonephros

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5
Q

Which duct is the upper third of the vagina, cervix, both fallopian tubes, and the uterus derived from?

A
  • Paramesonephric duct

- Müllerian duct

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6
Q

What are some anomalies that occur due to Müllerian duct fusion?

A
  • Bicornuate uterus

- Uterus didelphys

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7
Q

What is Mayer-Rokitansky-Küster-Hauser syndrome?

A
  • A disorder that occurs in females and mainly affect the reproductive system
  • Causes the vagina and uterus to be underdeveloped or absent although external genitalia are normal
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8
Q

What is the karyotype of someone with MRKH syndrome?

A
  • 46XX (normal)
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9
Q

Why does someone with MRKH syndrome still develop external genitalia?

A
  • The ovaries are working allowing for hormones to still be produced
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10
Q

What does the vulva include?

A
  • Mons pubis
  • Labia majora
  • Labia minora
  • Clitoris
  • Urethral opening
  • Vaginal opening
  • Perineum
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11
Q

Who can infectious diseases affect?

A
  • Elderly
  • Immunocompromised
  • Debilitating chronic diseases
  • Inadequate access to health care
  • Malnutrition
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12
Q

What are the different types of inflammatory responses to infection?

A
  • Suppurative (purulent) inflammation
  • Mononuclear and granulomatous inflammation
  • Cytopathic-cytoproliferative (viral change)
  • Tissue necrosis
  • Chronic inflammation and scarring
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13
Q

How are infectious agents diagnosed?

A
  • Gold standard has been culture
  • Now it is biologic or serologic identification
  • PCR
  • Molecular methods
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14
Q

Who is most likely to be infected with HSV2?

A
  • Women more than men due to it being easier to transmit from men to women during penile-vaginal sex
  • More common among non-hispanic blacks
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15
Q

What systemic symptoms show up in a HSV infection?

A
  • Fever
  • Malaise
  • Tender inguinal lymph nodes
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16
Q

When do the systemic symptoms show up in a HSV infection?

A
  • Only 1/3 of individuals are symptomatic

- Show up 3 to 7 days after transmission

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17
Q

What is the earliest lesion in HSV infection?

A
  • Red papules that progress to vesicles and then to painful coalescent ulcers
  • Easily visible on vulvar skin and mucosa, while cervical and vaginal lesions present with severe purulent discharge and pelvic pain
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18
Q

What is a simple screening test for HSV?

A
  • Tzanck Smear test
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19
Q

What is important to remember about HSV?

A
  • It is a latent virus meaning that it will persist indefinitely
  • Any decrease in immune function as well as stress, trauma, UV radiation, and hormonal changes can trigger reactivation of the virus and recurrence of the skin and mucosal lesions
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20
Q

What is the neonatal transmission of HSV associated with?

A
  • High mortality
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21
Q

What does HHV-1 cause?

A
  • Herpes simplex type 1
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22
Q

What does HHV-2 cause?

A
  • Herpes simplex type 2
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23
Q

What does HHV-3 cause?

A
  • Varicella-Zoster
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24
Q

What does HHV-4 cause?

A
  • Epstein-Barr
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25
Q

What does HHV-5 cause?

A
  • Cytomegalovirus
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26
Q

What does HHV-6/7 cause?

A
  • Exanthem subitum

- Roseola infantum

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27
Q

What does HHv-8 cause?

A
  • Kaposi sarcoma
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28
Q

What is CMV and what are some modes of transmission?

A
  • Variety of manifestations depending on age of the host and immune status
  • Transplacental transmission (congenital)
  • Neonatal transmission (perinatal)
  • Genital transmission
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29
Q

What is the characteristic histologic appearance for CMV?

A
  • Prominent intranuclear basophilic inclusions spanning half the nuclear diameter
  • Owl eye appearance
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30
Q

What does disseminated CMV cause?

A
  • Focal necrosis with minimal inflammation in virtually any organ
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31
Q

What is congenital CMV?

A
  • 95% are asymptomatic
  • If primary maternal infection, it causes cytomegalic inclusion disease that looks clinically like erythroblastosis fetalis
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32
Q

How does an infant with congenital CMV look?

A
  • Intrauterine growth retardation
  • Hepatosplenomegaly and jaundice
  • Anemia
  • Bleeding due to thrombocytopenia
  • Encephalitis/microcephaly
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33
Q

What are some ways of vertical transmission for CMV?

A
  • Placental-fetal transmission
  • Transmission during birth (birth canal)
  • Postnatal transmission (breast milk)
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34
Q

How will patients present with infectious diseases?

A
  • Asymptomatic
  • Rash
  • Pruritus
  • Odor
  • Discharge
  • Pain
  • Mass/lesion
  • History of recurrence or medical condition, infertility
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35
Q

What is chlamydial infections due to?

A
  • C. trachomatis
  • A small gram negative bacterium that is an obligate intracellular pathogen
  • Exists in two forms
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36
Q

What is the infectious form of chlamydia called?

A
  • The elementary body which differentiates into a metabolically active form called the reticulate body
37
Q

What are the diseases caused by C. trachamatis infection associated with?

A
  • Different serotypes of the bacteria
38
Q

What serotypes cause urogenital infections and inclusion conjuctivitis?

A
  • D to K
39
Q

What serotypes cause Lymphogranuloma venereum?

A
  • L1, L2, and L3
40
Q

What serotypes cause ocular infections of children and trachoma?

A
  • A, B, and C
41
Q

What is the most common bacterial STI in the world?

A
  • Genital infection by C. trachomatis
42
Q

What is an elementary body?

A
  • Metabolically inactive infectious form in endosome
43
Q

What is a reticulate body?

A
  • Metabolically active form
44
Q

What is the clinical presentation of C. trachomatis?

A
  • Usually asymptomatic in women

- PID major complication

45
Q

What are the best tests for C. trachomatis?

A
  • Urine or swabs for nucleic acid amplification test (NAATs)
46
Q

What is Neisseria gonorrhoeae?

A
  • Aerobic bacteria with stringent growth requirements

- Organisms adhere to and invade non-ciliated epithelial cells

47
Q

How does Neisseria gonorrhoeae present?

A
  • Women are often asymptomatic
  • Untreated women may develop PID
  • Also can infect anus/rectum and pharynx
48
Q

What are some complications of PID?

A
  • Cervicitis
  • Vulvovaginal abscess
  • Fitz-Hugh-Curtis syndrome
49
Q

What is Fitz-Hugh-Curtis syndrome?

A
  • PID causes bowel obstruction, bacteremia/sepsis, peritonitis
  • Common symptoms include: severe pain in RUQ, fever, chills, headaches, and malaise
50
Q

What can disseminated gonorrhea cause?

A
  • Septic arthritis accompanied by a rash
51
Q

What is dissemination of gonorrhea associated with?

A
  • Lack of complement proteins that form the MAC
52
Q

What is syphilis?

A
  • A “chronic” sexually transmitted disease with varied clinical and pathological manifestations
  • Treponema pallidum is too slener to be seen on gram staining but can be visualized by silver stains and immunofluorescence techniques
53
Q

What lesion is associated with syphilis?

A
  • Chancre

- Occurs on the penis or scrotum in 70% of men and on the vulva or cervix in 50% of women

54
Q

What does a chancre look like?

A
  • Nontender, slightly elevate firm, reddened papule, up to several centimeters in diameter, that erodes to create a clean based shallow ulcer
  • Leads to a button like mass adjacent to the chancre
55
Q

What is seen on histologic exam for syphilis?

A
  • Proliferative endarteritis affecting small vessels with a surrounding plasma cell-rich infiltrate is characteristic of all stages of syphilis
  • Regional nodes are usually enlarged due to nonspecific acute or chronic lymphadenitis, plasma cell-rich infiltrates, or granulomas
56
Q

What is seen in primary syphilis?

A
  • Chancre
57
Q

What is seen in secondary syphilis?

A
  • Palmar rash
  • Lymphadenopathy
  • Condyloma latum
  • Neurosyphilis (asymptomatic)
58
Q

What is the stage after secondary syphilis?

A
  • Latent syphilis
59
Q

What is seen in tertiary syphilis?

A
  • Neurosyphilis: asymptomatic, meningovascular, tabes dorsalis, general paresis
  • Aortitis: aneurysms, aortic regurgitation
  • Gummas: Hepar lobatum, skin, bone, others
60
Q

What is seen in the infantile form of syphilis?

A
  • Rash
  • Osteochondritis
  • Periostitis
  • Liver and lung fibrosis
61
Q

Shat is seen in the childhood form of syphilis?

A
  • Interstitial keratitis
  • Hutchinson teeth
  • Eighth nerve deafness
62
Q

What are some ulcerative sexually transmitted infections?

A
  • Treponema pallidum
  • Chancroid
  • Granuloma inguinale
  • Chlamydia serovars L1-L3 –> Lymphogranuloma venereum
63
Q

What is a chancroid (soft chancre) caused by?

A
  • Haemophilus ducreyi

- Found in the tropics and subtropics

64
Q

Who usually has a chancroid?

A
  • People of lower socioeconomic groups

- Men who have sex with prostitutes

65
Q

When does the chancre develop in chacroid?

A
  • 4 to 7 days after inoculation
66
Q

What does the chancre look like in chancroid?

A
  • Tender erythematous papule involving external genitalia
  • In males, primary lesion is on the penis
  • In females, most lesions occur in the vagina or the periurethral area
67
Q

What happens to the primary lesion in chancroid?

A
  • It erodes and produces an irregular, painful ulcer

- Base of the ulcer is covered by shaggy, yellow-gray exudate

68
Q

What happens 1 to 2 weeks after inoculation of chancroid?

A
  • Regional lymph nodes enlarge and become tender
69
Q

What can happen if chanroid is not treated?

A
  • Enlarged nodes may erode the overlying skin to produce chronic, draining ulcers
70
Q

What is granuloma inguinale?

A
  • Sexually transmitted chronic inflammatory disease caused by Klebsiella granulomatis (minute, encapsulated coccobacilli)
71
Q

What happens in untreated cases of granuloma inguinale?

A
  • Development of extensive scarring

- Often associated with lymphatic obstruction and lymphedema of the external genitalia

72
Q

How is diagnosis of granuloma inguinale made?

A
  • Microscopic examination of smears or biopsy samples of the ulcer
73
Q

What is lymphogranuloma venereum?

A
  • L serotypes

- Sporadic in US, endemic in Africa, Asia, South American, Caribbean

74
Q

What does lymphogranuloma venereum look like?

A
  • Starts as small papule on genital mucosa or skin
  • 2-6 weeks later draining swollen nodes
  • Can cause fibrosis and strictures in anogenital tract
75
Q

What is vulvobaginal candidias?

A
  • Intense vulvovaginal pruritus, erythema, swelling, pain/dysuria/dyspareunia
  • Thick white vulvovaginal discharge described as “curd-like or cottage cheese-like”
76
Q

How is diagnosis made for vulvovaginal candidias?

A
  • Inspection
  • KOH test
  • Pap smear
77
Q

What is the pathogenesis of candidias?

A
  • It is normally there

- When you change the ecosystem (like lose the lactobacilli), it allows the yeast to infiltrate

78
Q

Where else is a candida infection seen?

A
  • Most common fungal infection in patients with AIDS and infection of the oral cavity, vagina, and esophagus are it most common clinical manifestations
79
Q

What causes trichomonas vaginalis?

A
  • Large flagellated ovoid protozoan
80
Q

What is the presentation of someone with trichomonas vaginalis?

A
  • Asymptomatic or,
  • Frothy yellow vaginal discharge
  • Dysuria
  • Dyspareunia
81
Q

What will be seen on exam with trichomonas vaginalis?

A
  • Fiery red vaginal and/or cervical mucosa (strawberry cervix)
82
Q

What is Gardnerella vaginalis?

A
  • Gram negative coccobacillus

- Main cause of bacterial vaginosis

83
Q

How do patients with gardnerella vaginalis present?

A
  • Thin, green-gray malodorous (fishy) vaginal discharge
84
Q

What doe pap smears reveal in gardnerella vaginalis?

A
  • Superficial and intermediate squamous cells covered with a shaggy coat of coccobacilli
85
Q

What is molluscum contagiosum?

A
  • Cutaneous or mucosal lesion caused by poxvirus
86
Q

How is molluscum contagiosum transmitted?

A
  • In children 2-12, through direct contact or shared articles and most commonly affects the trunk, arms, or legs
  • In adults, sexually transmitted and affect the genitals, lower abdomen, buttocks, and inner thighs
87
Q

How is diagnosis made for molluscum contagiosum?

A
  • Characteristic clinical appearance of pearly, dome-shaped papules with a dimpled center
88
Q

What are the TORCH infections?

A
  • Toxoplasma
  • Other (syphilis, HIV, listeria, VZV, parvovirus B19)
  • Rubella
  • Cytomegalovirus
  • Herpes
89
Q

What are the clinical presentations of the TORCH infections?

A
  • Fever
  • Encephalitis
  • Chorioretinitis
  • Hepatosplenomegaly
  • Pneumonitis
  • Myocarditis
  • Hemolytic anemia
  • Skin lesion

Endo/Repro (31 decks)

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