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My Reproduction > Pathology (mainly G) > Flashcards

Pathology (mainly G) Flashcards

1
Q

What is implantation bleeding?

A

fertilised egg implants in endometrial lining about 10d post ovulation but this settles and pregnancy continues

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2
Q

When is anti-D given?

A

surgical management for miscarriage, ectopic pregnancy or molar pregnancy to stop sensitisation and formation of anti-D antigen

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3
Q

What do antimuscarinic drugs do?

A

-reduce intra-vesical pressure
-increase compliance
-raise volume threshold for micturition
-reduce uninhibited contractions
…by blocking parasympathetic receptors

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4
Q

What does the drug Mirabegron do?

A

activates sympathetic receptors to increase relaxation of the bladder

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5
Q

What are the key features of the proliferative phase of the menstrual cycle?

A

mitotic figures in the stroma and the glands

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6
Q

What are the key features of the secretory phase of the menstrual cycle?

A

tortuous glands and subnuclear vacuolation

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7
Q

What are the indications for endometrial sampling?

A
  • abnormal uterine bleeding
  • investigation for infertility
  • pregnancy loss
  • assessing response to hormonal therapy
  • endometrial cancer screening in high risk patients
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8
Q

What is menorrhagia?

A

prolonged and increased menstrual flow

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9
Q

What are the pre-menopausal causes of abnormal uterine bleeding?

A
  • Pregnancy and miscarriage
  • Disordered uterine bleeding (no organic cause)
  • Endometritis
  • Polyps
  • Leiomyomas
  • Adenomyosis
  • HRT
  • Bleeding disorders
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10
Q

What is seen in pathology with miscarriage?

A

chorionic villi

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11
Q

What is seen in endometritis in pathology?

A
  • abnormal pattern in inflammatory cells
  • caused by infection or by IUD
  • uncommon
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12
Q

What is seen with polyps in pathology?

A
  • common
  • asymptomatic but bleeding or discharge
  • usually benign
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13
Q

What is seen with leiomyomas in pathology?

A
  • benign smooth muscle tumour
  • causing menorrhagia and fertility issues
  • can cause mass effect in the pelvis
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14
Q

What is adenomyosis?

A

endometrial glands and stroma within the myometrium causing long, heavy periods

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15
Q

What are the causes of post-menopausal abnormal uterine bleeding?

A
  • Atrophy
  • Endometrial polyp
  • HRT
  • Endometritis
  • Bleeding disorders
  • Endometrial carcinoma
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16
Q

What are the ways to assess the endometrium?

A
  • TVUS

- hysteroscopy

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17
Q

How is the endometrium sampled?

A

endometrial pipelle or by dilation and curettage

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18
Q

What are endometrial samples assessed for?

A
  • evidence of bleeding
  • organic benign abnormality
  • dysfunctional bleeding
  • hyperplasia/malignancy
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19
Q

What is a molar pregnancy?

A

non-viable fertilised egg implants in the uterus

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20
Q

What is a complete mole?

A

one sperm combined with an egg that has lost its DNA so only paternal DNA is there so no development occurs in the embryo

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21
Q

What is a partial mole?

A

has mother’s DNA but it is fertilised by a sperm that reduplicated itself

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22
Q

What is the risk with a complete mole?

A

develop into a choriocarcinoma

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23
Q

What is metrorrhagia?

A

regular intermenstrual bleeding

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24
Q

What is polymenorrhea?

A

more periods

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25
Q

What is polymenorrhagia?

A

increase bleeding and frequency

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26
Q

What is menometrorrhagia?

A

prolonged menses and bleeding

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27
Q

What is amenorrhea?

A

absence of menstruation for longer than 6 months

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28
Q

What is oligomenorrhoea?

A

irregular or inconsistent menstrual periods

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29
Q

What are the local organic causes of menorrhagia?

A
  • Fibroids
  • Endometrial/endocervical polyps
  • Adenomyosis
  • Cervical eversion
  • Endometrial hyperplasia
  • IUCD
  • PID
  • Endometriosis
  • Malignancy ie uterus and cervix
  • Hormone producing tumours
  • Trauma
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30
Q

What are the systemic organic causes of menorrhagia?

A
  • Endocrine eg hyper/hypothyroidism, DM, adrenal disease and prolactin disorders
  • Disorders of haemostasis
  • Liver disorders
  • Renal disease
  • Drugs
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31
Q

What are the pregnancy related causes of menorrhagia?

A
  • Miscarriage
  • Ectopic pregnancy
  • Gestational trophoblastic disease
  • Postpartum haemorrhage
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32
Q

What is infertility?

A

inability to conceive after 12 months of regular intercourse without contraception

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33
Q

How common is infertility?

A

1 in 6 couples

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34
Q

What are the two categories of infertility?

A
  • primary: never got pregnant

- secondary: previous pregnancy, miscarriage or ectopic

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35
Q

What are the initial investigations at the GP for infertility?

A
  • Progesterone day 21
  • TSH
  • Rubella immunity
  • Chlamydia screen
  • Cervical screen up to date
  • Diagnostic semen analysis
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36
Q

What do these terms mean?

  • azoospermia
  • oligozoospermia
  • asthenozoospermia
  • teratozoospermia
A
  • azoospermia = no sperm
  • oligozoospermia = low sperm count
  • asthenozoospermia = low motility
  • teratozoospermia = small sperm
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37
Q

What is done at an infertility consultation?

A
  • TVUS: look for congenital abnormalities, fibroids, endometrial polyps, PCOS, hydrosalpinx or ovarian cyst
  • HSG for tubal patency
  • Hysteroscopy if needed
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38
Q

What is the lifestyle advice for infertility?

A
  • smoking cessation
  • low alcohol
  • normal BMI
  • moderate caffeine
  • no recreational drugs
  • female take folic acid
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39
Q

What is the medication for ovulation induction?

A
  • Clomifene citrate or letrozole 1st line
  • Gonadotrophin injections
  • Laparoscopic ovarian diathermy
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40
Q

What is the process for a male issue infertility?

A
  • examination of testes
  • hormone profile
  • check karyotype
  • not much treatment except ART
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41
Q

What is the only treatment for blocked Fallopian tubes to get pregnant?

A

IVF

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42
Q

What is IVF and ICSI?

A
  • IVF= adding lots of sperm in with an egg

- ICSI= better for sperm with low motility as a needle places one single sperm into the egg

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43
Q

What are the requirements for ART?

A
  • relationship for 2y
  • female under 40y
  • non-smokers
  • female BMI <30
  • no children
  • no drug use
  • no sterilisation
  • up to 3 cycles
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44
Q

When is foetal cardiac activity usually seen from?

A

6 weeks

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45
Q

What is the pathology causing amenorrhoea?

A
  • pituitary tumour (prolactinoma or compressing tumour)
  • anorexia/stress/bulimia
  • PCOS
  • premature ovarian failure
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46
Q

What are the most common bacterial infections of the genital tract?

A

chlamydia, gonorrhoea, mycoplasma genitalium and syphilis

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47
Q

What are the most common viral infections of the genital tract?

A

HPV, genital herpes, hepatitis and HIV

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48
Q

What are the most common parasitic infections of the genital tract?

A

scabies, crabs, trichomonas vaginalis

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49
Q

What is the difference between sensitivity and specificity?

A

Sensitivity is true positives identified

Specificity is true negatives identified

50
Q

What is the normal pH of the vagina?

A

acidic 4-4.5

51
Q

What is some of the normal flora that lives in the vagina that may not be pathogenic?

A
  • lactobacillus are protective
  • lactic acid
  • beta haemolytic strep
  • candida
  • strep viridans
52
Q

What is the treatment for pubic lice?

A

malathion lotion

53
Q

What is the differential list for unilateral pelvic pain hCG positive?

A

ectopic pregnancy

54
Q

What is the differential list for unilateral pelvic pain hCG negative?

A 
appendicitis
ovarian torsion
cyst accident
fibroid degeneration
renal calculi
55
Q

What is the differential list for bilateral pelvic pain hCG negative?

A 
PID
UTI
diverticulitis
endometriosis
constipation
IBS
urinary retention
56
Q

What is the differential list for bilateral pelvic pain hCG positive?

A

miscarriage

57
Q

What is the differential diagnosis for acute menstrual bleeding?

A
  • anovulatory
  • fibroids
  • anticoagulant
  • Von Willebrand’s disease
  • on anticoagulant for PE
58
Q

What is the differential diagnosis for acute non-menstrual bleeding?

A

miscarriage
cervical cancer
endometrial cancer
vaginal trauma

59
Q

What are the investigations for acute vaginal bleeding?

A
  • FBC, CR, Coag, G&S
  • HCG
  • LFT
  • Ferritin
  • Endometrial biopsy
  • Cervical biopsy
  • Examine pad
  • US (look for thickened endometrium and fibroids)
60
Q

What is the management for acute vaginal bleeding?

A
  • ABCDE
  • Tranexamic acid
  • Mefenamic acid
  • Norethisterone
  • IUS
  • COCP
61
Q

What does the smear test involve?

A
  • 360 degree view of cervix and 5 rotations on the cervix and then swirl in the pot 10 times
  • 25-65y every 5 years
62
Q

When is voluntary withdrawal from screening allowed?

A
  • women who are virgins
  • terminally ill
  • severe learning difficulties
63
Q

What is the process of colposcopy?

A
  • speculum and colposcope with magnification to look at transformation zone
  • acetic acid and iodine staining is done and biopsy for tissue diagnosis
64
Q

How many smears are abnormal and how many of these are cancer?

A
  • 1/20 have abnormal smear

- only 1/100 of these are cancer

65
Q

What does the HPV vaccine cover?

A
  • 6,11,16 and 18

- covers for 75% of cancers and 90% genital warts

66
Q

What are the cells tested by smear test?

A

exfoliating cells

67
Q

What is the endocervix and ectocervix lined by?

A
  • ectocervix = squamous epithelium

- endocervix is = glandular epithelium

68
Q

What are the inflammatory processes in the cervix?

A

cervicitis and cervical poly

69
Q

What are the features of HPV infection histologically?

A
  • multinucleation
  • koilocytes
  • dark chromatin
70
Q

How long does it take HPV to become cancer?

A
  • to high grade lesion takes up to 3 years

- to an invasive cancer takes up to 20 years

71
Q

What is vuvlar Paget’s disease?

A
  • rare
  • causes crusting painful/itchy rash
  • intraepithelial adenocarcinoma
72
Q

What is seen on smear with candida?

A

hyphae and spores

73
Q

What is pathology in the vagina usually?

A

metastases as primary tumours are very rare here

74
Q

How does endometrial hyperplasia present?

A

abnormal bleeding eg DUB or postmenopausal bleeding

75
Q

What is the most concerning form of endometrial hyperplasia?

A

atypical has the potential to develop into malignancy

76
Q

What are the most common tumours to spread to the ovaries?

A

stomach, colon, breast and pancreas

will be small and bilateral

77
Q

What are the physical symptoms of gynae cancer?

A
  • pain
  • N+V
  • constipation
  • bleeding
  • treatment-related
  • altered body image
  • fertility issues
78
Q

What are the common causes of N+V?

A
  • motion
  • GI distension
  • head injury
  • tumour mass
  • constipation
  • drugs
  • raised ICP
  • anxiety
  • uraemia
  • hypercalcaemia
79
Q

What is the presentation of impaired gastric emptying?

A

not usually nauseated then very nauseated with large volume vomit and then they will feel much better

80
Q

What is the non-pharmacological management for N+V?

A
  • keep bowels moving
  • small meals not large
  • mouth care
  • psychological approach
  • acupuncture/acupressure
81
Q

What is the presentation of malignant bowel obstruction?

A

nausea, vomiting, pain and anorexia

82
Q

What is the management of malignant bowel obstruction?

A
  • surgery with stoma formation of proximal bowel or stenting
  • steroids (dexamethasone)
  • antiemetics (metoclopramide)
  • analgesia (opioids)
  • antisecretory agents (buscopan, octreotide)
  • laxatives (docusate or movicol)
83
Q

What is the main palliative complication in advanced gynaecologist cancer?

A

malignant bowel obstruction

84
Q

What do squamous cell cancers respond very well to?

A

radiotherapy

85
Q

What are the main parts of the body affected by chemotherapy?

A

hair, bone marrow and GI tract as these are the areas with the most rapidly dividing cells

86
Q

What is chemotherapy induced nausea treated with?

A

ondansetron and dexamethasone before chemotherapy is given

87
Q

What are the main side-effects of the drug ondansetron (for chemo nausea)?

A

danger of long QT but more commonly causes constipation and headache

88
Q

What do you always prescribe with opiates?

A

laxative and antiemetic

89
Q

What are common chemotherapy side-effects?

A
  • alopecia
  • oral mucositis
  • weight loss
  • loss of appetite
  • diarrhoea
  • constipation
90
Q

What are the life threatening side-effects of chemotherapy?

A
  • myelosuppression leading to neutropenic sepsis
  • bleeding
  • anaemia
91
Q

What is the main differential for temperature and patient on chemotherapy?

A

neutropenic sepsis

92
Q

What drug is given to increase power of contractions in labour?

A

IV oxytocin

93
Q

What are the differentials for a pelvic mass?

A
  • Uterus: fibroids, adenomyosis, leiomyosarcoma, carcinosarcoma but most commonly is pregnancy
  • Ovary: ovarian cyst, endometrioma, ovarian cancer
  • Cervical: malignancy causing mass
  • Tubal: hematosalpinx, hydrosalpinx, pyosalpinx, TO abscess
  • Non-gynae: bladder distension, bowel tumours, appendicular abscess, pelvic kidney etc
  • Ascites: many causes including malignancy
94
Q

Where are metastatic ovarian tumours from?

A

breast, pancreas, stomach and GI

95
Q

What are the features of metastatic ovarian tumours?

A
  • called a krukenberg tumour
  • signet ring histology
  • suspect if Ca125:CEA ratio is <25
96
Q

What are the options for breast histopathology?

A
  • diagnostic: needle core biopsy, vacuum assisted, skin biopsy and incisional biopsy
  • therapeutic: vacuum assisted excision, excision biopsy or resection of cancer
97
Q

What can be the results of a core biopsy of the breast?

A

B1-B5 which ranges from normal to malignant

98
Q

What is a wide local excision vs a mastectomy?

A
  • wide local excision= removing a pathology with margins

- mastectomy= total removal of breast with axillary tail

99
Q

What are the features of mammography?

A
  • Xray low strength
  • uses breast compression to make uniform thickness for exposure and to make image clearer
  • CC and oblique views: white is breast and dark is fat
100
Q

What are the advantages of mammography?

A
  • images the whole of both breasts
  • high sensitivity for DCIS and invasive cancer
  • screening reduces population mortality
101
Q

What are the disadvantages of mammography?

A
  • decreased sensitivity for dense breasts
  • uncomfortable
  • uses ionising radiation (very low)
102
Q

What are some add ons for mammography?

A
  • Tomosynthesis: clearer images and detects spiculated cancers
  • Contrast enhanced spectral mammography: cancer lights up with contrast due to angiogenesis
103
Q

What is US breast used for?

A
  • palpable masses as it can tell a solid mass from a cyst
  • during pregnancy
  • for biopsy
104
Q

What are the advantages and disadvantages of US breast?

A 
\+comfortable
\+doesn’t use radiation
\+good for detecting cancer
\+cheap and quick 
-low sensitivity for DCIS
-low specificity for screening
105
Q

What are some add ons for US breast?

A
  • Strain elastography: colour map of stiffness but this is poor reproducibility between users
  • Shear wave elastography: quantitative measure of stiffness to determine if something is benign or malignant so no need for biopsy
106
Q

What are the features of MRI breast?

A
  • best for detecting breast cancer
  • used for lobular cancers to ascertain how big they are
  • track progress of neoadjuvant chemo
  • for Pagets
  • for cancer you can’t see on mammography
107
Q

What are the types of breast biopsy?

A
  • core (main option)

- vacuum (for calcification or when there is no discrete lump)

108
Q

What can be used to reduce breast surgery extent?

A

neoadjuvant treatment: chemotherapy, Herceptin and endocrine treatment

109
Q

What are the options for breast surgery?

A

-wide local excision
-image guided local excision
-oncoplastic surgery
-mastectomy
localisation with wires or magnetic seeds

110
Q

What are the types of oncoplastic breast surgery?

A

therapeutic mastopexy, breast reduction or volume replacement

111
Q

What are the options for breast reconstruction?

A
  • latissimus dorsi, stomach, glutes

- implants (this can have infection or distortion or movement so often revision surgery needed)

112
Q

What are the differentials for a breast lump in different age groups?

A
  • fibroadenoma in young <30
  • middle is cyst 30-50
  • postmenopause is cancer >50
113
Q

What is gynaecomastia?

A

ductal growth without lobular development in males

114
Q

What is gynaecomastia caused by?

A

exogenous/endogenous hormones, cannabis, prescription drugs, liver disease

115
Q

What is hamartoma?

A

developmental abnormality in the breast

116
Q

What are scleroising lesions of the breast?

A

benign, disorderly proliferations of acini and stroma

  • sclerosing adenosis (pain, tenderness, seen with other changes in the breast)
  • radial scar (common, can be bilateral, mimic carcinoma, excise)
117
Q

What are the inflammatory lesions of the breast?

A
  • fat necrosis (local trauma, warfarin, foamy macrophages then healing and scarring)
  • duct ectasia (pain, nipple discharge, associated with smoking, fistula can form)
  • acute mastitis (duct ectasia and lactation at the same time, give antibiotics and drain)
118
Q

What are the benign tumour of the breast?

A
  • Phyllodes tumour (ages 40-50, stromal overgrowth, can have local recurrence if not properly removed)
  • Papillary lesions eg intraductal papilloma
119
Q

What can radiotherapy cause in the breast?

A

angiosarcoma

120
Q

What are the tumours that can metastasis to the breast?

A
  • carcinoma (kidney, ovarian serous or bronchial)
  • malignant melanoma
  • soft tissue tumours
121
Q

What does ANDI encompass?

A

ANDI=aberrations in the normal development and involution of the breast

  • Fibroadenoma
  • Cysts
  • Papilloma
  • Pain isn’t associated with breast cancer
  • Nipple discharge

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