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
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
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
4
Q
What does the drug Mirabegron do?
A
activates sympathetic receptors to increase relaxation of the bladder
5
Q
What are the key features of the proliferative phase of the menstrual cycle?
A
mitotic figures in the stroma and the glands
6
Q
What are the key features of the secretory phase of the menstrual cycle?
A
tortuous glands and subnuclear vacuolation
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
8
Q
What is menorrhagia?
A
prolonged and increased menstrual flow
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
10
Q
What is seen in pathology with miscarriage?
A
chorionic villi
11
Q
What is seen in endometritis in pathology?
A
- abnormal pattern in inflammatory cells
- caused by infection or by IUD
- uncommon
12
Q
What is seen with polyps in pathology?
A
- common
- asymptomatic but bleeding or discharge
- usually benign
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
14
Q
What is adenomyosis?
A
endometrial glands and stroma within the myometrium causing long, heavy periods
15
Q
What are the causes of post-menopausal abnormal uterine bleeding?
A
- Atrophy
- Endometrial polyp
- HRT
- Endometritis
- Bleeding disorders
- Endometrial carcinoma
16
Q
What are the ways to assess the endometrium?
A
- TVUS
- hysteroscopy
17
Q
How is the endometrium sampled?
A
endometrial pipelle or by dilation and curettage
18
Q
What are endometrial samples assessed for?
A
- evidence of bleeding
- organic benign abnormality
- dysfunctional bleeding
- hyperplasia/malignancy
19
Q
What is a molar pregnancy?
A
non-viable fertilised egg implants in the uterus
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
21
Q
What is a partial mole?
A
has mother’s DNA but it is fertilised by a sperm that reduplicated itself
22
Q
What is the risk with a complete mole?
A
develop into a choriocarcinoma
23
Q
What is metrorrhagia?
A
regular intermenstrual bleeding
24
Q
What is polymenorrhea?
A
more periods
25
What is polymenorrhagia?
increase bleeding and frequency
26
What is menometrorrhagia?
prolonged menses and bleeding
27
What is amenorrhea?
absence of menstruation for longer than 6 months
28
What is oligomenorrhoea?
irregular or inconsistent menstrual periods
29
What are the local organic causes of menorrhagia?
- Fibroids
- Endometrial/endocervical polyps
- Adenomyosis
- Cervical eversion
- Endometrial hyperplasia
- IUCD
- PID
- Endometriosis
- Malignancy ie uterus and cervix
- Hormone producing tumours
- Trauma
30
What are the systemic organic causes of menorrhagia?
- Endocrine eg hyper/hypothyroidism, DM, adrenal disease and prolactin disorders
- Disorders of haemostasis
- Liver disorders
- Renal disease
- Drugs
31
What are the pregnancy related causes of menorrhagia?
- Miscarriage
- Ectopic pregnancy
- Gestational trophoblastic disease
- Postpartum haemorrhage
32
What is infertility?
inability to conceive after 12 months of regular intercourse without contraception
33
How common is infertility?
1 in 6 couples
34
What are the two categories of infertility?
- primary: never got pregnant
| - secondary: previous pregnancy, miscarriage or ectopic
35
What are the initial investigations at the GP for infertility?
- Progesterone day 21
- TSH
- Rubella immunity
- Chlamydia screen
- Cervical screen up to date
- Diagnostic semen analysis
36
What do these terms mean?
- azoospermia
- oligozoospermia
- asthenozoospermia
- teratozoospermia
- azoospermia = no sperm
- oligozoospermia = low sperm count
- asthenozoospermia = low motility
- teratozoospermia = small sperm
37
What is done at an infertility consultation?
- TVUS: look for congenital abnormalities, fibroids, endometrial polyps, PCOS, hydrosalpinx or ovarian cyst
- HSG for tubal patency
- Hysteroscopy if needed
38
What is the lifestyle advice for infertility?
- smoking cessation
- low alcohol
- normal BMI
- moderate caffeine
- no recreational drugs
- female take folic acid
39
What is the medication for ovulation induction?
- Clomifene citrate or letrozole 1st line
- Gonadotrophin injections
- Laparoscopic ovarian diathermy
40
What is the process for a male issue infertility?
- examination of testes
- hormone profile
- check karyotype
- not much treatment except ART
41
What is the only treatment for blocked Fallopian tubes to get pregnant?
IVF
42
What is IVF and ICSI?
- 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
43
What are the requirements for ART?
- relationship for 2y
- female under 40y
- non-smokers
- female BMI <30
- no children
- no drug use
- no sterilisation
- up to 3 cycles
44
When is foetal cardiac activity usually seen from?
6 weeks
45
What is the pathology causing amenorrhoea?
- pituitary tumour (prolactinoma or compressing tumour)
- anorexia/stress/bulimia
- PCOS
- premature ovarian failure
46
What are the most common bacterial infections of the genital tract?
chlamydia, gonorrhoea, mycoplasma genitalium and syphilis
47
What are the most common viral infections of the genital tract?
HPV, genital herpes, hepatitis and HIV
48
What are the most common parasitic infections of the genital tract?
scabies, crabs, trichomonas vaginalis
49
What is the difference between sensitivity and specificity?
Sensitivity is true positives identified
| Specificity is true negatives identified
50
What is the normal pH of the vagina?
acidic 4-4.5
51
What is some of the normal flora that lives in the vagina that may not be pathogenic?
- lactobacillus are protective
- lactic acid
- beta haemolytic strep
- candida
- strep viridans
52
What is the treatment for pubic lice?
malathion lotion
53
What is the differential list for unilateral pelvic pain hCG positive?
ectopic pregnancy
54
What is the differential list for unilateral pelvic pain hCG negative?
```
appendicitis
ovarian torsion
cyst accident
fibroid degeneration
renal calculi
```
55
What is the differential list for bilateral pelvic pain hCG negative?
```
PID
UTI
diverticulitis
endometriosis
constipation
IBS
urinary retention
```
56
What is the differential list for bilateral pelvic pain hCG positive?
miscarriage
57
What is the differential diagnosis for acute menstrual bleeding?
- anovulatory
- fibroids
- anticoagulant
- Von Willebrand’s disease
- on anticoagulant for PE
58
What is the differential diagnosis for acute non-menstrual bleeding?
miscarriage
cervical cancer
endometrial cancer
vaginal trauma
59
What are the investigations for acute vaginal bleeding?
- FBC, CR, Coag, G&S
- HCG
- LFT
- Ferritin
- Endometrial biopsy
- Cervical biopsy
- Examine pad
- US (look for thickened endometrium and fibroids)
60
What is the management for acute vaginal bleeding?
- ABCDE
- Tranexamic acid
- Mefenamic acid
- Norethisterone
- IUS
- COCP
61
What does the smear test involve?
- 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
When is voluntary withdrawal from screening allowed?
- women who are virgins
- terminally ill
- severe learning difficulties
63
What is the process of colposcopy?
- speculum and colposcope with magnification to look at transformation zone
- acetic acid and iodine staining is done and biopsy for tissue diagnosis
64
How many smears are abnormal and how many of these are cancer?
- 1/20 have abnormal smear
| - only 1/100 of these are cancer
65
What does the HPV vaccine cover?
- 6,11,16 and 18
| - covers for 75% of cancers and 90% genital warts
66
What are the cells tested by smear test?
exfoliating cells
67
What is the endocervix and ectocervix lined by?
- ectocervix = squamous epithelium
| - endocervix is = glandular epithelium
68
What are the inflammatory processes in the cervix?
cervicitis and cervical poly
69
What are the features of HPV infection histologically?
- multinucleation
- koilocytes
- dark chromatin
70
How long does it take HPV to become cancer?
- to high grade lesion takes up to 3 years
| - to an invasive cancer takes up to 20 years
71
What is vuvlar Paget's disease?
- rare
- causes crusting painful/itchy rash
- intraepithelial adenocarcinoma
72
What is seen on smear with candida?
hyphae and spores
73
What is pathology in the vagina usually?
metastases as primary tumours are very rare here
74
How does endometrial hyperplasia present?
abnormal bleeding eg DUB or postmenopausal bleeding
75
What is the most concerning form of endometrial hyperplasia?
atypical has the potential to develop into malignancy
76
What are the most common tumours to spread to the ovaries?
stomach, colon, breast and pancreas
| will be small and bilateral
77
What are the physical symptoms of gynae cancer?
- pain
- N+V
- constipation
- bleeding
- treatment-related
- altered body image
- fertility issues
78
What are the common causes of N+V?
- motion
- GI distension
- head injury
- tumour mass
- constipation
- drugs
- raised ICP
- anxiety
- uraemia
- hypercalcaemia
79
What is the presentation of impaired gastric emptying?
not usually nauseated then very nauseated with large volume vomit and then they will feel much better
80
What is the non-pharmacological management for N+V?
- keep bowels moving
- small meals not large
- mouth care
- psychological approach
- acupuncture/acupressure
81
What is the presentation of malignant bowel obstruction?
nausea, vomiting, pain and anorexia
82
What is the management of malignant bowel obstruction?
- surgery with stoma formation of proximal bowel or stenting
- steroids (dexamethasone)
- antiemetics (metoclopramide)
- analgesia (opioids)
- antisecretory agents (buscopan, octreotide)
- laxatives (docusate or movicol)
83
What is the main palliative complication in advanced gynaecologist cancer?
malignant bowel obstruction
84
What do squamous cell cancers respond very well to?
radiotherapy
85
What are the main parts of the body affected by chemotherapy?
hair, bone marrow and GI tract as these are the areas with the most rapidly dividing cells
86
What is chemotherapy induced nausea treated with?
ondansetron and dexamethasone before chemotherapy is given
87
What are the main side-effects of the drug ondansetron (for chemo nausea)?
danger of long QT but more commonly causes constipation and headache
88
What do you always prescribe with opiates?
laxative and antiemetic
89
What are common chemotherapy side-effects?
- alopecia
- oral mucositis
- weight loss
- loss of appetite
- diarrhoea
- constipation
90
What are the life threatening side-effects of chemotherapy?
- myelosuppression leading to neutropenic sepsis
- bleeding
- anaemia
91
What is the main differential for temperature and patient on chemotherapy?
neutropenic sepsis
92
What drug is given to increase power of contractions in labour?
IV oxytocin
93
What are the differentials for a pelvic mass?
- 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
Where are metastatic ovarian tumours from?
breast, pancreas, stomach and GI
95
What are the features of metastatic ovarian tumours?
- called a krukenberg tumour
- signet ring histology
- suspect if Ca125:CEA ratio is <25
96
What are the options for breast histopathology?
- diagnostic: needle core biopsy, vacuum assisted, skin biopsy and incisional biopsy
- therapeutic: vacuum assisted excision, excision biopsy or resection of cancer
97
What can be the results of a core biopsy of the breast?
B1-B5 which ranges from normal to malignant
98
What is a wide local excision vs a mastectomy?
- wide local excision= removing a pathology with margins
| - mastectomy= total removal of breast with axillary tail
99
What are the features of mammography?
- 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
What are the advantages of mammography?
- images the whole of both breasts
- high sensitivity for DCIS and invasive cancer
- screening reduces population mortality
101
What are the disadvantages of mammography?
- decreased sensitivity for dense breasts
- uncomfortable
- uses ionising radiation (very low)
102
What are some add ons for mammography?
- Tomosynthesis: clearer images and detects spiculated cancers
- Contrast enhanced spectral mammography: cancer lights up with contrast due to angiogenesis
103
What is US breast used for?
- palpable masses as it can tell a solid mass from a cyst
- during pregnancy
- for biopsy
104
What are the advantages and disadvantages of US breast?
```
+comfortable
+doesn’t use radiation
+good for detecting cancer
+cheap and quick
-low sensitivity for DCIS
-low specificity for screening
```
105
What are some add ons for US breast?
- 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
What are the features of MRI breast?
- 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
What are the types of breast biopsy?
- core (main option)
| - vacuum (for calcification or when there is no discrete lump)
108
What can be used to reduce breast surgery extent?
neoadjuvant treatment: chemotherapy, Herceptin and endocrine treatment
109
What are the options for breast surgery?
-wide local excision
-image guided local excision
-oncoplastic surgery
-mastectomy
localisation with wires or magnetic seeds
110
What are the types of oncoplastic breast surgery?
therapeutic mastopexy, breast reduction or volume replacement
111
What are the options for breast reconstruction?
- latissimus dorsi, stomach, glutes
| - implants (this can have infection or distortion or movement so often revision surgery needed)
112
What are the differentials for a breast lump in different age groups?
- fibroadenoma in young <30
- middle is cyst 30-50
- postmenopause is cancer >50
113
What is gynaecomastia?
ductal growth without lobular development in males
114
What is gynaecomastia caused by?
exogenous/endogenous hormones, cannabis, prescription drugs, liver disease
115
What is hamartoma?
developmental abnormality in the breast
116
What are scleroising lesions of the breast?
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
What are the inflammatory lesions of the breast?
- 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
What are the benign tumour of the breast?
- Phyllodes tumour (ages 40-50, stromal overgrowth, can have local recurrence if not properly removed)
- Papillary lesions eg intraductal papilloma
119
What can radiotherapy cause in the breast?
angiosarcoma
120
What are the tumours that can metastasis to the breast?
- carcinoma (kidney, ovarian serous or bronchial)
- malignant melanoma
- soft tissue tumours
121
What does ANDI encompass?
ANDI=aberrations in the normal development and involution of the breast
- Fibroadenoma
- Cysts
- Papilloma
- Pain isn’t associated with breast cancer
- Nipple discharge
