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Year 2 RE > Pathology of the Female Reproductive Tract Part 1 > Flashcards

Pathology of the Female Reproductive Tract Part 1 Flashcards

1
Q

What is the 3rd most common cause of death in women worldwide?

1 - cervical cancer
2 - CVD
3 - breast cancer
4 - lung cancer

A

1 - cervical cancer

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2
Q

Cervical cancer is the 3rd most common cause of deaths in women worldwide. What is the most common type of cervical cancer?

1 - columnar cell carcinoma
2 - squamous cell carcinoma
3 - vaginal cell carcinoma
4 - uterine cell carcinoma

A

2 - squamous cell carcinoma

- accounts for 75%, 2nd is adenocarcinoma

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3
Q

Cervical cancer is the 3rd most common cause of deaths in women worldwide. When a patient has cervical cancer where is the cancer likely to metastasise?

1 - bladder, rectum, pelvic lymph nodes
2 - pancreas, rectum, pelvic lymph nodes
3 - bladder, liver, pelvic lymph nodes
4 - femur, rectum, pelvic lymph nodes

A

1 - bladder, rectum, pelvic lymph nodes

  • bladder causing urinary frequency, dysuria and haematuria
  • rectum causes constipation
  • pelvic lymph nodes causes pelvic pain
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4
Q

Cervical cancer is the 3rd most common cause of death worldwide. Why does it have a higher prevalence in developing countries?

A
  • poorer screening process
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5
Q

What is human papillomavirus (HPV)?

A
  • group of non-enveloped DNA viruses
  • specifically infect human epithelial cells
  • can cause genital warts or cancer
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6
Q

The human papillomavirus (HPV) is a very common group of viruses that can cause genital warts or cancer. What are some common risk factors for contracting HPV?

A
  • multiple sexual partners without protection
  • prolonged infection
  • immunosuppression
  • smoking (twice as likely to have cervical cancer if smoking)
  • prolonged use of COCP > 5 years
  • having many children >3
  • low socio economic background
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7
Q

Which of the following are risk factors for the development of cervical/vulval intraepithelial neoplasia?

  • intraepithelial = abnormal cells present on the surface epithelial tissue of the cervix and have not grown past that surface layer
  • neoplasia = abnormal growth of cells
1 = HPV infection				 
2 = High Fat diet 				
3 = Early age of first intercourse	
4 = Multiple sexual partners		
5 = Excessive alcohol consumption	
6 = Smoking
A 
1 = HPV infection (type of HPV virus)			 
4 = Multiple sexual partners			
6 = Smoking
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8
Q

If you contract the human papillomavirus (hpv) what happens in most cases?

1 - patient becomes infected and this develops into cervical cancer
2 - patient becomes infected but immune system eliminates virus within months
3 - patient becomes infected but immune system cannot eliminates virus and virus persists
4 - patient becomes infected and then becomes pre-cancerous as immune system did not kill it

A

2 - patient becomes infected but immune system eliminates virus within months

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9
Q

If you contract the human papillomavirus (HPV) the majority of patients becomes infected but the immune system eliminates virus within months. However, if the infection persists what can this cause?

1 - cervical cancer
2 - endometrial cancer
3 - squamous intraepithelial lesions (SIL) also called cervical intraepithelial lesions (CIL)
4 - HPV remains dormant until patient is immunocompromised

A

3 - squamous intraepithelial lesions (SIL) also called cervical intraepithelial lesions (CIL)

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10
Q

If you contract the human papillomavirus (HPV) the majority of patients becomes infected but the immune system eliminates virus within months. However, if the infection persists this can cause squamous intraepithelial lesions (SIL) also called cervical intraepithelial lesions (CIL). What are SILs a precursor of?

A
  • invasive cervical carcinomas
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11
Q

If you contract the human papillomavirus (hpv) multiple times and the tissues becomes pre-cancerous, does that mean it will automatically become cancerous?

A
  • no

- could become cancerous or just remain with the infection, but not pre-cancerous

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12
Q

If you contract the human papillomavirus (hpv) multiple times what can determine if the cervical tissue then becomes cancerous?

A
  • polymorphisms in major histocompatibility complex
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13
Q

If you contract the human papillomavirus (hpv) multiple times the presence of polymorphisms in major histocompatibility complex can determine if the cervical tissue then becomes cancerous. What risk factors can then determine if the pre-cancerous tissues then becomes cancerous?

A 
1 - HPV infection	
2 - multiple sexual partners		
3 - smoking
4 - nutrition
5 - multi-parity (multiple child births)
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14
Q

What is squamous intraepithelial lesions (SIL) also called cervical intraepithelial neoplasia (CIN)?

1 - lesion in squamous epithelial cells leading to abnormal growth of basal cells at the cervix
2 - lesion in columnar epithelial cells leading to abnormal growth of basal cells at the cervix
3 - lesion in squamous epithelial cells leading to cancer
4 - lesion in uterine epithelial cells leading to abnormal growth of basal cells

A

1 - lesion in squamous epithelial cells leading to abnormal growth of basal cells at the cervix

  • could potentially lead to cervical cancer
  • SIL I-III same as CIN I-III determines the level of affected epithelial cells of the cervix
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15
Q

Which of the following are risk factors for the development of cervical intraepithelial neoplasia?

BRCA mutation positive		
Sun exposure			
Immunocompromise		
Tampon use				
Low socioecomonic status		
Lack of physical exercise
A

3 - Immunocompromised

5 - Low socio-economic status

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16
Q

What is the basic cell type of the ectocervix?

A
  • non-keratinising stratified squamous epithelial cells

- resistant to low pH of the vagina

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17
Q

What is the basic cell type of the endocervix?

A
  • columnar epithelial cells

- secrete mucus

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18
Q

The basic cell type of the endocervix is columnar epithelial cells that secrete mucus. What happens to the columnar epithelial cells if they are exposed to the acidic pH of the vagina?

1 - undergo hyperplasia
2 - undergo hypertrophy
3 - undergo metaplasia
4 - undergo dysplasia

A

3 - undergo metaplasia

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19
Q

What is metaplasia?

A
  • replacement of one differentiated somatic cell type with another differentiated somatic cell type in the same tissue
  • cervix cells turn from columnar to squamous
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20
Q

The basic cell type of the endocervix is columnar epithelial cells that secrete mucus. If the columnar epithelial cells are exposed to the acidic pH of the vagina they undergo metaplasia, which is the change from one cell type to another (columnar to squamous). Alternatively, if a patient is infected with human papillomavirus (HPV), what can happen to the cells of the cervix?

A
  • cells change in a gene mutated manner

- called dysplasia (abnormal development of cells)

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21
Q

What is the name of the junction where the endocervix and ectocervix meet?

1 - transformation zone
2 - endocervix
3 - ectocervix
4 - squamocolumnar junction

A

4 - squamocolumnar junction

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22
Q

The junction where the endocervix and ectocervix meet is called the squamocolumnar junction SCJ). The position of this changes throughout a woman’s life. During childhood, where the SCJ will be in its original position, what is the location of the SCJ?

1 - very close to the external OS below the internal OS
2 - located in the ectocervix far away from the external OS
3 - progressively moves closer to the external OS
4 - retracts and moves back into the endocervical canal

A

1 - very close to the external OS below the internal OS

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23
Q

The junction where the endocervix and ectocervix meet is called the squamocolumnar junction SCJ). The position of this changes throughout a woman’s life. Following puberty and as the woman moves into pregnancy bearing age, where does the SCJ move to from its original position?

1 - very close to the external OS below the internal OS
2 - located in the ectocervix far away from the external OS
3 - progressively moves closer to the external OS
4 - retracts and moves back into the endocervical canal

A

2 - located in the ectocervix far away from the external OS

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24
Q

The junction where the endocervix and ectocervix meet is called the squamocolumnar junction SCJ). The position of this changes throughout a woman’s life. During menopause, what is the location of the SCJ?

1 - very close to the external OS below the internal OS
2 - located in the ectocervix far away from the external OS
3 - progressively moves closer to the external OS
4 - retracts and moves back into the endocervical canal

A

4 - retracts and moves back into the endocervical canal

- due to lack of estrogen

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25
Q

The junction where the endocervix and ectocervix meet is called the squamocolumnar junction SCJ). The position of this changes throughout a woman’s life. During perimenopause, what is the location of the SCJ?

1 - very close to the external OS below the internal OS
2 - located in the ectocervix far away from the external OS
3 - progressively moves closer to the external OS
4 - retracts and moves back into the endocervical canal

A

3 - progressively moves closer to the external OS

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26
Q

Metaplasia is the term used to describe when one cell type changes into another, and this occurs when the columnar cells become squamous cells when exposed to the acidic vaginal pH. This causes the the squamocolumnar junction (where endocervical (columnar) and ectocervix (squamous) meet to move throughout a woman’s life. What is the movement of the squamocolumnar junction called?

1 - eversion
2 - inversion
3 - migration
4 - hyperplasia

A

1 - eversion

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27
Q

Metaplasia is the term used to describe when one cell type changes into another, and this occurs when the columnar cells become squamous cells when exposed to the acidic vaginal pH. This causes the the squamocolumnar junction (where endocervical (columnar) and ectocervix (squamous) meet to move throughout a woman’s life. What is the movement of the squamocolumnar junction called?

1 - eversion
2 - inversion
3 - migration
4 - hyperplasia

A

1 - eversion

28
Q

What is the most common site for development of cervical squamous neoplasia?

1 - transformation zone
2 - endocervix
3 - ectocervix
4 - squamocolumnar junction

A

1 - transformation zone

29
Q

What is dyskaryosis?

1 - change in cervical cells appearance, increase cytoplasmic:nuclear ratio, hyperchromatic
2 - change in cervical cells appearance, increase nuclear:cytoplasmic ratio, hyperchromatic
3 - change in cervical cells appearance, increase in cell size
4 - change in cervical cells appearance, decrease in cell size and nucleus, hyperchromatic

A

2 - change in cervical cells appearance, increase nuclear:cytoplasmic ratio, hyperchromatic
- characterised by hyperchromatic (darker than usual) nuclei and/or irregular nuclear chromatin

30
Q

Cervical intraepithelial neoplasia (CIN), also called squamous intraepithelial lesions (SIL) is abnormal growth of cells from the basal epithelial of the cervix that could potentially lead to cervical cancer. CIN I-III is used to determine the level of affected epithelial cells of the cervix and ranges from mild to moderate. Match the levels of cells affected in CIN1, CIN II and CIN III using the labels below:

  • changes in basal 1/3 of epithelial layer of cervix
  • changes in basal 2/3 of epithelial layer of cervix
  • changes in most or all of the epithelial layer of cervix
A
  • CIN I = changes in basal 1/3 of epithelial layer of cervix = Low Grade
  • CIN II = changes in basal 2/3 of epithelial layer of cervix = High Grade
  • CIN III = changes in most or all of the epithelial layer of cervix = High Grade
31
Q

In a woman who has persistent human papillomavirus (HPV) what % do the following for cervical intraepithelial neoplasia (CIN) I?

regress
persist
progress
become invasive carcinoma

A
  • regress = 57%
  • persist = 32%
  • progress = 11%
  • become invasive carcinoma = 1%
32
Q

In a woman who has persistent human papillomavirus (HPV) what % do the following for cervical intraepithelial neoplasia (CIN) II?

regress
persist
progress
become invasive carcinoma

A
  • regress = 43%
  • persist = 35%
  • progress = 22%
  • become invasive carcinoma = 5%
33
Q

In a woman who has persistent human papillomavirus (HPV) what % do the following for cervical intraepithelial neoplasia (CIN) III?

regress
persist
become invasive carcinoma

A
  • regress = 32%
  • persist = 56%
  • become invasive carcinoma = >12%
34
Q

Does a cervical screening diagnose cancer?

A
  • no
  • just identifies the pre-malignant phase only 70% sensitive
  • not 100% sensitive
35
Q

At what age do women begin getting cervical smear tests for screening?

1 - 18 y/o
2 - 25 y/o
3 - 35 y/o
4 - >40 y/o

A

2 - 25 y/o

36
Q

How often does cervical screening occur for the following:

  • women - 25-49 y/o
  • women - 49-64 y/o
A
  • women - 25-49 y/o = every 3 years

- women - 49-64 y/o = every 5 years

37
Q

The findings from a smear test can be scored by cytology, and this falls into 3 categories, what are they?

1 - unsuitable, negative, abnormal
2 - ok, good, bad
3 - inadequate, negative, abnormal
4 - inadequate, positive, negative

A

3 - inadequate, negative, abnormal

  • inadequate (not enough sample, blood interfered etc..)
  • negative = no abnormalities
  • abnormal = requires further investigation and/or closer monitoring
38
Q

The findings from a smear test can be scored by cytology can be scored as inadequate, negative and abnormal. What are the categories of abnormal?

A
  • borderline changes in squamous or endocervical cells
  • low-grade dyskaryosis
  • high-grade dyskaryosis (moderate)
  • high-grade dyskaryosis (severe)
  • invasive squamous cell carcinoma
  • glandular neoplasia
39
Q

If patients test positive for human papillomavirus (HPV) but they have a negative cytology report from their smear test, what should happen to the future test for HPV?

1 - screened again in 12 months
2 - return to normal screening programme depending on their age
3 - screened again in 6 months
4 - screened again in 24 months

A

1 - screened again in 12 months

40
Q

If patients test positive for human papillomavirus (HPV) but they have a negative cytology report from their smear test, they should have a further HPV tests at 12 months. If the patient is still HPV positive, but the cytology again comes back negative, what should happen to their screening for HPV and smear test routine?

1 - screened again in 12 months
2 - return to normal screening programme depending on their age
3 - screened again in 6 months
4 - screened again in 24 months

A

1 - screened again in 12 months

41
Q

If patients test positive for human papillomavirus (HPV) but they have a negative cytology report from their smear test, and they have had 2 further tests, each 12 months apart and both have come back positive for HPV buy negative cytology, what should be the next step for this patient?

1 - screened again in 12 months
2 - return to normal screening programme depending on their age
3 - screened again in 6 months
4 - refer for colposcopy

A

4 - refer for colposcopy

42
Q

If patients test negative for human papillomavirus (HPV) after 2 previous smear tests where both have been positive for HPV and the cytology is negative, what should be the next step for this patient?

1 - screened again in 12 months
2 - return to normal screening programme depending on their age
3 - screened again in 6 months
4 - refer for colposcopy

A

2 - return to normal screening programme depending on their age

43
Q

If patients test positive for human papillomavirus (HPV) and the cytology report is borderline dyskaryosis or worse at 12 or 24 month follow up, what test should be the next step for this patient?

1 - screened again in 12 months
2 - return to normal screening programme depending on their age
3 - screened again in 6 months
4 - refer for colposcopy

A

4 - refer for colposcopy

44
Q

All patients who are positive for human papillomavirus (HPV) and have abnormal cytology should be referred for what test?

1 - blood tests to test for HPV
2 - return to normal screening programme depending on their age
3 - screened again in 6 months
4 - refer for colposcopy

A

4 - colposcopy

45
Q

What is the colposcopy?

1 - larger speculum to help visualise the cervix
2 - larger sample collection of the cervix
3 - colposcope providing magnification of cervix and biopsy
4 - biopsy of the cervix using guided ultrasound

A

3 - colposcope providing magnification of cervix and biopsy

46
Q

During a colposcopy a colposcope will be used to provide a magnification view of the cervix. At the same time the doctor can insert a speculum which will allow a further biopsy for analysis. This is assisted using a citric/acetic solution which will then be sprayed onto the cervix. We may see some tissue then become white. Why would the tissue become white?

1 - cancerous/pre-cancerous cells increase citric uptake and appear white
2 - cancerous/pre-cancerous cells do not increase citric uptake and appear darker
3 - used to wash away mucus and give better view of the cells

A

2 - cancerous/pre-cancerous cells do not increase citric uptake and appear darker

  • abnormalities are present
  • high mitotic cells replication and glycogen stores so citric acid is taken up causing them to become white
47
Q

During a colposcopy a colposcope will be used to provide a magnification view of the cervix. At the same time the doctor can insert a speculum which will allow a further biopsy for analysis. This is assisted using a citric/acetic solution which will then be sprayed onto the cervix. We may see some tissue then become white. Cancerous/pre-cancerous cells are high mitotic replicating cells and glycogen stores so citric acid is taken up causing them to become white. What is the name given to this?

1 - acid-white
2 - acetowhite
3 - alwhite
4 - citric-white

A

2 - acetowhite

48
Q

During a colposcopy a colposcope will be used to provide a magnification view of the cervix. At the same time the doctor can insert a speculum which will allow a further biopsy for analysis. This is assisted using a citric/acetic solution which will then be sprayed onto the cervix. We may see some tissue then become white due to cancerous cells being high mitotic replicating cells and glycogen stores so citric acid is taken up causing them to become white. If there are small areas of acetowhite then they may do a punch biopsy. However, if the doctor suspects CIN II or III what would be performed?

1 - large loop excision of the transformation zone
2 - repeat colposcopy in 6 months
3 - repeat colposcopy in 12 months
4 - return to normal cervical screening pathway

A

1 - large loop excision of the transformation zone

- large sample removed for cytology and histology

49
Q

During screening for HPV, if someone is high risk for HPV and this is confirmed what sample is taken?

1 - blood sample
2 - swab is taken
3 - liquid based cytology
4 - large Loop Excision of the Transformational Zone

A

3 - liquid based cytology

  • this approach is able to detect early cervical intra-epithelial neoplasia (CIN)
  • DOES NOT DIAGNOSE THOUGH AND USED AS A TRIAGE
50
Q

During screening for HPV, if someone is high risk for HPV and this is confirmed what method needs to be used to diagnose the patient?

1 - blood sample
2 - colposcopy (could include punch biopsy or LLETZ)
3 - liquid based cytology
4 - large Loop Excision of the Transformational Zone (LLETZ)

A

2 - colposcopy (could include punch biopsy or LLETZ)

51
Q

What are glandular cells of the cervix?

A
  • cells that makes mucus

- located on the inner part of the cervix

52
Q

Glandular cells of the cervix are cells that make mucus that are located on the inner part of the cervix. What is cervical glandular intraepithelial neoplasia (CGIN)1?

1 - abnormal dysplasia of glandular cells
2 - normal glandular cells but positive HPV
3 - normal glandular cells but elevated blood markers for GCIN

A

1 - abnormal dysplasia of glandular cells

  • squamous cells are located here, which should not be present
  • rare, but requires colposcopy immediately
53
Q

Glandular cells of the cervix are cells that make mucus that are located on the inner part of the cervix. Cervical glandular intraepithelial neoplasia (CGIN) is abnormal dysplasia of glandular cells normally squamous cells are present, which should not be. What investigation is performed immediately if CGIN is suspected?

1 - blood sample
2 - colposcopy (could include punch biopsy or LLETZ)
3 - liquid based cytology
4 - large Loop Excision of the Transformational Zone (LLETZ)

A

2 - colposcopy (could include punch biopsy or LLETZ)

- if just abnormal cells then the colposcopy should be repeated in 2 weeks

54
Q

Glandular cells of the cervix are cells that make mucus that are located on the inner part of the cervix. Cervical glandular intraepithelial neoplasia (CGIN) is abnormal dysplasia of glandular cells normally squamous cells are present, which should not be. Colposcopy (could include punch biopsy or LLETZ) should be performed immediately to diagnose the patient. If the patient is diagnosed with CGIN would should be done as they are at risk of endometrial pathology?

A
  • surgical excision

- if fertility is not an issue then hysterectomy should be considered

55
Q

Glandular cells of the cervix are cells that make mucus that are located on the inner part of the cervix. Cervical glandular intraepithelial neoplasia is an abnormality of the glandular cells, that is rare, but requires colposcopy immediately. What are the main human papillomavirus (HPV) that causes this?

1 - HPV E7
2 - HPV E6
3 - HPV 18
4 - HPV 21

A

3 - HPV 18

- generally occurs in older women

56
Q

What is the main form of transmission of human papillomavirus (HPV)?

A
  • sexually transmitted
57
Q

The human papillomavirus (hpv) is a small, non-enveloped deoxyribonucleic acid (DNA) virus that infects skin or mucosal cells. How many genes does the HPV contain?

1 - 2
2 - 4
3 - 6
4 - 8

A

4 - 8

58
Q

Which 2 forms of the human papillomavirus (HPV) are low risk with the NHS, but can still cause warts and respiratory papillomatosis?

1 - HPV 6 and 18
2 - HPV 6 and 11
3 - HPV 18 and 11
4 - HPV 21 and 18

A

2 - HPV 6 and 11

59
Q

Which 2 forms of the human papillomavirus (HPV) are high risk with the NHS and can lead to cervical head, neck and anogenital cancer?

1 - HPV 16 and 18
2 - HPV 16 and 11
3 - HPV 18 and 11
4 - HPV 21 and 18

A

1 - HPV 16 and 18

  • account for 70% of cervical cancers
  • 99% of cervical cancers are because of HPV virus
60
Q

The vulva is the outer part of the female genitals. The vulva includes the opening of the vagina (sometimes called the vestibule), the labia majora (outer lips), the labia minora (inner lips), and the clitoris. What is Vulvar Intraepithelial Neoplasia?

A
  • abnormal cells develop in the surface layers of the skin covering the vulva
  • divided into HPV related (subdivided to wart, baseloid and mixed), and differentiated, which has nonviral aetiology
61
Q

A 27-year-old nulliparous woman is seen in colposcopy following a smear report of severe dyskaryosis. Colposcopy reveals a transformation zone with large areas of dense acetowhite epithelium consistent with cervical intraepithelial neoplasia III. What is the most appropriate management for this patient?

1 - repeat Smear in 6 months
2 - HPV testing 
3 - loop excision of transformation zone
4 - single punch biopsy of TZ
5 - repeat colposcopy in 12 months
A

3 - loop excision of transformation zone

62
Q

A severely dyskaryotic smear is associated with the colposcopic finding of high-grade cervical intraepithelial neoplasia (CIN) II or III in what % of cases?

1 - 80–90% of cases
2 - 50–60% of cases
3 - 10–20% of cases
4 - 100% of cases

A

1 - 80–90% of cases

63
Q

What are the 2 main oncogenes (mutated form of a gene involved in normal cell growth) that are involved in suppressing genes involved in monitoring the cell cycle, essentially ensuring tumours do not develop?

1 - E6 and 18
2 - E6 and 7
3 - E7 and 18
4 - E7 and 21

A

2 - E6 and 7

64
Q

The 2 main oncogenes (mutated form of a gene involved in normal cell growth) that are involved in suppressing genes involved in monitoring the cell cycle, essentially ensuring tumours do not develop are E6 and E7. What are the 2 oncogenes that they are able to supress?

1 - p53 and rasN
2 - p53 and Rb
3 - Rb and rasN
4 - myc and Rb

A

2 - p53 and Rb

65
Q

What is the main intervention that has significantly dropped the number of HPV cases worldwide?

1 - screening using smear tests
2 - regular blood tests
3 - regular cervical colposcopy
4 - vaccination

A

4 - vaccination

- up to 99% effective

Year 2 RE (53 decks)

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