Repro Path+Micro Flashcards
human papilloma virus (HPV) is a small [ss/ds] [RNA/DNA] virus
HPV is a small ds DNA virus
causes skin and genital warts; types 16 and 18 are associated with cervical cancer
[?] can survive for on inanimate objects (fomites), so furniture, counters, and bathroom towels are a source of transmission
HPV (human papilloma virus)
skin warts, benign head and neck tumors, anogential warts (condyloma acuminata), and cervical dysplasia/ neoplasia are manifestations of [?]
HPV (human papilloma virus)
HPV is identified on Pap smears by [?] squamous epithelial cells which contain [?]
HPV is identified on Pap smears by koilocytotic squamous epithelial cells which contain vacuolated cytoplasm and occur in rounded clumps
[?] painless lesion with a raised border that heals in ~6 months
primary syphilis: painless raised border (chancre) that heals spontaneously in ~6 months, but organism spread throughout bloodstream
[?] “great imitator rash” - may be maculopapular, pustular, or scaly; also headache, fever, myalgia, lymphadenopathy
secondary syphilis; develops due to replication in lymph nodes, tissues, and skin
secondary syphilis includes raised lesions called [?] in skin folds and in mucous membranes
condyloma lata
manifestations of neurosyphilis
tabes dorsalis: loss of positional sensations => staggering
Charcot joint: trauma to knee and ankle joints
general paresis: gradual loss of higher integrative functions and personality
Argll Robertson pupil: pupil does not react to light but contracts when object is moved closer to eye
congenital syphilis results in [?]
premature birth, intrauterine growth retardation, facial and tooth deformities, deafness, arthritis, cardiovascular disease
non-treponemal syphilis tests include [?]
venereal disease research laboratory (VDRL) and rapid plasma regain (RPR)
measure flocculation of cardiolipin from sera; often result in false positives; recommended for screening
treponemal specific tests include [?]
fluorescent treponemal antibody-absorption test (FTA-ABS) and T. palldium particle absorption test (TP-PA)
syphilis is treated with [?]
penicillin G
there is no vaccine for T. pallidum
Pathology/ organism?
primary syphilis (chancre)
caused by T. pallidum
Pathology/ organism
secondary syphilis (“great imitator rash”)
caused by T. pallidum
Neisseria gonorrheoae is a gram [positive/ negative] [shape]; the cell wall contains [?]
N. gonorrheoae is a gram negative cocci (assorts as diplococci; coffee-bean shaped); cell wall contains LOS (not LPS)
clinical manifestations of N. gonorrheoae
urethritis: purulent discharge, thick greenish-yellow; accompanied by pain
cervicitis: 30% asymptomatic; dysuria, dyspareunia, discharge, genital discomfort; local spread can cause fallopian tube inflammation => chronic pain, ectopic pregnancy, infertility
disseminated gonococcal infections: skin lesions, septicemia, septic arthritis
ophthalmia neonatorum: conjunctivitis in newborn from infected mother
N. gonorrheoae infections are treated with [?]
dual therapy with ceftriaxone and doxycycline
Pathology?
N. gonorrheoae urethritis (purulent discharge, thick greenish-yellow; accompanied by pain)
Pathology?
ophthalmia neonatorum (N. gonorrheoae infection in baby born to infected mother)
Organism?
T. pallidum (syphilis)
Organism?
N. gonorrheoae (cultured on chocolate agar or Thayer Martin medium)
[?] are an intracellular bacteria with a complex life cycle including an elementary body (resistant to environmental conditions) and reticulate body
Chlamydia trachomatis
[?] is the leading cause of preventable blindness in the world
Trachoma caused by Chlamydia trachomatis
chronic disease caused by inflammation => corneal scarring
clinical manifestations of Chlamydia trachomatis
trachoma: corneal scarring
acute follicular conjunctivitis: mucopurulent discharge, keratitis
neonatal conjunctivitis
urogenital infections: asymptomatic in 25% M, 80% F; cervicitis, salpingitis, endometritis, urethritis, discharge (less purulent than gonorrhea)
LGV: small painless lesions on genitals that heal spontaneously; second stage involves draining lymph nodes - enlarged nodes (painful, can rupture), fever, myalgia
Chlamydia trachomatis is treated with [?]
antimicrobials that can penetrate cells (macrolides)
Haemophilis ducreyi are small pleomorphic gram [positive/ negative] [shape]
H. ducreyi are small pleomorphic gram negative rods
Pathology?
chancroid - tender raised lesion with erythematous base that develops in genital region; ulcerates and becomes painful; soft ragged margins
caused by H. ducreyi
H. ducreyi infections are treated with [?]
azithromycin or ceftriaxone; drain involved nodes
the predominant vaginal flora genus is [?], which are gram positive rods that produce hydrogen peroxide
Lactobacillus species
may help protect against vaginal pathogens
low vaginal pH results from [?]
bacterial fermentation of glycogen to lactic acid
[disease] often asymptomatic; minimal discharge; usually has a fishy odor; may have mild vulvar irritation
bacterial vaginosis
treatment: metronidazole
[disease] purulent vaginal discharge; usually has a bad odor; vulvar irritation
trichomoniasis (caused by Trichomonas vaginalis)
treatment: metronidazole
[disease] vulvar pruritis/ irritation; may have mild discharge
Candida vulvovaginitis (caused by Candida albicans in immune suppressed individuals/ patients on antibiotics)
treatment: fluconazole
bacterial vaginitis is associated with a reduction in [?] and a concomitant increase in [?]
reduction in Lactobacilli + increase in anaerobes (Gardnerella, Mobiluncus, Prevotella species)
[disease] painful genital ulcers or vesicles, generally multiple; local lymphadenopathy; fever; headache
primary genital HSV (herpes simplex virus 2)
HSV treatment
acyclovir, famiciclovir, valacyclovir
HSV and H. ducreyi (chancroid) generally cause [painless/ painful] lesions
syphilis generally causes [painless/ painful] lesions
HSV and H. ducreyi (chancroid) generally cause painful lesions
syphilis generally causes painless lesions
syphilis and H. ducreyi (chancroid) generally cause [single/ multiple] lesions
HSV generally causes [single/ multiple] lesions
syphilis and H. ducreyi (chancroid) generally cause single lesions
HSV generally causes multiple lesions
pelvic inflammatory disease is treated with [?]
ceftriaxone + doxycycline + metronidazole
OR
cefotetan OR cefoxitin + doxycycline
Listeria monocytogenes infections are treated with [?]
penicillin G, ampicillin, erythromycin, chloramphenicol
grown on blood agar (beta hemolytic), [?] are catalase positive and demonstrate tumbling end-over-end motility at 25 C
Listeria monocytogenes
important causes of congenital infections
TORCH
Toxoplasma gondii, Other [T. pallidum, parvovirus B19, Zika virus], Rubella, CMV, HSV
Name the congenital infection:
infection in first trimester usually results in spontaneous abortion or stillbirth; manifest months to years later as intellectual disability, visual impairment, hearing loss, learning disabilities, hydrocephalus, chorioretinitis, hepatosplenomegaly, thrombocytopenia
Toxoplasma gondii
treatment: pyrimethamine-sulfadiazine
Name the congenital infection:
10-20% infants infected in utero have intellectual disability or deafness; other manifestations = microcephaly, chorioretinitis, hepatosplenomegaly, jaundice
Cytomegalovirus
treatment: ganciclovir/ valganciclovir
Name the congenital infection:
ophthalmologic, cardiac, auditory, and neurologic anomalies (deafness, patent ductus arteriosus, and cataracts)
Rubella
treatment: none, but immunization is 100% protective
Name the congenital infection:
global development/ intellectual disability, rash, hepatosplenomegaly, osteomyelitis, dental/long bone abnormalities, blindness
T. pallidum (syphilis)
treatment: penicillin IV
diamniotic/ dichorionic twins develop [?] days post-fertilization; diamniotic/ monochorionic twins develop [?] days post-fertilization; monoamniotic/ monochorionic twins develop [?] days post-fertilization
diamniotic/ dichorionic: <3 days
diamniotic/ monochorionic: 4-8 days
monoamniotic/ monochorionic: 9-12 days
conjoined: 12+ days
the endoplasmic reticulum of the syncytiotrophoblasts is responsible for production of [?]
human chorionic gonadotropin
hCG enters maternal circulation => corpus luteum maintained
teratogen exposure during weeks [?] is when most structural defects occur
weeks 2-8
[?] bluish discoloration of vagina and cervix
Chadwick’s sign
[?] softening of the cervix
Hegar’s sign
Pathology? (ovarian)
surface inclusion cysts
secondary to invagination of surface epithelium
Pathology? (ovarian)
corpus luteum cysts
seen in ovaries of reproductive age F
Pathology? (ovarian)
polycystic ovarian syndrome
Pathology? (ovarian)
stromal hyperthecosis (cortical stromal hyperplasia)
postmenopausal women who present with symptoms similar to PCOS
Pathology? (ovarian)
serous cystadenoma
one or several cysts with smooth inner and outer surfaces; lined by a layer of tall columnar, serous secreting ciliated or non-ciliated cells with no atypia
Pathology? (ovarian)
serous tumor of borderline malignancy (low malignant potential)
Pathology? (ovarian)
malignant serous tumors (cystadenocarcinoma)
Pathology? (ovarian)
mucinous cystadenoma
many show KRAS mutations
Pathology? (ovarian)
mucinous borderline tumor
epithelial stratification, tufting, and/or papillary intraglandular growth; may look similar to intestinal adenomas
Pathology? (ovarian)
mucinous carcinoma
expansile invasion; marked epithelial atypia; can get very large
Pathology? (ovarian)
endometrioid carcinoma
mutations in PTEN, PIK3A, ARIDIA, KRAS => increased PIEK/AKT pathway signaling
Pathology? (ovarian)
clear cell adenocarcinoma
large cells with clear cytoplasm or hobnail type cells arranged in solid, tubular, or papillary configuration
Pathology? (ovarian)
Brenner tumor
fibrous stroma containing scattered groups of transitional epithelial cells
Pathology? (ovarian)
mature teratoma
filled with sebaceous material, hair shafts, and other tissue types
Pathology? (ovarian)
immature teratoma
contain immature embryonic tissues, mostly solid with focal necrosis and hemorrhage; more common in children and young adults
Pathology? (ovarian)
dysgerminoma
large cells with clear cytoplasm and centrally located nuclei in cords or sheets, separated by thin, fibrous septa that contains lymphocytes
ALWAYS malignant
Pathology? (ovarian)
yolk sac tumor
yolk sac differentiation with Schiller-Duval bodies (look like glomerulus) that contain intracytoplasmic hyalin droplets (AFP and alpha-1-antitrypsin)
malignant and very aggressive
Pathology? (ovarian)
choriocarcinoma
produce hCG; rare tumor
Pathology? (ovarian)
embryonal carcinoma
solid tumor with necrosis and hemorrhage; solid sheets and nests of large primitive cells; syncytiotrophoblast-like cells
secrete hCG, see elevated AFP
Pathology? (ovarian)
granulosa cell tumor
microfollicular with Call-Exner bodies (coffee bean nuclei)
Pathology? (ovarian)
theca/fibroma
solid, round, firm; fascicles of spindle cells; can see fat in thecomas
Pathology? (ovarian)
sertoli-leydig cell tumor
resembles immature testes with Sertoli and Leydig cells
[?] cycles of bleeding with intervals >35 days
[?] bleeding that occurs at intervals <21 days
oligomenorrhea: cycles of bleeding with intervals >35 days
polymenorrhea: bleeding that occurs at intervals <21 days
[?] prolonged or excessive bleeding at regular intervals (>7 days or >80 mL)
[?] irregular intervals of bleeding
menorrhagia: prolonged or excessive bleeding at regular intervals (>7 days or >80 mL)
metrorrhagia: irregular intervals of bleeding
menometrorrhagia: prolonged bleeding at irregular intervals
Pathology? (uterine)
endometriosis
chocolate cyst - ovaries can contain large cysts containing degenerated bloody material
Pathology?
endometriosis
Pathology?
adenomyosis
endometrial glands and stroma within myometrium
Pathology? (uterine)
endometrial hyperplasia
loss of PTEN gene expression in intraepithelial neoplasia
Pathology? (uterine)
atypical endometrial hyperplasia
gland crowding, approaching adenocarcinoma
Pathology? (uterine)
mucinous carcinoma
Pathology? (uterine)
serous papillary adenocarcinoma
Pathology (uterine)
clear cell adenocarcinoma
Pathology? (uterine)
malignant mixed mullerian tumor (MMMT)
highly malignant tumors of postmenopausal F that present with postmenopausal bleeding; many have prior radiation therapy
Pathology? (uterine)
leiomyoma
sharply circumscribed, discrete, round, firm, gray-white tumors with a “whorled” appearance
rearrangements of chromosomes 12q14 and 6p; mutations in MED12 gene
Pathology? (uterine)
leiomyoma
whorled bundles of smooth muscle cells that resemble uninvolved myometrium
Pathology? (uterine)
leiomyosarcoma
Pathology? (cervix)
chronic cervicitis
Chlamydia trachomatis, Candida albicans, Trichomonas vaginalis, HPV, herpes
Pathology?
condyloma acuminatum
usually caused by HPV 6, 11
Pathology?
koilocytes - indicates HPV infection
Pathology? (cervix)
low grade SIL = mild dysplasia = CIN I
abnormal cells within bottom 1/3
Pathology? (cervix)
moderate dysplasia = CIN II
atypical cells 2/3 of the way up
Pathology? (cervix)
severe dysplasia = CIN III
atypical cells into top 1/3
Pathology?
herpes
shallow ulcers
Pathology?
syphilis chancre
Pathology?
granuloma inguinale (Donovanosis)
large ulcerated lesions that contain inflamed granulation tissue and numerous macrophages; bacteria in cytoplasm of neutrophils, histiocytes, and plasma cells (Donovan bodies) shaped like a safety pin
Pathology?
lymphogranuloma venereum (LGV)
transient vesicles on penis or vagina followed by lymphadenopathy with formation of bubos containing Chlamydia trachomatis
Pathology?
sarcoma botryoides
most common neoplasm of lower genital tract in girls <5 years
Pathology?
clear cell adenocarcinoma of the vagina
Pathology?
placental abruption
premature separation of normally implanted placenta prior to birth of the fetus
Pathology?
complete hydatidiform mole
cystic swelling of the chorionic villi, sometimes with trophoblastic proliferation
all villi affected in complete
Pathology?
partial hydatidiform mole
nor all villi are affected, less trophoblastic proliferation, may see fetal parts
karyotype is usually triploid (69, XXY)
Pathology? (pregnancy)
choriocarcinoma
Marfan syndrome is an inherited defect in [?]
fibrillin
patient is tall with arachnodactyly, lax joints, lens discoloration, mitral valve prolapse, dilation of aortic ring and root of aorta, aortic dissection
Pathology?
G6PD deficiency
Pathology?
Marfan syndrome
Pathology?
Ehlers-Danlos syndrome
hyperextensible skin, hypermobile joints; can lead to colon rupture, artery rupture, etc.
Pathology?
Tay-Sachs disease (cherry red spot in macula)
due to deficiency of hexosaminidase A on chromosome 15
[?] lysosomal accumulation of sphingomyelin due to deficiency of sphingomyelinase
Neimann-Pick disease
[?] mutation in gene encoding glucocerebrosidase => glucocerebrosidase accumulation in phagocytes
Gaucher disease
Pathology?
Gaucher disease
mutation in gene encoding glucocerebrosidase => glucocerebrosidase accumulation in phagocytes
Gaucher cells resemble “crumpled tissue paper” due to fibrillary cytoplasm
all mucopolysaccharidoses are autosomal recessive except [?]
Hunter Syndrome (X-linked recessive)
alkaptonuria: lack of [?]
homogentisic oxidase => blocks metabolism of phenylalanine-tyrosine at level of homogentisic acid => accumulation of homogentisic acid
Pathology?
alkaptonuria
accumulation of homogentisic acid => discoloration of connective tissue, tendons, cartilage
Pathology?
neurofibromatosis
NF1 gene encodes neurofibrinin (downregulates p21 oncoprotein on chromosome 17)
NF2 gene encodes protein suppressor gene on chromosome 22
name the disorder: simian crease, flat facial profile, epicanthal folds, large tongue, hypotonia, gap between first and second toes, Brushfield spots in iris
trisomy 21 (Down syndrome)
name the disorder: micrognathia, low set ears, overlapping fingers, mental retardation, cardiac and renal defects
trisomy 18 (Edward syndrome)
name the disorder: microphthalmia, microcephaly, mental retardation, cleft lip and palate, cardiac and renal defects, “rocker-bottom” feet
trisomy 13 (Patau syndrome)
rarely live more than a few years
[?] intrinsic abnormalities occurring during the developmental process
malformation
[?] alteration in form or structure resulting from mechanical factors
deformation
[?] due to secondary destruction of or interference with an organ or body region that was previously normal in development
disruption
[?] pattern or cascade of abnormalities
sequence
[?] constellation of congenital abnormalities which are believed to be pathologically related but cannot be explained on the basis of a single, localized initiating defect
syndrome
acute mastitis is typically due to [?]
Staph aureus
Pathology? (breast)
duct ectasia
palpable periareolar mass with thick, white nipple secretions; ducts filled with inspissated secretions and lipid-laden macrophages
Pathology? (breast)
fibroadenoma
well-circumscribed, rubbery, easily movable on exam, no necrosis; very rarely become malignant
Pathology? (breast)
fibroadenoma
epithelial (round or elongated glands, distorted by growth of stromal cells) and stromal (loose CT) elements
Pathology? (breast)
phyllodes tumor
similar to fibroadenoma, but less well-delineated and stroma is more cellular
Pathology? (breast)
intraductal papilloma
most common cause of nipple discharge; complex papillary configuration with fibrovascular core upon which lie two layers of cells
Pathology? (breast)
fibrocystic change (blue dome cyst)
fibrosis + cysts with tenderness beyond usual monthly changes
breast DCIS pattern?
cribiform DCIS
breast DCIS pattern?
papillary DCIS
breast DCIS pattern?
comedo DCIS (pleomorphic high grade nuclei and central necrosis)
Pathology? (breast)
invasive ductal carcinoma
Pathology? (breast)
invasive carcinoma
Pathology? (breast)
invasive lobular carcinoma (cells often line up)
Pathology?
inflammatory carcinoma
dermal lymphatics are filled with metastatic carcinoma that blocks lymphatic drainage => peau d’orange
Pathology? (breast)
Paget disease
large, pale Paget cells extend from DCIS in ductal system via lactiferous sinuses into nipple skin without crossing basement membrane
Pathology? (penis)
balantis xerotica obliterans
atrophy of glans penis, counterpart to vulvar lichen sclerosus in F
Pathology?
condyloma acuminatum (genital wart)
HPV infection
Pathology?
Bowen disease (carcinoma in situ of penis)
Pathology? (testis)
granulomatous orchitis
unknown etiology; non-caseating granulomas around seminiferous tubules
Pathology? (testis)
seminoma (pale tissue in testicle)
corresponds to dysgerminoma in ovary
Pathology? (testis)
spermacytic seminoma
no lymphocytic infiltrate (differs from seminoma)
Pathology? (testis)
embryonal carcinoma
highly aggressive tumors; solid sheets, trabeculae, abortive glands, papillary and cleft-like spaces
Pathology? (testis)
yolk sac tumor
Schiller-Duval body (looks like a glomerulus)
Pathology? (testis)
teratoma (mature)
Pathology? (testis)
Leydig cell tumor
architecture of solid sheets, nests, or trabeculae surrounded by stroma; cells are polygonal with granular acidophilic or vacuolated cytoplasm
Pathology? (prostate)
acute prostatitis
see neutrophils
Pathology? (prostate)
benign prostatic hyperplasia
glandular hyperplasia
Pathology? (prostate)
benign prostatic hyperplasia
atrophic area
Pathology? (prostate)
adenocarcinoma
