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Conditions + definitions > Repro wk 5 +6 > Flashcards

Repro wk 5 +6 Flashcards

1
Q

How do you investigate menstral complaints?

A 
Heavy periods - FBC
Intermenstral bleeds/post coital bleeds - chlamydia test
Pregnancy test
Transvaginal ultrasound
Hypsteroscopy
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2
Q

What are the common menstral problems in early teens?

A

Anovultaory cyts

Coagulation problems

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3
Q

What are the common menstrual problems in teens to 40s?

A 
Chlymadia
Contraception related
Endometriosis/adenomyosis
Fibroids
Endometrial/cervical polyps
Dysfunctional bleeding
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4
Q

What are the common menstrual problems in 40s-menopause?

A 
As of those below 40 along with:
Perimenopausal anovulation
Endometrial cancer
Warfarin
Thyroid dysfunction
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5
Q

What is the PALM-COEIN classification of bleeding?

A 
Polyp
Adenomyosis
Leiomyoma
Malignancy/hyperplasia
Coagulation
Ovarian (PCOS etc)
Endocrine (thyroid)
Iatorgenic (warfarin)
Not yet classified
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6
Q

What is dysfunctional uterine bleeding?

A

Abnomral bleeding but no structural/ endocrine/neoplastic /infectious cause found

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7
Q

What is endometriosis?

A

Where endometrial tissue is found outside the uterine cavity
A chronic condition based on oestrogen
Most often affects ovary, pouch of douglas and peritoneum

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8
Q

What are the theories of the pathogensis of endometriosis?

A 
Retrograde menstruation
Colemic metaplasia
Coelmic metaplasia
Haemtogenous spread
Direct transplatation
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9
Q

What are the signs + symtpoms of endometriosis?

A 
Symptoms
>Premenstrual pelvic pain
>Dysmenorrhoea
>Deep dyspareunia
>Subfertility
Signs
>None
>Tender nodules in rectovaginal septum
Limited uterine mobility
Adnexal masses
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10
Q

How do you diagnose endometriosis?

A

Laparascopy
>Lesions in varying colours - clear, red, bluish black or white
MRI for deep
US can diagnose chocolate cyst

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11
Q

How do you treat endometriosis?

A

Medical (hormonal+analgesics)
>Progestogen
>Combined OCP
>GnRH analogues

Surgical
>Excision
>Diathermy/laser ablation of deposits
Removal of ovaries +/- hysteroectomy

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12
Q

What is adenomyosis?

A

Endometrial tissue in myometrium

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13
Q

What are the signs/symptoms of adenomyosis?

A

Heavy painful perdios
Bulk tender uterus
Parous women
Co-exists (sometimes) with endometriosis

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14
Q

How do you diagnose adenomyosis?

A

MRI

Histology of uterine muscles (usually post hysterectomy)

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15
Q

How do you treat adenomyosis?

A

Treat symptoms of heavy/painful periods with contraception
Mirena coil
Progestogens
combined OCP

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16
Q

What are fibroids?

A

Smooth muscle growths (leiomyomas)

Common and asymptomatic

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17
Q

How do you diagnose fibroids?

A

Clinical exam - irregularly enlarged uterus
USS
Hysteroscopy

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18
Q

What are the types of fibroids?

A

Sub-mucous - uterine cavity
Intramural - within uterine wall
Sub-serous - project into peritoneal cavity

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19
Q

What are the symptoms of fibroids?

A

May cause pressure symptoms
Menorrhagia
Intermenstural bleeding (in submucosal or fibroid polyps)
Can rapidly increase in size in pregnancy

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20
Q

How do you treat fibroids?

A 
If symptomatic then:
GnRH analogues to try and shrink
Resection of sumucous fibroids
Myomectomy
Uterine artery embolisation
Hysterectomy
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21
Q

How do you treat dysfunctional uterine bleeding?

A

Reassure no sinister pathology

Medical:
>Tranexamic acid/mefanamic acid
>Progestogen tablets, Progesterone hormonal contraception (depo provera, minera c-OCP)

Surgical
>Endometrial ablation
Hysterectomy

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22
Q

How do tranexamic acid + mefanamic acid work?

A

Reduce blood loss
Megenamic also reduces pain
Taken at time of periods and useful for those trying to concieve
Do not regulate cycles

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23
Q

How does hormonal contraception affect dysfunctional uterine bleeding?

A

Makes periods lighter
More regular
Less painful

Same with progesterone, although may not reduce bleeding

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24
Q

What is endometrial ablation?

A

Permanent destruction of endometrium using energy
Diathermy
Thermal balloon
Radiofrequency

Some will require hysterectomy

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25
Q

What are the pre-requisites to endometrial ablation?

A

Uterine cavity >11cm
Submucous fibrous <3cm
Previously normal endometrial biopsy

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26
Q

How can a hysterectomy be performed?

A

Adominaly
Vaginally
Laparascopically

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27
Q

What are the risks of a hysterectomy?

A 
Infection
DVT
Bladder/bowel/vessel injury
Altered bladder function
Adhesions

Takes 2-3 months to recover

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28
Q

What is a salpingo-oophorectomy?

A

Removal of tubes + ovaries

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29
Q

Why are women who have had a hysterectomy at high risk of menopause even if ovaries are left in?

A

Compromised blood supply

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30
Q

What is the breast?

A

A highly specialised, modified sweat gland
Has no special capsule or sheath
More developed in females where it is a secondary sexual characteristic

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31
Q

What contributes to breast size/shape?

A

Genetic
Racial
Dietary factors

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32
Q

How is the breast attached to the dermis?

A

By suspensory ligament of cooper

Which helps supports the lobules of the gland

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33
Q

How much of the breast lies on the pectoralis major and how much on the serratus anterior?

A

2/3 on pec major

1/3 on serratus anterior

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34
Q

What are the structures of the breast?

A

Nipple
Areloa
15-20 lobules of glandular tissue (parenchyme)

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35
Q

How are the parenchyma of the breast drained?

A

Via the lactiferous duct

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36
Q

What is the lactiferous sinus?

A

A dilated portion of the lactiferous duct

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37
Q

Where do the lactiferous ducts drain?

A

Into the nipple

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38
Q

What are the features of the nipple?

A

Has no fat or hair
Contains collagenous dense connective tissue, elastic fibres and bands of smooth muscle
Tips fissured by lactiferous ducts

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39
Q

What are the features of the areola?

A

Skin covering nipple/areloa contains numerous sebacous/sweat glands
Enlarges during pregnancy
Oily material secreted provides protective lubricant for nipple and areola

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40
Q

What are the anatomical divisions of the breast?

A 
4 quadrants + axillary tail
Superolateral
Inferolateral
Supermedial
Inferomedial
  • axillary tail extension of superolateral quadrant
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41
Q

What are the features of the male breast?

A

Rudimentary throughout life
Formed by small ducts without lobules/alveoli
LIttle supporting fibroadipose tissue
Temporary enlargement in newborn/puberty

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42
Q

How does the breast develop?

A

Mammary crests or ridges appear during 4th week
Extend from axillary region to inguinal
Usually dissappear everywhere but pectoral region

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43
Q

What is gynaecomastia?

A

Postnatal development of rudimentary lactiferous ducts in males
During mid puberty about 2/3 develop various hyperplasia in breasts

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44
Q

What is polymastia?

A

An extra breast

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45
Q

What is polythelia?

A

An extra nipple

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46
Q

What is athelia/amastia?

A

Abscence of nipple/breast

47
Q

What is the blood supply of the breast?

A

Bracnhes of axillary artery
Internal thoracic
And intercostal arteries

Thoracoacromial artery
Lateral thoracic
Internal mammary artery

48
Q

WHat is the nerve supply of the breast?

A

Anterior/lateral cutaneous branches of intercostal nerves 4-6

49
Q

What do the nerves of the breast innervate?

A

Convey sensory fibres to skin of breast

Carry sympathetic fibres to blood vessels/smooth muscle around nipple

50
Q

Why is the lymphatic in the breast of partocilar importance?

A

Do not contain valves

Metastatic dissemination primarily by these lymphatic routes

51
Q

Where do the breasts’ lymphatics drain?

A

Most from lateral quadrants into axillary lymph nodes
Some into supraclavicular/cervical nodes

Medial quadrants into parasternal to opposite breast

52
Q

How is a sentinel node biopsy done?

A

Radiolabelled colloid used to locate senitnel node
When surgery is done, a blue dye is injected
Gives an accurate means of localising the node
Used to map and stage patients

53
Q

What is the histology of the normal breast?

A

Extensive branching duct system
Surrounded by dense fibrous + interlobular tissue and adipose tissue
Ducts + acini lined by epithelial + myoepithelial cells

54
Q

What are the prepuberty changes of the breast?

A

Neonatal breast contain lactiferous ducts but no alveoli
Until puberty little branching of the ducts occurs
Slight breast enlargement reflects growth of fibrous stroma and fat

55
Q

What are the puberty changes of the breast?

A

Branching of lactiferous ducts
Solid spherhoidal masses of granular polyhedral cells (alveoli)
Accumulation of lipids in adipocytes

56
Q

How does the breast change during pregnancy?

A

Lobules enlarge
Acini dilate
Epithelium vary from cubuoudal to low columnar
Colostrum - protein reich fluid available few days after birth
Rich in maternal antibodies

57
Q

How does the breast change with lactation?

A

Acini distend with milk
Thin septa between lobules
At higher magnification - can see acini with eosinophillic material containing clear vaculoes
Milk production through suckling

58
Q

What are the diagnostic methods used on the breast?

A

Mammography
USS
FNA
Core biopsy

59
Q

What is the chance of devloping breast cancer?

A

1 in 9

60
Q

What are the types of benign breast tumours?

A 
Fibroadenomas
Duct papiloomas
Ademonas
Connective tissue tumours
Pajects disease of the nipple
61
Q

What is pagets disease?

A

Erosion of the nipple - resembles eczema

Asociated with ductal or invasive carcinoma

62
Q

How can you take a cytology from the breast?

A

FNA
Direct smear from nipple discharge
Scrape of nipple with scapel

63
Q

What palpable abnormalities would you use an FNA for in the breast?

A 
Discrete masses (either cystic/solid)
Diffuse thickening
Nipple Lesion (either discharge or eczmatous skin)
64
Q

What are the features of benign cystology?

A 
Low/moderate cellularity
Cohesive groups of cells
Flat sheets of cells
Bipolar nuclei in background
Cells of uniform size
Uniform chromatin pattern
65
Q

What are the features of malignant cytology?

A 
High cellularity
Loss of cohesion
Crowding/overlapping of cells
Nuclear pleomorphism
Hyperchromasia
Absence of bipolar nuclei
66
Q

What is the cytology scoring system?

A 
Unsatisfactory - C1
Benign - C2
Atypia - C3
Suspicious - C4
Malignant - C5
67
Q

When do you not discard cystic fluid?

A

When it is blood stained

Or residual mass

68
Q

What are the advantages of cytology?

A

Simple procedure
Well tolerated
Inexpensive
Get immediate results

69
Q

What are the limitations of cytology?

A 
Not 100% accuracy
Invasion cannot be assessed
Nor can grading
Can miss small lesions
Difficult to examine cells
Differing interpretation
70
Q

What are the complications of FNA?

A

Pain
Haematoma
Faiting
Infection, pneumothorax

71
Q

What can be diagnosed from a nipple scrape?

A

Paget’s disease (squamous + malgnant cells)

Eczema (squamous cells from epidermis only)

72
Q

When would you perform a nipple discharge cytology?

A

Bloody discharge from a single duct

73
Q

What can be diagnosed by a nipple discharge cystology?

A 
Duct ectasia (only macrophages)
Intraduct papilloma (benign cells in papillary groups)
Intraduct carcinoma (malignant cells)
74
Q

When is a core biospy performed?

A

All cases with
Clinical
radiological
Or cytological suspicion

Breast screening
Or pre-op classification

75
Q

What is performed on a core biopsy?

A

Confirm invasion
Tumour grading/typing
Imminohistochemistry

76
Q

What is the pre-puberty breast like?

A

No lobules with varying degrees of branching
15-25 lactiferous ducts
Ducts start from nipple and branch outwards forming terminal ductal lobular units

77
Q

What are the histological changes in menopause?

A

Lobular size decreases and is replaced by fibrous/adipose tissue
Increasing adipose as time does on

78
Q

What are the two linings of the breast ducts?

A

Internal

Peripheral (myoepithelial)

79
Q

What determines if a breast neoplastic condition is in situ?

A

If the myoepithelial cells are still present

80
Q

What determines if a breast neoplastic condition is invasive?

A

If the myoepithelial lining has been lost

81
Q

What are the benign breast conditions?

A 
Fibrocycstic change
Fibroadenoma
Intraduct papilloma
Fat necrosis
Duct ectasia
82
Q

What are some examples of fibrocystic change?

A 
Fibrosis
Adenosis
Cysts
Apocrine metaplasia
Ductal epithelial hyperplasia
83
Q

What is the most common cause od fat necrosis?

A

Traumatic

84
Q

What is duct ectasia?

A

Diltation of the duct
Most often due to blockage of duct
Can rupture - resulting in nipple discharge

85
Q

What does fibrocystic change look like?

A

Enlarged ducts (white) with pink fibrous tissue

86
Q

What is fibroadenoma?

A

Proliferation of pithelial and stromal elements
Most common breast cancer in adolescent /young women
May regress with age if untreated
Well circumscribed non painful mass, freely mobile

87
Q

What are the types of fibroadenoma?

A

Ducts being distorted/elongated = intracanalicular pattern (slit like)
Ducts not compresssed = pericanalicular growth pattern (normal appearance)

88
Q

What is tubular adeoma?

A

Less common
Young women, discrete, freely moveable
Uniform sized ducts

89
Q

What is lactating adeoma?

A

Enlarging mass during lactation/pregnancy

Prominent secretory change

90
Q

Who is affected by intraduct papilloma? What is it?

A

Usually middle aged women
Present with nipple discharge
Epithelial hyperplasia
A papillary infiltration that occurs within a duct

91
Q

What is fat necrosis?

A

History of trauma
Can simulate carcinoma both clinically and in mamogram
Has histocytes with foarmy cytoplasm
Lipid filled cysts
Fibrosis, calcifications on mamography (egg shel

92
Q

What is phyllodes tumour?

A

A fleshy tumour (fibroepithelial lesion)
Has leaf-like pattern + cysts on cut surface
Circumscribed connective tissue + epithelial elements
Can be borderline, malignant or benign
Metasteses travel by haematogenous spread

It is the stromal component that is proliferative

93
Q

Who is affected by breast carcinoma?

A

1/8 women
1 in 870 men
Commonest cause of female cancer death (1/3 from disease)

94
Q

How does breast carcinoma appear on a mamogram?

A

Soft tissue opacity

Microcalcification

95
Q

How does breast carcinoma present macroscopically?

A

Hard lumps fixed in place
Tethered to skin
Dimpling of skin

96
Q

What are the risk factors for breast cancer?

A 
Female
Inc age
Delayed age of first pregnancy
Early menarch/late menopause
Family /personal history
HRT
Obesity
Alcohol
Lack of physical activity
Radiation
97
Q

What is LCIS?

A

Lobular carcinoma in situ

98
Q

What is DCIS?

A

Ductus carcinoma in situ

99
Q

How much do the BRACA genes incrweas your risk of cancer?

A

BRACA1 - 20-40%

BRACA2 - 1–30%

100
Q

What are the histological classification of breast cancer?

A 
Non invasive (DCIS/LCIS)
Invasive:
Invasive ductal carcinoma (75%)
Invasive lobular carcinoma (5-15%)
Special types
101
Q

What is in situ carcinoma?

A

Preinvasive - does not form palapble tumour
No lump - not detected clinically
Multicentricity (multiple parts of same breast) + bilaterality
No metastatic spread

102
Q

What is the difference between atypical lobular displasia and LCIS?

A

LCIS affects the whole lobule

Atypical lobular dysplasia ia not whole lobule

103
Q

What is the characteristic abnormality of lobular carcinoma?

A

The loss of the transmembrane molcule

104
Q

What types of procedures are diagnostic for breast cancer?

A

Clinical exam
Radiology (mamogram etc)
FNA
Needle core biopsy

105
Q

When is breast screening carried out?

A

Ever 3 years

From age 50-70

106
Q

What are microcalcifications?

A

Tiny depostis of calcium appearing anywhere in the breast

Mostly harmless however small percentage precancerous or cancerous

107
Q

What are the two main indicators for breast cancer picked up on a mammography?

A

Masses

Microcalcifications

108
Q

What do cancers does anti-oestrogen therapy work on?

A

Oestrogen receptive tumours

109
Q

What does transonimab work on?

A

HER-2 positive tumours

110
Q

How do breast cancers spread?

A

Local (skin/pectoral muscles)
Lymphatic (axillary/internal mammary nodes)
Blood (bone, lungs, liver, brain)

111
Q

What is the prognosis of breast cancer dependant on?

A 
Node status (if no nodes good prognosis, if positive depends on nodes amount)
Younger = more aggressive cancers
HER-2  + ER/PR good prognosis now with treatment (ER best)
112
Q

What is pagets disease of the nipple?

A

Result of intraepithelial spread of intraductal carcinoma
Large pale-staining cells within epidermis of nipple
Pain, itching, scaling + redness
Can be mistaken for ecezma
Ulceration, crusting + serous/bloody discharge possible

113
Q

What is gynaecomastia?

A

Most common clinical/patholigcal abnormality in male breast
Increasein subareolar tissue
30-40% of males
Associated with cirrhosis, chronic renal failure, hypothyroidism, COPD + drugs

Conditions + definitions (68 decks)

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