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Patho II > Reproductive > Flashcards

Reproductive Flashcards

1
Q

Sexually Transmitted Diseases

A

Also known as sexually transmitted diseases or general diseases (STI or VD)
Spread by sexual contact (vaginal, oral, rectal)
More easily transmitted to a woman than a man
Overal increase in STIs though “real numbers not known”

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2
Q

STIs

A

Increased related to factors such as:

  • Increase in premarital sex
  • Increased divorce rate
  • Increased number of sexual partners for many individuals
  • Lack of preventive measures especially with use of the oral contraceptives
  • Most can be prevented with use of latex condoms
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3
Q

STIs: Concerns related to STIs

A

Immunity against recurrent infections is not achieved
More than one STI may be present in one individual at one time
Frequently STIs are asymptomatic - many carriers
No cure for viral STIs
More drug resistant micro-organisms
Infection from mother to fetus or newborn
Partners not always notified
Condoms not used or used incorrectly for ugh risk activities

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4
Q

Bacterial

A

Chlamydia
Gonnorhea
Syphillis

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5
Q

Chlamydia

A

Most common STI
Caused by a bacteria (Chlamydia trachomatis) that acts like a virus (only reproduces in host cell)
Spread by any sexual contact or to neonate by passage through birth canal
Incubation period 1-3 weeks
Invades the cervix in women
Invades the urethra in men
Can cause conjunctivitis and pneumonia in newborns

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6
Q

Chlamydia: S&S

A 
Asymptomatic initially
Dysuria
Urinary frequency
Vaginal discharge/testicular pain
Swollen inguinal lymph nodes
May be present for years without noticeable symptoms
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7
Q

Chlamydia: Complications

A 
PID
Infertility/ Sterility
Ectopic pregnancy (goes beyond cervix and invades uterus)
Epididymitis
Prostatitis
Reiter's syndrome (affects vascularity)
Blindness/ pneumonia (newborn)
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8
Q

Gonorrhea

A

 Most common reportable communicable disease
Caused by Neisseria gonorrhoeae gram-negative diplococcus
Incubation period 2 to 8 days
Transmitted by direct sexual contact or
during delivery
Targets female cervix and male
urethra
Without treatment can spread to other organs

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9
Q

Gonorrhea: S&S

A

Females
- Often asymptomatic, may have vaginal discharge, abnormal menses, dysuria
Males
- Dysuria, increased urinary frequency, serous, milky or purulent urethral discharge

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10
Q

Gonorrhea: Complications

A

Men
- Acute painful inflammation of prostate, epididymitis, urethritis, nephritis
Can cause sterility
Females
- PID, sterility, ectopic pregancy, abdominal adhesions, endometritis, salpingitis, and pelvic peritonitis
Newborn
- Infect eyes, nose or anorectal region

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11
Q

Gonorrhea: Diagnostic tests

A

Smear of urethral discharge in males
Cultures done if Gram stains of smears are negative despite clinical symptoms of gonorrhea
In women, cultures of cervical discharge necessary to confirm diagnosis
Individuals with gonorrhea are often infected with other STIs so they are also tested for syphilis, chlamydia, and HIV

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12
Q

Syphilis

A

Complex STI can infect almost any body, tissue or rogan
Caused by spirochete (..)
Tranismitted through open lesions during any sexual contact
May also be transmitted through infected blood and body fluids such as saliva
Once in the system, spreads through blood and lymphatic system
Incubation period 20-30 days
Can also be passed to the fetus by placental circulation

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13
Q

Syphilis: 4 Stages (primary)

A

Primary

  • Presence of painless, chancre (ulcer) at the point of contact about 3 weeks after exposure - heals spontaneously
  • Swollen lymph nodes
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14
Q

Syphillis: 4 stages (Secondary)

A

Secondary
Symptoms may appear 2 weeks to 6 months after the initial chancre. Symptoms include skin rash (hands, feet, palate), general signs of infection (malaise, fever..)

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15
Q

Syphillis: Stages (Latent - Tertiary)

A

Latent
- This stage can last up to 50 years
- No apparent symptoms and disease is not transmissible by sexual contact but by infected blood
- Unless treated at least 1/3 will progress
Tertiary
- A “gumma” lesion (tumor) in skin, bones and liver
- Diffuse inflammatory response involving the CNS and the cardiovascular system - irreversible

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16
Q

Syphilis: Diagnostic Test

A

VDRL and RPR are positive 4-6 weeks after infection
Tests nonspecific if positive further tests are done
FTA-ABS is specific for T. pallidum used to confirm VDRL and RPR findings
Immunofluorescent staining or dark field microscopy can be used on specimen obtained from a chancre or lymph node

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17
Q

Viral

A

Genital Herpes

Genital Warts

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18
Q

Genital Herpes

A

Chronic asymptomatic STI
Caused by herpes simplex virus type 2 (HSV-2)
HSV-2 closely related to HSV-1, which causes cold sores
HSV-1 can also infect genitalia
Spread by vaginal, anal, or oral genital contact
Incubation period 3-7 days

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19
Q

Genital Herpes: S&S

A

Within a week develop painful red papules
Small painful blisters form after papules appear
Blisters break, shed virus, and create painful ulcers
First outbreak of herpes lesions called first episode infection

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20
Q

Genital Herpes: S&S

A

Subsequent episodes are recurrent and usually less severe
Period between episodes called latency
Still infected even during latency
Prodromal symptoms:
- Burning, itching, tingling, or throbbing at sites where lesions commonly appear
- Sexual contact should be avoided during this time
- General malaise, fever, headache, dysuria, urinary retention, discharge

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21
Q

Genital Herpes: Complications

A

General
- Cervical cancer
- Neuralgia, encephalitis, urethral strictures, pus forming in lymph nodes
Newborns
- Affect the eye, skin, mucous membranes and CNS

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22
Q

Genital Herpes: Diagnosis

A

Virus Culture Detection test

Serology (blood) test

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23
Q

Genital Warts (Condyloma Acuminatum)

A

Caused by HPV
Common STI
HPV transmitted by all types of sexual contact
Incubation period about 3-6 months
Different types of HPV can cause chronic genital infections
Most people who carry HPV have no symptoms

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24
Q

Genital Warts: S&S

A

May develop single or multiple cauliflower-like growths

Often painless, genitals or perianal area

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25
Q

Genital Warts

A

Complications
- Some subtypes of HPV are associated with cervical dysplasia and increased risk of cervical cancer
- Infants infected can develop papillomatosis chronic respiratory condition
Diagnosis
- Primarily by clinical appearance or by examination of cervical cells

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26
Q

Trichomoniasis

A

Caused by Trichomonas vaginalis, flagellated protozoa (extracellular parasite)
Localized infection attaching to the epithelium of the vaginal or urethral mucosa

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27
Q

Trichomoniasis: S&S

A

Copious, yellowish, foul smelling discharge
Inflammation and itching of the mucosa
Discomfort during sex and when urinating
May have occasional lower abd. pain

28
Q

Trichomoniasis

A 
Complications:
Increased risk of HIV transmission
Premature delivery or a low birth weight baby
Diagnostics:
Visual examination
Culture of fluid (vaginal or urethral)
29
Q

Pelvic Inflammatory Disorder (PID)

A

Involves the fallopian tubes, ovaries, uterus, and cervix
Cause:
- Neisseria gonorrhoeae
- Chlamydia trachomatis
Major cause of female infertility and ectopic pregnancy
Potential acute complication is peritonitis and pelvic abscess

30
Q

PID: Pathophysiology

A

Infectious organism enters the vagina and travels to the uterus during intercourse or sexual activity, childbirth, abortion, reproductive tract surgery (IUD)
– Invasion of bacteria into the mucosa
– Tubal walls become edematous and the lumen is filled with purulent exudate which cannot drain into the uterus
– Exudate drips onto the ovary and surrounding tissues
– Spreads to surrounding pelvic organs
– Enters lymphatic system and bloodstream, leading to systemic infection

31
Q

PID Manifestations

A

Fever
Purulent vaginal discharge
Severe lower abd. pain
Dysuria
Pain during intercourse during a pelvic exam
Peritonitis may result in increasing abdominal distension and rigidity

32
Q

PID Diagnosis

A

Endocervical secretions
WBC
Ultrasonography
Laparoscopy

33
Q

Dysfunctional Uterine Bleeding (DUB)

A

Vaginal bleeding that is abnormal in amount, duration, or time of occurrence
Related to hormonal imbalances or pelvic tumors

34
Q

DUB

A

Hormone imbalance of progesterone - deficiency
- Anovulation: absence of ovulation
- Amenorrhea: absence of menstruation
- Polymenorrhea: short cycle
- Oligomenorrhea: long interval between cycles (>35 days)
Other causes of bleeding: cancer, polyps, hyperplasia
- Metrorrhagia: bleeding between menstrual periods
- Menorrhagia: increased amount and duration of flow
- Postmenopausal bleeding

35
Q

Predisposing Factors (DUB)

A

Stress
Extreme weight changes
Use of oral contraceptives or IUDs
Postmenopausal changes

36
Q

Dysfunctional Uterine Bleeding: Diagnosisq

A 
Complete blood count
Thyroid function test
Hormone levels
- Serum estradiol and progesterone levels
- Serum hCG and LH levels
Pelvic ultrasound
Laparoscopy
Endometrial Biopsy
37
Q

Leiomyoma (Fibroids)

A 
Patho:
Benign tumor of the myometrium
Cause unknown
Common in women during reproductive years - shrink following menopause
Not considered precancerous
38
Q

Fibroids

A

Classified by location

  • Intramural: in the uterine wall
  • Submucosal: beneath endometrium - projecting inward into the uterine cavity
  • Subserosal: under the serosa - grows outward into the pelvic cavity
39
Q

Fibroids

A

Occur as multiple well-defined but unencapsulated masses
Vary in size
Are hormone dependent

40
Q

Fibroids: Manifestations

A

Asymptomatic until grow large enough to palpate
Abnormal bleeding
large tumours may cause pressure on adjacent structures
- Urinary frequency
- Constipation
- Heavy sensation abdomen
- Infertility

41
Q

Fibroids: Diagnostic test

A

Laporscopy: identify the fibroid
Ultrasound
Physical exam

42
Q

Breast Cancer

A

Incidence increases after age 20 years
- Most cases in women between ages 50 and 69 years
Most tumours are unilateral
Earlier onset associated with more aggressive growth
Different types:
- Most arise from ductal epithelial cells
Metastasis occurs via lymph nodes early in the course of the disease
Presence of estrogen or progesterone receptors on tumor cells influences treatment

43
Q

Breast Cancer: Predisposing Factors

A

First degree relative with the disease
Strong genetic predisposition (BRCA1 and BRCA2)
Longer and higher exposure to estrogen
Nulliparous (someone who’s never had a baby) or late first pregnancy
Lack of exercise
Smoking
High-fat diet
Radiation therapy to the chest
Cancer of the uterus, ovaries, or pancreas

44
Q

Breast Cancer: Manifestations

A

Change on mammogram
Initial sign: single, small, hard, painless nodule
Later: distortion of breast tissue, dimpled skin, discharge from nipple
Ultrasound or needle biopsy confirms diagnosis

45
Q

Breast Cancer

A 
Course of breast cancer
Metastasis occurs by the time the tumour is 1-2 cm in diameter
Axillary lymph node involvement
Secondary tumors in:
- Bone
- Lung
- Brain
- Liver
46
Q

Cervical Cancer

A

Most cases of cervical cancer are caused by HPV infection, a sexually transmitted virus
Routine pap smears of cervical cells are important in identifying early, treatable stages of the disease:
- By age 20 or in the year that sexual intercourse begins
- At intervals, as advised by health care worker

47
Q

Cervical Cancer

A

Course of disease

  • Early dysplasia of cells; abnormal cells showing less differentiation
  • In situ tumor is located on the mucosal surface
  • Invasion to submucosa
  • Invasion and spread to adjacent organs
  • Late metastasis
48
Q

Cervical Cancer: Risk factors

A

Age

49
Q

Uterine Cancer

A

Most common in postmenopausal women
Early indicator is painless vaginal bleeding or spotting
Risk factors
- Age >50
- High dose estrogen hormone treatment without progesterone
- Obesity
- DM

50
Q

Ovarian Cancer

A

No reliable screening available
Large mass detected by pelvic examination  Transvaginal ultrasound
– Considered a silent tumor
-  Few diagnosed in the early stage
- Research is ongoing to identify markers for serum diagnosis.
– Different types—vary in aggressiveness

51
Q

Ovarian Cancer: Risk Factors

A
  • Obesity
  • BRCA1 gene
  • Early menarche
  • Nulliparous or late first pregnancy
  • Use of fertility drugs
    Oral contraceptives containing progesterone are somewhat protective
52
Q

BPH: Pathophysiology

A

Common in older men (50%>50, 75%>70)  Mild to severe forms

Change is hyperplasia (increase in number of cells of prostate tissue)

53
Q

BPH

A

Nodules surrounding the urethra
Compression of urethra
Variable degrees of urinary obstruction
Hyperplasia related to imbalance between estrogen and testosterone

54
Q

BPH: Clinical Manifestations

A

Initial signs – direct results of narrowed urethra
Obstruction of urinary flow  Hesitancy
Dribbling
Decreased force or stream

55
Q

BPH

A 
Incomplete bladder emptying leads to Frequency, nocturia
Recurrent UTI’s
Diagnostic Tests 
- Rectal exam: enlarged gland 
Urine for C&S
56
Q

BPH: Complications

A 
Continued obstruction leads to
-  Distended bladder
-  Dilated ureters
-  Hydronephrosis
-  Possible renal damage
57
Q

Prostate Cancer

A
  • Most common cancer in men, excluding skin cancer
  • Second leading cause of cancer death in men
  • More than 75% of cases develop in men over 65
58
Q

Prostate Cancer: Etiology and pathophysiology

A 
Androgen-dependent adenocarcinoma
Majority of tumours occur in outer aspect of
the gland
Usually slow-growing
Spreads by three routes
– Direct extension
– Through lymph system
– Through bloodstream
59
Q

PRostate Cancer: Etiology and Pathiphysiology

A
  • Age, ethnicity, and family history are non- modifiable risk factors
  • Incidence rises markedly after age 50
  • High-fat diet and exposure to certain chemicals may also be associated with higher cancer risk
60
Q

Prostate Cancer: Manifestations

A 
Usually asymptomatic in early stages 
Eventually may experience symptoms similar to BPH
– Dysuria
– Hesitancy 
– Dribbling
– Frequency
61
Q

Prostate Cancer: Manifestations

A 
– Urgency
– Hematuria
– Nocturia
– Retention
– Interruption of urinary stream
– Inability to urinate
– Pain in lumbosacral area that radiates to hips or legs
62
Q

Prostate Cancer: Diagnostics

A
  • PSA (prostate-specific antigen) blood test
  • Elevated levels of PAP (prostatic acid
    phosphatase) also indicate prostate cancer
  • DRE (digital rectal exam) may find the prostate hard and have asymmetric enlargement with areas of induration or nodules
63
Q

Prostate Cancer: Diagnostics

A
  • Bone scan, CT, MRI, and TRUS are used to determine location and extent of spread of cancer
  • SPECT imaging uses a monoclonal antibody to target prostate-specific membrane antigens
  • Can detect spread to pelvic lymph nodes
64
Q

Testicular Cancer

A
  • Testicular germ cell carcinoma occurs most often in men between ages of 18 and 34
  • Three established risk factors: cryptorchidism, white race, and previous testicular cancer
  • Other factors: history of orchitis, HIV infection, and in utero exposure to diethylstilbestrol
65
Q

Testicular Cancer

A
  • Grows within one testicle
  • Local spread limited
  • Can spread rapidly through lymph and blood vessels to other organs with metastasis to lungs, bone, or liver
    Manifestations:
    – Painless hard nodule
    – Occasional dull ache in pelvis or scrotum

Patho II (9 decks)

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