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203 Endocrinology and Reproduction > Theme 3 - Gynae Pathology > Flashcards

Theme 3 - Gynae Pathology Flashcards

1
Q

Vagina, acid or alkali and why?

A

Glycogen shed from stratified squamous epithelium acts as substrate for anaerobic lactobacilli produce acid keeping pH 4.5. So acid

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2
Q

Draw label the ectocervix, endocervix and transformation zone.

A

outside exo
then transformation
then endo

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3
Q

type of cells make up ectocervix?

A

strat sq epithelium

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4
Q

type of cells make up endocervix?

A

Single layer of tall, mucin producing columnar cells

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5
Q

What feature gives endocervix a larger surface area?

A

Clefts

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6
Q

What is the junction between the endo and ectcervix called?

A

squamo-columnar junction

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7
Q

What changes occur to the cervix during puberty, and what happens to the SCJ? 4 points

A 
During puberty the cervix changes shape
The lips of the cervix grow
The distal end of the endocervix opens
Endocervical mucosa becomes exposed to the vaginal environment
So the SCJ moves inwards
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8
Q

During the pubertal changes to the cervix the columnar cells are exposed to the vaginal environment. What happens to them and why?

A

The distal endocervical columnar epithelium is exposed to the acidic vaginal environment
It is not suited to this, so undergoes an adaptive change called metaplasia

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9
Q

define neoplasm (4 points)

A

New growth,
abnormal
excessive
persists despite withdrawal of genetic or hormone stimulation

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10
Q

What are 3 features of a benign neoplasm?

A

Remains localised and doesn’t invade surrounding tissues
Generally grow slowly
Good resemblance of parent tissue

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11
Q

5 consequences of benign neoplasms?

A 
Pressure on adjacent tissue
Obstruction of lumen of a hollow organ
Hormone production
Transformation into a malignant neoplasm
Symptoms for the patient
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12
Q

4 features of malignant neoplasms

A

Invade into surrounding tissues
Spread via lymphatics to lymph nodes and blood vessels to other sites (metastasis)
Generally grow relatively quickly
Variable resemblance to parent tissue

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13
Q

7 consequences of malignant neoplasms

A 
Destruction of adjacent tissue
Metastasis
Blood loss from ulcerated surfaces
Obstruction of a hollow viscera
Production of hormones
Weight loss and debility
Anxiety and pain
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14
Q

Neoplasms have the suffix ….

A

oma

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15
Q

Malignant epithelial tumours are..

A

carcinomas

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16
Q

Carcinomas are named for the ..

A

epithelial cell type which they resemble

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17
Q

Carcinomas of glandular epithelium are called

A

adenocarcinomas

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18
Q

Malignant stromal tumours are

A

sarcomas

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19
Q

what is the pre malignant state of a neoplasm known as

A

dysplasia

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20
Q

define dysplasia

A

There is an accumulation of cells which look somewhat like malignant cells but do not invade the basement membrane

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21
Q

Term for dysplasia in the cervix - UK and US

A

UK: Cervical intra-epithelial neoplasia (CIN)
US: Squamous intra-epithelial lesion (SIL)

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22
Q

Difference between carcinoma and dysplasia?

A

invasion through the basement membrane

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23
Q

Most common HPV that cause cervical cancer?

A

16, 18

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24
Q

Most common HPV that cause genital warts?

A

6, 11

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25
Q

What are the 4 subtypes of endometrial cancer acoording to morphology (microscopic appearance)?

A

Endometrioid
Serous
Clear cell
Mixed (components of the previous 3)

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26
Q

What group of women is affected by type 1 endometrial cancer, type of cell, how does this spread and progonosis?

A 
50-60yo
Obese
endometriod
stimulated by oestrogen
SLow transition
spread by lympahtic system
good prognosis
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27
Q

What group of women is affected by type 2 endometrial cancer, type of cell, how does this spread and progonosis?

A 
60-70 year old
non obese
serous mixed
non oestrogen stimulated
spread into pertoneium 
poor prognosis
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28
Q

In the cervix, we recognize a precursor lesion to invasive squamous cell carcinoma
Wah6t is it called

A

Cervical Intra-Epithelial Neoplasia (CIN)

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29
Q

7 Risk factors for endometrial cancer?

A 
Endogenous hormones and reproductive factors
Excess body weight
Diabetes mellitus and insulin
Exogenous hormones & modulators
Ethnicity
Familial (Cowden’s syndrome; HNPCC)
Smoking not a risk
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30
Q

What reproductive factors reduce the risk of endometrial cancer and why?

A

Pregnanacy and parity - break from unopposed oestrogen

Delivery - removal of abnormal cells diring delivery

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31
Q

What are the 3 parameters for evaluating tumors?

A

Type
Grade
Stage

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32
Q

What is tumor grading?

A

Grading reflects how much a tumour resembles its parent tissue
Has to be done on tissue under a microscope
Many use a three-point system

Well differentiated Grade 1
Moderately differentiated Grade 2
Poorly differentiated Grade 3

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33
Q

What are the tumor stages?

A

T for tumour: local spread
N for nodes: lymph node deposits
M for metastasis: metastatic deposits

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34
Q

What is the FIGO system?

A

Grading for gynaecological cancers

35
Q

FIGO stages

A

Stage 1: Confined to corpus
Stage 2: Involving cervix
Stage 3: Serosa/Adnexa/Vagina/Lymph Nodes
Stage 4: Bladder, Bowel, Distant Metastasis

36
Q

Where does the transforamtion zone relocate to post menopause?

A

Recedes towards endocervix

37
Q

4 functions of the cervix

A

Produces mucus to facilitate sperm migration
Acts as a barrier to ascending infection
Holds a developing pregnancy in place
Effaces and dilates to enable vaginal birth

38
Q

What 6 physiological changes occur to the cervix in pregnancy?

A

Hypertrophies, but not as much as the uterus
Becomes softer
Increased vascularity/venous congestion, “purple tinge”
Glands distended with mucus, “mucus plug”
Prominent ectropion
Remains elongated until the onset of labour

39
Q

What is cervical ectopy and its cause?

A

Erosion effect of oestrogen

40
Q

What is cervical atrophy ?

A

Cervicitis due to lack of oestrogen

41
Q

Name 4 infections of the cervix

A

Chlamydia
Gonorrhoea
Trichomonas Vaginalis
HPV

42
Q

What are the three treatment options for cervical cancer?

A

1a cone biopsy / excision
1b radical hysterectomy / trachelectomy
2a chemo-radiotherapy

43
Q

Are most ovarian cysts benign or malignat?

A

Benign 90%

44
Q

Surgical interventions for ovarian cystes are mostly 45% performed on what pt group

A

Post meonpausal women

45
Q

4 complications of ovarian cysts

A

Torsion
rupture
haemorrhage
infection

46
Q 
22 y.o. Woman G0P0
seen by G.P. With vague RIF pain
USS 5cm right ovarian cyst
presented to A & E with lower abdominal pain
tenderness and guarding lower abdo
USS:  no cyst  some free fluid
Diagnosis and why?
A

Ovarian Cyst Rupture
Peritonitis absence of cyst on ultrasound scan
pain

47
Q 
29 y.o. Woman presents with acute lower right sided abdominal pain. 
minimal abdominal symptoms 
Tender 6cm mass right adnexum
USS haemorrhage into a cyst
management determined by symptoms
Diagnosis and why?
A

haemorrage into ovarian cyst

48
Q 
72 y.o woman G3 P2
occasional left sided twinges
presents with acute abdominal pain with nausea and vomiting. 
Tachycardia and temperature 37.8C
Lower abdo guarding and rigidity
leucocytosis
Tender 10cm mass high on left side of pelvis
Diagnosis and why?
A

Ovarian Cyst Torsion
necrosis of ovary
infection like symptoms

49
Q

19 year old female presents with two year history of “fullness” in the right side of the pelvis.
deep dysparunia, but increasing urinary frequency
Periods normal
otherwise fit and well
mass felt in right adnexum
USS complex cystic mass ?
Diagnosis and why?

A

Dermoid cyst

complex cystic mass

50
Q

18 year old female. Nulliparous
presents with recent onset of amenorrhoea
noted also hair recession and hirsuitism
on examination: clitoromegaly and slightly tender 10cm mass in left side of the pelvis.
USS complex mass in pelvis mainly solid and vascular
Daignosis and why?

A

sertoli-leydig tumour of ovary

hormone producing because stromal in origin

51
Q

3 categories of epithelial ovarian tumors?

A

Benign
borederline
malignant

52
Q

What is the peri menopause?

A

transition from reproductive cycles to post menopause

53
Q

Age and mean duration of peri menopause?

A

typical age at start 45-50 y, median 47.5 y

mean duration: 3.8 y

54
Q

4 symptoms of perimenopause?

A

irregular menstrual cycles
occasional heavy bleeding
hot flushes
nervousness, irritability

55
Q

3 primary symptoms of menopause

A

menstrual cycle changes - (oligomenorrhea, amenorrhea)
vasomotor symptoms - (Hot flushes, night sweats)
vaginal dryness

56
Q

7 secondary symptoms of menopause

A 
urinary stress/urge incontinence
cystitis-like symptoms
depression/irritability changes
musculoskeletal pains (joint aches & osteoporosis)
dry skin, hair thinning, nail changes
decreased concentration
decreased libido
57
Q

2 components of HRT?

A

Oestrogen

Progestogens

58
Q

What are each of the HRT hormones used to manage/treat?

A

Oestrogen - menopausal symptoms

Progetrogens - prevent endometrial cancer

59
Q

Other than HRT, what drugs can be used as an altrenative treatment for osteoperosis?

A

Biphosphonates - (Alendronate and Risedronate)

60
Q

Other than HRT, what drugs can be used as an altrenative treatment for the vasomotor symptoms?

A

Progesterone
SERMs – Raloxifene
Beta-blocker
Clonidine

61
Q

Via what 6 routes can HRT be given?

A 
Oral
Patches
Implants
Vaginal rings
Transdermal gel
Nasal
62
Q

If no uterus then what HRT given?

A

Oestrogen only.

63
Q

If uterus remaining, what HRT is given?

A

Oestrogen and progesterone
Oestradiol every day (white tablets)
Oestrogen plus progestagen (norgestrol) for 11 days (brown tablets)
Packet taken one after the other or 7 days break
Withdrawal bleeding during the brown tablets
`

64
Q

5 absolute contraindications to HRT

A 
Pregnancy
Active venous thromboembolism
Severe active liver disease
Endometrial carcinoma with recurrence
Breast carcinoma with recurrence
65
Q

6 relative contraindication to HRT

A 
Abnormal bleeding
Breast lump (prior to investigation)
Previous endometrial cancer
Previous breast cancer
Strong family history breast cancer
Family history of thromboembolism
66
Q

Side effects of HRT (up to 11)

A 
Mood swings/Low mood
Acne
Backache
Lower abdominal ache
Bleeding
Stomach upset (indigestion)
Tender or painful breasts
Fluid retention causing bloating and weight gain
Nausea
Headaches
Leg cramps
67
Q

2 short term benefits of HRT

A

Reduces vasomotor symptoms (eg hot flushes)

Improves psychological symptoms (eg mood swings)

68
Q

5 long term benefits of HRT

A

Maintains bone mass and reduces the risk of fracture
Reduces urogenital problems (eg dry vagina)
Improves skin (cosmetic)
Reduces the risk of bowel cancer
May improve balance and reduce falls – less fractures

69
Q

4 risks of HRT

A

Endometrial Cancer (if unopposed oestrogen used)
Breast Cancer
Cardiovascular disease (stroke and MI)
Venous thrombo-embolic disease (VTE)

70
Q

6 Differnces between HRT and COCP

A

Ethinyl oestradiol (not natural)
Massive first pass metabolism by the liver
Increased clotting factors
High dose oestrogen suppressing GnRH/ FSH/LH
Stops ovulation
Progestagen given to prevent hyperplasia of endometrium not really to add to contraception

Oestradiol (natural)
Lower dose to the body
Some increased clotting factors
Doesn’t suppress the FSH and LH to the same degree as the COCP
Doesn’t stop ovulation
Progestagen given to prevent hyperplasia of endometrium

71
Q

What is included in a biopsychosocial definition of “sexual health”?

A

a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence

72
Q

Why is “sexual health” preferable to “reproductive health”?

A

doest take into account non reproductive sexual activity or how people adentify their sexuality

73
Q

How could sexual coercion lead to poorer health outcomes?

A

sexual coercion has potentially long lasting effects on

  • psychological well-being
    e. g., higher prevalence of depression and anxiety
  • physical well-being
    e. g., lower well-being, greater cigarette/drug/alcohol use
  • sexual well-being
    e. g., more STIs, more negative attitudes attitudes
74
Q

How do sexual health comcerns vary over youth, adulthood, older age?

A

e. g. youth – avoiding unintended pregnancy
- avoiding STIs
- treating STIs to protect reproductive health

e. g. adulthood - optimising reproductive health
- optimising sexual satisfaction

e. g. older age - optimising sexual function
- limiting impact of physical health on sexual health

75
Q

Why is promoting preventative behavior in exual health important, give an example?

A

absence of vaccines, cures or effective treatment increases importance of behaviour

high and increasing rates of STIs, particularly among young people

comdom use

76
Q

If you were asked to design an intervention to increase condom use but could only focus on one thing, what would you try to change?

A

Preventative skills
condom use
interventions that include a skills component in addition to knowledge/ attitudes are the most effective (Carey et al. 2000)

77
Q

For what 6 reasons could STIs be increasing?

A

artefact?

- more sensitive tests
- more people getting tested  

real increase 

- more young people sexually active 
- inconsistent condom use
- lack of concern about HIV affects STI concern 
- belief that STIs are not serious
78
Q

What are 7 increse risk groups for contracting an STI?

A

young age (<20 years) - low age at 1st intercourse - coitarche
frequent partner change, high no. lifetime partners, concurrency (simultaneous partners)
sexual orientation
ethnicity for some STIs
use of non barrier contraception
residence in inner city/ deprivation
history of previous STI

79
Q

For what reasons are young people more at risk for contracting an STI?

A

Behaviourally more vulnerable to STI acquisition
higher numbers of sexual partners / partners change
greater numbers of concurrent partners
yet to develop skills and confidence to use condoms, negotiate safe sex,
more risk-taking behaviour/ experimentation
poor contraception awareness

80
Q

STI most prevalant amonst young people especially young women

A

Chlamydia

81
Q

What 5 vulnerabilites os early intercourse assocciated with ?

A

leaving home / not living with parents before 16 years
leaving school early
family disruption & disadvantage
lack of nurturing relationships
those whose main source of information on sex was not school / parents

82
Q

6 main messages for young peole in terms of sexual health?

A

Don’t rush into it – avoid peer pressure
Use a condom with all new partners - continue until both screened
Sort out contraception
Avoid overlapping sexual relationships
Get screened for chlamydia/gonorrhoea when you have a new partner
MSM should have regular sexual health screens, including HIV, get vaccinated for hepatitis A/B and HPV & consider PrEP for HIV prevention

83
Q

Most common STI daignosis in MSM?

A

Syphillis

84
Q

Most common STI in young men?

A

Gonnorrhea

203 Endocrinology and Reproduction (3 decks)

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