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Clinical Pathology > Theme 9: Gynaecological and Breast Pathology > Flashcards

Theme 9: Gynaecological and Breast Pathology Flashcards

1
Q

True or false: there are more than 100 subtypes of Human Papillomavirus.

A

True

Many are considered ‘low risk’ and most women can clear high and low risk HPV via their immune system.

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2
Q

Which are the two main low risk subtypes of HPV?

A

HPV 6 and 11

Low risk HPV are linked with genital warts and other low-grade cytological abnormalities.

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3
Q

Which are the four main high risk subtypes of HPV?

A

HPV 16, 18, 31 and 33

High risk HPV are associated with high-grade pre-invasive and invasive diseases.

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4
Q

True or false: roughly 50% of cervical cancers contain HPV DNA?

A

False. The figure is much higher.

99.7% of cervical cancers contain HPV DNA.

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5
Q

HPV types 16 and 18 are associated with what percentage of cervical cancers?

A

HPV types 16 and 18 are associated with ~70% of cervical cancers.

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6
Q

What are the two main vaccines available for HPV? Which subtypes does each cover?

A
  1. Gardasil
    Covers HPV 6, 11, 16 and 18
    6 and 11 are low-risk types that cause condylomata (genital warts)
    16 and 18 are high-risk types that cause cervical intraepithelial neoplasms and invasive carcinoma
  2. Cervarix
    Covers HPV 16 and 18
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7
Q

How do high risk subtypes of HPV cause cancer?

A

Express E6 and E7 genes.

E6 bind to and inhibits p53. As p53 usually triggers apoptosis when faulty DNA is detected, these cells no longer self-destruct.

E7 binds to RB1, a tumour suppressor gene. RB1 usually regulates cell proliferation, therefore these cells proliferate without control.

Accumulation of genetic damage plus uncontrolled proliferation leads to neoplasms.

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8
Q

Which area of the cervix is most susceptible to oncogenic effects of HPV?

A

Transformation zone - an area that undergoes metaplasia even in normal physiological conditions.

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9
Q

The pre-invasive stage of cervical squamous cell carcinoma is known as ____.

A

The pre-invasive stage of cervical squamous cell carcinoma is known as cervical intraepithelial neoplasia (CIN).

Detection of CIN is the aim of the cervical screening programme.

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10
Q

What is dyskaryosis?

A

Presence of squamous cells with abnormal cytological changes

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11
Q

If, at cervical screening, a woman is found to have a degree of dyskaryosis, what is the usual treatment option?

A

Large loop excision of the transformational zone (LLETZ)

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12
Q

What is the most important causative factor associated with cervical squamous cell carcinoma?

A

Infection by high risk HPV subtype (HPV 16, 18, 31, 33)

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13
Q

Although HPV is the number one cause of cervical cancer, what other risk factors are associated?

A
  • Multiple sexual partners or male partner with multiple partners
  • Young age at first intercourse
  • High parity
  • Low socioeconomic group
  • Smoking (immunosuppressed as smoking lowers number of antigen presenting cells)
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14
Q

Cervical glandular intraepithelial neoplasia (CGIN) is the precursor to which cancer?

A

Cervical adenocarcinoma

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15
Q

True or false: Cervical squamous cell carcinoma is highly related to high-risk HPV, but cervical adenocarcinoma is not.

A

False.

While high risk HPV is the most important factor in cervical SCC, it is also related to cervical adenocarcinoma.

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16
Q

Stage for stage, which has the worst prognosis, cervical SCC or cervical adenocarcinoma?

A

Cervical adenocarcinoma has the worse prognosis as it is harder to treat, due to its radioresistance.

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17
Q

What system is used to stage cervical cancer?

A

FIGO

I: Confined to cervix
II: Invades beyond uterus, but not pelvic side
III: Extends to pelvic wall, lower third of vagina, hydronephrosis
IV: Invades bladder or rectum or outside pelvis

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18
Q

What are the usual sites of metastasis for cervical cancers?

A

Pelvic and para-aortic lymph nodes

Via blood to liver, lungs and bone

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19
Q

How is vulval intraepithelial neoplasia visualised?

A

Toluidine blue is painted over the area

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20
Q

What are the two subtypes of vulval intraepithelial neoplasia?

A
  1. Classical/warty/basaloid

2. Differentiated

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21
Q

How is classical/warty/basaloid VIN graded?

A

Classical/warty/basaloid VIN (vulval intraepithelial neoplasia) is graded as VIN 1-3

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22
Q

Which type of VIN is related to HPV infection?

A

Classical/warty/basaloid VIN (vulval intraepithelial neoplasia)

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23
Q

Which type of VIN is more common in younger women?

A

classical/warty/basaloid VIN

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24
Q

How is differentiated VIN graded?

A

It isn’t graded

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25
Q

True or false: Differentiated VIN is unrelated to HPV

A

True.

Classical/warty/basaloid VIN is related to HPV and is more common in younger women.

Differentiated VIN is unrelated to HPV, but is associated with chronic dermatoses, especially lichen sclerosus. It is more common in older women.

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26
Q

Lichen sclerosus is associated with which genital neoplasia?

A

Differentiated vulval intraepithelial neoplasia

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27
Q

When a tumour is removed, positive margins suggest what about recurrence?

A

It is more likely to recur, because malignant cells were found at the margins of the excised tissue. This suggests some could be left in situ.

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28
Q

What is the most common type of vulval cancer?

A

Vulval squamous cell carcinoma

Accounts for 90% of vulval cancers

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29
Q

True or false: Vulval Intraepithelial Neoplasia (VIN) is more likely to become invasive in young, postpartum women.

A

False.

Invasion is most likely to occur in postmenopausal/immunocompromised women.

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30
Q

True or false: Spontaneous regression of vulval intraepithelial neoplasia (VIN) may occur, particularly in young, postpartum women.

A

True

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31
Q

Which of the following are incorrect:

A) Vulval squamous cell carcinoma is associated with inflammatory dermatoses, such as lichen planus and lichen sclerosus.
B) Inflammatory dermatoses are more likely to lead to vulval squamous cell carcinoma in over 70s
C) Vulval squamous cell carcinoma has very little link with HPV
D) Vulval intraepithelial neoplasia can lead to vulval squamous cell carcinoma

A

C) Vulval squamous cell carcinoma has very little link with HPV

There are two main types of vulval squamous cell carcinoma:
1] Associated with VIN, age <60, associated with lower genital tract neoplasia (CIN), HPV +

2] Associated with inflammatory dermatoses (lichen sclerosus, lichen planus), age >70

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32
Q

Which system is used to estimate the prognosis of vulval squamous cell carcinoma?

A) Dukes
B) Nottingham
C) FIGO
D) TMN

A

C) FIGO

grade, nodes, tumour size

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33
Q

What is the most important prognostic factor for malignant melanoma?

A

Depth of invasion

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34
Q

True or false: Extramammary Paget’s disease is linked with HPV

A

False

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35
Q

Which cancer is responsible for 5% of vulval tumours and is common around the age of 80?

A

Paget’s disease (extramammary)

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36
Q

How does extramammary Paget’s disease present?

A

Pruritic/burning/eczematous patch

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37
Q

Extramammary Paget’s disease begins as an in situ __1__ of the __2__ mucosa, but can develop into an invasive __3__.

A

1) adenocarcinoma
2) squamous
3) adenocarcinoma

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38
Q

Paget’s disease (extramammary) is associated with cancers of the __1__ and __2__

A

1) Bladder

2) Cervix

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39
Q

Which cancer is responsible for 5% of vulval tumours and is common between the ages of 50-60?

A

Malignant melanoma

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40
Q

Where is a very common site of spread for malignant melanoma of the vulva?

A

Urethra

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41
Q

In which condition do you find endometrial tissue where it shouldn’t be normally found?

A

Endometriosis

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42
Q

How is endometriosis diagnosed?

A

Laparoscopy to visualise the ectopic tissue

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43
Q

How might a patient present with endometriosis?

A 
25% asymptomatic
Dysmenorrhoea
Dyspareunia
Pelvic pain
Subfertility
Pain on passing stool
Dysuria
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44
Q

How might you treat endometriosis?

A

Medical:

  • Combined OCP
  • GnRH agonist/antagonist
  • Progesterone antagonist

Surgical

  • Ablation
  • Total abdominal hysterectomy
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45
Q

What other conditions are associated with endometriosis?

A

Ectopic pregnancy
Ovarian cancer
IBD

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46
Q

Inflammation of the endometrium is known as ____

A

endometritis

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47
Q

What is the most common cause of endometritis?

A

Pelvic Inflammatory Disease (PID)

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48
Q

What are the most likely causes of endometritis?

A

Pelvic inflammatory disease

Retained gestational tissue

Endometrial TB

IUCD infection (intrauterine contraceptive device)

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49
Q

What microscopic change would be seen on a biopsy of endometritis?

A

Lymphocytes/plasma cells

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50
Q

Which of these is not associated with endometrial polyps?

a) Often asymptomatic
b) Oestrogen-dependent
c) Often pre-cancerous
d) Medically treated with progesterone or gonadotropin-releasing hormone agonists

A

c) Often pre-cancerous

It is rare for endometrial polyps to become malignant (<1%)

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51
Q

What term describes a benign myometrial tumour with oestrogen/progesterone-dependent growth?

A

Leiomyoma

a.k.a uterine fibroids

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52
Q

What options are available for treating leiomyoma?

A

Medical:
- Intrauterine system (IUS, e.g. mirena coil)

  • OCP
  • Progesterone
  • Fe2+
  • NSAIDs

Surgical:
- artery embolisation

  • ablation
  • TAH (total abdominal hysterectomy)
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53
Q

What risk factors are associated with endometrial hyperplasia?

A

Obesity

Exogenous oestrogen

PCOS

Oestrogen-producing tumours

Tamoxifen

HNPCC

(PCOS = polycystic ovary syndrome; HNPCC = hereditary non-polyposis colorectal cancer)

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54
Q

Which of these is not a subtype of endometrial hyperplasia?

a) simple non-atypical
b) complex non-atypical
c) simple atypical
d) complex atypical

A

Trick question: they’re all subtypes of endometrial hyperplasia!

Endometrial hyperplasia is divided into 2 types: simple and complex. Each type has typical and atypical forms.

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55
Q

What term describes excessive proliferation of endometrium?

A

Endometrial hyperplasia

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56
Q

What causes endometrial hyperplasia?

A

Increased oestrogen, reduced progesterone

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57
Q

Left untreated, endometrial hyperplasia may develop into non-atypical hyperplasia, atypical hyperplasia and, finally, __?__.

A

endometrioid adenocarcinoma

type 1 endometrial adenocarcinoma

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58
Q

When endometrial hyperplasia has invaded into the myometrium it is termed __?__

A

Endometrioid adenocarcinoma

type 1 endometrial adenocarcinoma

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59
Q

What is the most common cancer of the female genital tract?

A

Endometrial adenocarcinoma

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60
Q

How many new cases of endometrial adenocarcinoma are there each year?

a) <500
b) 1000-2000
c) 5000-7000
d) >9000

A

d) >9000

Each year: Roughly 9,200 new cases of endometrial adenocarcinoma, roughly 2,500 deaths

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61
Q

Which staging system is used for staging endometrial adenocarcinoma?

A

FIGO (1-4)

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62
Q

What are the treatment options for endometrial adenocarcinoma?

A

Medical: progesterone

Surgical: Total abdominal hysterectomy (TAH)

Adjuvant: chemo, radio

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63
Q

What is the 5-year survival rate for a person diagnosed with stage 1 endometrial adenocarcinoma?

A

90%

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64
Q

A person with stage 2 or 3 endometrial adenocarcinoma has a 5-year survival rate of __?__

A

less than 50%

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65
Q

What types of endometrial adenocarcinoma are there?

A

Type 1: Endometrioid

Type 2: Serous

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66
Q

__?__ adenocarcinoma is a type of endometrial cancer that tends to affect postmenopausal women.

A

Serous adenocarcinoma

type 2 endometrial adenocarcinoma

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67
Q

__?__ adenocarcinoma is a type of endometrial cancer that tends to affect pre-/perimenopausal women.

A

Endometrioid adenocarcinoma

type 1 endometrial adenocarcinoma

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68
Q

Which type of endometrial adenocarcinoma develops from endometrial hyperplasia?

A

Endometrioid adenocarcinoma

type 1

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69
Q

Which type of endometrial adenocarcinoma develops from endometrial atrophy?

A

Serous adenocarcinoma

type 2

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70
Q

PTEN and KRAS mutations are associated with which type of endometrial cancer?

A

Endometrioid adenocarcinoma

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71
Q

What type of mutation is associated with endometrial serous adenocarcinoma?

A

P53

serous it type 2 endometrial adenocarcinoma. It is usually preceded by endometrial atrophy.

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72
Q

Which type of endometrial adenocarcinoma is linked to oestrogen?

A

Endometrioid

type 1

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73
Q

What is the Rotterdam criteria?

A

Tool for diagnosing polycystic ovary syndrome.

Patient must meet two out of the three below:

  • polycystic ovaries
  • hyperandrogenism (hirsutism/biochemical)
  • Irregular periods (>35 days)
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74
Q

How would you expect PCOS to affect serum levels of FSH, LH, testosterone and DHEAS?

A

↑ LH, testosterone, DHEAS

↓ FSH

(DHEAS = Dehydroepiandrosterone sulfate)

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75
Q

What investigations would be done to test for PCOS?

A

USS, fasting biochemical screen (↓FSH, ↑LH, ↑testosterone, ↑DHEAS ), OGTT

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76
Q

What treatment options are available for PCOS?

A

Lifestyle: weight loss

Medical: metformin, OCP, clomiphene

Surgical: ovarian drilling

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77
Q

PCOS increases the risk of which type of endometrial cancer?

A

Endometrioid adenocarcinoma

(type 1 endometrial adenocarcinoma)

PCOS can lead to endometrial hyperplasia, which can develop into this.

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78
Q

Which of the following is a cause of secondary gonadal failure (hypogonadotropic hypogonadism)?

a) Sheehan syndrome
b) Turner syndrome
c) Chemotherapy
d) Klinefelter’s syndrome

A

a) Sheehan syndrome

Postpartum haemorrhage causes the pituitary gland
to become ischaemic due to hypovolaemia. Failure of the gonads is secondary to failure of the pituitary.

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79
Q

What are the clinical features of gonadal failure?

A

Amenorrhoea/absent menarche, delayed puberty, ↓ sex hormone levels (+/- ↑ LH and FSH levels)

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80
Q

Which of these is associated with increased levels of FSH and LH?

a) PCOS
b) Hypogonadism
c) Endometrial TB
d) Fibrothecoma

A

b) Hypogonadism

Amenorrhoea/absent menarche, delayed puberty, ↓ sex hormone levels (+/- ↑ LH and FSH levels)

81
Q

What treatment options are available for hypogonadism?

A
  • Address the underlying cause

- HRT

82
Q

What are the three potential origins of ovarian neoplasms?

A
  • Surface epithelium
  • Sex cord stroma
  • Germ cell
83
Q

Which are the most common origin of ovarian tumours?

A

Epithelium

84
Q

Which is the most common histological type of ovarian tumour?

A

Serous (tubal) tumours. Originate from the ovarian epithelium.

85
Q

True or false: Ovarian tumours are the most common type of gynae cancer.

A

False. They are 2nd commonest.

Endometrial adenocarcinoma is the commonest cancer of the female genital tract.

86
Q

Which age group is usually more affected by serous tumours of the ovary?

A

Older women

87
Q

What are the benign variants of epithelial tumours?

A

Cystadenoma
Adenofibroma
Cystadenofibroma

88
Q

What term describes malignant epithelial tumours?

A

Cystadenocarcinoma

89
Q

What are the subclassifications of germ cell tumours?

A

Germinomatous (arise directly from the germ cells)

Non-germinomatous (not directly from germ cells)

90
Q

Which of the following is a germinomatous germ cell tumour?

a) Yolk sac tumour
b) Choriocarcinoma
c) Dysgerminoma
d) Teratoma

A

c) Dysgerminoma

91
Q

Which of the following (if any) are benign germ cell tumours?

a) Dysgerminomas
b) Teratomas
c) Yolk sac tumours
d) Choriocarcinomas

A

b) Teratomas

The rest are malignant.

Teratomas are benign but there is a 1% risk of malignant transformation.

92
Q

Which type of tumours arise from the primordial germ cells of the ovary?

A

Dysgerminomas

Arise from oogonia (primordial germ cells of the ovary)

93
Q

Which of the following is not chemosensitive?

a) Dysgerminomas
b) Yolk sac tumours
c) Choriocarcinomas
d) They are all sensitive to chemotherapy

A

c) Choriocarcinomas

94
Q

Which tumour originates from the extraembryonic yolk sac?

A

Yolk sac tumour

95
Q

Which tumour arises from the placenta?

A

Choriocarcinoma

96
Q

True or false: Sex cord stromal tumours are rare.

A

True

97
Q

Thecoma, granulosa and Sertoli-Leydig are all types of cancer from what origin?

A

Ovarian tumours arising from sex cord stroma

98
Q

What is Meig’s syndrome?

A

Triad of benign ovarian tumour, right-sided hydrothorax, ascites. Should resolve upon resection of the tumour.

99
Q

Which of these do not produce oestrogen?

a) Fibroma
b) Thecoma
c) Fibrothecoma
d) Granulosa cell tumour

A

a) Fibroma

The others all produce oestrogen, but fibromas are hormonally inactive.

100
Q

What term describes a tumour which includes a mix of granulosa cells and thecoma/fibroma?

A

Sertoli-Leydig cell tumour

These tumours produce androgens and are usually benign, although 10-25% are malignant

101
Q

True or false: Thecoma, fibroma and fibrothecoma are all benign.

A

True

102
Q

True or false: Granulosa cell tumours are benign.

A

False.

Granulosa cell tumours are low-grade malignant.

They also produce oestrogen.

103
Q

Spindle cells are associated with which ovarian neoplasm?

A

Thecoma/fibrothecoma

104
Q

In primary gonadal failure, where is the problem?

A

Within the gonad itself

105
Q

In secondary gonadal failure, where is the problem?

A

In the hypothalamus or pituitary gland

106
Q

What condition is being described:

oestrogenic stimulation of endometrial proliferation; continuous stimulation may lead to atypical hyperplasia and carcinoma

A

Endometrial hyperplasia

107
Q

What condition is being described:

benign smooth muscle tumours of the myometrium

A

Leiomyomata

108
Q

What condition is being described:

local endometrial overgrowth

A

Endometrial polyps

109
Q

What condition is being described:

acute/chronic inflammation of endometrium (usually due to infection)

A

Endometritis

110
Q

What condition is being described:

spread of endometrium into the pelvis

A

Endometriosis

111
Q

What common condition is being described:

Multiple follicular cysts, hyperandrogenism, menstrual irregularity

A

Polycystic ovary syndrome (PCOS)

112
Q

What is the breast screening triple assessment?

A

1) Clinical examination
(history and physical examination)

2) Radiological examination
(USS, mammography)

3) Pathological examination
(core-cut biopsy, fine-needle aspiration cytology FNAC)

All three need to agree before patient is returned to normal screening pool.

113
Q

Describe the normal glandular parenchyma of the breast by filling in the gaps:

__1__ lobes of glandular tissue, drained by __2__. Lobes __3__ toward areola.

Near the areola the lactiferous duct __4__ to form the __5__.

A

1) 15-20
2) lactiferous duct
3) converge
4) dilates
5) lactiferous sinus

114
Q

Which of the following are synonyms for fibrocystic disease of the breast?

a) Fibrous mastopathy
b) Mammary dysplasia
c) Schimmelbusch’s disease
d) Chronic cystic mastitis

A

All of them

They all describe fibrocystic change/disease in the breast.

115
Q

Which group is generally affected by fibrocystic disease?

A

Pre-menopausal women

116
Q

True or false: Fibrocystic changes are usually unilateral in the breasts

A

False

Usually they are bilateral and multifocal. Fibrocystic change is seen in roughly 60% of normal breasts

117
Q

What is the biggest risk factor for women developing fibrocystic change in their breasts?

A

Hyperoestrogenism

HRT, oestrogen-secreting tumour etc

118
Q

What is the risk of fibrocystic breasts developing into subsequent carcinoma?

A

No risk - FCC is completely benign.

119
Q

What condition is being described?

a constellation of bening, hormone-mediated breast changes including cyst formation, stromal fibrosis and mild epithelial hyperplasia without atypia.

A

Fibrocystic disease

aka. Fibrous mastopathy, mammary dysplasia, Schimmelbusch’s disease, chronic cystic mastitis

120
Q

How are triple assessment findings scored?

A

Clinical: P1-P5 (P = palpation)
Radiological: R1-R5 (R = radiology, or U for ultrasound)
Pathological: B1-B5 (B = biopsy, or C = cytology)

121
Q

What do the triple assessment scores mean?

A

P/R/B 1-5

1: Normal; return to normal screening
2: Benign; reassure and return to normal screening
3: Malignant potential; excision
4: Suspected malignancy; rebiopsy/excision
5a: Carcinoma in-situ (DCIS); wide local excision/mastectomy
5b: Invasive carcinoma; WLE/mastectomy

122
Q

What triple assessment score would be given to a patient with fibrocystic changes on histological examination?

A

B2

Benign changes. Reassure and return to regular screening.

123
Q

What triple assessment score would be given to a patient with fibroadenoma?

A

B2

Benign changes. Reassure and return to regular screening.

124
Q

What condition is being described:

A mobile, painless, well-defined breast lump that is most commonly found in afro-Caribbean women.

A

Fibroadenoma

These are common benign growths usually found in women aged 20-30yo.

125
Q

What triple assessment score would be given to a patient with invasive breast carcinoma?

A

B5b

126
Q

What risk factors are associated with breast carcinoma?

A

Hyperoestrogenism
- Early menarche, late menopause, OCP and E2 HRT

Obesity (in postmenopausal women)

Alcohol

127
Q

What triple assessment score would be given to a patient with DCIS?

A

B5a

DCIS = ductal carcinoma in-situ

These carcinomas show no signs of invasion.

128
Q

__?__ is the precursor to invasive breast carcinoma

A

DCIS (ductal carcinoma in-situ)

129
Q

What is most commonly seen on screening in patients with DCIS?

A

Microcalcifications

130
Q

What are the red flags associated with a palpable lump in breast examination?

A

Older patient

Tethering (low mobility, puckered skin, retracted nipple)

Discharge

131
Q

How is the histological grade of breast cancer assessed?

A

Nottingham Grading System (1-3)
- assesses tissue based on tubule formation, nuclear pleomorphism and mitosis.

Grade 1: Well differentiated. >75% tubule formation, mild degree of nuclear pleomorphism and low mitotic count

Grade 2: Moderately differentiated

Grade 3: No tubule formation, marked nuclear pleomorphism and frequent mitoses

132
Q

What information should a pathology report tell you about a breast malignancy?

A
  • In situ or invasive
  • Type (ductal, lobular etc…)
  • Grade (Nottingham system 1-3)
  • Size
  • Vascular invasion
  • Nodal status
  • Relationship to margins
  • Molecular marker status (oestrogen/progesterone/HER2 receptors)
133
Q

What is the most common type of breast cancer?

A

Ductal (75%)

134
Q

Cribiform, medullary, mucoid and lobular are all types of which cancer?

A

Breast

135
Q

What are the key prognostic factors when assessing breast cancer?

A

Tumour grade
Tumour size
Nodal status

136
Q

What factors inform the Nottingham Prognostic Index?

A

Grade (Nottingham System 1-3)
Nodal status (scored 1-3)
Tumour size

(grade + nodal status + 0.2 x size)

137
Q

What score boundaries define the prognosis of breast cancer?

A

Nottingham Prognostic Index score:

> 3.4 = good (80% 16y survival)

  1. 41-5.4 = moderate (46%)
  2. 41< = poor (10%)
138
Q

What does the circumscription of a mass usually tell you about whether it is benign or malignant?

A

Good circumscription is usually a feature of benign masses

139
Q

What does calcification tell you about whether a mass is benign or malignant?

A

Calcification is not a good indicator of whether a mass is benign or malignant - it only tells you there is an abnormality

140
Q

What is meant by ‘triple negative’ breast cancer?

A

The tumour is negative for oestrogen, progesterone and HER2 receptors. This means it cannot be targeted easily by current therapies and is a bad sign.

141
Q

What is trastuzumab used for?

A

Trastuzumab [herceptin] is a drug that targets HER2 positive tumours

142
Q

What is tamoxifen used for?

A

Targeted breast cancer therapy, targets oestrogen receptors on tumours.

143
Q

What targeted therapies are available for treating breast cancer?

A

Tamoxifen
Aromatase inhibitors
Bisphosphonates
Herceptin (trastuzumab)

144
Q

Luminal A, luminal B, Basal and normal-like are all molecular subtypes of which type of cancer?

A

Breast

Classified based on their molecular receptor status (HER2, E2, P4 etc)

145
Q

True or false: During pregnancy women are more resistant to infections.

A

False.

Pregnancy does not alter resistance to infection.

146
Q

Which infections can be passed from mother to baby during pregnancy (in utero)?

A

TORCH

Toxoplasmosis

Other: coxsackie, HBV, HIV, syphilis, varicella zoster

Rubella

CMV

Herpes simplex

147
Q

Why should pregnant women be careful around cat and dog faeces?

A

They can contract toxoplasmosis, which is more severe in pregnancy and can transfer to the foetus

148
Q

Which neonatal infections are contracted during passage through the birth canal?

A

Group B strep, herpes simplex

Gonorrhoea, chlamydia

HIV, HBV

149
Q

What screening test does NICE recommend to help reduce the risk of pyelonephritis in pregnant women?

A

Women should be offered routine screening for asymptomatic bacteriuria by midstream urine culture early in pregnancy.

Identification and treatment of asymptomatic bacteriuria reduces the risk of pyelonephritis.

150
Q

True or false: Antenatal screening for Group B Streptococci is not recommended in UK

A

True.

Until it is clear that antenatal screening for GBS carriage does more good than harm and that the benefits are cost effective, the National Screening Committee does not recommend routine screening in the UK.

151
Q

What is IAP and to whom is it offered?

A

IAP = intrapartum antimicrobial prophylaxis

IAP offered to:

  • Women with previous baby with neonatal Group B Strep disease
  • Women with GBS in current pregnancy
  • Women who are pyrexial in labour
152
Q

How is early-onset neonatal group B strep disease (EOGBS) prevented?

A

Intrapartum antimicrobial prophylaxis, if indicated.

153
Q

Which of the following is not associated with intraamniotic infections?

a) Affects 20-25% of pregnancies with pre-term labour
b) Can lead to chorioamnionitis
c) Primarily acquired haematogenously
d) Amniocentesis increases the risk of infection

A

c) Primarily acquired haematogenously

Haematogenous (via blood) infection is rare but can occur with bacteria such as listeria monocytogenes.

Primary mode of infection is from vaginal bacteria ascending through the cervix.

154
Q

What is the most common risk factor for intra-amniotic infection?

A

Prolonged rupture of membranes

Other risk factors include: amniocentesis, cordocentesis, cervical cerclage (cervical stitch), multiple vaginal examinations, bacterial vaginosis.

155
Q

What are the risk factors for intra-amniotic infection?

A

Most common after prolonged rupture of membranes.

Other risk factors include: amniocentesis, cordocentesis, cervical cerclage (cervical stitch), multiple vaginal examinations, bacterial vaginosis.

156
Q

Where do intra-amniotic infections usually originate from?

A

Bacteria present in the vagina cause infection by ascending through the cervix.

Haematogenous infection is rare.

157
Q

What are the most common causative organisms for intra-amniotic infections?

A

Group B Strep
E-Coli
Genital Mycoplasma

158
Q

How are intra-amniotic infections managed?

A

Antimicrobials (started at time of diagnosis; not after delivery)

Delivery of foetus

159
Q

Define puerperium

A

The period of approx six weeks following childbirth, during which time the mother’s reproductive organs return to their non-pregnant state.

160
Q

What is being described:

Infection of the womb within 6 weeks of childbirth

A

Puerperal endometritis

Affects ~5% of pregnancies

161
Q

What risk factors are associated with puerperal endometritis?

A

Risk factors: c-section, prolonged labour, PROM, multiple vaginal examinations

162
Q

What are the clinical features of puerperal endometritis?

A
  • Fever
  • Uterine tenderness
  • Purulent, foul-smelling lochia
  • Raised WCC
  • Malaise, abdo pain
163
Q

What are the main causative organisms of puerperal endometritis?

A

Frexently a mix of:

  • E-Coli
  • B-Haemolytic Streptococci
  • Anaerobes
164
Q

How is puerperal endometritis managed?

A

Broad-spectrum IV Abx until is apyrexial for 48 hours

165
Q

Define early-onset neonatal sepsis

A

Sepsis within 72 hours of birth

Usually from vertically-transmitted infection

166
Q

Define late-onset neonatal sepsis

A

Sepsis after 72 hours of birth

Usually from hospital acquired infection

167
Q

What is the mortality rate for early-onset neonatal sepsis?

A

1 in 4 babies who develop EOS will die, even if given Abx

168
Q

How do neonates acquire the organism(s) that lead to early-onset sepsis?

A

Maternal genital tract

169
Q

True or false: It is typical to have multisystem involvement and pneumonia associated with early-onset neonatal sepsis

A

True

170
Q

Which organism is the commonest cause of late-onset neonatal sepsis?

A

Coagulase-negative staphylococci

Associated with prosthetic devices, such as feeding tubes, IV access etc.

Can also be caused by E-Coli

171
Q

What is the leading cause of all childhood infections?

A

Streptococcus pneumoniae

172
Q

Childhood infections most commonly affect which system?

A

Respiratory

173
Q

What is the leading cause of sore throat in children?

A

70-80% viral

20-30% Group A B-Haemolytic Streptococcus

174
Q

A mother brings in her toddler who has been unusually irritable, not sleeping, has a fever and is struggling to keep balance more than usual.

What is the most likely organism causing these symptoms?

A

Streptococcus pneumoniae

Other common causes of otitis media are haemophilus influenzae and moraxella catarrhalis.

175
Q

Which of the following is least likely to be the cause of acute respiratory infection in children?

a) Chlamydia pneumoniae
b) Mycoplasma pneumoniae
c) RSV
d) Streptococcus pneumoniae

A

a) Chlamydia pneumoniae

Leading aetiology of acute resp. infections in children:

  1. RSV (63%)
  2. Mycoplasma pneumoniae (9%)
  3. Streptococcus pneumoniae (8%)
176
Q

What condition is being described?

A seasonal viral illness characterised by fever, nasal discharge and a dry, wheezy cough. On examination there are fine inspiratory crackles and/or high-pitched expiratory wheeze

A

Bronchiolitis

Aetiology:

  • RSV
  • Metapneumovirus
  • Adenovirus
  • Parainfluenza virus
  • Influenza
  • Rhinovirus
177
Q

What is pertussis more commonly known as?

A

Whooping cough

178
Q

What are the 3 clinical stages seen in pertussis?

A
  1. Catarrhal phase
  2. Paroxysmal phase
  3. Convalescent phase
179
Q

A child presents with fever, irritability and poor feeding. On examination you notice the fontanelle appears to be bulging slightly. What differentials are you most concerned about?

A

Meningitis and encephalitis

180
Q

What are the most likely causes of bacterial meningitis in:

(i) Neonates?
(ii) Children 1m-5y?

A

(i) Neonatal bacterial meningitis: Group B Strep, E Coli, Listeria Monocytogenes
(ii) 1m-5ys: Streptococcus pneumoniae, Neisseria meningitidis

181
Q

What is the most common cause of meningitis in children under one year?

A

Enteroviruses

182
Q

What is meningococcemia?

A

The dissemination of meningococci (Neisseria meningitidis) into the bloodstream (see the image below). Patients with acute meningococcemia may present with:

(1) meningitis;
(2) meningitis with meningococcemia; or,
(3) meningococcemia without clinically apparent meningitis

183
Q

What symptoms are associated with UTI in older children?

A
  • Dysuria
  • Increased frequency
  • Increased urgency
  • Small volume voids
  • Lower abdo pain
184
Q

What is the most common cause of UTI in children?

A

E Coli (60-80%)

Others: proteus, klebsiella, enterococcus, staph. saprophyticus

185
Q

Which of these is not an appropriate method of urine sampling in a child with suspected UTI:

a) Clean catch sample
b) Sanitary towel
c) Suprapubic aspiration
d) Catheter sample

A

b) Sanitary towel

Also should not use cotton wool or gauze

186
Q

Meningococcemia has a mortality rate of __1__% (90% if __2__). The morbity rate is __3__% (deafness, neurological problems, amputations).

A

1) 5-10%
2) DIC
3) 10%

187
Q

Peak incidence of Meningococcemia is around what age?

A

Under 4 years

188
Q

60% of bacterial meningitis in the UK is due to __?__

A

Meningococcal B

189
Q

Why is it more difficult to diagnose UTI in infants?

A

Their symptoms are less specific: fever, irritability, vomiting, poor appetite

190
Q

When should a child with UTI be referred to a paeds specialist?

A

If they have recurrent UTI or abnormal imaging

  • If they don’t need imaging, they don’t need the specialist
191
Q

Which of the following is most appropriate following asymptomatic bacteriuria in a child:

a) Antibiotic prophylaxis
b) Imaging
c) Specialist referral
d) No follow-up required

A

d) No follow-up required

192
Q

Impetigo is caused by which organism(s)?

A

Staphylococcus aureus

Staphylococcus pyogenes

193
Q

A child presents with ruptured vesicles and honey-coloured crusting. What is this a classic description of?

A

Impetigo

194
Q

True or false: Impetigo is not very contagious.

A

False: Impetigo is very contagious, spread rapidly.

195
Q

Which sites are normally first affected by impetigo?

A

Face, mouth

196
Q

What prescription is usually offered to children with How is impetigo usually managed?

A

Topical Abx or oral flucloxacillin

Advice re nursery/school

197
Q

What organism causes a condition characterised by:

  • Fever, sore throat, flushed face
  • Rough sandpaper skin, rash
  • White strawberry tongue
A

Scarlet fever is caused by Group A beta-Haemolytic Streptococcus

After 5 days you may also see desquamation of the soles and palms

198
Q

What tests are used to confirm scarlet fever diagnosis?

A

Throat swab

Antistreptolysin O titre (antibody against streptolysin produced by group A b-haemolytic strep)

199
Q

What is usually prescribed to a patient with scarlet fever?

A

Penicillin (if NKDA)

Clinical Pathology (11 decks)

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