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Repro 2 > Vulva, Vagina, Cervix - Dobson > Flashcards

Vulva, Vagina, Cervix - Dobson Flashcards

1
Q

Vagina is itchy, red, swollen, with a thick white discharge

Diagnostic test?
pH?

A

Candidiasis

KOH test - pseudohyphae or pseudospores

Normal pH (4.0 - 4.5)

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2
Q

Vulvovaginal candidiasis - what can be assumed?

Causes?

A

Disturbance in microbial ecosystem or neutrophils or T-helper cells

DM, antibiotics, pregnancy, OCPs, immunodeficiency (cancer, transplant, HIV), burns, indwelling catheter

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3
Q

Painful vesicles w/ purulent exudate on vulva that become ulcers rimmed by inflammatory infiltrate, fever, headache, myalgia, tender inguinal LNs

Viral inclusions w/ ground-glass appearance

A

HSV-2 genital herpes

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4
Q

2 ways HSV-2 can be transmitted

A

Sexual, perinatal

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5
Q

Describe HSV-2 infection and recurrences

A
  • Replicate in skin/mucous membranes at entry, causing infectious virions and vesicular lesions
  • Viruses spread to LUMBOSACRAL GANGLIA (sensory neurons) and lie dormant
  • Infection recurs in immunocompetent or immunocompromised for various reasons
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6
Q

Immunocompromised + HSV recurrence…potential presentations

A

Meningitis, hepatitis, pneumonitis

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7
Q

Baby is born with lymphadenopathy, splenomegaly, encephalitis, necrotic foci throughout body

Prognosis?

A

Neonatal HSV-2 (TORCH infection)

Poor (high mortality rate)

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8
Q

Things that can trigger HSV recurrence in immunocompetent person

A

Stress, trauma, hormones, temperature extremes, UV radiation

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9
Q

Men vs. women - symptomatic w/ HSV?

A

Men - ALWAYS

Women - 1/3

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10
Q

Yellow, frothy vaginal discharge, pain, painful urination, painful intercourse (dyspareunia)

What to expect on full exam?

A

Trichomonas vaginalis

Fiery red vaginal/cervical mucosa (inflammation) (STRAWBERRY CERVIX)

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11
Q

Large, flagellated ovoid protozoan

A

Trichomonas vaginalis

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12
Q

Thin, green-gray, malodorous (fishy) vaginal discharge, no inflammation

Bacteria type?

Test?

A

Gardnerella vaginalis

Gram-negative bacillus

Whiff test (enhances fishy odor)

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13
Q

Pap smear = squamous cells covered in shaggy coating of coccobacilli

A

Clue cells – Gardnerella vaginosis

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14
Q

Pregnant woman presents w/ thin green-gray fishy vaginal discharge. Dx?

Caution?

A

Gardnerella

Risk of premature labor

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15
Q

Female presents for routine Pap smear. Results show small gram-negative obligate intracellular bacteria.

What else can be seen in the cells?

A

Chlamydia trachomatis

Elementary bodies and reticulate bodies

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16
Q

Men vs. women - symptomatic w/ Chlamydia?

A

Women - asymptomatic

Men - urethritis or asymptomatic

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17
Q

Chlamydia - risk?

A

PID (spread to uterus and fallopian tubes)

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18
Q

Pearly, dome-shaped papules w/ dimpled/umbilicated center; cytoplasmic viral inclusions

Bug?

A

Molluscum contagiosum

Poxvirus

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19
Q

Molluscum contagiosum - kids vs adults

A

Kids (2-12) - direct contact/shared articles - trunk, arms, legs

Adults - sexually transmitted - genitals, lower abdomen, buttocks, inner thighs

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20
Q

What is PID?

A

Infection beginning in the vulva/vagina that spreads upward into the rest of the female genital system, causing mucosal inflammation and exudate and healing and scarring

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21
Q

Pelvic pain, adnexal tenderness, fever, vaginal discharge

A

PID

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22
Q

Causes of PID (3)

A

N. gonorrhea, Chlamydia, post-abortion infections (polymicrobial)

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23
Q

Severe acute inflammation of the mucosal surfaces of the genital tract, exudate w/ phagocytosed gram-negative diplococci w/in neutrophils

A

N. gonorrhea

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24
Q

First typical place of spread from the vagina/cervix of gonococcal infection

Complication? Explain findings

A

Fallopian tubes (endometrium is skipped)

Acute salpingitis (tubal mucosa infiltrated diffusely by neutrophils, plasma cells, and lymphocytes), causing SLOUGHING OF PLICAE and PURULENT EXUDATE

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25
Q

Next potential complication of gonococcal infection after salpingitis

Findings

A

Ovary (salpingo-oophoritis)

Pus accumulation (tubo-ovarian abscesses or pyosalpinx (tubal lumen))

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26
Q

First chronic complication of gonococcal PID

Explain

Complication of this complication

A

Chronic salpingitis

Denuded tubal walls adhere to one another and fuse/scar, causing gland-like spaces and blind pouches

Infertility or ectopic pregnancy

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27
Q

Second chronic complication of gonococcal PID (after chronic salpingitis)

Explain

A

Hydrosalpinx

Accumulation of tubal secretions, causing distention of the tubes

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28
Q

How does PID of other organisms differ from gonococcal PID?

Results?

A

Less mucosal involvement, more deeper tissue layer involvement

Involvement of serosa, broad ligaments, pelvic structures, and peritoneum

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29
Q

What immune deficiency increases the risk for disseminated gonococcal infection?

A

Complement 6-9 (MAC) deficiency

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30
Q

Men vs. women - symptomatic w/ gonorrhea?

A

Women - often asymptomatic (unless PID)

Men - urethral discharge

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31
Q

Most common diseases of the vulva are what?

A

Cutaneous disorders (dermatoses) and superficial infections

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32
Q

Vulva - opaque, white plaque-like epithelial thickening, producing pruritis and scaling

Causes

A

Leukoplakia

Squamous cell hyperplasia, neoplasias, (inflammatory dermatoses)

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33
Q

Post-menopause, smooth white patch/plaques that coalesce into parchment-like skin around the vulva.

Any risk? If?

A

Lichen sclerosis

Slight risk of squamous cell carcinoma - IF SYMPTOMATIC

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34
Q

Lichen sclerosis - histology (5)

A

Hyperkeratosis, THIN EPIDERMIS, basal cell layer degeneration, sclerosis of superficial dermis, band-like lymphocytic infiltrate

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35
Q

Cigarette paper, butterfly, or figure 8 pattern of skin plaques on vulva

A

Lichen sclerosis

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36
Q

Complications of lichen sclerosis (besides SCC)

A

Atrophic labia minora, clitoral hood fusion (phimosis), vaginal orifice constriction

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37
Q

How does squamous cell hyperplasia (lichen simplex chronicus) differ from lichen sclerosis? (3)

A
  • From rubbing/scratching to relieve itchiness
  • THICKENING of epidermis
  • Mitotic activity (maybe)
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38
Q

How to know that squamous cell hyperplasia is not neoplastic?

A

No cellular atypia

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39
Q

Multifocal warty growths on the vulva, vagina, cervix, perineal, or perianal areas. Papillary, exophytic, tree-like cores of stroma covered by thick squamous epithelium.

Cause?

A

Condyloma acuminatum

HPV 6 or 11

40
Q

Condyloma acuminatum - characteristic finding

A

Koilocytic atypia - nuclear enlargement, hyperchromasia, cytoplasmic perinuclear halo

41
Q

Broad-based, elevated plaques in the anogenital region, inner thigh, or axilla. Lymphadenopathy, mild fever, malaise, weight loss

Cause?

A

Condyloma lata

2º syphilis

42
Q

2 types of vulvar carcinomas

A
  • HPV-related

- Non-HPV

43
Q

HPV-related vulvar cancers

Typically in who?

A
  • Basaloid
  • Warty

Younger women

44
Q

Non-HPV vulvar cancer

Typically in who?

A

Keratinizing squamous cell carcinoma

Older women

45
Q

HPV-related vulvar carcinoma develops from what?

Cause?

A

Classic VIN (precursor)

HPV 16

46
Q

Risk factors for HPV infection?

Thus, these are also risk factors for what cancers?

A

Young at 1st intercourse, multiple partners, male partner w/ multiple partners

HPV-associated vulvar carcinoma and cervical carcinoma

47
Q

Risk factors for non-HPV vulvar carcinoma

Precursor?

A

Long-standing Lichen sclerosus or squamous cell hyperplasia

Differentiated VIN

48
Q

TP53 - which VIN?

A

Differentiated (non-HPV)

49
Q

Vulva - White or pigmented lesion w/ epidermal thickening, nuclear atypia, increased mitoses, and no cellular maturation

A

Classic VIN

50
Q

Exophytic or indurated vulvar mass with small, tightly-packed cells that lack maturation and resemble basal layer epithelium. Foci of central necrosis

Came from what?

A

Basaloid vulvar carcinoma

Via Classic VIN

51
Q

Exophytic, papillary vulvar mass w/ prominent koilocytic atypia (halo, large hyperchomatic nuclei).

Came from what?

A

Warty vulvar carcinoma

Via Classic VIN

52
Q

Vulva - Squamous basal layer atypia, normal differentiation of superficial epidermal layers

A

Differentiated VIN

53
Q

Vulva - leukoplakia, nests and tongues of malignant squamous epithelium w/ prominent central keratin pearls

A

Keratinizing squamous cell carcinoma (vulva)

54
Q

Risk factors for developing carcinoma from VIN

A

Long duration, severe extent of disease, poor immune status

55
Q

Differentiated VIN may be first mistaken as what?

A

Dermatitis or leukoplakia

56
Q

Risk factors for metastasis of vulvar cancer

A

Primary tumor size, invasion depth, lymphatic involvement

57
Q

Erythematous, pruritic, ulcerated, map-like vulvar rash on labia majora

Prognosis?

A

Extramammary Paget Disease

Good w/ excision, but can recur

58
Q

Intraepithelial proliferation of large malignant vulvar epithelium, PAS+, cytokeratin 7 positive, keratin+, S100-. Glandular differentiation

A

Extramammary Paget Disease

59
Q

Extramammary Paget Disease vs. Paget Disease of Breast…

Underlying cancer?

A

Breast - YES

Vulva - NO

60
Q

2 uteri, 2 vaginas - why?

A

Failure of mullerian duct fusion

61
Q

Red, granular areas on the vaginal wall that are abnormal from the surrounding pale-pink mucosa

Common cause?

A

Adenosis - residual glandular (endocervical) epithelium

DES exposure

62
Q

Vaginal adenosis - rare complication?

A

Clear cell carcinoma

63
Q

Submucosal, fluid-filled lesions along the lateral wall of the vagina

A

Gartner duct cysts - residual wolffian ducts

64
Q

Nearly ALL primary vaginal carcinomas are what type? Cause?

A

SCC - HPV 16

65
Q

Most common cause/risk of vaginal SCC

A

Previous cervical/vulvar SCC

66
Q

Vaginal SCC - precursor

67
Q

Vaginal SCC - most common location

A

Posterior wall @ jxn with ectocervix

68
Q

Vaginal SCC - lymph drainage

A

Lower 2/3 = inguinal LNs

Upper 1/3 = iliac LNs

69
Q

Infant/child, polypoid round bulky mass of grape-like clusters emerging from vagina

Spindle-shaped cells, desmin+

A

Sarcoma botryoides (embryonal rhabdomyosarcoma)

70
Q

2 cell types of cervix

A 
Outer = Squamous
Inner = Columnar, mucus-secreting
Junction = TZ
71
Q

SC junction (TZ) movements

A

Repro years = out onto cervix

Old age = up into canal

72
Q

Dominant bacteria of cervix

Describe (physio/micro)

A

Lactobacilli

Squamous cells become glycogenated (menarche) –> energy for lactobacilli –> lower vaginal pH –> suppress other bacteria

73
Q

Things that can disrupt lactobacilli

A

Things that increase pH – bleeding, sex, douching, antibiotics

74
Q

Common causes of acute cervicitis

A

Gonococcus, Chlamydia, Mycoplasma, HSV

75
Q

Pap test - acute cervicitis

A

Shedding of atypical-looking squamous cells due to reparative/reactive changes

76
Q

Irregular vaginal spotting or bleeding + growths in endocervical canal

A

Endocervical polyps

77
Q

Small bumps to large polypoid masses within endocervical canal; loose stroma covered in mucus-secreting glands

A

Endocervical polyps

78
Q

Most important, crucial risk factor for cervical cancer or precursor

A

High risk HPV

79
Q

Most HPV infections are (asymptomatic/symptomatic) and (eliminated/persistent)

A

Asymptomatic and eliminated via the immune system

80
Q

_____ increases the risk of the development of cervical cancer precursor from HPV

A

Persistent infection

81
Q

What do HPVs infect? (2)

A
  • Immature basal cells of squamous epithelium

- Immature metaplastic squamous cells at SC jxn

82
Q

HPV infection REQUIRES what?

A

Damage to surface epithelium – allows access to immature cells below

83
Q

Why is the cervix the most vulnerable to HPV?

A

Has the most coverage of immature squamous cells

84
Q

HPV viral proteins - fxns

A

E6 - degrades p53, increases telomerase

E7 - degrades RB and p21

85
Q

Which HPV viral protein interaction is DEFINITIVE for HIGH-RISK types?

A

E6 binding p53

86
Q

Is HPV infection enough to cause cervical cancer?

Explain

A

NO

Co-carcinogens = CIGARETTE smoking, infections, hormone changes, dietary deficiencies

87
Q

Name of cervical cancer precursor

Types?

A

SIL (squamous intraepithelial lesion)

LSIL = mild dysplasia (lower 1/3)
HSIL = moderate to CIS (more than lower 1/3)
88
Q

Most cases of LSIL _____

THUS, LSIL is NOT treated as _____

A

Regress spontaneously

NOT Premalignant

89
Q

ALL HSIL cases are considered _____

ALL are due to what?

MOST stem from what?

A

High risk for progression to carcinoma

HPV (high risk)

LSIL

90
Q

SIL morphology (5)

These are synonymous with ____

A
  • Nuclear enlargement - Hyperchromasia
  • Coarse chromatin granules
  • Variation in nuclear size and shape
  • Cytoplasmic halos

KOILOCYTIC ATYPIA

91
Q

2 major types of cervical carcinoma

A

SCC, Adenocarcinoma

92
Q

Exophytic or infiltrative mass, nests and tongues of malignant squamous epithelium, invades underlying stroma

93
Q

Exophytic or infiltrative mass, proliferation of glandular epithelium w/ malignant endocervical cells and mucin-depleted cytoplasm

A

Adenocarcinoma

94
Q

5 stages of cervical cancer

A 
0 = CIS (HSIL)
1 = Cervix only
2 = Upper vagina
3 = Pelvic wall, lower vagina
4 = Beyond pelvis, bladder/rectum, and/or metastasis
95
Q

Majority of cervical cancers are in women who did not _____

A

Have regular screenings

96
Q

Most common consequence of cervical cancer (w/ examples)

A

Local invasion - ureteral obstruction, pyelonephritis, uremia, kidney failure

97
Q

LSIL vs HSIL - level of CELLULAR replication/growth

How to measure this?

A

LSIL - low
HSIL - high

Ki-67 and p16 = actively dividing cells = HSIL (if above lower 1/3)

Repro 2 (28 decks)

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