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EndoRepro > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What are the general epidemiology, etiology, and symptoms for urogenital dysfunction?

A
  • Epidemiology: 10-60% woman, elderly
  • Etiology: vaginal delivery, aging, estrogen deficiency, neurological/psychological disease
  • Symptoms: frequency, nocturia, dysuria, incomplete emptying, incontinence, urgency, recurrent infections, dyspareunia, prolapse
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2
Q

For stress incontinence:

  • Provide pathophys and etiology
A
  • Stress incontinence
    • Pathophysiology: increases in abdominal pressure (cough, laugh, lifting) → loss of urine
    • Etiology: pelvic floor damage OR weak sphincters
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3
Q

For urge incontinence:

  • Provide pathophys and presentation
A
  • Urge incontinence (OAB)
    • Pathophysiology: involuntary bladder contractions → loss of urine (complete emptying)
    • Presentation: Urinating 15-20 times a day
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4
Q

For mixed incontinence:

  • Provide pathophys
A
  • Mixed incontinence
    • Pathophysiology: combination of stress and urge incontinence
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5
Q

For overflow incontinence:

  • Provide pathophys and etiology
A
  • Overflow incontinence (Chronic urinary retention)
    • Pathophysiology: outlet obstruction OR bladder underactivity → loss of urine
    • Etiology: post-surgery, aging, medication (antidepressants), neurological disorders, bad bladder habits
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6
Q

For functional/transient incontinence:

  • Provide description, epidemilogy, and etiology (be specific with etiology)
A
  • Functional/transient incontinence
    • Description: patient unaware that he/she needs to urinate → leakage
    • Epidemiology: elderly
    • Etiology: UTI, restricted mobility, constipation, medications, psych/cognitive deficiency
      • Drugs include: diuretics, antipsychotics, alpha-blocking agents
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7
Q

What are some other cuases of urinary incontinence?

A
  • Other causes of urinary incontinence: urethral diverticulum, genitourinary fistula (pregnancy or past surgery), congenital abnormalities (bladder extrophy, ectopic ureter), detrusor hyperreflexia
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8
Q

How do you diagnose urinary incontinence? Be specific about indications, technique, and what the results of this diagnostic test mean.

A
  • Diagnosis: Postvoid Residual Volume (PVR), urinalysis
    • PVR
      • Indications: symptoms of incomplete emptying, diabetes mellitus, past hx of urinary retention, failure of drug therapies, pelvic floor prolapse, past surgery
      • Technique: ultrasound or catheterization
      • Results: PVR < 50 – normal; PVR > 200 – not normal
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9
Q

What are non drug or non-surg treatments for urinary incontinence?

A
  • Treatment
    • Fluid management – avoid caffeine/alcohol, or drinking lots of fluid at night
    • Bladder retraining – regular voiding by clock
    • Physiotherapy – pelvic floor exercises, vaginal cones (weights to build strength)
    • Pessaries – devices that correct prolapse and hold up bladder
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10
Q

Provide drugs that can be used for urinary incontinence.

A
  • Treatment
    • Medications – oxybutynin (muscarinic (M3) antagonist → treats OAB), tolteridine (muscarinic (M3) antagonist → treats OAB), flavoxate (anticholinergic → relax smooth muscles), imipramine (beta agonist → treats OAB)
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11
Q

Provide surgical options for urinary incontience. What is the gold standard?

A
  • Treatment
    • Surgery: Burch repair, Marshall-marchetti-krantz repair, Sling (gold standard), injections (botox @ bladder or ureter)
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12
Q

What are the 4 types of prolapse?

A

Prolapse

  • Types:
    • Cystocele – protrusion of the bladder
    • Rectocele – protrusions of the rectum
    • Apical prolapse – uterine OR vaginal vault prolapse
    • Procidentia – total prolapse of bladder AND uterus (rectocele may be present)
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13
Q

What is the epidemiology, pathophys, etiology, and treatment of prolapse?

A
  • Epidemiology: common
  • Pathophysiology: damage to pelvic floor structures → loss of support → prolapse
  • Etiology: childbirth, aging, chronic stress/strain, congenital abnormalities
  • Treatment:
    • None – can be asymptomatic
    • If symptomatic (not emptying properly)
      • Pessary - devices that correct prolapse and hold up bladder
      • Surgery
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14
Q

What is the grading scale of prolapse?

A
  • Grading
    • Grade I: Into the vagina but not to the introitus
    • Grade II: To the introitus (vaginal opening) with strain
    • Grade III: Through the introitus with strain
    • Grade IV: Through the introitus at rest
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15
Q

For Normal, provide:

  • Description of stroma and terminal duct lobular unit
A
  • Consists of stroma: connective and fatty tissues, nerve and vessels
  • Terminal duct lobular unit – most active part of breast tissue
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16
Q

What is this an image of?

A

Normal breast: Ducts lined by double layer of epithelial cells and surrounded by layer of myoepithelial cells

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17
Q

What is this an image of?

A

Normal breast

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18
Q

For fibrocystic change breast disease:

  • Provide a description
  • Age of onset?
A
  • Most common benign breast disorder
  • 20-40 y/o woman
  • Hormone medicated
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19
Q

What is this?

A

Fibrocystic change: Bilateral, lumpy-bumpy, Blue domed cysts

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20
Q

What is this?

A

Fibrocystic change breast disease: Dilation of duct lobules, stromal fibrosis

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21
Q

What is this?

A

Fibrocystic changes breast disease: apocrine metaplasia

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22
Q

What is this?

A

Fibrocystic change breast disease: ductal ectasia

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23
Q

Describe breast abscess:

  • Description:
  • Complication
  • Gross appearance
A
  • Painful lump of inflammatory/purulent tissue
  • Complication: fistula formation
  • Gross: Unilateral, fibrous cavity with pus
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24
Q

What is this?

A

Breast abscess: Fibrous capsule with inflammatory infiltrates

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25
Q

For fibroadenoma:

  • Descirption:
A
  • Most common benign neoplasm of breast
  • Tumor of fibrous stroma and duct epithelium
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26
Q

What is this?

A

fibroadenoma of breast: Mobile, spherical, well circumscribed lesion

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27
Q

What is this?

A

Fibroadenoma

  • Loose/dense textured stroma
  • May have hyperplastic ducts
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28
Q

For Phyllodes tumor:

  • Age?
  • Malignancy potential?
  • Description?
    • Gross
A
  • 60s – common age
  • May be malignant
  • Similar to fibroadenoma with increased cellularity and cytologic atypia
  • Gross: palpable mass
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29
Q

What is this?

A

Phyllodes tumor (breast disease): leaflike growth pattern

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30
Q

Name 4 benign diseases of the breast

A

Phyllodes tumor, fibroadenoma, breast abscess. fibrocystic change

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31
Q

What is adenosis of the breast? Name three types

A

Adenosis: Adenoma, Sclerosing adenosis (1), radial scar (2)

  • Description: Proliferation of glands
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32
Q

What is this?

A

Sclerosing adenosis of the breast

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33
Q

What is this?

A

Radial scar of the breast

34
Q

What are two types of hyperplasia (proliferative breast disease without atypia)?

Describe it

A

Hyperplasia: Papilloma (2), Usual ductal hyperplasia (UDH) (1)

Descritpion: proliferation of normal looking cells

35
Q

What is this?

A

Usual ductal hyperplasia of breast: growth is irregular into duct

36
Q

What is this?

A

Papiloma of breast

37
Q

How likely is it for proliferative disease without atypia of breast to develop into cancer?

A

Slightly likely only

38
Q

How likely is it for proliferative disease with atypia of breast to develop into cancer?

A

Moderately likely

39
Q

What are the two diseases under hyperplasia (proliferative disease with atypia)?

Describe.

A

Hyperplasia: atypical ductal hyperplasia (1), atypical lobular hyperplasia (2)

Description: Proliferation of irregular looking epithelial cells

40
Q

What is this?

A

ADH: Growth is from peripheral inwards

41
Q

What is this?

A

atypical lobular hyperplasia

42
Q

What are the two types of carcinoma in situ for breast?

Describe.

A

Carcinoma in situ: Duct (4 subtypes shown) and Lobular subtypes

Descsirption: Malignant proliferation of cells that has not breached the basement membrane

43
Q

What is this?

A

Ductal carcinoma in situ of the breast

44
Q

What is this?

A

Lobular carcinoma in situ of the breast

45
Q

Describe Paget’s disease of the breast.

A

Eczema – like nipple disease associated with DCIS

46
Q

What is this?

A

Paget’s Disease of the breast: large clear cells in the epidermis

47
Q

For invasive ductal carcinoma: provide a general description.

A
  • Most common breast cancer
  • Gross: hard-mass
48
Q

What is this?

A

Invasive ductal carcinoma of the breast: duct structures in dense fibrous tissue (desmoplasia)

49
Q

What is this?

A

Invasive lobular carcinoma of the breast: single file pattern of infiltration

50
Q

For paraphimosis of the penis, provide:

  • Description?
  • Pathophys?
  • Clinical stuff?
  • Picture?
A
51
Q

For Peyronie disease of the penis, provide:

  • Description?
  • Pathophys?
  • Clinical stuff?
A
52
Q

For penile fracture, provide:

  • Description?
  • Pathophys?
  • Clinical stuff?
  • Picture?
A
53
Q

For carcinoma in situ and SCC of the penis, provide:

  • Location?
  • Painful?
  • Resolves?
  • Color of lesion?
  • Appearance?
  • Picture?
A
54
Q

For licehn planus of the penis, provide:

  • Location?
  • Painful?
  • Resolves?
  • Color of lesion?
  • Appearance?
  • Picture?
A
55
Q

For pearly penile papules, provide:

  • Location?
  • Painful?
  • Resolves?
  • Color of lesion?
  • Appearance?
  • Picture?
A
56
Q

For HPV, provide:

  • Location?
  • Painful?
  • Resolves?
  • Color of lesion?
  • Appearance?
  • Picture?
A
57
Q

For HSV, provide:

  • Location?
  • Painful?
  • Resolves?
  • Color of lesion?
  • Appearance?
  • Picture?
A
58
Q

For syphilis, provide:

  • Location?
  • Painful?
  • Resolves?
  • Color of lesion?
  • Appearance?
  • Picture?
A
59
Q

What is the presentation of carcinoma in situ (two types)? What are the complications associated with this?

A
  • Carcinoma in situ of penis (CIS)
    • Presentation
      • Erythroplasia of Queyrat when on glans penis of uncircumcised men
      • Bowen disease when involves the penile shaft
    • Complications: can progress to SCC in untreated
60
Q

What is the presentation, diagnosis, and risk factors of SCC of penis?

A
  • Squamous Cell Carcinoma of penis (SCC)
    • Presentation: disease of older (>60) men
    • Diagnosis: biopsy
    • Risk factors: circumcision practice, hygienic standard, phimosis, number of sexual partners, HPV infection, exposure to tobacco products
61
Q

What is the pathophys of HSV?

A
  • Initiates replication in epithelial cells at site of entry → damages the cells → enters peripheral sensory nerves → transports in retrograde manner to sensory root ganglia → latent phase → recurrent and reactivation → transportation to mucosal and skin surface
62
Q

For lichen simplex chronicus: provide presentation, treatment, and pathology (gross and micro)

A
  • Lichen simplex chronicus
    • Presentation: pruritis
    • Tx: topical steroids
    • Pathology:
      • Gross: thickened ruggated skin, red/white (pic)
      • Micro: squamous hyperplasia (pic)
63
Q

For lichen sclerosus: provide presentation, treatment, and pathology (gross and micro)

A
  • Lichen sclerosus
    • Presentation: inelastic skin, pruritus, burning, dyspareunia (painful sex), post-menopausal women
    • Tx: topical steroids
    • Pathology:
      • Gross: skin is thin, white (tissue paper like),
      • Micro: thinning of the epidermis, lymphocytes in lower layers, red/white/blue layers (pic)
64
Q

For Condyloma acuminatum: provide pathophys, presentation, treatment, and pathology (gross and micro)

A
  • Condyloma acuminatum
    • Pathophysiology: HPV (types 6 or 11) infection → warts
    • Presentation: non-painful, cauliflower like outgrowths
    • Tx: chemical/surgical removal
    • Pathology:
      • Gross: cauliflower warts
      • Micro: papillomatosis, koilocytes (squamous cells with peri-nuclear halo – white around nucleus) (picx2)
65
Q

For bartholin gland cyst: provide pathophys, presentation, complications, and treatment.

A
  • Bartholin gland cyst
    • Pathophysiology: blockage of gland → cysts
    • Presentation: palpable/visible protrusion on the labia major, reproductive age
      • Complications: infection → abscess
    • Tx: incision/drainage
66
Q

What are two types of vulvular dystrophy?

A

Lichen sclerosus and licehn simplex chronicus

67
Q

For embryonal rhabdomyosarcoma of the vulvovaginal area, provide epidemiology and pathology (gross and micro)

A
  • Embryonal Rhabdomyosarcoma
    • Epidemiology: < 5 y/o
    • Pathology:
      • Gross: bleeding of grape like mass of vagina/penis
      • Micro: proliferation of mesenchyme → immature skeletal muscle (pic)
        • Lower power slides – show nodules
68
Q

For clear cell adenocarcinoma of the vulvovaginal area, provide risk factors and pathology (micro)

A
  • Clear cell adenocarcinoma
    • Risk factors: DES (diethylstilbestrol) in utero [funfact: daughters born between 1938 and 1973 were exposed]
    • Pathology:
      • Micro: adenocarcinoma with clear cytoplasm (pic)
        • May present with adenosis of squamous epitheliuem to columnar glandular
69
Q

For Paget’s disease of the vulvovaginal area, provide presentation and pathology (gross and micro)

A
  • Paget’s Disease
    • Presentation: pruritis
    • Pathology:
      • Gross: well demarcated lesions, often erythematous around vulva
      • Micro: Intra-epithelial clusters of malignant appearing cells
        • PAS stain: mucin positive, s100 negative
70
Q

For melanoma cancer of the vulvovaginal area, provide epidemiology, diagnosis, and pathology (micro)

A
  • Melanoma
    • Epidemiology: 50+, white
    • Diagnosis: look for ABCDE lesion
    • Pathology:
      • Micro: expansion of the epidermis with increased N/C ratios, s100 marker (pic)
71
Q

For squamous cell cancer of the vulvovaginal area, provide epidemiology, risk factors (go into depth for these), presentation, and pathology (gross and micro)

A
  • Squamous cell cancer
    • Epidemiology: poor, old, dirty
    • Risk factors
      • Old: Granulomatous venereal disease, HPV, diabetes, obesity, co-existing vulvar dystrophies (lichen sclerosis)
        • In HPV related: VIN is precursor lesion
        • In non-HPV related: vulvar dystrophies is precursor lesion
      • Young: smoking, CIN (cervical interepithelial neoplasia)
    • Presentation: pruritis, late to metastasize
    • Pathology:
      • Gross: ulcerated, raised, kissing lesions
      • Micro: increased cellularity, N/C ratio, penetrating basement membrane (pic)
72
Q

What is this?

A

Condyloma acuminatum

Micro: papillomatosis (on the left), koilocytes (on the right) (squamous cells with peri-nuclear halo – white around nucleus)

73
Q

What is this?

A
  • Lichen sclerosus: thinning of the epidermis, lymphocytes in lower layers, red/white/blue layers
74
Q

What is this?

A
  • Lichen simplex chronicus

thickened ruggated skin, red/white

75
Q

What is this?

A
  • Lichen simplex chronicus: squamous hyperplasia
76
Q

What is this?

A

Squamous cell cancer of the vulvovaginal area: increased cellularity, N/C ratio, penetrating basement membrane

77
Q

This is what melanoma looks like. Where is this located and what tells you that this is a melanoma?

A

Melanoma of the vulvovaginal area: expansion of the epidermis with increased N/C ratios, s100 marker

78
Q

What is this?

A

Paget’s Disease: Intra-epithelial clusters of malignant appearing cells

79
Q

What is this?

A

Clear cell adenocarcinoma of the vulvovaginal area: adenocarcinoma with clear cytoplasm

80
Q

What is this?

A
  • Embryonal Rhabdomyosarcoma: proliferation of mesenchyme → immature skeletal muscle
    • Lower power slides show nodules!

EndoRepro (8 decks)

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