Week 3 - MGS Flashcards
STDs, Orchitis, Tumours, Penis
1
Q
What bacteria causes syphilis? and how is it transmitted?
A
Treponema pallidum
- body fluids –> skin/mucosa
- vertical transmission (placenta to newborn)
- bacteria CANNOT survive outside the body (i.e. direct contact required)
2
Q
What is the characteristic lesions present in syphilis?
A
proliferative endarteritis
- vascular damage
- chronic inflamm - plasma cells**
3
Q
What is chancre?
A
- primary phase of syphilis (3wks)
- ulcerated papule
- resolve spontaneously*
- highly infectious!
4
Q
What are the 3 stages of syphilis?
A
- primary (3wks)
- chancre –> ulcerated papule; resolves spontaneously, highly infectious* - secondary (months)
- following healing of primary chancre
- recurrent lymphadenopathy
- palmar rash
- condyloma lata (painless, moist plaques)
- highly infectious*
- resolves without Tx usually - tertiary (years)
- 5-20yrs
- gumma - necrotising granuloma
- CVS* + CNS involvement –> aortitis (AR); neurosyphilis
- tabes dorsalis
- general paresis
- aortic aneurysms* (80%)
5
Q
What are 2 forms of neurosyphilis and what stage are they seen?
A
- tabes dorsalis –> demyelination of posterior cord tracts (proprioception, vibration, discriminative touch)
- general paresis –> chronic inflammation of the brain and meninges and is characterized by memory loss, muscle weakness, personality changes, progressive dementia, seizures, and generalized paralysis
* seen in tertiary syphilis
6
Q
What is condyloma lata?
A
-moist painless plaques which occur as a manifestation of secondary syphilis
7
Q
What are the possible outcomes for congenital syphilis?
A
intrauterine –> rash, liver + lung fibrosis, 8th nerve deafness, interstitial keratitis, hutchinson teeth
8
Q
What are hutchinson teeth?
A
-sign of congenital syphilis. –babies with this have teeth that are smaller and more widely spaced than normal and which have notches on their incisors
9
Q
What are non-treponemal antibodies directed against?
A
cardiolipin
- present in bacteria AND in our bodies
- usually only in early phase (not in tertiary phase)
10
Q
What are the 2 tests for non-treponemal antibodies?
A
- VDRL (venereal disease research lab)
- RPR (rapid plasma reagin)
* non-specific; false positive; only early phase
11
Q
What are the treponemal antibody tests?
A
- FTA-ABS (fluorescent treponema antibody)
- TP-PA (TP particle agglutination)
- MHA-TP (microhemagglutinin assay)
12
Q
What is the purpose of non-treponemal Ab tests?
A
- non-specific to bacteria
- used for SCREENING purposes only
- diagnostic confirmation achieved by treponemal Ab specific testing (FTA-ABS, TP-PA, MHA-TP)
13
Q
How is syphilis diagnosed via direct detection?
A
- darkfield microscopy
- PCR*
- culture
14
Q
What is the most common and second most common STI?
A
1 = chlamydia 2 = gonorrhoea
15
Q
How is gonorrhoea transmitted?
A
- only in humans
- person to person
- vertical transmission on birth (passage)
16
Q
What are the Sx. of gonorrhoea?
A
- stick to epithelia, incubation 1-14days –> then penetrate and cause Sx:
- fever, pain, inflammation, dysuria, discharge (white pus)
- urethritis, conjunctivitis, cervicitis, proctitis, pharyngitis, iritis –> “ITIS”
- dysuria, mucopurelent discharge –> PID
17
Q
What bacteria causes gonorrhoea?
A
Neisseria gonorrhoeae
-gram negative diplococci (intracellular - within neutrophils)
18
Q
What are the complications of gonorrhoea?
A
- stricture –> urethritis, proctitis (dysuria) –> PID
- fibrosis of pelvic region –> “frozen pelvis”
19
Q
What is nongonococcal urethritis commonly caused by?
A
- chlamydia** (commonest)
- trichomonas vaginalis
- ureaplasma
- mycoplasma genitalium
20
Q
Which STI is more suppurative - gonnorhoea or chlamydia?
A
gonorrhoea
21
Q
What type of bacteria is Chlamydia trachomatis?
A
gram negative
22
Q
What are the 2 forms of chlamydia trachomatis?
A
- elementary body (outside cell)
2. reticulate body (inside cell)
23
Q
What can NGU lead to in patients with HLAB27?
A
Reiter’s syndrome
24
Q
What does chlamydia trachomatis cause in men?
A
- urethritis
- epididymo-orchitis
- prostatitis
25
What is the commonest Sx. of chlamydia?
- 50% asymptomatic**
- 40% PID
- 20% infertility
- 9% ectopic pregnancy
26
What does chlamydia trachomatis cause in children?
- seasonal purulent conjunctivitis
| - repeated, untreated --> scarring of cornea/eyelids --> visual impairment/blindness
27
How is NGU diagnosed?
Nucleic acid amplification test (NAAT)
- sensitive
- in combination with tests for Neisseria gonorrheae and HIV (sexually transmitted)
28
What are 2 differences between GU and NGU?
GU:
- intracellular diplococci
- less pus
NGU:
- no organisms; polymorphonuclear leukocytes
- more pus
29
What is lymphogranuloma venereum?
- LGV (L1-L3 serotypes)
- caused by chlamydia trachomatis
- chronic ulcerative (ulcers form after initial inguinal lymphadenitis)
- lymphedema; procto-colitis
- genital painless papule 2-5days
- suppurative granuloma (neutrophil abscess) + chlamydial inclusions in microscopy
30
What are the complications of LGV?
- rectal strictures
- PID
- frozen pelvis - extensive fibrosis
31
What is chancroid (soft chancre) AKA?
third venereal disease (syphilis, gonorrhoea)
32
What causes LGV?
chlamydia trachomatis
33
What causes chancroid?
Haemophilus ducreyi
| -gram negative coccobacillus
34
Which disease is prostitution a risk factor for?
chancroid (soft chancre)/third venereal disease
35
What are the characteristic features of chancroid?
- erythematous papule --> painful ulcer with yellow pus
| - marked inguinal lymphadenopathy --> buboes --> pus draining ulcers
36
What does Klebsiella granulomatis cause?
granuloma inguinale
37
What are the features of granuloma inguinale?
- initial papules on genitalia --> ulcers --> urethral, vulvar or anal strictures
- granulation tissue and intense epithelial hyperplasia that can mimic SCC
- donovan bodies
38
What are donovan bodies?
-intracellular coccobacilli (Klebsiella granulomatis) within vacuolated macrophages --> seen in granuloma inguinale
39
Which HSV is most common in genital herpes?
HSV2
40
What % of HIV+ are also positive for HSV?
95%
41
True or false?
| HSV can be transmitted via fomites
FALSE
| -direct contact only
42
What are the features of genital herpes?
- itchy, painful, CLOSELY grouped vesicles surrounded by erythema
- vesicles burst --> PAINFUL ulcers
- multinucleate giant cells with viral inclusion
- painful inguinal lymphadenopathy
- self limited/mild in normal pts., severe infection in immunocomprimised
43
What are Cowdry type A bodies?
- viral inclusions seen in multinucleated giant cells in herpes simplex virus
- characteristic; positive by anti herpes virus Ab
44
Which LNs correspond to testes and which correspond to penis/scrotum?
Testes
-para-aortic LNs (testes develop in the abdomen)
Penis/Scrotum
-inguinal LNs
45
Outline development of sperm
spermatogonium --> primary spermatocyte --> secondary spermatocyte --> spermatids --> sperm cells (haploid)
46
What is the commonest etiology of epididymo-orchitis?
1. non-gonococcal (chlamydia*, mycoplasma)
| 2. gonococcal (N. gonorrhoeae)
47
What are the Sx. of epididymo-orchitis?
- testicular pain (unilateral)
- erythema/oedema of scrotum
- urethritis, dysuria, urethral discharge
48
What are the gross and microscopic features of epididymo-orchitis?
Gross:
- swollen
- hot
- acute inflammation
- oedema
Micro:
- neutrophils
- oedema
- necrosis
49
What Ix are used to diagnose epididymo-orchitis?
* exclude torsion/trauma in <30yrs
| - serology, microbiology: C/S, PCR
50
True or False?
| Mumps can cause orchitis?
TRUE
- patchy inflammation
- can lead to infertility if severe due to patchy atrophy
51
What is cryptorchidism AKA?
"undescended testes"
52
What is the normal descent timeline for testes?
- reaches pelvis at 3months
- reaches scrotum by birth (9months)
*non-descent --> 5% at birth; 1% at 1yr
53
What are the causes of cryptorchidism?
- hormonal
- intrinsic
- mechanical
*common in Patau syndrome, Praer willi syndrome, etc
54
What is the complication of cryptorchidism?
ATROPHY*
- due to increased temperature --> spermatogonia undergo atrophy
- sertoli + leydig cell hyperplasia**
- 3-5 fold increase in germ cell malignancy - even in other testes
55
What is orchiopexy?
- surgical fixing of undescended testes
| - reduces risk of sterility + cancer
56
What is torsion of testes and what is it precipitated by?
- twisting of spermatic cord on its axis
- 1yr or 13-16yr
- swollen, hard, painful*
*precipitated by exertion/contraction of cremaster muscle
57
What are the risk factors for torsion of testes?
- maldescent of testes
| - long spermatic cord/mesorchium
58
What are the 2 types/levels of torsion of testes?
1. within tunica vaginalis
- commonest*
- testis and epididymis involvement ONLY
2. above tunica
- all structures in that side of the scrotum (includes tunica vaginalis)
59
What is the pathogenesis of torsion of testes?
- due to twisting there is obstruction to venous outflow --> venous infarction
- arterial supply still intact
60
What is Tx of torsion of testes?
```
surgical emergency (within few hrs)
-correction/orchidectomy
```
61
What are the 4 inflammatory accumulations in the testes?
1. hydrocele
2. varicocele
3. spermatocele
4. hematocele
62
What is hydrocele?
- common
- accumulation of clear fluid in tunica vaginalis
- congenital or acquired (inflammation)
63
What is varicocele?
- engorged spermatic cord veins (pampiniform plexus)
- common cause of infertility/oligospermia
- primary/secondary
64
What is spermatocele?
- trauma/infection of tubules of epididymis causing dilatation forming a cyst containing semen
- multilocular
65
What is hematocele?
- blood in tunica in vaginalis
- caused by trauma or tumours
- accumulation of blood leads to atrophy of testes due to compression and increased temperature
66
Why is hydrocele transilluminating?
-clear fluid, no inflammation
67
What are the 3 types of hydrocele?
1. non-communicating (confined to TV)
2. communicating
- communicates with abdominal cavity
3. hydrocele of the cord
- clear fluid in spermatic cord
68
What is required for an individual to become male sex?
* by default we are ALL female*
| - unless we have the SRY gene (sex-determining region Y/TDF) on short arm of Y chromosome --> androgens --> MALE SEX
69
What is the most common cause of transgender sex?
congenital adrenal hyperplasia (CAH)
| -female pseudohermaphrodite** --> XX male (46, XX DSD - disorder of sexual development)
70
What causes male pseudohermaphroditism?
XY female - 46, XY DSD
**gonadal dysgenesis**
71
What is true hermaphroditism?
ovotesticular DSD
| -both gonads in single person (ovaries + testes)
72
What is 45 XO?
Turner's syndrome
73
What is 47 XXY?
Klinefelter's syndrome
74
What is the commonest tumour of young males?
- testes tumours
| - PAINLESS swellings
75
What is the etiology of testes tumours?
* *idiopathic = most common
| - undescended testes (10%; 10x more likely to develop tumours)
76
What is the classification of testes tumours and specify which is the commonest type?
1. Germ cell tumours** (95% - commonest)
- seminoma (45%) --> good prognosis
- non-seminoma (NSGT - 45%) --> poor prognosis; embryonal ca, teratoma, chriocarcinoma
- mixed --> common
2. Sertoli/leydig cell tumours (5%)
77
What is the commonest testes tumour?
seminoma* --> adults (20-40yrs)
N.B. children <10yrs --> NSGT (yolksac tumour*)
78
What are the clinical features of testes tumours?
- painless
- 'dragging' sensation
- unilateral, solid swelling
* metastases to para-aortic LBs (embryologic origin)
79
What are the gross and microscopic features of seminoma?
Gross:
- firm, grey, smooth, painless swelling
- benign appearance
- well demarcated
- minimal haemorrhage
Micro:
-uniform clear cells + lymphocytes
80
What tumour is seminoma mixed with to produce beta-hCG?
choriocarcinoma --> beta-hCG 10%
| -otherwise seminomas do not produce hormones
81
What are the clinical features of non-seminomatous germ cell tumours (NSGT): embryonal carcinoma?
- painless swelling
- haemorrhagic ** (c.f. seminoma)
- malignant
- poor prognosis :(
- metastases rapidly
82
What are the gross and microscopic features of NSGT: embryonal carcinoma?
Gross:
-haemorrhagic, necrotic tumour
Micro:
- pleomorphic cells forming embryoid structures/bodies
- pink AFP (alpha feto protein) globules in cells
83
What is NSGT referred to as in adults vs. children?
adults --> embryonal carcinoma
children --> yolksac tumour
84
What tumour marker is present in NSGT: embryonal ca?
alpha feto protein (AFP)
85
What is the commonest NSGT?
embryonal carcinoma
86
True or False?
| all teratomas are malignant
False
- normal looking, mature cells --> mature/benign teratoma
- malignant cells --> immature/malignant teratoma
87
What is teratocarcinoma?
teratoma + other germ cell tumour (i.e. embryonal carcinoma)
88
What does it suggest if beta-hCG and AFP are btoh positive in a teratoma?
-that it is MIXED type with embryonal carcinoma
89
Which tumour is strongly positive for AFP?
yolk sac tumour (<3yrs) - 90%
90
Which tumour is 100% positive for beta-hCG?
choriocarcinoma
91
What are the erectile tissues of the penis?
3 cylindrical bodies
- corpus cavernosum (2 bodies)
- corpus spongiosum (base)
* urethra in the middle of corpus spongiosum
92
What is the lymphatic drainage of the penis?
skin --> superior inguinal LNs
| deeper tissues --> interior iliac LNs
93
What is phimosis?
- congenital malformation; can be acquired due to infections
| - narrow opening of prepuce (foreskin) --> cannot be pulled back over glans
94
What is paraphimosis?
- congenital malformation
- urologic emergency
- retracted foreskin cannoth be returned to its normal anatomic position
- foreskin/prepuce strangulates penis
95
What is hypospadias?
- congenital malformation
| - urethra opens on the ventral surface
96
What is epispadias?
- congenital malformation
| - urethra opens on the dorsal surface
97
What is inflammation of the glans and prepuce reffered to as?
balanitis --> inflammation of glans
posthitis --> inflammation of the inner surface of prepuce
balanoposthitis --> inflammation of BOTH glans + prepuce
98
What is balanitis/posthitis/balanoposthitis often associated with/what does it lead to?
-often associated with phimosis or leads to phimosis
99
What is the etiology of inflammation of the penis (balanitis, posthitis, balanoposthitis)?
- poor hygiene, accumulation of smegma
- non-STI --> candida**, staph/strep, gardnerella
- STI --> syphillis, gonorrhoea, herpes, etc
*common cause of balanoposthitis = candida infection (non-STI cause)
100
What is balanitis xerotica obliterans?
- similar to lichen sclerosus of vulva or elsewhere
- not common, adults, >30yrs
- white plaques, fissures --> glans/prepuce
- epidermal atrophy, hyperkaratosis with basal layer degeneration, dermal hyalinisation
101
What is peyronie's disease?
- penile fibromamtosis --> fibrous plaques
- focal, fibrosis with deformity
- unknown cause
102
What is peyronie's disease associated with?
dupuytren's contracture
- palmar fibromatosis
- 25% cases
103
What causes condyloma accuminatum?
human papilloma virus (HPV)
- HPV serotypes 6 + 11 (benign wart)
- papillary epithelial benign growth
104
What is the difference in appearance of warts in HPV causing condylmoa accuminatum on the glans v skin?
glans --> fleshy appearance
| skin --> warty, hard growths
105
What are koilocytes?
- clear cells loaded with HPV virus
- seen on microscopy of condyloma accuminatum
- acanthosis is also seen on microscopy*
106
What is epithelial hyperplasia and DYSPLASIA conditions known as on the glans vs the shaft?
on glans --> erythroplasia of Queyrat
on shaft --> bowen's disease
107
What is the microscopy of bowen's disease/erythroplasia of Queyrat?
- pleomorphic cells with intact basal layer
- DYSPLASIA
- pre-malignant --> sq. cell ca.
108
What is the commonest carcinoma of the penis?
squamous cell carcinoma
109
What are the risk factors for penis carcinoma (sq. cell ca)?
- smoking
| - HPV 16 + 18 (malignant strains)
110
What is known to prevent carcinoma of the penis?
circumcision
| -supports the fact that it is due to infection (hygiene, smegma irritation?)
111
What is the pathogenesis of penis carcinoma?
-risk factors (smoking, HPV 16/18, uncircumcised penis) --> erythroplakia/leukoplakia: dysplasia/ca-in-situ --> well-differentiated squamous cell carcinoma (epithelial pearls) --> slow growth, good prognosis (70% 5yr survival rate)
112
True or False?
| There is no pleomorphism on microscopy of verrucous carcinoma nor metastasis?
TRUE
- looks benign (large, irregular, papillary/warty "cauliflower")
- variant of sq. cell ca
- locally invasive (no mets)
113
What is the micrscopy of mumps orchitis?
PATCHY INFLAMMATION
114
Bilateral orchitis is typical of?
Mumps
