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Week 4 - "Silent Shadow" Flashcards

1
Q

What is pelvic inflammatory disease?

Microbiology

A

An infectious and inflammatory disorder of the upper female genital tract, including the uterus, fallopian tubes and adjacent pelvic structures

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2
Q

What is PID complicated by?

Microbiology

A

Some are often complicated by sexually transmitted infections (STIs)

Or other infections like bacterial vaginosis that are not STIs

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3
Q

Why is most of time PID left untreated?

Microbiology

A

Most of them are asymptomatic, and people do not know they are infected

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4
Q

What can untreated PID cause?

Microbiology

A

Tissue scarring and abscess formation which damages the reproductive system:
1. Infertility
2. Chronic pelvic pain
3. Ectopic pregnancy
4. Tubo-ovarian abscess

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5
Q

How is infertility a complication of PID?

Microbiology

A

Untreated PID might damage the reproductive system and dramatically increase the risk of infertility

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6
Q

How is chronic pelvic pain associated with PID?

Microbiology

A

Lasts for months or years, scarring of the fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation

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7
Q

How can ectopic pregnancies be a complication of PID?

Microbiology

A

The scar tissue prevents the fertilized eggs from moving through the fallopian tube to uterus

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8
Q
A
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8
Q

How can tubo-ovarian abscess be a consequence of PID?

Microbiology

A

Untreated abscesses in fallopian tubes and ovaries could develop into life threating infection

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9
Q

What % of untreated STDs progress to PID?

Microbiology

A

Up to 20% of untreated STDs

–> Untreated STD infection + inflammation = PID

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10
Q

What are the causative agents of primary PID?

Microbiology

A

Greater than 90% of PID cases are caused by Chlamydia rachomatis and Neisseria gonorrhea which are also the leading causes of STDs

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11
Q

What is the most common STD agent?

Microbiology

A

Chlamydia trachomatis

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12
Q

What is polymicrobial PID?

Microbiology

A

30 to 40% of cases, may begin as an isolated infection with N. gonorrhea or C. tachomatis which causes inflammation of the upper genitelia tract that facilitates the involvement of other pathogens

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13
Q

What are soem other examples fo causative agents in polymicrobial PID?

Microbiology

A

Gardenerella vaginalis, Haemophilus influenzae and anaerobes such as Peptococcus and Bacteroides species.

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14
Q

How many STDs are acquired everyday world-wide?

Microbiology

A

1 million every day

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15
Q

What period of time was there a drastic icrease in gonorrhe cases and why?

Microbiology

A

Flower-power era, co-exusted with HIV epidemic

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16
Q

What are the symptoms of most STDs like?

Microbiology

A

The majority of STDs have no symptoms or only mild symptoms that may not be recognized as an STD –> silent infections

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17
Q

What is the relation between STDs (such as Gonorrhea, HSV 2and syphilis) and HIV?

Microbiology

A

Gonorrhea, HPV 2 and syphilis increase the risk of HIV acquisition

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18
Q

What is a major threat to reducing the impact of STDs worldwide?

Microbiology

A

Drug resistance, espcially with gonorrhea

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19
Q

What is the most common affected population of new STDs?

Microbiology

A

15 to 24 years of age

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20
Q

What are the common agents for STDs? (10)

Microbiology

A
  1. Chlamydia trachomatis
  2. Nisseria gonorrhea
  3. Trichomonas vaginalis
  4. Treponema pallidum
  5. Mycoplasma genitalium
  6. Ureaplasma urealticum
  7. Hemophilus ducreyii
  8. HIV
  9. HPV
  10. HSV
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21
Q

What is C. trachomatis like?

Microbiology

A

Gram negative tiny bacteria, obligate inracellular
–> live in eukaryotic cells to use energy sources and amino acids

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22
Q

What are Ν. gonorrhea like?

Microbiology

A

Gram negative diplococci bacteria

Fastidious non-motile bacteria & strict human pathogen

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23
Q

What is trichomonas vaginalis?

Microbiology

A

Parasite, protozoa

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24
Q

What are mycoplasma genitalium and ureaplasma urealyticum?

Microbiology

A

Tiny bacteria without a cell wall

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25
Q

What is hemophilus ducreyii?

Microbiology

A

Gram negative coccobacilli

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26
Q

What does chlamydia trachomatis cause?

Microbiology

A
  1. Silent infections (asymptomatic): urethritis in 50% of emn
  2. Cervicitis infection: 60 to 75% of women do not show symptoms
  3. Contageous STD and increase in HIV acquisition
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27
Q

What can untreated chlamydia cause?

Microbiology

A

PID,
Infertility,
Ectopic pregnancy

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28
Q

How are Chlamydia trachomatis infections treated?

Microbiology

A

Curable with antibiotics

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29
Q

What is the lifecycle of chlamydia trachomatis like?

Microbiology

A

Biphasic with two unique forms of the organism

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30
Q

What are the two unique forms of the chlamydia bacteria during its lifecycle?

Microbiology

A

Elementary body (EB)
Reticulate Body (RB)

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31
Q

What is the elementary body of chamydia trachomatis?

Microbiology

A

Infectious, extracellular form, metabolically inactive, non-replicative form and has a rigid cell wall

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32
Q

What is the reticulate body of chlamydia lifecycle like?

Microbiology

A

Non-infectious, intracellular, membrane-bound, no rigid wall, metabolically active and replicate by binary fusion

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33
Q

What virulnce factor does Chlamydia contain in the outer membrane?

Microbiology

A

LPS but no peptidoglycan, Chlamydia LPS has very weak activity as an endotoxin and does not induce innate immunity –> thus asymptomatic/silent infections

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34
Q

What is the pathogenesis of Chlamydia?

Microbiology

A
  1. Attachment of elementary body to cell surface –> attached to sialic acid receptors on the surface of columnar epithelial cells
  2. Internalization by endocytosis and inhibition of ednosome fusion to lysosome
  3. Transformation from EB to RB form
  4. Replication of RB form by binary fission –> until apoptosis is caused
  5. Immune evasion
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35
Q

Why is there no vaccine against Chlamydia?

Microbiology

A

Due to its antigenic variation –> subvert host defenses

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36
Q

What is the treatment for Chlamydia?

Microbiology

A

Azithromycin or Doxycycline for 7 days

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37
Q

How can Chlamydia be diagnosed in a lab?

Microbiology

A

Chlamydia is obligate intracellular tiny bacteria so it can:
1. Grow in tissue culture cell lines and not on agar plates
2. Stained for inclusion bodies
3. NAAT
4. EIA: Enzyme immune assay

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38
Q

What family does Chlamydia belong to?

Microbiology

A

Chalmydiaceae family

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39
Q

How are Chlamydia infections acquired?

Microbiology

A

Direct contact with mucous membranes like the case in sexual contact

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40
Q

What other diseases can Chlamydia lead to?

Microbiology

A

Trachoma: inflammatory granulomatous process of eye surface
Adult inclusion conjuctivitis
Neonatal conjuctivitis
Infant pneumonia
Urogenital infections
Lymphogranuloma venereum

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41
Q

What can Gonorrhea cause?

Microbiology

A
  1. Sterility
  2. PID (in women)
  3. Sponteneous abortions and ectopic pregnancies
  4. Enhanced HIV transmission
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42
Q

What can maternal transmission of Gonorrhea lead to?

Microbiology

A

Blindness in newborns

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43
Q

What is the incubation period of Gonorrhea?

Microbiology

A

2 to 10 days

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44
Q

Which gended has a higher rate of Gonorrhea cases?

Microbiology

A

MEN

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45
Q

What is the health disparity among races?

Microbiology

A

Looking at data, the incidence of disease is higher among low class populations, due to the lack of education and awareness

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46
Q
A
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47
Q

What is the pathogenesis of Gonorrhea?

Microbiology

A

It induces robust innate immune resposnses but suppresses adaptive immunity (thus no vaccine has been developed yet)

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48
Q
A
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49
Q

How is Gonorrhea retrived?

Microbiology

A

Viable in neutrophils from gonorrhea discharge
It can survive in macrophages

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50
Q

How does N. gonorrhea evade killing by host defences?

Microbiology

A
  1. Immune evasion
  2. Virulenece factors
  3. IgA protease
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51
Q

How does immune evasion of Gonorrhea help evade killing?

Microbiology

A

Antigenic variation (which is the factor that allows for recurrence of the infection) of proteins expressed on the surface; modifications of bacterial targets like LPS

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52
Q

What are the virulenece factors of Gonorrhea?

Microbiology

A
  1. Fimbriae
  2. Pilli
  3. Porins (outer membarne proteins)
  4. LPS (reduces phagocytosis)
  5. Lactoferrin utilization
  6. Antioxidant and detoxification system
  7. Type IV secretion system
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53
Q

What is the role of type 4 secretion system as a virulenece factor in Gonorrhea?

Microbiology

A

It secretes chromosomal DNA into the environment.

This released DNA facilitates horizontal gene transfer, increasing genetic diversity and antibiotic resistance.

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54
Q

How does IgA protease help Gonorrhea evade killing by host defense?

Microbiology

A

Facilitates bacteria adherence to mucosa by blocking IgA antibodies

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55
Q

What kind of agar is used for Gonorrhea culture?

Microbiology

A

Chocolate agar due to iron

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56
Q

What is the main site of gonococcal infections?

Microbiology

A

Genital tract

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57
Q

What are examples of disseminated gonococcal infections?

Microbiology

A

Gonococcal pharyngitis
Neonatal opthalmia
Purulent eye infection
Gonococcal skin papules
Gonococcal arthiritis
Rectal gonorrhea

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58
Q

Which antibitics in gonorrhea resistant to?

Microbiology

A

Penicillin
Erythromycin
Fluoroquinolones

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59
Q

What is the causative agent of Syphilis ?

Microbiology

A

Treponema pallidium

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60
Q

What is venereal syphilis?

Microbiology

A

An STI with incubation period around 21 days, but can range from 10 days to 90 days

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61
Q

What type of agent is Treponema pallidium?

Microbiology

A

A motile spirochete bacteria, gram negatve but very thin t stain, visible under fluorescence and dark field microscopy

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62
Q

What is the importance of the helical structure of Treponema pallidum?

Microbiology

A

Allows it to move in a corkscrew motion through mucous membranes or enter minuscule breaks in the skin

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63
Q

What are the virulenece factors of Treponema pallidum?

Microbiology

A

Hyalorunidase which attached to variety of cells: epithelail, endothelial and fibroblasts

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64
Q

What is primary syphilis?

Microbiology

A

Primary lesion called chancre appears at the site of inoculation, usually perists for 4 to 6 weeks and then heals spontaneously.

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65
Q

How is the primary lesion of primary syphilis cleared?

Microbiology

A

Macrophages phagocyte Treponema and clear the primary chancre butTreponeam can spread by blood and lymoh through out the body

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66
Q

What is secondary syphilis?

Microbiology

A

Generalized, non-tender lymphoadenopathy, parenchymal, constitutioal and mucutaneous manifestations of secondary syphilis usually appear 6 to 8 weeks after then chancre heals

(skin rashes and mucosal lesions)

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67
Q

What is latent syphilis?

Microbiology

A

Positive serologic tests for syphilis, together with a normal CSF examination anf the absence of clinical manifestations of syphilis

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68
Q

What is the only way to diagnose latent syphilis?

Microbiology

A

Serology tests will come back positive

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69
Q

What can untreated syphilis lead to?

Microbiology

A

Tertiary syphilis

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70
Q

What is tertiary syphilis?

Microbiology

A

Hyperimmune response that affects many organs including the skin. Treponema can move to the blood stream, spinal fluid and to other internal organs very rapidly via its internal flagella

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71
Q

What can tertiary syphilis lead to?

Microbiology

A

Neurosyphilis (syphilis in CNS)
Aortitis/carditis
Gummas/skin lesions

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72
Q

What are gummas?

Microbiology

A

Solitary lesions ranging from microscopic to several centimeters in diameter. They produce indolent, painless, indurated nodular or ulcerative lesions that may resemble other chronic granulomatous conditions, including TB, sarcoidosis, leprosy, and deep fungal infections

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73
Q

Why can Treponema not be cultured?

Microbiology

A

It is fastidious and very sensitive

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74
Q

What are the diagnostic approaches to Syphilis?

Microbiology

A

NAAT and sensitive PCR
Serologic testing

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75
Q

How is syphilis treated?

Microbiology

A

Penicillin

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76
Q

What are the two types of serology used for syphilis?

Microbiology

A

Nontreponemal and treponemal

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77
Q

What is the most widely used non-treponemal antibody test used for syphilis?

Microbiology

A

Rapid plasma reagin and venereal disease research laboratory tests –> measure the IgG and IgM directed against the cardiolipin-lecithin-cholesterol antigen complex

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78
Q

What are treponemal tests used for?

Microbiology

A

To measure antibodies to native or recombinant T pallidum antigens and include the FTA-ABS tests, and the TPPA test

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79
Q

What are the subspecies of Treponema pallidum?

Microbiology

A
  1. Treponema pallidum subspecies pallidum –> Syphilis STD
  2. Treponema pallidum sbspecies carateum –> Pinta
  3. Treponema pallidum subspecies endemicum –> Bejel (rare)
  4. Treponema pallidum subspecies pertenue –> Yaws (rare)
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80
Q

What does hemophilus ducreyi cause?

Microbiology

A

Chancroid

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81
Q

What is Chancroid?

Microbiology

A

An STD characterized by genital ulcers and enlarged regional lymph nodes

The esion are similar to those caused by Siphylis but they are painful

They increase the risk of HIV

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82
Q

What is hemophilus ducreyi like?

Microbiology

A

Gram negative coccobacili bacteria

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83
Q

How is Hemophilus ducreyi diagnosed?

Microbiology

A

Culture or chocolate agar
Diagnosed by biochemical test
PCR and NAAT

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84
Q

What is the treatment for hemophilus ducreyi?

Microbiology

A

Erythromycin
Trimethoprim - sulfamethaxazole orally x 10
OR
Amoxycillin-clavulan (augmentin) x7

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85
Q

What is mycoplasma genitalium?

Microbiology

A

The main cause of non gonococcal urethritis (NGU), mucopurulent cervicits, endometritis and PID

They are tiny bacteria that lack a cell wall and infect ciliated epithelial cells

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86
Q

What are examples of mycoplsma genitalium virulence factors?

Microbiology

A

The ability to adhere to host epithelial cells using the terminal tip organelle with its adhesins, the release of enzymes and the ability to evade the host immune response by antigenic variation

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87
Q

What does ureaplasma urealyticum cause?

Microbiology

A

Non-gonococcal urethritis (NGU), renal calculi, neonatonal abscesses

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88
Q

What are ureaplamsa urealyticum?

Microbiology

A

They are tiny bacteria that lack a cell wall and infect ciliated epithelial cells

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89
Q

What is the main virulence factor of ureaplasma urealyticum?

Microbiology

A

The hydrolization of urea

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90
Q

What agar is specific to uregenital mycosplasma and ureaplasma?

Microbiology

A

A7 agar –> shows fried egg colony morphology

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91
Q

What does Trichomonas vaginalis cause?

Microbiology

A

Trichomoniasis, asymptomatic silent infection in 70% of the cases

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92
Q

What is trichomonas vaginalis?

Microbiology

A

Anaerobic flagellated protozoan parasite

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93
Q

WHat are the symptoms of trichomonas infection?

Microbiology

A

In females: strawberry cervix, itching and pain
In males: burning sensation and itching

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94
Q

What are important viruence factors of trichomonas parasite?

Microbiology

A

Fagella and undulating membrane to allow for motility

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95
Q

What is the treatment for the trichomonas vaginalis protozoan?

Microbiology

A

Metronidazole

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96
Q

What does brown discharge indicate?

Microbiology

A

No infection, tends to be normal during menstrual cycle

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97
Q

What does white thick, creamy and clumpy discahrge indicate?

Microbiology

A

Yeast infection

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98
Q

What does yellow discharge indicate?

Microbiology

A

STDs (trichomonas, chlamydia, gonorrhea)

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99
Q

What does green discharge inidicate?

Microbiology

A

STDs (trichomonas, gonorrhea, chlamydia)

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100
Q

What does smelly discharge indicate?

Microbiology

A

STD (trichomonas) or bacterial vaginosis

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101
Q

What does pink discharge indicate?

Microbiology

A

Cervical or endometrial cancer, vaginal infection (BV) or cervical erosion

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102
Q

What does orange discharge indicate?

Microbiology

A

Vaginal infections

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103
Q

What are clue cells and what do they indicate?

Microbiology

A

They are vaginal cells with bacteria stuck to them, they provide us with a clue hat there is something abnormal –> bacterial vaginosis

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104
Q

What is the vaginal microbiome like?

Microbiology

A

It consists of many species of bacteria, viruses and yeast that colonize the vagina

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105
Q

Which is the dominant species of the vaginal microbiome?

Microbiology

A

Lactobacillus species are the dominant colonizing bacteria in health adult women

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106
Q

What is reduced number of Lactobacillus indicative of?

Microbiology

A

Increased vaginal pH and altered vaginal microbiome (dysbiosis)

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107
Q
A
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108
Q

What is the normal pH environment of the vagina like?

Microbiology

A

Both the environmnet and the fluid are acidic

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109
Q

What pH do Lactobacilli thrive in?

Microbiology

A

Low pH, below 4.5

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110
Q

What are the Lactoboacillus bacteria like?

Microbiology

A

Gram positive bacilli, faculative anaerobic, non-spore forming bacteria

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111
Q

What do Lactobacilli produce?

Microbiology

A
  1. Lactic acid from sugars through fermentation –> contributes to low vaginal pH –> other bateria cannot thrive at low pH so protects from infections
  2. Hydrogen peroxide (H2O2) which kills other bacteria
  3. Bacteriocins that kill other bacteria
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112
Q

Where else are lactobacilli bacteria found in the body?

Microbiology

A

Digestive system
Urinary system
Genital system

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113
Q

When does lactobacilli dominance develop?

Microbiology

A

In adult women during child-bearing age

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114
Q

What is the environment/diversity of the vaginal microbiome in prepubertal girls and postmenopasual women?

Microbiology

A

Increased diversity –> thin vaginal mucosa –> low levels of glycogen –> low activity of lactobacilli –> high pH –> diverse environment

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115
Q

How does a low pH allow for lactobacillus dominance?

Microbiology

A

Low pH –> thick vagina mucosa –> deposition of glycogen –> more glycogen metabolized by lactobacilli into lactic acid (for energy) –> low pH –> bacteria cannot survive –> lactobacillus dominance

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116
Q

What is the effect of Lactobacilli towards pathogenic microorganisms?

Microbiology

A

It has been shown to inhibit in vitro growth of pathogenic microorganisms –> any alterations in the vaginal environment would allow for such microorganisms to thrive and ths cause an infection

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117
Q

Is bacterial vaginosis a strictly STD related infection?

Microbiology

A

No, it can be due to an alteration (dysbiosis is the enviornment) of any nature

It does increase the risk of STDs though

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118
Q

What is bacterial vaginosis?

Microbiology

A

Bacterial infection that is not STDs, caused by imbalance in the maount of bacteria in the vagina

It does not cause dysuria, dyspareunia, pruritus or vulvar inflmmation

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119
Q

What are common agents that cause bacterial vaginosis? (8)

Microbiology

A

Gardenerella vaginalis
Prevotella
Mobiluncus
Bacteroides
Peptococcus
Fusobacterium
Veillonella
Eubacterium

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120
Q

What is the most common cause of bacterial vaginosis?

Microbiology

A

Gardenella vaginalis

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121
Q

What is Gardenella vaginalis like?

Microbiology

A

Gram variabe coccobacilli, faculative anaerobic bacteria that grow on blood and chocolate agar as tint colonies

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122
Q

What are the characteristics of normal healthy vaginal discharge?

Microbiology

A

Healthy cervicovaginal mucosa and a small amount of oforless, clear like vaginal discharge

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123
Q

What is vagina discharge like in the case of bacterial vaginosis?

Microbiology

A

Heavy, milky, homogenous vaginal discharge with bublles of gaseous by-products of anaerobic bacteria, fishy odor

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124
Q

What is the microscopic results of bacterial vaginosis?

Microbiology

A

Vaginal epithelial cells covered by coccobacilli –> a feature of clue cells

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125
Q

What infection shows up as yellow-green-gray discharge?

Microbiology

A

Trichomoniasis

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126
Q

How is bacterial vaginosis diagnosed?

Microbiology

A

Microscopic examinations (wet mount) of vagina discharge swabs to inspect the presnec of clue cells

Vaginal swabs are also cultred for microbiological investiagations

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127
Q

Which criteria are used to classify bacterial vaginosis?

Microbiology

A

Nugent Scoring System
Amsel

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128
Q

What are the classifications of the Nugent Scoring System?

Microbiology

A

Lactobacillus morphotypes
Gardenella and Bacteroides morphotypes
Curved gram-variable rods

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129
Q

What are the criteria of teh Amsel criteria?

Microbiology

A
  1. Thin, white, yellow, homogeneous discharge
  2. Clue cells
  3. pH of vaginal fluid > 4.5
  4. Release of fishy odor
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130
Q

What are the characteristics of vaginal discharge in BV?

Microbiology

A

Grey, homogenous, amine odor

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131
Q

What are the characteristics of vaginal discharge in gonorrhea?

Microbiology

A

Greenish yellow, mucopurulent, odorless

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132
Q

What are the characeristics of vaginal dischage in chlamydia?

Microbiology

A

Greenish yellow, purulent, odorless

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133
Q

What are the characteristsics of vaginal discahrge in Trichomonas?

Microbiology

A

Grayish yellow, purulent, often mixed with bubbles, amine odor

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134
Q
A
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134
Q

WHat are the characteristics of vagina discahrge in candida?

Microbiology

A

Whitish, cottage cheese-like consistency, odorless

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135
Q

WHat are the characteristics of vaginal dischareg in lactobacillus overgrowth?

Microbiology

A

WHite, pasty, odorless

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136
Q

What are the characteristics of vaginal discahrge in treponema?

Microbiology

A

Chancre ulcer no discharge

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137
Q

What are teh characteristics of vaginal discharge in hemophilus ducreyii?

Microbiology

A

Typica chancroid ulcer, if severe infection vaginal discharge may be observed

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138
Q

What is cytolytic vaginosis?

Microbiology

A

The overgrowth of lactobacilli bacteria, resulting in acidity and irritation

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139
Q
A
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140
Q

What are the signs of cytolytic vaginosis?

Microbiology

A

Moderate to profuse discahrge which is usally white, thick, pastry and odorless
Itching
Burning
Pain
Irritation

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141
Q

How is cytolytic vaginosis diagnosed?

Microbiology

A

MIcroscopic examinations

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142
Q

What is the treatment for cytolytic vaginosis?

Microbiology

A

Treated with a baking soda rinse solution

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143
Q

What is vaginal candidiasis caused by?

Microbiology

A

candida species, mainly Candida albicans

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144
Q

What are the symptoms of yeast infection, like the one cause by candida?

Microbiology

A

Fungal infections, irritation, swelling, vaginal itching, and cheesy white vaginal discharge

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145
Q

What is herpes simplex virus?

Microbiology

A

STI caused by HSV 1 and 2

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146
Q

How is HSV transmitted?

Microbiology

A

Direct contact only

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147
Q

What is the incubation period of HSV?

Microbiology

A

About 4 days

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148
Q

What are the symptoms of herpes simplex virus?

Microbiology

A

Itchy, painful vesicles when burst form a painful ulcer

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149
Q

What kind of virus is HSV?

Microbiology

A

Enveloped DNA virus taht can stay latent in human host

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150
Q

What is HPV?

Microbiology

A

The most common sexually transmitted viral infection in the US

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151
Q

What are most HPV infections like?

Microbiology

A

Asymptomatic and resove spontaneously

Can cause skin and plantar warts and geniral warts

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152
Q

What kind of virus is HPV?

Microbiology

A

DNA virus from the papillomavirus family

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153
Q

Which cancer is associated with HPV?

Microbiology

A

Cervical cancers due to HPV 16 and 18

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154
Q

What do the genital warts look like in HPV cases?

Microbiology

A

Small bumps or group of bumps n the genital area, they can be small or large, flat or raised or shaped like a cauliflower

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155
Q

What are the common causes of genital warts? (HPV subtypes)

Microbiology

A

HPV 6 and 11

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156
Q

What are the common causes of skin warts? (HPV subtypes)

Microbiology

A

HPV 1 and 2

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157
Q

Which STIs can be transmitted transplacentally?

Pharmacology

A

Treponema Pallidum

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158
Q

Which STIs can be transmitted during delivery from th emother to the child?

Pharmacology

A

N. gonorrhea

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159
Q

How are bacterial STDs cured?

Pharmacology

A

Antibiotics treatment is detected eraly enoug

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160
Q

What is the general aim of treatment in STDs?

Pharmacology

A

To resolve symptoms and prevent complications and prevent risk of transmission and re-infection

162
Q

What is different about the treatment of viral vs bacterial STDs?

Pharmacology

A

Vira STDs cannot be cured even if detected early, unlike bacterial, their symptoms can ony be managed

164
Q

How can we determine effectiveness of a drug?

Pharmacology

A

Monitoring the levels of infection before and after treatment –> drug resistance problems can also be fetected this way

165
Q

What is Acyclovir?

Pharmacology

A

The prototype of synthetic nucleoside analogs

165
Q

How is HSV infection transmitted?

Pharmacology

A

Seual contact including oral sex or perinatally from mother to child

165
Q

What is the treatment for primary HSV?

Pharmacology

A

Oral antiviral therapy within 72 hours of lesion appearnce –> decrease in duraction and severity of illness by days to weeks and decreases in the risk of complications (like meningitis)

166
Q

What are examples of antiviral agents that can be used to treat primary HSV?

Pharmacology

A
  1. Acyclovir (Zovirax)
  2. Famciclovor (Famvir)
  3. Valacyclovir (Valtrex)
167
Q

Which is the antiviral drug of choice when it comes to treatment of primary HSV?

Pharmacology

A

Acyclovir, becuase it is cheaper

168
Q

What is the MOA of Acyclovir?

Pharmacology

A

Inhibits viral DNA replication by acting as a false substrate for DNA polymerase, DNA poymerase is blocked and thus assembly of DNA stops

169
Q

What is Valacyclovir?

Pharmacology

A

A prodrug of ACV with higher bioavailability (50 to 60%)

170
Q

What is Famciclovir?

Pharmacology

A

A prodrug of penciclovir, bioavailability of 70%
Its active triphosphate form is more stable than that of Acyclovir in HSV-infected cells, longer duration of action

171
Q

WHy is higher bioavailability a feature that we desire in pharamcological treatments?

A

SHortest doasge –> longest duration –> better compliance and less long term risks

172
Q

What changes are made to he dosage if the HSV+ atient is also HIV+?

Pharmacology

A

Dosage has to be higher

174
Q

WHat are the side effects of Acyclovir?

Pharmacology

A

Quite safe drug

Nausea, vomiting, headache and fatigue

Long term effects of high dosaeg can lead to neurotoxicity –> in elderly (confusion, tremors) and seizures

175
Q

How are antivirals excreted?

Pharmacology

A

Renal excretion so caution in case of renal impairement –> reduction of dosage may be required

176
Q

How can antiviral therapy be optimised through the choice of drug?

Pharmacology

A

For instance in patients with HIV as well as HSV, instead of bi valacyclovir (500 mg) we can give once Famciclovir (1000 mg)

–> Point is trying to find alternatives that allow for better compliance by being taken once daily

177
Q

What happens during the initial phase of infection of Syphillis?

Pharmacology

A

The organism (treponema pallidum) disseminates widely, setting the stage for subsequent manifestations (primary, secondary and tertiary phases)

178
Q

Why is early treatment important is Syphilis infections?

Pharmacology

A

If untreated, syphilis can have a number of significant late manifestations, including cardiovascular, gummatous and neurological

179
Q

What is the drug of choice for syphilis treatment?

Pharmacology

A

Parenterally-delivered Penicillin G for all sages of syphilis, dosage may ony change depending on the stage of syphilis

180
Q

What is Penicillin G?

Pharmacology

A

A beta lactam –> acts as a cell wall inhibitor

181
Q

Who is penicillin therapy effective towards in the treatment of syphilis?

Pharmacology

A

Treating maternal disease, preventing transmission to the fetus and also treating established fetus disease –> in addition to normal patienst suffering from syphilis

182
Q

Which antibiotic types are indicated for the treatment of syphilis in the case the patient is allergic to penicillin?

Pharmacology

A

Tetracyclines (Doxocycine)
3rd generation cephalosporine (Ceftriaxone) –> if allergy is not severe

183
Q

What is the treatement of syphilis in prgenancy?

Pharmacology

A

Desensitize and administer Penicillin G benzthine as a regimen of choice

AVOID Tetracyclines –» teratogenic (affect bone development)

184
Q

What is Benzylpenicllin benzathine?

Pharmacology

A

Combination of penillin G with benzanthine

186
Q

What is the purpose of benzanthine componenet in benzypenicillin benztahine?

Pharmacology

A

It slowly releases the penicillin making the combination long acting and very effectiev against T. pallidum’s slow growth rate

187
Q

How is Benzypenicillin Benztahine administered?

Pharmacology

A

IM in the buttocks or thigh region

188
Q

WHat is the drug of choice when it comes to the treatment of syphilis?

Pharmacology

A

Benzylpenicillin benzathine as it allows for prolonged antibiotic action (1 IM dose every 2 to 4 weeks)

Also wide therapeutic range –> safe

189
Q

What are the side effects of Penicillin G Benzathine?

Pharmacology

A

Hypersensitivity reactions (rashes to anaphylaxis)
Jarisch Herxheimer reactions

190
Q

What are Jarisch Herxheimer reactions?

Pharmacology

A

An inflmmatory recation to endoroxin-like products rleased by the death of the microorgansm during antibiotic treatment

191
Q

How do Jarisch-Herxheimer reactions manifest?

Pharmacology

A

A few hours after the first dose of antibiotic as fever, chills, hypotension, headache, tachycardia, hyperventilation, vasodialtion, myalgia, exacerbation of skin lesions

192
Q

What are alternative treatment regimens for syphilis?

Pharmacology

A

Doxocycine (tetracycline)
Ceftriaxone (3rd generation cephalosporin)
Amoxicillin & probenecid

193
Q

Why is probenecid given with Amoxicilln in the treatment of syphilis?

Pharmacology

A

It prevents renal excretion of penicllins by competing with the organic transporter in the peritubular capillaries that excretes them from the bood –> longer duration of action and reduced dosing frequency

194
Q

How is neurosyphilis treated?

Pharmacology

A

Neurosyphilis is the ate stage syphilis that has impacted the neurological function

IM Benzathine penicillin is ineffective becuase it does not cross the BBB

Instead iV treatment is preferred

195
Q

Why is IV treatment of neurosyphilis preferred over IM?

Pharmacology

A

The dose of IM benzanthine that is administered for other stages of syphilis does not produce measurabe CSF levels of drug, aqueous IV peniocillin has more chances of passing through the BBB

196
Q

What are the approaches when treating Gonorrhea?

Pharmacology

A

Treatment should :
1. Be highly effective at all anatomic sites of infection
2. Be well tolerated
3. Offer the feasibility of single-dose therapy

The selation of the actual regimen is based on drug resistance and the presence of co-pathogens

197
Q

What are some examples of co-pathogens of Gonorrhea?

Pharmacology

A

Chalmydia
Trachomatis
Mycoplasma genitallum

198
Q

What is the drug of choice for Gonorrhea?

Pharmacology

A

High dose of IM ceftriaxone as a single IM injection of 500mg or 1g (based on weight)

199
Q

What are alternative treatment regimens to Gonorrhea?

Pharmacology

A

Azithromycin plus gentamicin or gemifloxacin

200
Q

When are alternative treatments for Gonorrhea used?

Pharmacology

A

In patients who are severely allergic to cephalosporins

201
Q

Which other STIs is Azithromycin also effective against?

Pharmacology

A

Chlamydia which is a common co-pathogen of Gonorrhea, this way both can be treated

202
Q

What is the goal of treatment when it comes to Chlamydia?

Pharmacology

A

Prevent complicated infections related to Chamydia such as PID, infertility and ectopic pregnancies), decrease the risk of transmission, resolve symptoms and prevent re-infection

203
Q

What is C. trachomatis susceptible to?

Pharmacology

A

Tetracycline
Macrolides
Ony some Fluroquinolones

204
Q

What is the preferred treatment for Chlamydia infections?

Pharmacology

A

Doxocycline for seven days or Delayed release doxocycline which is just as effective and better tolerated

205
Q

What is the alternative treatment for Chamydia?

Pharmacology

A

Azithromycin or Levofloxacin

206
Q

What is treatemennt of Chlamydia like in pregnancy?

Pharmacology

A

Azithromycin or Amoxicillin, no Doxycycline because it is teratogenic

207
Q

Why is treatment of Chlamydia important during pregnancy?

Pharmacology

A

It prevents the transmission to infents during passage through the birth canal

208
Q

What is the preferred treatment for trichomonas infection?

Pharmacology

A

5-nitromidazole drugs like Metronidazole, tinidazole, secnidazole

–> single dose therapy is more convinient, oral > topical

209
Q

What is Metronidazole?

Pharmacology

A

A synthetic nitroimidazole

Antibitoc and antiprotozoal medication that is effective orally

210
Q

What agents is Metronidazole effective towards?

Pharmacology

A

Protozoa against Trichomonasvaginalis, amoebiasis, and giardiasis

211
Q

What are common side effects of Metronidazole?

Pharmacology

A

Nausea, metallic taste, epigastric distress/cramps and headaches

212
Q

What should be avoided when taking Metronidazole?

Pharmacology

A

Avoid alcohol as leads to disulfiram-like reactions

213
Q

What is the MOA of Metronidazole?

Pharmacology

A

Unionized metronidazole is intracellularly reduced to its active form leading to the production of toxic metabolites/reactive nitrosi radicals that damage DNA and proteins, inhibiting microbial nucelic acid synthesis and cell death

214
Q

What medication is effective against Mycoplasma genitalium infections?

Pharmacology

A

They have no cell wall –> so cannot targetted so penicillins and other beta-lactams are not useful

Usually susceptible to macrolides (Azithromycin)

215
Q

What is the alternative treatment for Mycoplasma genitalium infectio?

Pharmacology

A

Multi-dose doxycycline or moxifloxacin

216
Q

What is PID like?

Pharmacology

A

Usually a multi-agent disease, acute polymicrobial infections

217
Q

What is the initial treatment of PID?

Pharmacology

A

Combination parenteral regimen that provides antimicrobial coverage against a wide range of bacteria

E.g. Cefoxitin, doxycycline and metronidazole

218
Q

When does the transition to oral therapy of PID happen?

Pharmacology

A

After 24 hours of sustained clinical improvement, reflected by the resolution of symptoms

Doxocycline plus metronidazole

219
Q

What is outpatient therapy of PID?

Pharmacology

A

Single dose of IM of a long acting cephalosporin plus metronidazole

220
Q

What is the treatment of vulvovaginal candidiasis?

Pharmacology

A

Ora single dose of Fluconazole
Topical azole therapy (Clotrimazole, miconazole, terconazole)

221
Q

What is the MOA of azole antifungals?

Pharmacology

A

Inhibit ergosterol synthesis (principal in funga cell membrane) and inhibit cell membrane formation –> leads to cell leakage and death

222
Q

What is the treatment of choice for the different STDs?

Pharmacology

A
  1. Syphilis: Benzathine penicillin
  2. Gonorhhea: Ceftriaxone
  3. Chlamydia: Doxocycline
  4. Trichomoniasis: Metronidazole
  5. Mycoplasma: Azithromycin
  6. PID: Cephalosporin + Doxycycline + Metronidazoe
  7. HSV: Acyclovir
223
Q

Which bones does the bony pelvis consist of?

Anatomy

A

2 hip bones
Sacrum
Coccyx

224
Q

What are the bones that form the hip bones?

Anatomy

A

Ilium
Ischium
Pubis

225
Q

What are the anatomic features of the ileum?

Anatomy

A
  1. Lateral part of the pelvic girdle
  2. The ala of the iulm forms the iliac crest
  3. It connect with the ischium and the pubis and forms the superior part of he acetabulum
226
Q

What are the anatomic features of the ischium?

Anatomy

A
  1. Posterior and inferior of the pelvic girdle
  2. The ramus of the ischium connects with the inferior pubic ramus to form to ischiopubic ramus
  3. Forms the inferoposterior part of the aetabulum
227
Q

What are the anatomical features of the pubis?

Anatomy

A
  1. Anteriomedial part of the pelvic girdle
  2. Articulates on the midline to form the pubic symphisis
  3. The inefrior ramus connects with the ramus of the ischium to form theischiupubic ramus
  4. The superior ramus forms the anterior part of the acetabulum
228
Q

What is the pelvic outlet?

Anatomy

A

The inferior opening of the pelvic, closed by funnel shaped muscle floor

229
Q

Which muscles make up the floor of the pelvic outlet?

Anatomy

A

Levator ani
Coccygeus

230
Q

What are the sublayers of the evator ani?

Anatomy

A

Puborectalis
Pubococcygeus
Iliococcygeus

231
Q

What are the divisions of the true pelvis in males?

Anatomy

A

Rectovesicular pouch (intraperitoneal fluid collection)
Pararectal fossa
Ischiorectal fossa

232
Q

What are the divisions of the true pelvis in females?

Anatomy

A

Rectouterine pouch (interperitoneal fluid and endometrial collections)
Vesicouterine pouch
Pararectal fossa
Ischiorectal fossa

233
Q

What are the anatomical borders of the perineum?

Anatomy

A

Posterior: tip of coccyx
Anterior: inferior borderof pubic symphysis
Lateral: Ischiopubic rami, iscial tuberosities, sacrotuberous ligaments
SUperior: pelvic floor (pelvis diaphragm, urogenital diaphragm)
Inferior: skin, superficial perineal (Colle’s fascia)

234
Q

Which ligament is associated with he anterior anatomica border f the perineum?

Anatomy

A

Arcuate pubic ligament

235
Q

What are the contents of the urogenital triangle in males?

Anatomy

A

Penis
Scrotum (with testes and associated structures)

236
Q

What are the contents of the urogenital triangle in females? (11)

Anatomy

A

The vulva; including:
1. mons pubis,
2. labia majora,
3. labia minora,
4. clitoris,
5. vestibular
6. bulbs,
7. vulva vestibule,
8. Bartholin’s glands,
9. Skene’s glands,
10. urethra,
11. vaginal opening

237
Q

What are the two subdivisions of the perineum?

Anatomy

A

The urogenital triangle and the anal triangle

238
Q

What are the contents of the anal triange?

Anatomy

A

Anus
Ana canal
Ischioanal fossa

240
Q

What is the pelvic floor?

Anatomy

A

Fibromuscular section, inferior to the pelvic cavity

241
Q

What is the function of the pelvic floor (diaphragm)?

Anatomy

A

Prevent organ prolapse maintain urinary/fecal continence and separate the pelvic cavity from the peritoneum

242
Q

What are the layers of the pelvic floor (from deep to superficial)?

Anatomy

A
  1. Pelvic diaphragm (floor)
    a. levator ani
    b. coccygeus (posterior to levator ani)
  2. Urogenital diaphragm
    a. deep transverse perineal muscle
    b. urethral sphincter
  3. Superficial perinea layer
    a. ischiocavernosous
    b. bulbocavernosous (male) & spongiosum (female)
    c. external anal canal
    d. superficial transverse perineal muscle
243
Q

What do the openings in the pelvic floor allow passage for?

Anatomy

A

Rectum
Vagina
Urethra

244
Q

Explain the structures of pelvic diaphragm from a superior view? (image)

Anatomy

A

Anal canal
Levator ani and sublyers
Anococcygeus body
Perineal body
Obtutaror internus
Obtutaor facsia
Coccygeus muscle

246
Q

What is the obturator fascia?

Anatomy

A

Space filled with fat lateral to the ana canal just below plevic diaphragm

247
Q

What are the structures within pudendal canal? (Alcock’s canal)

Anatomy

A

Pudendal nerve
Internal pudendal artery and vein

248
Q

What is the ischioanal (ischiorecta fossa)?

Anatomy

A

Wedge-shaped space on each side of the anal canal
Extends from pelvic diaphgarm to the skin of ana region

249
Q

What are the borders of the ischioanal fossa?

Anatomy

A

Medially: soping levator ani muscle
external anal shincter
Laterally: obturator internus muscle & fascia
Ischium

250
Q

What is the function of ischioanal fossae?

Anatomy

A

Allows for expaansion at the rectoanal canal during defecation

251
Q

What does ano-rectal mucosa damage lead to?

Anatomy

A

Spread of infection into ischioanal fossa, such infections can spread in between sphicters and produce intersphincter fistulae (perianal fistulae)

252
Q

What are the different types of abscesses that can be formed in the ischioanal fossa?

Anatomy

A
  1. Submucosa
  2. Supralevator
  3. Intersphincteric
  4. Ischioanal
253
Q

Where is the Pudendal canal (Alcock;s canal) found?

Anatomy

A

In the lateral wals of the ischioanal fossa

254
Q

What is the pudendal canal?

Anatomy

A

Horizontal passage within the obturator internus fascia on the lateral wall of the ischioanal fossa

255
Q

What is the main nerve innervation of perineum?

Anatomy

A

Pudendal nerve (S2 to S4)

256
Q

The pudendal nerve is a branch of?

Anatomy

A

Sacral plexus in the pelvic cavity

257
Q

How does the pudenda nerve exit the pelvic cavity?

Anatomy

A

Through the greater sciatic foramen

258
Q

How does the pudendal nerve enter the perineum?

Anatomy

A

Lesser sciatic foramen

259
Q

Which branches does the pudendal nerve give rise to?

Anatomy

A
  1. Inferior rectal
  2. Perineal
    a. Posterior scrotal/labial nerve
  3. Dorsal nerve of penis / clitoris
260
Q

What does the deep branch of the pudenda nerve supply?

Anatomy

A

Superficial and deep transverse perineal muscle, bulbospongiosus, ischiocavernosus, sphincter of urethra, bulb of the penis, corpus cavernosum

261
Q

What does the deep nerve of the penis or the clitoris supply?

Anatomy

A

Corpus cavernosum, skin of penis or clitoris, vagina

262
Q

What does the inferior rectal nerve supply?

Anatomy

A

Externa anal sphincter msuce and skina round the anus

263
Q

What does the superficial branch of the pudendal nerve supply?

Anatomy

A

Skin of the scrotum or labia majora

264
Q

What is the pudendal nerve block, why is it done?

Anatomy

A

Anesthesia of the perineum during episiotomt can be obtained by injecting anesthetics via the vagina, into the pudenda canal to block the pudendal nerve

265
Q

What are the branches of the internal pudendal artery? (6)

Anatomy

A
  1. Inferior rectal
  2. Perineal
    a. Posterior artery of scrotum/labia
  3. Artery of bulb/vestibule
  4. Urethral artery
  5. Deep artery of penis/clitoris
  6. Dorsal artery of the penis/clitoris
266
Q

What are the perineal pouches? (from most deep to most superficial)

Anatomy

A
  1. Deep perineal pouch
  2. Perineal membrane
  3. Superficial perineal pouch
  4. Perineal fascia
267
Q

What structures does the deep perineal pouch contain?

Anatomy

A

Urethra, external urethral sphincter, vagina, bulbourethral glands, deep transverse perineal musce

268
Q

What is the perneal membrane perforate by?

Anatomy

A

Urethra and vagina (females)

269
Q

What does the superficial perineal pouch contain?

Anatomy

A

Erectile tissue of penis and clitoris, ischiocavernosus, bulbospangiosis, superficial transverse perineal muscle, burtholoin glands

270
Q

What are the sublayers of the perineal fascia?

Anatomy

A

Deep: superficial perineal muscles, citoris/penis
Superficial: colle’s fascia (continuous with scarpas on anterior abdomen)
camper’s fascia

271
Q

What are the exact contents of the superficial perineal pouch in males?

Anatomy

A
  1. Penile part of the urethra
  2. Posterior scrota nerves, arteries and veins
  3. Bulbospongiosus msucle
  4. Ischiocavernosus muscle
272
Q

What are the contents of the deep perineal pouch in males?

Anatomy

A
  1. Muscles of urogenital diaphragm
  2. Membranous urethra
  3. Dorsal nerve of the penis
  4. Internal pudendal artery and vein
  5. Bulbourethral glands
273
Q

What are the contents of the superficial perineal pouch in females?

Anatomy

A

Vagina
Urethra
Posterior labial nerves, arteries and veins
Greater vestibular gland (Barthaloin)
Bulbospongiosum
Ischiocavernosus
Cus of clitoris
Bulb of vestibule

274
Q

Which pouch are the Bartholin gands located in?

Anatomy

A

Superficial perineal pouch

275
Q

What is the function of the Bartolin glands?

Anatomy

A

They make a smal amount of mucus-like fluid to lubricate the vagina

276
Q

What happens in Bartholinitis?

Anatomy

A

The gland’s duct gets blocked, mucus accumulates and forms a cyst

277
Q

How are Barthlin cysts treated?

Anatomy

A

Antibiotics
Cyst marsupialization

278
Q

What are the contents of the deep perineal pouch in females?

Anatomy

A
  1. Muscles of urogenital diaphragm
  2. Membranous urethra
  3. Vagina
  4. Dorsal nerve of the citoris
  5. Interna pudenda artery and vein
279
Q

What is the vagina?

Anatomy

A

A muscular tube that extends upwards and backwards from the vulva to the uterus

280
Q

How long is the vagina?

Anatomy

281
Q

What is the vagina penetrated by anteriorly?

Anatomy

A

Uterine cervix

282
Q

What is the normal pH of the vagina?

Anatomy

283
Q

What is the vaginal lumen devided into?

Anatomy

A

4 Forinces: anetrior, posterior and 2 lateral

284
Q

What is a vaginal forinx?

Anatomy

A

Recess between the vagina nad the cervix

285
Q

What is special about the posterior forinx?

Anatomy

A

It is the deepest and lies below the rectouterine puch

286
Q

What is the hymen of the vagina?

Anatomy

A

A membrane that partiallycovers or surrounds the vaginal opening

287
Q

What does hymen artesia lead to?

Anatomy

A

Causes compete occlusion of the vagina, which obstructs blood flow at menarche, causing primary amenorrhea

288
Q

What is the blood supply of the vagina?

Anatomy

A

Vaginal artery from the inferior inguinal
Vaginal branch from the uterine artery

289
Q

What are the relations of the vagina?

Anatomy

A

Anterior: urethra and bladder
Posterior: rectum and anal canal
Superior: rectouterine pouch
Distal: pelvic floor and vulva

290
Q

What is culdocentesis ?

Anatomy

A

Checks for abnorma fluid in the abdominal cavity behind the uterus, accessed from the posterior fornix

291
Q

What are the histological layers of the vagina?

Anatomy

A

Lamina epithelialis
Lamina propria
Tunica muscularis

292
Q

What is the epithelium of the vagina?

Anatomy

A

Stratified squamous non keratinized

293
Q

What is the tunica mucosa layer of the vagina like?

Anatomy

A

The cells of nob-keratinized stratified squmous become filled with glycogen to manage activity
Thin walled veins of the mucosa and muscuar layers exude fluid into the epithelium

294
Q

What is the tunica muscularis layer like?

Anatomy

A

Has bundles of smooth muscle arranged in a circular manner near the mucosa and longitudially near the adventitia (inner cicrular, outer longitudinal)

295
Q

What is the tunica adventitia of the vagina like?

Anatomy

A

A coat of dense connective tissue rich in thick elastic fibers
1. Inner later of dense connective tissue
2. Outer layer of loose connective tissue

296
Q

What is atrophic vaginitis?

Anatomy

A

A condition in which the tissues lining the inside of the vagina become thin, dry and inflammed

297
Q

What is vaginal epithelium dependnent on?

Anatomy

A

It is hormone dependent, depends on hormones like estrogen
Atrophic vaginitis is triggered by decreased estrogen levels

298
Q

What is the consequence of thinning of the vaginal epithelial lining?

Anatomy

A

Vagina is more prone to infections

299
Q

What is the lining of exocervix?

Pathology

A

Non keratinizing stratified squamous epithelium

300
Q

What is the lining of the endocervix like?

Pathology

A

Simple columnar mucus secreting cells

301
Q

What is the junction between exocervix and the endocervix called?

Pathology

A

Squmocolumnar junction

302
Q

What is the transformation zone?

Pathology

A

The area where columnar epithelium abuts squamous epithelium

303
Q

What is cervicitis?

Pathology

A

Inflammatory conditions the cervix associated with a purulent vaginal discharge

307
Q

What are the classifications of cervicitis?

Pathology

A

Acute, chronic, infectious and non-infectious

308
Q

What are the causative agents of infectious cervicitis?

Pathology

A

Strep
Staph
Entercoccus
E. coli
Candida
STDs (Chlamydia, gonorrhea, HSV, HPV and trichomonas)

309
Q

What are the causes of non-infectious cervicitis?

Pathology

A

Irritation (perhaps from birth control devices)
Allergies (eg. latex rubber)
Hormonal imbalance

310
Q

What is acute cervicitis caused by?

Pathology

A

Usually caused by staph or strep

311
Q

When is acute cervicitis commonly seen?

Pathology

A

During the postpartum period

312
Q

What are the characteristics of acute cervicitis?

Pathology

A

Extensive infiltrate of polymorphonuclear leukocytes and stromal edema

313
Q

When is chronic cervicitis commonly seen?

Pathology

A

DUring reproductive years

314
Q

What is chronic cervicitis?

Pathology

A

Inflammation but severe enough to produce mucosal damage with hemorrhage

315
Q

What are the characteristics of chronic cervicitis?

Pathology

A

Hyperplasia and reactiv changes in both squamous and columnar mucosa
Eventually: columnar epithelium undergoes squamous metaplasia

316
Q

What is HPV cervicitis?

Pathology

A

Sexually transmitted DNA virus infection, usually infects lower genital tract –> espcially cervix (transitional zone)

317
Q

What is the risk associated with persistent HPV cervicitis?

Pathology

A

Increased risk for cervical dysplasia –> CIN/SIL

318
Q

What is CIN/SIL?

Pathology

A

Cervical Intrepithelial neoplasia also known as squamous intraepithelial lesion

–> A spectrum of intraepithelial changes that begin with minimal atypia and progress through stages of more marked intraepithelial abnormalities to invasive squamous cell carcinoma (precursor for cervical cancer)

319
Q

What makes CIN/SIL high risk?

Pathology

A

The type of HPV that is affecting the patient

320
Q

Which are the high and low risk HPV types?

Pathology

A

High risk –> 16 and 18 (31, and 33 as well)
Low risk –> 6 and 11 (genital warts, condylomas)

321
Q

What are the risk factors of CIN?

Pathology

A
  1. Early age of first sexual intercourse
  2. Mutiple sexual partners
  3. Male partner with multiple previous sexual partners
  4. Persistant infection by high risk stains of HPV
322
Q

What are co-risk factors of CIN?

Pathology

A
  1. Immune status (whether the patient is immunocompromised or not)
  2. Co-infection with other sexuallt transmitted agents (gonorrhea or chlamydia)
  3. Smoking
  4. Low social economic class
  5. OCPs
323
Q

How are OCPs a co-risk factor of CIN?

Pathology

A

They change the susceptibility of cervical cells to reinfection of high risk HPV strains

324
Q

What is the pathogenesis of CIN/SIL?

Pathology

A
  1. Sexual activity
  2. HPV
  3. Basal cell of squamous epithelium
  4. Episomal DNA replication
  5. High or Low risk strains
  6. If high risk: integration into cellular genome
  7. E6 binds to p53 and E7 binds to Rb –> both inhibit their functions inactivating tumor suppressor genes
  8. Inhibition of apoptosis –> continuous proliferation –> high grade intraepithelial lesions
  9. Invasive carcinoma
325
Q

What is the CIN grading like?

Pathology

A

CIN 1 –> mild dyspasia (involves less than 1/3 of the thickness of epithelium)
CIN 2 –> moderate dysplasia (invoves less than 2/3)
CIN 3 –> severe dysplasia (involves slightly less than the entire thickness

326
Q

What is the Bethesda system?

Pathology

A

Low and High grade SIL

327
Q

What is LSIL like?

Pathology

A

Conditions that should rarely progress in severity and commonly reress and disappear –> equivalent to CIN 1

328
Q

What is HSIL?

Pathology

A

Corresponds t more severehistologic lesions (CIN 2 and 3)
Tend to progress an require treatment

329
Q

What is the morphology of CIN like?

Pathology

A
  1. Koilocytic changes (immature squamous cells with dense irregularly staining cytoplasm and perinuclear clearing –> halo),
  2. disordered cell maturation,
  3. nuclear enlargement,
  4. hyperchromasia and atypia,
  5. coarse chromatin and increased mitotic activity
330
Q

What is CIS?

Pathology

A

Involves the entire thickness of the epithelium

331
Q

What is the relationship between garding and progression?

Pathology

A

The higher the grading of dysplasia –> the more ikely it will progress to carcinoma and less likely to regress

332
Q

What are the different techniques of screening for CIN/SIL?

Pathology

A

Pap Smear (convectional or liquid base)
HPV Molecuar testing (high risk strains)
Co-testing

333
Q

What is the aim of screening for CIN/SIL?

Pathology

A

Can be detected early and thus prevented from progressing into carcinoma

334
Q

What can be seen in a Pap smear?

Pathology

A

Different types of squamous cells and different types of endocervical glandular cells

335
Q

What are the limitations of pap smears?

Pathology

A
  1. Sampling error (inadequate sampling of transformation zone)
  2. Interpretation error
  3. Difficulty in identifying glandular abnormality
  4. A Pap smear is a screening and not a diagnostic test
336
Q

What are the steps following an abnormal pap smear?

Pathology

A

Followed by HPV DNA testing and colposcopy

337
Q

What is the purpose of colposcopy?

Pathology

A

We visualize the cervix by magnifying lens, apply acetic acid and take biopsy from abnrormal cells which have picked up the dye

338
Q

What are the different treatment options of CIN II and III?

Pathology

A

Cryosurgery
Conization

339
Q

What are ways of preventing CIN/SIL?

Pathology

A

Vaccines which have been created and they specifically target high risk strains

Gardasil, Gardasil 9 and Cervarix

340
Q

When is the optimal time to take the HPV vaccine?

Pathology

A

Prior to an individual’s sexual debut

341
Q

Why should HPV vaccines be given to both males and females?

Pathology

A

In females, to prevent and in males because they can be carriers who spread it

342
Q

Why should vaccinated females still be screened for HPV?

Pathology

A

Vaccines do not cover all high risk subtypes of HPV

343
Q

What is the target population of cervical carcinomas?

Pathology

A

Middle age women –> around the age of 45

344
Q

What do cervical carcinomas present as?

Pathology

A

Vaginal bleeding (post coital bleeding) or discharge (leukorrhea), dyspareunia and dysuria

Advanced cases: hydronephrosis due to tumor extension to ureter

345
Q

What is the key risk factor for cervical carcinomas?

Pathology

A

Persistent HPV infections

346
Q

What are co-risk factors of cervical carcinomas?

Pathology

A
  1. Immunodeficiency (HIV)
  2. Co-infections
  3. Smoking
347
Q

What are the most common subtypes of cervical carcinomas?

Pathology

A

Squamous cel carcinoma
Adenocarcinoma
Adenosquamous
Small cell neuroendocrine carcinoma

348
Q

What is the gross appearance of squamous cell carcinoma?

Pathology

A

Friable mass protruding from the cervix

349
Q

What is the histological appearance of squamous cell carcinoma?

Pathology

A

Nests and sheets of epithelial cells with squamous differentiation in subepithelaila region invading the stroma
Keratin pearls

350
Q

What is the prognosis of cervical cancer like?

Pathology

A

Prognosis depends on:
1. Stage TNM
2. Type of cancer (adenosquamous and neuroendocrien are worse)

351
Q

What are the treatment options for cervical cancer?

Pathology

A

Early: surgery (remova of uterus)
Advanced: radiation and chemotherapy

352
Q

What are endocervical polyps?

Pathology

A

Benign polypoid masses seen protruding from the endocervical mucosa

353
Q

What are endocervical cysts composed of?

Pathology

A

Cystically dilated spaces filled with mucinous secretions

354
Q

WHat is the surface epithelium of endocervical polyps like?

Pathology

A

Mucus secerting columar cells with edematous stroma and scattered mononuclear cells

355
Q

What is the endocervical polyp like if it superimposed with chronic inflammation?

Pathology

A

Squamous metaplasia and ulcerations

357
Q

What are the symptoms of endocervical polyps?

Pathology

A

They may bleed –> No malignant potential

358
Q

What are Bartholin cysts?

Pathology

A

Cystic dilation of Bartholin gland

359
Q

What are bartholin glands?

Pathology

A

They are located on each side of the vaginal canal, they produce mucus that lubricates the canal and drains via ducts into the ower vestibule

360
Q

How do bartholin cysts arise?

Pathology

A

Due to infammation and obstruction of the draining duct –> dilation adn cyst formation

361
Q

What is the target population of bartholin cysts?

Pathology

A

Women of the reproductive age

362
Q

What are teh clinica presentation of bartholin cysts?

Pathology

A

Painful unilateral cyst lesion at ower vestibule at the vaginal canal

363
Q

What happens if the bartolin cyst is left untreated?

Pathology

A

May be complicated by abscesses

364
Q

What are treatment options of bartholin cysts?

Pathology

A

Antibiotics or drainage

365
Q

What are condylomas?

Pathology

A

Warty lesions of the vulva skin, STD

366
Q

What are the subtypes of condylomas?

Pathology

A

Condyloma accuminatum
Condyloma latum

367
Q

What is the cause of condyloma accuminatum?

Pathology

A

HPV related (6 and 11 –> low risk HPV strains) –> rarely proceed to carcinoma

368
Q

What is the cause of condyloma latum?

Pathology

A

Due to secondary syphilis –> rare but larger

369
Q

What is Lichen sclerosus?

Pathology

A

Thinning of the epidermis and fibrosis of the dermis

370
Q

How does Lichen sclerosus present as?

Pathology

A

White patch (leukoplakia) with parchment like skin –> red violet border

371
Q

What is the target population of Lichen Sclerosus?

Pathology

A

Postmenopausal women

372
Q

Are lichen sclerosus benign or malignant?

Pathology

A

Benign with a slight increased risk of squamous cell carcinoma

373
Q

What is Lichen Simplex Chronicus?

Pathology

A

Hyperplasia of vulvar squamous epithelium

374
Q

How does Lichen simplex chronicus present?

Pathology

A

Present as white patch (leukoplakia) with thick leathery skin and enhanced skin markings

375
Q

What is lichen simplex chronicus associated with?

Pathology

A

Chronic inflammation, irritation, pruritus with continuous rubbing

376
Q

Is Lichen simplex chronicus benign or malignant?

Pathology

A

Benign with no risk for squamous cell carcinoma

377
Q

What is vaginitis?

Pathology

A

Inflammation of the vagina associated with discahrge (leukorrhea)

378
Q

What are the risk factors of Vaginitis?

Pathology

A
  1. Diabetes
  2. Systemic antibiotic theraoy –> dysbiosis of microbial flora
  3. Immunodeficiency and STDs
  4. Pregnancy and recent abortion
379
Q

What is candida albicans in terms of vaginal microbiome?

Pathology

A

It is part of the normal microbial flora

380
Q

How does Candida vaginitis present?

Pathology

A

Symptomatic infection
Characterized by a curdy white discharge

381
Q

What is trichomonas vaginalis?

Pathology

A

A parasute that can be identified by microscopy

382
Q

What is trichomonas vaginitis like?

Pathology

A

Asymptomatic or watery, copious gray-green discharge

383
Q

What is bacterial vaginosis?

Pathology

A

Infection due to overgrowth of Gardenella vaginalis

384
Q

What is bacterial vaginosis characterised by?

Pathology

A

Fish odor discharge

385
Q

What is vaginal adenosis?

Pathology

A

Focal persistence of columnar eoithelium in the upper 1/3 of the vagina

386
Q

What is the traget population of vaginal adenosis?

Pathology

A

Females who were exposed to DES in utero

387
Q

What can vaginal adenosis be complicated with?

Pathology

A

Clear Cell Adenocarcinoma

388
Q

What does vaginal adenosis present as?

Pathology

A

As mucoid vaginal discharge or post coita bleeding

389
Q

What is the clinical appearance of vaginal adenosis?

Pathology

A

Red granular area which stands out from the pale pink vaginal mucosa

390
Q

What is the histological appearance of vaginal adenosis?

Pathology

A

Endocervical type mucous glands on vaginal surface or in laminate propria

391
Q

What is the most common type of vaginal carcinoma?

Pathology

A

Squamous Cell Carcinoma

392
Q

What is vaginal carcinoma related to?

Pathology

393
Q

What is the precursor lesion of Vaginal carcinomas?

Pathology

A

VAIN –> vaginal intraepithelial neoplasia

394
Q

Whrcome at are sarcoma botryoides?

Pathology

A

Maignant mesenchymal proliferation of immature skeletal muscle

395
Q

What is the target population of sarcoma botryoides?

Pathology

A

Encountered in infants and children under the age of 5

396
Q

What do sarcoma botryoides manifest as?

Pathology

A

Soft polypoid masses (grape-like masses) and bleeding from the vagina

397
Q

What is the microscopic appearance of Sarcoma Botryoides?

Pathology

A

Eosinophilic strap-like cytoplasm, spindle shaped cells

398
Q

Where else can sarcoma botryoides occur or appear?

Pathology

A

Urinary bladder and bile ducts

Reproductive System (5 decks)

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