Gen Path - Class 25

Front 1

What is amenorrhea?

Back 1

an abnormal absence of menstruation

Front 2

What is menorrhagia?

Back 2

abnormally heavy bleeding at menstruation

Front 3

What is nulliparous?

Back 3

woman who has not had a child

Front 4

What is vulvovaginal candidiasis?

Back 4

75% of all women experience an attack of vulvovaginal candidiasis in their lifetime. Etiology: Candida albicans.

Front 5

What are four risk factors for vulvovaginal candidiasis?

Back 5

(1)Immune compromise, (2)Antibiotic use, (3)Pregnancy, (4)Diabetes

Front 6

What are four clinical features of vulvovaginal candidiasis?

Back 6

(1)Vulvar pruritus and burning - Primary symptoms of the disease, (2)Erythema and edema of the vestibule and of the labia majora and minora, (3)Thrush patches - Usually found loosely adherent to the vulva, (4)Thick, white, curd-like vaginal discharge

Front 7

What are two other types of vaginitis?

Back 7

(1)Trichomoniasis, (2)Bacterial vaginosis

Front 8

What is trichomoniasis?

Back 8

STI/ Protozoal infection caused by Trichomonas vaginalis.

Front 9

What are four clinical features of trichomoniasis?

Back 9

(1)Vaginal discharge, vulvovaginal irritation and itching are most common complaints, (2)50-75% infected women have discharge, (3)Discharge is described as frothy or bubbly and yellow-green, (4)Other symptoms: dyspareunia, dysuria, lower abdominal pain, vaginal redness,“strawberry cervix” (only seen with naked eye in 2%)

Front 10

What is bacterial vaginosis?

Back 10

Not really considered an STI. 4 diagnostic criteria, 3 of which must be present to confirm diagnosis

Front 11

What are the four diagnostic criteria of bacterial vaginosis?

Back 11

(1)Discharge: thin, frothy, gray, odorous, (2)pH: greater than 4.5 with pH paper, (3)Clue cells: from wet-mount lab sample, (4)Positive whiff test (KOH added – smells fishy)

Front 12

What is vulvadynia?

Back 12

is chronic pain in the area around the opening of your vagina (vulva) for which there is no identifiable cause.

Front 13

What is vulvadynia?

Back 13

Unknown. Possibly: Injury to or irritation of the nerves, Past vaginal infections, Allergies or sensitive skin, Hormonal changes

Front 14

What are six clinical features of vulvadynia?

Back 14

(1)Burning, (2)Soreness, (3)Stinging, (4)Rawness, (5)Painful intercourse (dyspareunia), (6)Throbbing

Front 15

What is cervicitis?

Back 15

inflammation of the cervix. Non infection or infections.

Front 16

What are three potential causes of noninfectious cervicitis?

Back 16

(1)Local trauma – Ex. caused by tampons, (2)Chemical irritation - Eg, vaginal douches, (3)Systemic inflammation

Front 17

What are two potential causes of infectious cervicitis?

Back 17

(1)Sexually transmitted infections (STIs), (2)Much more common than the noninfectious causes.

Front 18

What are five clinical features of cervicitis?

Back 18

(1)Usually asymptomatic, When present, symptoms are often nonspecific and may include increased (2)vaginal discharge, (3)dysuria, (4)urinary frequency, (5)intermenstrual or postcoital bleeding

Front 19

What is cervical cancer?

Back 19

Carcinoma of the cervix – squamous cell carcinoma. 20% of female reproductive tract cancers.

Front 20

What is the etiology of cervical cancer?

Back 20

Not known. Most common cause – HPV.

Front 21

What are five risk factors for cervical cancer?

Back 21

(1)Sex at an early age, (2)Multiple partners, (3)HPV infection, (4)Other STD’s – genital herpes or syphilis, (5)Smoking

Front 22

What is the pathogenesis of cervical cancer?

Back 22

Most originate at the transformation zone (between exocervix squamous epithelium and endocervix columnar epithelium). Undifferentiated, uncontrolled proliferation.

Front 23

What is cervical dysplasia?

Back 23

Precancerous changes of the cells of the cervix. Lack of normal maturation of squamous cell epithelium. Classified as mid, moderate and severe. Asymptomatic – detected on Pap smear screening tests.

Front 24

What are five clinical features of cervical dysplasia?

Back 24

(1)Average age = 50, (2)CIN age = 35 (No symptoms, Bleeding after sex, ‘Abnormal’ Pap smear, Curable), (3)No pain, (4)Rare vaginal bleeding, (5)Few symptoms – rarely interfere with daily life

Front 25

What is benign cervical polyps?

Back 25

Inflammation and proliferation of cervical mucosa. Benign. Usually estrogen stimulated.

Front 26

What is a clinical feature of benign cervical polyps?

Back 26

Abnormal bleeding between cycles, esp after intercourse

Front 27

What is endometriosis?

Back 27

Endometrial tissue that forms outside the uterus. May be caused by retrograde menstrual flow. Estrogen dependent. Respond to estrogen and menstrual flow into the peritoneal cavity. Most commonly located – on the ovary or on the pelvic peritoneum.

Front 28

What are seven other areas where endometriosis can take place?

Back 28

(1)Umbilicus, (2)Fallopian tubes, (3)Broad ligaments, (4)Bladder, (5)Pelvic muscles, (6)Intestines, (7)Rare – KD, appendix, diaphragm

Front 29

What are six clinical features of endometriosis?

Back 29

(1)Pain, (2)Infertility, (3)Dysmenorrhea, (4)Dysparurenia – pain with intercourse, (5)Low grade fever, (6)Low back pain

Front 30

What are endometrial fibroids?

Back 30

Aka Leiomyomas. Benign tumours of the myometrium – not pre-malignant. Most common reason for hysterectomy. Stimulated mainly by estrogen surges.

Front 31

What are seven clinical features of endometrial fibroids?

Back 31

(1)Small are asymptomatic, (2)Large or Multiple, (3)Abdominal heaviness, (4)Urinary urgency (form compression of bladder), (5)Constipation (compression of rectum), (6)Pain, (7)Menorrhagia, (8)anemia

Front 32

What is Pelvic Inflammatory Disease (PID)?

Back 32

Inflammation of the entire female reproductive tract. Complication of lower genital tract infection. Pathogen ascends into the uterine cavity.

Front 33

What are three potential causes of PID?

Back 33

(1)Most commonly caused by Chlamydia and Gonorrhea, (2)Abortion, surgery, (3)D & C after miscarriage

Front 34

What organs are commonly affected by PID?

Back 34

Fallopian tubes mostly affected: Red, swollen, pus filled, Abscess of the fallopian tube and ovary

Front 35

What are three risk factors for PID?

Back 35

(1)Multiple partners, (2)Unprotected sex, (3)Untreated chlamydia

Front 36

What are two complications of PID?

Back 36

Fallopian tubes become scarred and obstructed leading to: (1)Infertility, (2)Ectopic pregnancy

Front 37

What are five clinical features of PID?

Back 37

(1)Abnormal bleeding, (2)Discharge – esp. strange colours, (3)Pain – pelvic and back, (4)Dyspareunia, (5)Systemic infection sx’s: fever, chills, malaise, nausea

Front 38

What is endometrial hyperplasia?

Back 38

Thickening of the uterine lining. Not cancer. Complex cystic forms (increase in number of glands) have a increased risk of endometrial adenocarcinoma.

Front 39

What is the etiology of endometrial hyperplasia?

Back 39

Excess estrogen. Anovulation.

Front 40

What is uterine cancer?

Back 40

Aka. Endometrial Cancer or Endometrial Carcinoma. Most common tumour of the female reproductive system - 50%

Front 41

What is the etiology of uterine cancer?

Back 41

Hormone induced – high Estrogen. Hormone replacement – Estrogen. Obesity and form estrogen at a higher rate. Nulliparous, early menarche or late menopause.

Front 42

What are three clinical features of uterine cancer?

Back 42

(1)Rare before age 35, (2)Women entering menopause and postmenopausal, (3)Most common presenting symptom is vaginal bleeding (Spotting between menstruations, Menorrhagia, Any bleeding post-menopausally)

Front 43

What is salpingitis?

Back 43

Inflammation of the fallopian tubes. Usually occurs as part of PID. Infectious cause.

Front 44

What are ovarian cysts?

Back 44

Very common. Normally – ovarian follicles transform into mature/graafian follicles (At ovulation one mature/graffian follicle ruptures, Transforms into corpus luteum)

Front 45

How is a cyst formed?

Back 45

Unruptured mature follicles may remain filled with fluid and enlarge into cysts. Or – corpus luteum becomes fibrotic -- cyst

Front 46

What are six clinical features of ovarian cysts?

Back 46

(1)Depends on size, number, and location, (2)Can be asymptomatic, (3)Abdominal pain/pressure, (4)Bloating, (5)Dyspareunia, (6)Changes to cycle if ovarian function is disrupted

Front 47

*What is Polycystic Ovarian Syndrome (PCOS)?

Back 47

also known as Stein-Leventhal Syndrome. S clinical syndrome characterized by mild obesity, irregular menses or amenorrhea, and signs of androgen excess (eg, hirsutism, acne). In most patients, the ovaries contain multiple cysts. Polycystic ovary syndrome (PCOS) occurs in 5 to 10% of women. Most common cause of infertility. PCOS is associated with insulin resistance.

Front 48

How is PCOS diagnosed?

Back 48

The diagnosis requires at least two of the following three criteria: 1. Ovulatory dysfunction causing menstrual irregularity 2. Clinical or biochemical evidence of hyperandrogenism 3. > 10 follicles per ovary (detected by pelvic ultrasonography), usually occurring in the periphery and resembling a string of pearls

Front 49

What is the pathophysiology of PCOS?

Back 49

Chronically elevated luteinizing hormone (LH) and insulin resistance are 2 of the most common endocrine aberrations. In vitro and in vivo evidence offer support that high LH and hyperinsulinemia work synergistically, causing ovarian growth, androgen production, and ovarian cyst formation. The correlation between hyperandrogenism and insulin resistance has been recognized in both obese and nonobese anovulatory women. It's important to realize that a nonobese patient may also have insulin resistance.

Front 50

What are eight clinical features of PCOS?

Back 50

Three major symptoms: (1)menstrual dysfunction, (2)anovulation, (3) signs of hyperandrogenism, Other symptoms: (4)Hirsutism, (5)Infertility, (6)Obesity and metabolic syndrome, (7)Diabetes, (8)Obstructive sleep apnea

Front 51

What is ovarian cancer?

Back 51

2nd most common female repro cancer. 4th most common female cancer. Most lethal – late diagnosis, metastasis. Etiology: Unknown

Front 52

What are three types of ovarian cancer?

Back 52

(1)Epithelial – most common, (2)Germ cells - teratomas, (3)Sex cord stromal tumours

Front 53

What are two risk factors for ovarian cancer?

Back 53

(1)Nulliparous, (2)Family history (Ovarian or breast cancer, 25-40% higher risk)

Front 54

What are seven clinical features of ovarian cancer?

Back 54

(1)Asymptomatic mostly, (2)Abdominal bloating, (3)Flatulence, bloating, (4)Fatigue, malaise, (5)Abnormal bleeding, (6)Pelvic pain late in the progression of the dz, (7)General cancer symptoms (anorexia, night sweats, etc.)

Front 55

What is menopause?

Back 55

‘Ovarian Retirement’. NOT A PATHOLOGY. Onset 45-50 y.old – but varies greatly. Complete cessation of menses for 12 consecutive months. Any bleeding after that: possibly cancer or polyps.

Front 56

What are five physiological changes that happen with menopause?

Back 56

(1)Cessation of ovarian function - decreased estrogen and progesterone, (2)Increased FSH, (3)Atrophy of endometrial, vaginal, & breast tissue, (4)Decreased tone of pelvic floor muscles, (5)Decreased thyroid function

Front 57

What is perimenopause?

Back 57

“the change before the change” – the stage leading up to menopause. The physiologic reverse of puberty, but with diminishing predictability. Can last up to 10 years.

Front 58

What are five clinical features of perimenopause?

Back 58

(1)Change to cycle – lighter/heavier bleeding, shorter/longer cycles, (2)Sleep problems, (3)Heat, (4)Depression or other mood changes – irritability & anxiety, (5)Fatigue, particularly mental – difficulty concentrating

Front 59

What are 12 common symptoms of perimenopause?

Back 59

(1)Hot flashes, flushing, sweats (day or night), (2)Vulvar and/or vaginal atrophy (dryness, dyspareunia), (3)Anxiety, panic, depression, mood swings, irritability, (4)Fatigue, (5)Urinary incontinence, (6)Insomnia/sleep issues, (7)Headache, (8)Decreased libido, (9)Prolonged heavy bleeding, irregular cycles, (10)Heart palpitations, (11)Memory & concentration problems, (12)Changes to body comp: muscle loss with fat gain (central)

Front 60

What is morning sickness?

Back 60

Nausea and vomiting associated with pregnancy. Varying level of severity. Etiology: unknown (hormonal, gastrointestinal, liver all theorized)

Front 61

What is hyperemesis gravidarum?

Back 61

The most severe form of nausea and vomiting in pregnancy, characterized by persistent nausea and vomiting associated with ketosis and weight loss (>5% of prepregnancy weight). This condition may cause volume depletion, electrolytes and acid-base imbalances, nutritional deficiencies, and even death.

Front 62

What is toxemia of pregnancy?

Back 62

Includes preeclampsia and eclampsia. Disease that occurs as a result of an abnormally functioning placenta or abnormal maternoplacental interaction. Etiology: Unknown. Pathogenesis: Unknown

Front 63

What is eclampsia?

Back 63

Rarely seen

Front 64

What are six clinical features of eclampsia?

Back 64

(1)Life threatening, (2)Hypertension, (3)Edema, (4)Proteinuria, (5)Seizures, (6)Induced delivery

Front 65

What is preeclampsia?

Back 65

Effects 3-5% of all pregnant women; usually after the 34th week of pregnancy. Mild preeclampsia requires no treatment, but when more severe delivery is induced.

Front 66

What are three clinical features of preeclampsia?

Back 66

(1)Hypertension, (2)Edema, (3)Proteinuria

Front 67

What is an ectopic pregnancy?

Back 67

Extrauterine pregnancy. Many locations: Ovary, Fallopian tube – most common – 95%, Abdominal cavity. Often effects fallopian tube that was affected with PID, previous surgery or foci of endometriosis. Also can a rare complication of non-hormonal IUDs.

Front 68

What is the pathogenesis of an ectopic pregnancy?

Back 68

Trophoblast cells of the placenta form at the site of implantation and penetrate the thin walls of the tube -- rupture -- fatal hemorrhage

Front 69

What are two clinical features of an ectopic pregnancy?

Back 69

(1)The classic clinical triad of ectopic pregnancy is pain, amenorrhea, and irregular vaginal bleeding., (2)Patients may present with other symptoms common to early pregnancy (eg, nausea, breast fullness).

Front 70

What is placenta abruptus?

Back 70

Premature separation of placenta. Major RF = Eclampsia. Bleeding, cramping, severe pain, loss of fetal HR. If severe, emergency C-section regardless of fetal age. Mom can die quickly – shock & infection

Front 71

What is placenta previa?

Back 71

Zygote implants in the lower segment of the uterus. Prone to a lot of bleeding (Vaginal birth may endanger fetus and mother). Usually caesarean section is performed.

Front 72

What is placenta accreta?

Back 72

The result of deep penetration of the placental villi into the wall of the uterus. Placenta extends into the muscularis.

Front 73

What are two clinical features of placenta accreta?

Back 73

(1)Placenta does not shed out spontaneously at the time of birth, (2)Extensive bleeding

Front 74

What is an abortion?

Back 74

Interruption of pregnancy before the term of fetal viability. Spontaneous abortion – miscarriage

Front 75

What is a miscarriage/spontaneous abortion?

Back 75

Miscarriage in early pregnancy is common. Studies show that about 8 to 20 percent of women who know they are pregnant have a miscarriage some time before 20 weeks of pregnancy; 80percent of these occur in the first 12 weeks.

Front 76

What are five risk factors for miscarriages?

Back 76

(1) low progesterone, (2)cord accidents, (3)clotting disorders, (4)trauma, (5)amniocentesis

Front 77

What is a hydatiform mole?

Back 77

A placental abnormality – is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. Benign. A complete mole contains no fetal tissue. A partial mole, fetal tissue is often present. Occurs in 1 of every 2000 pregnancies. Malignant form is called choriocarcinoma can arise from the complete form of hydatiform mole.

Front 78

What is the cause of hydatiform mole?

Back 78

Results from abnormal fertilization – lost maternal chromosomes (complete) or oocyte fertilized with two sets of male chromosomes(incomplete)

Front 79

What is gestational diabetes?

Back 79

defined as glucose intolerance of variable degree with onset or first recognition during pregnancy.

Front 80

What is the pathogenesis of gestational diabetes?

Back 80

Products of the placenta, including tumour necrosis factor-alpha (TNF-alpha) and human placental lactogen are thought to play key roles in inducing maternal insulin resistance. Insulin resistance is most marked in the third trimester.

Front 81

Four signs of hyperglycemia associated in baby:

Back 81

(1)macrosomia, (2)neonatal hypoglycaemia, (3)hyperbilirubinaemia, (4)hypocalcaemia

Front 82

Three signs of hyperglycemia associated in mom:

Back 82

(1)gestational hypertension, (2)pre-eclampsia, (3)caesarean delivery.

Front 83

What is pelvic floor dysfunction?

Back 83

Chronic pelvic pain, lasting 6 months or longer. Continuous or intermittent. Mostly women; men to a much smaller degree.

Front 84

What is a cystocele?

Back 84

Herniation of the bladder into the vagina. Many urination sx’s – freq., urgency, discomfort, diff.emptying, incontinence.

Front 85

What is rectocele?

Back 85

Herniation of rectum into the vaginal opening or vaginal canal. Perineal pain, diffic. with bowel movements, feeling of constant fullness in the rectum.

Front 86

What is a uterine prolapse?

Back 86

The neck of the uterus (cervix)to bulge down into the vagina.

Front 87

What is benign breast disease?

Back 87

Formerly called Fibrocystic breast disease/chronic cystic mastitis. The most common cause of a lump – most common is fibroadenoma. 50% of women.

Front 88

What are four morphologic changes of benign breast disease?

Back 88

(1)Cystic dilation of terminal ducts or fluid-filled cysts, (2)Fibrosis, (3)Proliferation of epithelium in terminal ducts, (4)Usually bilateral

Front 89

What are six diagnostic features of benign breast disease?

Back 89

(1)Cyclical – swelling & discomfort, (2)Mastalgia – more severe pain – may not be cyclical, (3)Nodularity – may not be cyclical, (4)Nipple discharge, (5)Infections - mastitis – usually Staph or Strep, (6)Inflammation

Front 90

What are three clinical features of benign breast disease?

Back 90

(1)Nodules, (2)Tender with PMS (3)Can fluctuate in size with the cycle

Front 91

What is breast cancer?

Back 91

Second leading cause of death in women. Most common cancer in women (Can occur in men 1/100th as often). Rare before the age of 30. After menopause – much higher incidence. Two genes increase susceptibility to breast cancer: BRCA1 and BRCA2. 70% occur in women over 50 years old. Risk for women: 1 in 9.

Front 92

What is the most common location for breast cancer?

Back 92

Outer upper quadrant. Most are adenocarcinomas. 80% originate in the epithelium of the ducts. 20% in the lobules

Front 93

What are nine risk factors for breast cancer?

Back 93

(1)Estrogen exposure, therefore being female is the most significant RF, (2)Age 50-60 or older, (3)Early menarche/late menopause, (4)Children after age 35, or nulliparity, (5)Obesity, (6)Significant Family history of breast or ovarian cancer – mother or sister, (7)Atypical breast cells on biopsy, (8)Previous history of breast cancer, (9)Previous cancer treatment - radiation

Front 94

What is the etiology of breast cancer?

Back 94

Gene mutations of two suppressor genes: BRCA1 and BRCA2. These genes normally keep abnormal cell proliferation in check. Mutations eliminate that control.

Front 95

What is the pathology of breast cancer?

Back 95

Estrogen – seems to be key promoting factor. Epithelial hyperplasia progressing to malignancy. Changes in proteins within the ECM – change cell adhesion – allows for abnormal cell growth.

Front 96

What are six types of breast cancer?

Back 96

(1)Ductal carcinoma-in-situ [20-30%], (2)Invasive / infiltrative ductal carcinoma, (3)Invasive / infiltrative lobular carcinoma, (4)Medullary, tubular, and mucinous, (5)Inflammatory breast cancer, (6)Paget’s disease

Front 97

What are seven clinical features of breast cancer?

Back 97

(1)Palpable lump/nodule – 90% discovered through self-exam, (2)Firm, irregular, non-tender, fixed in place to underlying fascia, (3)Changes in contour, dimpling (Peau d’orange), symmetry, (4)Nipple discharge, (5)Flattened or retracted nipple, (6)Flaking around the areola, rash, (7)Lymphadenopathy

Front 98

Where does breast cancer metastasize to?

Back 98

Local – chest wall, pleura, 1st and 2nd ribs. Distal – bone, lungs, liver, brain, skin, adrenals. Upper extremity edema, bone pain, weight loss, jaundice, and symptoms of the organ involved –ie dyspnea.

Front 99

How can breast cancer be prevented?

Back 99

‘risk-factor modification’ – good weight management, exercise, decr’d alcohol/ incr’d folic acid intake, avoiding xenoestrogens. Chemo-prevention: Tamoxifen

Front 100

What is fat necrosis of the breast?

Back 100

Benign. Can occur anywhere in the breast. Can affect women of any age. It does not increase your risk of getting breast cancer. The damage to the fatty tissue -- necrosis

Front 101

What are four risk factors for fat necrosis of the breast?

Back 101

(1)needle biopsy, (2)breast surgery, (3)Radiation, (4)bruise or injury to the breast

Front 102

What are four clinical features of fat necrosis of the breast?

Back 102

(1)firm, round lump (or lumps), (2)usually painless, but in some people it may feel tender or even painful, (3)skin around the lump may look red, bruised or occasionally dimpled, (4)nipple retraction (rare)