Path Spring 4 Sti

Front 1

syphalis- causative agent

1
2
3

Back 1

treponema pallidum

1. occurs 3 weeks after infection, appears as a single chancre. painless, heals w/o tx. TONS of plasma cells. seen on dark field. goes to regional LN

2. 2-10 weeks after chancre resolves- goes to other places: CSF, brain, eye, ear, liver, intestines, kidney, skin. get RASH, MUCOUS patch, CONDYLAMATA LATA, orchitis

3. seen in only 30& of pts. its BAD. latent for 1-30 years. aneurysm of aortic srch bc of endaritis. orchitis, gumma, hepar lobatim (fibrosis seen in liver)

Front 2

what does syphalis look like at gross and micro

Back 2

plasma cell infiltrate, obliteratice endartitis

Gumma: special granuloma,

Micro: granuloma- macrophages, fibroblasts, plasma cells w/coagulated necrotic center

Front 3

obliterative endaritis is characteristic of what STI

Back 3

syphalis. the trepenoma likes to get into the endo and cause blockage of BV, vascular lesion

*in syphalis will also see plasma cell infiltrates and chancre and gumma

Front 4

when in syphalis might you see condylamata lata or orchitis

Back 4

in 2 syphalis

2-10 weeks after initial lesion heals

Front 5

what STI goes to the palms and soles

Back 5

2 syphalis

also will have mucous patches in oral cavity

Front 6

whats condylomata lata

Back 6

warts seen in 2 syphalis
flat EPITHELIAL proliforation

occur in moist areas with skin folds or in oral cavity- anus, mouth

Front 7

34 y/o bisexual male HIV. month history of oral and anal lesions. He recalled
a lesion of his penis 3 mon. earlier that spontaneously
resolved. Pos TPA- ABS; T. pallidum titer > 1:5120

explain whats going on

Back 7

1. newly dx HIV means likely to have other STI

2. 3 mo ago a lesion that healed on its own- 1 chancre from syphalis

3. now its condylamata lata

TPA ABS and a T palidum titer that high is DIAGNOSTIC

Front 8

what is a CLASSIC finding with a person with 3 syphalis? what is the pathogenesis

Back 8

AROTIC ARCH ANERUYSM- its due to endaritis of the vasa vasorum

Front 9

why does 3 syphalis see an anerrysm of the aortic arch

Back 9

endaritis of vasa vasorum

can lead to regurg and CHF

Front 10

what are features of 3 syphalis

Back 10

1. neuro syphalis
2. anerurys of aortic arcch- endaritis
3. orchitis- seen in 2 also
4. gumma
- seen in liver called hepar lobatum, its gumma that causes fibrosis (no cirrhosis, no nodules)

Front 11

whats hepar lobatum

Back 11

gumma in liver of 3 syphalis

**its fibrosis but NOT cirrhosis. recall cirrhosis has nodiles

Front 12

how is a fetus infected with syphalis

what complications occur

Back 12

transplacental infection in 2 trimester. T pallidum crosses placenta


abortion, still birth,

Congenital Syphilis: rash, osterchronditis, periostitis, liver/lung fibrosis

Front 13

if you got syphalis from your mom as a babe what might you look like now

Back 13

hutchinson teeth
saddle nose
8th Nerve deafness
orchitis
interstitial keratitis

Front 14

hutchinsons teeth are assocated with what

Back 14

congenital syphilis

*8when T pallidum crosses placenta in 2 trimester and the fetus gets it

Front 15

what diseases are caused by chlamydia infection

Back 15

lymphogranuloma venereum
urethritis, reactive arthritis
cervicitis
PID

Front 16

reiters is caused by what

Back 16

chlamydia

**reactive arthritis, urethritis, conjunctivitis

Front 17

is a chlamydia infection apparent

Back 17

in men its often sx but in women its asx. they might present with PID

*can be a cervcitis that is "just some discharge" so women dont get seen

Front 18

what are the High Risk HPV's

Back 18

6 11: warts

16 18: cancer

Front 19

what causes condyloma accuminata

what does it look like gross and micro

Back 19

HPV 6 11

Gross: recurr, benign, multiple- coalesce. can have spontaneous regression. papillary excrescences

MICRO: koilocytosis, acanthoses-thick epithelim, hyperkeratosis: thick epidermis

Front 20

what is a urethral papilloma

Back 20

its HPV warts in the urethra

Front 21

where on the penis are there HPV warts
where are they in females

Back 21

coronal sulcus, can enter urethra


Femals: vulva, perineal, cervix, vagina

perianal can be in both men and women

papillary excresenceces

Front 22

what layers of the skin are affected in condyloma acuminatum

Back 22

papillary

Acanthosis: thick EPITHELIUM
Hyperkeratosis: thick EPIDERMIS

will see koilocytosis of the prickle cell layer. thses are cells with clearing around the nucleus

Front 23

what is a clear vacuolization of the prickle cell layer

Back 23

koilocyte, its HPV infection

Front 24

can you get warts on the cervix

Back 24

you bet

Front 25

what cancers are related to HPV infection

Back 25

1. Sq cell carcinoma of vulva, vagina, cervix, penis, perianal, sinus, oral cavity, lung

Front 26

what is the mech of action of HPV 16, 18

**recall the 6, 11 get into cell, integrate DNA, host cells replication, viral shedding

Back 26

*in warts HOV viral DNA is benign, in cancer the genome is integrated into nuclear DNA and...

1. E2 viral repressor is lost
2. Overexpression of E6, E7
-E6 decreases p53 levels
-E7inactivates RB

Front 27

is HPV infection that causes cancer limited to sq cell carcinoma of cervix

Back 27

nope- penix, perianal, vagina, even respiratory

Front 28

what is the progression or evolution of HPV to sq cell carcinoma

Back 28

1. get HPV
2.dysplasia, intraepithelial neoplasia grades
3. carcinoma in situ: high grade intraepithelial neoplasia

**infection alone wont cause cancer!!!!!!!!

Front 29

in HPV what does this do...

E2
E6
E7

Back 29

E2 is lost so is expressed, this allows expression of E6 and E7

E6 expression decreases p53. p53 induces apoptosis
E7 expression inactivates RB. RB stops growth

**by increasing E6 and E7 we have removed our check points for cell death

Front 30

HPV related sq cell carcinomas look like what at micro

Back 30

____ IN. its an intraepithelial neoplasia/lesion

VINL vaginal intraepithelial neoplasia
CIN: cervical
PIN: penis
AIN: anus

**this is the HPV related precacner

**nuclear atypia, loss of polairty, hyperchromatic, pleomorphic, increased Nuclear to cytoplasm, increased MItosis, BM IN TACT

Front 31

what is VIN CIN PIN AIN

Back 31

its HPV related precancer of the Vagina, cervic, penis, anus

**intraepithelial neoplasia

Front 32

whats the gross appearance of intraepithelial neoplasia (the HPV related precacner)

Back 32

white plaquw on vulva, anus, peis, cervix

Front 33

in intraepithelial neoplasia what does micro look like

Back 33

its the HPV precanver

1. nuclear atypia
2. hyperchromatic
2. pleomorphic
4. increase Nuclear to cytoplasm ratio
5. icnreased mitoses
6. BM is intact

Front 34

when do we see this list of things

1. nuclear atypia
2. hyperchromatic
2. pleomorphic
4. increase Nuclear to cytoplasm ratio
5. icnreased mitoses
6. BM is intact

Back 34

intrapeithelial neoplasia, the HPV related neoplasia

Front 35

if you see VIN and VIL what is the difference

Back 35

nothing, both refer to the precancer assocaited with HPV, one is neoplasm, one is lesion. same thing different terminology

**cytology calls it lesion
**biopsy call it neoplasm

Front 36

NILM
LGSIL/LSIL
HGSIL/SHIL

Back 36

NILM: no intraepithelial lesion or malignanct, benign

LGSIL/LSIL: low grade sq Intraepithelial lesion (neoplasm).

HGSIL/HSIL: high grade squamous intraepithelial lesion (neoplasm).

Front 37

carcinoma in situ from HPV in biopsy is reported as CIN III, what is the nomenclature for cytology

Back 37

High Grade sq intraepithelial lesion

**this refers to anything from moderate sydplasia to carcinoma in situ

Front 38

whats the pathogenesis of cervical cancer

Back 38

HPV in transformation zone --> CIN --> sq cell carcinoma

**CIN to CA takes YEARS
**not all ppl w/HPV get cacmer,
**huge decrease in cancer bc of pap smears

Front 39

what does the transformation zone have to do with cervical cacner

Back 39

transformation zone is squamo columnar junction, it is high in the vagina prepuberty and post menopause. its where cancer is bc its where HPV infection occurs

Front 40

why include the transformation zone in pap smear

Back 40

its where HPV infects. tis the squamocolumnar junction. it changes location throughout a womans life

Front 41

what cells are taken in a pap smear

Back 41

the ones that are exfoliating. can detect PREINVASIVE lesions. the invasive lesions rarely shed.

the precancer MUST BE SHEDDING

Front 42

is high grade or low grade CIN more liekly to get CA

Back 42

high grade, more likely to get CA nad less likely to regress

Front 43

what is a pap smear best at detecting,

Back 43

pap is HUGE for decrease cases of cervical cancer. we can detect the preinvasive shedding and TREAT!!!

detect abnormal cells, NOT CA DX!!

best if sample is taken at the trasnformation zone bc that is where HOV get in

Front 44

when do you get false neg on pap

Back 44

1. poor sample- the doc didnt get the right stuff

2. lab error-

3. no shedding of precancer. invasive CA doesnt shed. if you repeate smear too soon

ANY LESION MUST BE BIOPSIED.

Front 45

will a pap detect endometrial cacner

Back 45

nope

Front 46

Patient was admitted c/o abnormal vaginal
bleeding for g 6 years since delivery of her last
child.
• Patient was gravida 7, para 4 with history of 3
spontaneous abortions. She lives with her
husband and does not smoke.
• 9 mon. earlier she had a pap smear that was
reported as “infection.” She was treated
empirically with a cream.
• 6 mon prior to admission, Pap smear was
repeated by gynecologist and reported as normal.
She underwent a D & C that was benign.
• Hysterectomy was performed on current
admission.
Histologic sections of the cervix showed
infiltrating moderately well differentiated
squamous cell carcinoma of the cervix.
What contributed to the negative smear in this pt.?

Back 46

gravida- how many times preggo
para- how many times delivered

**negative pap smear because
1. the doc didnt do it right
2. the lab didnt do it right
3. the CA was invasive and so wasnt shedding
4. the pap was taken too soon after the D&C

Front 47

does dysplastic sq epithelium of cervix shed

Back 47

nope, failure of exfoliation is a common cause of a false neg pap

Front 48

what is the general indication for a pap smear

what dx requires FU and what procedure will be done

Back 48

begin screen 3 years after onset of sexual activity or at 21

annual screen until 30 and then after that do q2-3 years

**if they have ASCUS do a biopsy and HPV test

Front 49

what is the current status of HPV test in us

Back 49

after 30 or if abnormal pap

Front 50

what does it mean if the labs reports your pap was inadequate

Back 50

transformation zone was not included. its not valid. redo

presence of columnar cells and or malignant cells makes for an adequate sample

Front 51

whats ASCUS

Back 51

atypical sq cells of uncertain origin- if this is reported on a pap get HPV test

Front 52

does the HPV vaccine work

Back 52

you bet

70% reduciton in dysplasia carcinoma in situ in females

Front 53

whats teh most common type of carcinoma of the cervix

Back 53

Sq CEll Carcinoma- MOST common

can also have adenocarcinoma- HPV
clear cell carcinoma- DES exposure in utero, cervical adenosis

Front 54

other than sq cell carcinom, which is the most common type of cervical carcinoma, what are 2 others. what are htey assocated with

Back 54

1. Adenocarcinoma- HPV infeciton

2. Clear cell adenocarcinoma: DES exposure in utero. arises in cervical adenosis. seen in younger ppl

Front 55

what risk factors are assocated with cervical cancer

Back 55

HPV
sex early
multiple sex partners
sex partner who had a partner w/cervical cancer
HLA
OCP
SMOKING
genital infection
multiple pregnancies
clear cell adenocarcinoma: DES

Front 56

does smoking increase risk of cervical cancer

Back 56

you bet

OCP too

Front 57

you MUST KNOW THE PICTURE OF CERVICAL CARCINOMA

Back 57

its a cervix with nasty growths, it WONT shed cells, its invasive. only precancer will shed for pap detection

Front 58

stage IV cervical cacner can invade into what structures

Back 58

bladder
rectum


**recall stages
0- in situ
1: invasive, limited to cervix
II: extends though cervix
IV: extends through pelvis

Front 59

keratin pearl is assocated with that

Back 59

invasive sq cell carcinoma

Front 60

how is cervical cancer staged

0
1
2
4

Back 60

0- carcinoma in situ

I: invasive but LIMITED TO CERVIX
II: extends through cervix
IV: extends beyond pelvis- rectum, bladder

Front 61

stage IV sq carcinoma of cervix has invaded into bladder/rectum. whats the cause of death

Back 61

uremia usually

**LOCAL disease is what causes death

Front 62

cervical adenocarcinoma is caused by

clear cell adenocarcinoma is caused by

Back 62

HPV

in utero DES exposure

Front 63

A 39 year old woman with extensive pelvic
spread of carcinoma p of the cervix has been
treated with surgery and radiation.
• Three weeks previously an IVP showed
bilateral hydronephrosis, mild of the left side.
• 30 hours before hospitalization, she developed
fever, shaking chills, severe back pain, dysuria
and increased frequency. PE showed an acutely
ill, febrile woman with bilateral flank
tenderness. • WBC 19,000 with 88% neutrophils
• Urine 2+ protein, numerous WBCs,
• RBCs, WBC casts and bacteria.
• E. coli was cultured from the initial blood and
urine cultures.
• At autopsy, the right ureter was surrounded
by retroperitoneal tumor and enlarged nodes
containing tumor. The renal pelvis and calyces
were dilated

Back 63

invasive cervical cacner