Repro Zaman; Vaginal/cervical Diseases; Kek

Front 1

name some vaginal congenital anomalies.

Back 1

vaginal agenesis, obstruction, duplication (incomplete fusion of mullerian tracts), and fusion; urogenital sinus anomalies; imperforate hymen (1:1000)

Front 2

how do you diagnose congenital anomalies?

Back 2

PE, ultrasonography, retrograde contrast studies

Front 3

what causes the mullerian ducts to fuse and elongate?

Back 3

urogenital sinus

Front 4

what is the most common cause of primary amenorrhea?

Back 4

Turner's Syndrome (XO)

Front 5

name the disorder of congenital absence of the upper vagina and uterus; second most common cause of primary amenorrhea. what stops developing to cause this?

Back 5

RKH (Rokitansky Kuster-Hauser Syndrome); mullerian duct system stops developing during gestational days 44-48

Front 6

name the term used to describe when their is a remnant of the wolffian (mesonephric) duct (responsible for male development). how would it present?

Back 6

Gartner's Duct Cyst - cyst inside on the lateral wall of the vagina

Front 7

what cells will you see microscopically to indicate gardnerella vaginalis?

Back 7

clue cells - large cells heavily coated with bacteria

Front 8

name the pathogen. STD, flagellated protozoan with motility; produces vaginitis, cervicitis, and urethritis with strawberry colored cervix and fiery red vaginal mucosae; greenish, frothy, discharge.

Back 8

Trichomonas vaginalis - treatment: metronidazole (both partners)

Front 9

what pathogen produces koilocytic changes in squamous epithelium; the cells have a wrinkled pyknotic nuclei surrounded by a clear halo.

Back 9

HPV - condyloma acuminata (veneral warts - HPV 6,11); 16,18 with dysplasia and squamous cancer

Front 10

name the term used to describe a staphylococcal infection that used to kill many women; caused by super absorbant tampons.

Back 10

Toxic Shock Syndrome

Front 11

name the cells seen on pap smear that are consistant with postmenopausal women/atrophic vaginitis.

Back 11

parabasal cells - apparent when lacking estrogen and progesterone

Front 12

name the most common vaginal cyst and describe it histologically.

Back 12

epidermal inclusion cyst (aka vaginal inclusion cyst); a distinct squamous lined cyst with debris inside

Front 13

the most common place for endometriosis is the ovary; however it appears that traumatically removed endometrium can implant in scars. name a place that is commonly scarred and left with endometrial tissue.

Back 13

episiotomy site - tissue responds and cycles with estrogen (lesion will involute with pregnancy (progesterone dominated) or anytime there is less estrogen (ie postmenopausal)

Front 14

benign tumors of the vagina are rare, however there is a mixed benign tumor composed of ________ and _______ that generally occurs in young women (30) and is located in or just above the ________ _____.

Back 14

epithelium and stroma; hymenal ring

Front 15

goljan: this is a benign tumor of skeletal muscle that shows up in the vagina, tongue, and/or heart.

Back 15

rhabdomyoma

Front 16

most vaginal malignancies are an extension of cancer from ______.

Back 16

squamous cell carcinoma from the cervix - ie they are there because of metastasis

Front 17

the most common primary cancer of the vagina is this type and is a result of what HPV type?

Back 17

epidermoid (Vaginal Squamous Cell Carcinoma); result of HPV 16

Front 18

name the malignant grape-like mass that protrudes from the vagina of girls <6 years of old.describe it histologically.

Back 18

embryonal rhabdomyosarcoma - surgery and chemo usually curative; see dense cambium layer beneath the epithelium; the sarcoma is beneath the cambian layer

Front 19

why were women given Diethylstilbestrol (DES) in the 40s?

Back 19

commonly given to women to prevent miscarriage

Front 20

what was the common occurence in the female fetus of women taking DES?

Back 20

the female fetuses that were exposed to DES(especially in the 1st 18wks) commonly had irregular menses; most got vaginal adenosis (remnants of mullerian ducts) and was the precursor to the rare clear cell adenocarcinoma.

Front 21

embryologically, What did DES do to the fetus?

Back 21

DES inhibited mullerian differentiation responsbile for mullerian structures: tubes, uterus, cervix, upper 1/3 of the vagina

Front 22

what is adenosis?

Back 22

DES exposed women most commonly got adenosis: it is the presence of a columnar mucin-secreting epithelium in the vagina, the glands are often lying in the lamina propria of the vagina - this is a precursor to clear cell adenocarcinoma

Front 23

what is going on histologically with adenosis?

Back 23

the glands are moving upwards toward the lamina propria

Front 24

describe clear cell adenocarcinoma histologically.

Back 24

arises from vaginal adenosis, the glands are irregular,multiple, and close together; within the lining of the glands you can see the malignant nuclei.

Front 25

what happened if a women taking DES had a male fetus?

Back 25

reports of epididymal cysts, hypotrophic testes, microphallus (small penis); sperm abnormalities

Front 26

name some conditions associated with pelvic relaxation and why does this occur?

Back 26

the pelvic musculature gets weakened (usually from traumatic childbirth, poor obstetrical care, lots of births); conditions include: uterine prolapse, cystocele, urethracele, and rectocele - often presents as urinary incontinence

Front 27

describe the appearance on a histo slide of trichomonas vaginalis.

Back 27

pear shaped flagellated protozoan

Front 28

describe the appearance on a histo slide of HSV.

Back 28

classic ground glass appearance; the cells have a multi-nucleated appearance; the nuclei looked rimmed with color

Front 29

describe the appearance of a histo slide of bacterial vaginosis.

Back 29

gardnerella vaginalis is characterized by "clue cells" - these cells are large with lots of bacteria on them (the nucleus looks small); the right shift of pH to a more alkaline fluid causes a decrease in lactobacilli; this allows bacteria to grow

Front 30

name the benign cervical cyst derived from endocervical glands.

Back 30

nabothian cysts

Front 31

name the lesion that is usually found around menopause and may protrude from the endocervix and bleed.

Back 31

endocervical polyps (postcoital bleeding)

Front 32

this neoplasm comprises 55-65% of all malignancies of the female genital tract.

Back 32

cervical carcinoma

Front 33

what strains produce E6 oncoproteins that bind to p53 (tumor suppressor gene).

Back 33

HPV 16 and 18

Front 34

what race/ethnicity has the highest incidence of cervical cancer? which has the highest mortality?

Back 34

hispanic/latino have the highest incidence; blacks have the highest mortality

Front 35

name the symptoms of cervical cancer.

Back 35

often none; postcoital bleeding; pain is a late sign

Front 36

what is the most common cause of death in cervical cancer patients?

Back 36

the cervical cancer infiltrates the bladder wall and obstructs the ureters; this causes postrenal azotemia and RENAL FAILURE and UREMIA

Front 37

there are 3 types of cervical cancer. name them and name which is most common.

Back 37

Epidermoid aka Squamous Cell Carcinoma(90%); Adenocarcinoma (4%); Undifferentiated Small Cell

Front 38

where on the cervix does cervical cancer arise?

Back 38

epithelium at the squamocolumnar junction (b/w the squamous exocervix and the transformation zone of the cervix);

Front 39

describe the progression from HPV infection to invasive cervical cancer.

Back 39

it progresses from HPV infection -> metaplasia -> dysplasia (CIN I-II)-> CIN III or carcinoma in situ -> Microinvasive carcinoma -> Frankly Invasive Carcinoma (invaded into the lamina propria)

Front 40

define CIN I,II,III.

Back 40

CIN = cervical intraepithelial Neoplasia;measures amount of dysplasia; CIN I: mild dysplasia involving 1/3 of the epithelium; CIN II: moderate dysplasia involving 2/3 of the epithelium; CIN III: severe dysplasia involving the full thickness of the epithelium (carcinoma in situ)

Front 41

describe squamous metaplasia on cytology.

Back 41

the glandular cells begin looking like squamous cells (due to chronic irritation)

Front 42

describe condyloma acuminata on cytology.

Back 42

koilocytosis; the squamous cells have wrinkled pyknotic (shriveled) nuclei

Front 43

what is ASCUS?

Back 43

atypical squamous change of unknown significance; something is wrong; its b/w condyloma and metaplasia; the nuclear:cytoplasm ratio has increased but it is unknown as to why

Front 44

what is HGSIL?

Back 44

high grade squamous intraepithelial lesion (aka CIN III) - see dark and large nuclei

Front 45

describe the cytology of SCC (squamous cell carcinoma) keratinizing vs nonkeratinizing.

Back 45

keratinizing look like pink tadpoles; both have very dark large nuclei

Front 46

describe the cytology of endocervical adenocarcinoma in situ.

Back 46

2nd most common type of cervical ca; glands grow very thick; hasn't invaded into the lamina propria (in situ)

Front 47

describe carcinoma in situ.

Back 47

CIS or CIN III is diagnosed when the entire epithelium is replaced by dysplastic process (no organization); cells have gone vertical, the nuclei are traveling upward; does NOT always progess to invasive cancer and may even regress; unpredictable

Front 48

what is FIGO?

Back 48

International Federation of Gynecology and Obstetrics; used to stage cervical cancer based on clinical examination, rather than surgical findings: Stage 0: CIS; Stage I: invasive carcinoma strictly confined to the cervix (invaded the lamina propria); Stage II: local, but beyond the uterus; Stage III: extended to pelvic wall or the lower 1/3 of the vagina, causes hydronephrosis; Stage IV: beyond true pelivs or into the bladder or rectum (methods do not include CT or MRI findings - based on palpation, inspection, colposcopy, biopsy, endocer. curettage, hysteroscopy, cystoscopy, proctoscopy, IVU, and xrays)

Front 49

CIS can progress to this? what stage is it in and describe it histologically.

Back 49

microinvasive carcinoma (stage Ia); treated surgically; may be able to preserve the ability to have children; see "tongues" of dysplastic tissue invading the lamina propria

Front 50

carcinoma of the cervix has four growth patterns. name them and describe them.

Back 50

1) exophytic (Most COmmon)- arise from exocervix, large mass that may bleed; 2) Nodular: arise from endocervix, large thick barrel-shaped cervix; 3) Infiltrative: Stone-hard cervix that invades the vaginal fornices and upper vagina; 4) ulcerative: tumor necrosis and sloughing with infectiona and purulent discharge

Front 51

Squamous Cell Carcinoma (SCC) accounts for 90% of the cervical cancers. name the major histopathologic subtypes.

Back 51

1)Moderately Differentiated, nonkeratinizing large cell SCC (70%); 2)Well-differentiated, keratinizing large cell SCC (25%); 3) small cell undifferentiated carcinoma - poor prognosis; 4) pure adenocarcinoma from endocervical cells are on the rise (5-20%)

Front 52

if the cervix gets a secondary metastasis, where is it most likely from?

Back 52

endometrium

Front 53

In the US, invasive cancer of the cervix is the __#__ most common genital malignancy in women, after _____ and _____.

Back 53

3rd; endometrial and ovary.

Front 54

worldwide, invasive cervical cancer is the __#__ genital female malignancy and the 2nd most common cause of malignancy in women.

Back 54

#1

Front 55

Invasive cervical cancer is __#__ only to ________ cancer as a leading cause of worldwide cancer related mortality in women.

Back 55

second; breast

Front 56

CIS is detected at what age? invasive cancer is diagnosed at what age?

Back 56

25-34; >50yo

Front 57

on a cytology slide, describe the difference between adenocarcinoma and SCC.

Back 57

adenocarcinoma clumps together; SCC looks as if the cells are falling off eachother

Front 58

describe invasive adenocarcinoma on a HISTO slide.

Back 58

lymphocytes surrounding a gland that is producing something (mucin?); lined by malignant cells; lights up with a special stain for mucin

Front 59

how do you treat CIN I or II?

Back 59

mild or moderate dysplasia on pap would then get confirmed by biopsy, then treat by freezing

Front 60

how do you treat CIN III?

Back 60

CIS or severe dysplasia, 1st confirm with biospy and coposcopy; then freeze or "cold knife cone" (follow pt closely)

Front 61

how do you treat a locally invasive (microinvasive carcinoma)?

Back 61

usually hysterectomy

Front 62

the ACS and ACOG recommend women to get paps how often?

Back 62

<30 annual or (ACS only) if use "thin prep" aka liquid-based cytology (every 2); non-immunocompromised women >30: 3 types: conventional pap and liquid-based cytology: do it annually (when you get 3 conseqative negatives, every 3); if using liquid-base with HPV every 3 years if both are negative

Front 63

what HPV types does the vaccine prevent?

Back 63

HPV (6,11,16,18)

Front 64

where in the GU tract are specimens taken to assess hormones?

Back 64

lateral vaginal wall

Front 65

where in the GU tract are specimens taken to help diagnose endocervical, endometrial, and ovarian malignancies?

Back 65

vaginal pool (fluid)

Front 66

what parts of the GU system are tested in a pap smear?

Back 66

ectocervical scraping (great for cervical neoplasm detection, poor for endometrial ca), vaginal pool specimen, and/or endocervical specimen. (both vag. pool and endocervical speciments are taken to detect malignancies arising in the endocervix and endometrium)

Front 67

name the common infectious pathogens that are commonly seen on pap smears.

Back 67

gardnerella vaginalis, candida albicans, herpes simplex, trichomonas vaginalis, actinomyces, chlamydia, HPV - condyloma acuminata

Front 68

the squamous epithelium cells will vary depending on what hormones are present in the exocervix and upper vagina.name the cell and what hormone/s are present.

Back 68

superficial squamous cells - estrogen; intermediate cells - progesterone; parabasal cells - no estrogen or progesterone (postmenopausal)

Front 69

in a normal premenopausal menstruating woman, what cells will you see?

Back 69

70% superficial squamous cells; 30% intermediate cells

Front 70

what is the maturation index?

Back 70

a way to express the amount of parabasal/intermediate/superficial (P/I/S); ie. in a completely postmenopausal woman: 100/0/0

Front 71

name the term. cells of an epithelium convert to a different cell type (ie. columnar -> squamous);

Back 71

METAPLASIA occurs from chronic inflammation, hormonal changes, not always indicative of a serious problem

Front 72

name the term. an increase in the number of cells and thickness of the epithelium.

Back 72

hyperplasia

Front 73

name the term that means regenerative changes.

Back 73

reparative

Front 74

name the term that means the cytological equivalent of leukoplakia (white patches) often result of irritation or hormonal disturbance and seen commonly in uterine prolapse.

Back 74

hyperkeratosis - if situated toward the squamocolumnar junction is associated in about 10% of cases with cervical dysplasia or CIS.

Front 75

name the term. an abnormal form of keratinization in which the nuclei are retained in the keratinized layer. what is the significance?

Back 75

parakeratosis; dysplasia and carcinoma are found in smears with parakeratosis and this layer of parakeratosis can prevent getting a good sample of a lesion

Front 76

when should you not see endometrial cells?

Back 76

postmenopausal women and premenopausal women after day 10

Front 77

name the term. disorganized growth. is graded as mild, moderate, and severe.

Back 77

dysplasia