cervix, vulva, vagina Flashcards Preview

repro > cervix, vulva, vagina > Flashcards

Flashcards in cervix, vulva, vagina Deck (89)
1

normal ectocervixn- cell layers

exfoliating cells, superficial cells, intermediate cells, basement membrane

2

which part of the cervix can you feel in vaginal canal?

ectocervix

3

which part has hard squamous cells?

ectocervix

4

which part has soft columnar glandular cells?

endocervix

5

hard squamous becomes soft columnar glandular cells?

transition zone

6

the position of the tz alters throughout life. this is physiological. what is it a response to?

menarche, pregnancy, menopause

7

which part is the opening of the uterus?

endocervix

8

what is tz also known as?

squamo columnar junction

9

exposure of delicate endoecervical epithelium to acid environment of vagina leads to ?

physiological squamous metaplasia

10

what is a nathobian cyst

mucus filled cyst on the surface of the cervix. caused by squamous cells growing over columnar cells

11

what happenst to nathobian cysts?

usually disappear on their own

12

how can cervicitis lead to infertility?

can cause simultaneous silent fallopian tube damage

13

cervicitis can be? (4)

non specific, follicular, chlamydia, hsv infection

14

what kind of cells would you see in follicular cervicitis?

lymphoid follicles

15

cervical polyp - when can it cause bleeding? is it malignant?

it can cause bleeding but is not malignant

16

two main types of cervical cancer

squamous and aden squ ad

17

how does HPV infect the cervical cells

infects epithelial cells in the cervical mucosa. HPV DNA integrates into the cellular genome when causing cancer

18

within weeks you can get viral replication

90% heal within 2 years

19

over 10-30 years, how many will develop into an invasive cancer?

0.8%

20

why does having many sexual partners increase risk of cervical cancer?

increases likelihood and time exposed to high risk HPV

21

smoking increases risk of cervical cancer by?

3

22

age at first intercourse, long term use of oral contraceptive and non use of barrier contraception all increase risk of cervical cancer

immunosuppression also

23

in genital warts, koilocytosis is seen, how can this be picked up?

cervical smear

24

how long does it take to get from HPV infection to high grade CIN?

6 months - 3 years

25

high grade CIN - invasive cancer?

5-20 years

26

pre i invasive stage of cervical cancer, occurs at transformation zone, can involve large area, not visible to naked eye, asymptomatic, detectable by cervical screening

CIN

27

normal pathway of CIN?

normal epithelium - koilocytosis - CIN 1-2-3

28

in CIN, there is a delay of maturation/differentiation. which type of cells are occupying more of the epithelium?

immature basal

29

some of the nuclear abnormalities?

hyperchromasia, increased nucleocytoplasmic ratio, pleomorphism

30

there is excess mitotic activity situated above normal layers

CIN 1 - 1/3 basal occupied by abnormal cells

31

2 - abnormal cells in 2/3 and mitosis in middle third. ABNORMAL MITOTIC figures

in CIN3, abnormal cells occupy the full thickness of the epithelium

32

mitosis, often abnormal, in upper 1/3

what percentage of these progress to invasion

33

12%

y

34

what is the most common cervical carcinoma?

squamous

35

how does it develop?

from pre existing CIN

36

therefore why should it be preventable?

by screening

37

symptoms of invasive cervical carcinoma?

usually none, abnormal bleeding, (post coital, post menopausal, BROWNISH or BLOODSTAINED vaginal discharge, contact bleeding)

38

what sort of pain would you get>=?

pelvic pain

39

why would you get haematuria?

local spread to ureter

40

why would it lead to renal failure?

causes ureteric obstruction

41

how can it spread?

local, blood, lymph

42

CGIN - what is it?

cervical glandular intraeputhelial neoplasia

43

where is its origin?

endocervical epithelium

44

what is it a pre invasive phase of?

endovervical adenocarcinoma

45

CGIN PRADA, why is screening of adenocarcinoma les effective?

difficult to diagnose pre invasive adenocarcinoma of the endocervix

46

adenocarcinoma has an increased incidence in what age group?

young women

47

although overall it is less common

y

48

which has a better prognosis, squamous or aden?

squamous

49

what HPV is adenocarcinoma associated with?

18

50

what else is it associated with?

smoking

51

makes up what percentage of cervical cancer?

15-25%

52

commoner in young women of higher social class with later SA

y

53

vulval HPV, whats it like in young women?

multifocal/recurrent/persitent, causing tx problems

54

in older people, there is a greater risk of progression to invasive squamous carcinoma

y

55

vulvar invasive squamous carcinoma - usually which age group?

usually elderly with ulcer or exophytic mass

56

how can it arise?

from epithelium or VIN

57

what is the most important prognostic factor?

spread to the inguinal lymph nodes

58

treatment?

radical vulvectomy and lympadenectomy

59

vulvar pages disease?

crusting rash, tumour cells in the epidermis ,contain mucin

60

most of the time where does this arise from?

sweat gland in skin, mostly non underlying cancer

61

crusting rash on vulva, contains mucin, arises from sweat gland

vulvar pagets disease

62

what HOV involved in vulvar warts?

HPV 6 and 11

63

squamous carcinoma of the vagina, disease of the elderly

y

64

what is cervical ectropion?

increased oestrogen results in larger area of columnar epithelium in ectocervix. as its glandular, you get post coital bleeding and discharge

65

which fibres carry pain from annexe/uterus/vagina?

visceral afferents

66

from the perineum?

somatic sensory

67

the superior aspect of pelvic organs (touching peritoneum). visceral afferents run alongside?

sympathetic fibres

68

where do they enter the spinal cord?

T11-L2

69

what is pain from here perceived as?

suprapubic

70

inferior parts of pelvic organs (NOT TOUCHING PERITONEUM) run along side?

parasympathetic fibres

71

where is pain perceived?

perineum

72

what level does it go to?

S2, 3 and 4

73

above the elevator ani, visceral afferents..parasympathetic s2,3,4

below levator ani, somatic sensory, s2,3,4, pudendal nerve, localised pan within the perineum

74

when does the spinal cord become the caudal equine?

L2

75

epidural - where is anaesthetic injected?

l3-l5 region

76

what is epidural space made up of?

fat and veins

77

where do sympathetic nerves exit spinal chord?

t1-l2

78

what do all spinal nerves contain?

sympathetic fibres

79

what do sympathetic fibres supply?

all arterioles (sympathetic tone)

80

in spinal anaesthetic you get vasodilation

y

81

what physical signs would you see?

skin look flushed, warm lower limbs, reduced sweating

82

what are all these a sign of?

spinal anaesthetic is working

83

pudendal nerve is a branch of which plexus?

sacral

84

bloccking pudendal nerve affects?

majority of perineum

85

which ligament does the pudendal nerve cross

lateral aspect of sacrospinous ligament (ischial spine can be used as a landmark)

86

when would this be done?

painful delivery - during labour

87

if baby is rhesus positive, why would future pregnancies be at risk?

rhd antigens could enter mothers circulation at delivery, mother mounts attack against these. antibodies could cross placenta in future pregnancies and cause homeless in fetus

88

what is sensitisation?

when a rhd negative woman is exposed to rhd positive blood and has an immune response to it

89

what do anti d antibodies given do?

neutralise any rhd positive antibodies that may have entered mothers circulation