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cervix, vulva, vagina Flashcards

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1
Q

normal ectocervixn- cell layers

A

exfoliating cells, superficial cells, intermediate cells, basement membrane

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2
Q

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

A

ectocervix

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3
Q

which part has hard squamous cells?

A

ectocervix

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4
Q

which part has soft columnar glandular cells?

A

endocervix

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5
Q

hard squamous becomes soft columnar glandular cells?

A

transition zone

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6
Q

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

A

menarche, pregnancy, menopause

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7
Q

which part is the opening of the uterus?

A

endocervix

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8
Q

what is tz also known as?

A

squamo columnar junction

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9
Q

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

A

physiological squamous metaplasia

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10
Q

what is a nathobian cyst

A

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

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11
Q

what happenst to nathobian cysts?

A

usually disappear on their own

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12
Q

how can cervicitis lead to infertility?

A

can cause simultaneous silent fallopian tube damage

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13
Q

cervicitis can be? (4)

A

non specific, follicular, chlamydia, hsv infection

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14
Q

what kind of cells would you see in follicular cervicitis?

A

lymphoid follicles

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15
Q

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

A

it can cause bleeding but is not malignant

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16
Q

two main types of cervical cancer

A

squamous and aden squ ad

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17
Q

how does HPV infect the cervical cells

A

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

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18
Q

within weeks you can get viral replication

A

90% heal within 2 years

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19
Q

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

A

0.8%

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20
Q

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

A

increases likelihood and time exposed to high risk HPV

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21
Q

smoking increases risk of cervical cancer by?

A

3

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22
Q

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

A

immunosuppression also

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23
Q

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

A

cervical smear

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24
Q

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

A

6 months - 3 years

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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

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