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Endo/Repro > Introduction to the Female Genital Tract (Embryo, Anatomy, STI) > Flashcards

Introduction to the Female Genital Tract (Embryo, Anatomy, STI) Flashcards

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1
Q

What is the female reproductive system derived from?

A
  1. Mesoderm
  2. Primordial germ cells
  3. Coelomic epithelium
  4. Mesenchyme
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2
Q

What are the three main groups of the female reproductive system?

A
  • Gonads
  • Reproductive ducts
  • External genitalia
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3
Q

When does the uterus form?

A
  • During Müllerian organogenesis accompanied by the development of the upper third of the vagina, cervix, and both fallopian tubes
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4
Q

Which duct is the ovary derived from?

A
  • Mesonephric duct (Wolffian duct)

- Mesonephros

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5
Q

Which duct is the upper third of the vagina, cervix, both fallopian tubes, and the uterus derived from?

A
  • Paramesonephric duct

- Müllerian duct

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6
Q

What are some anomalies that occur due to Müllerian duct fusion?

A
  • Bicornuate uterus

- Uterus didelphys

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7
Q

What is Mayer-Rokitansky-Küster-Hauser syndrome?

A
  • A disorder that occurs in females and mainly affect the reproductive system
  • Causes the vagina and uterus to be underdeveloped or absent although external genitalia are normal
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8
Q

What is the karyotype of someone with MRKH syndrome?

A
  • 46XX (normal)
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9
Q

Why does someone with MRKH syndrome still develop external genitalia?

A
  • The ovaries are working allowing for hormones to still be produced
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10
Q

What does the vulva include?

A
  • Mons pubis
  • Labia majora
  • Labia minora
  • Clitoris
  • Urethral opening
  • Vaginal opening
  • Perineum
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11
Q

Who can infectious diseases affect?

A
  • Elderly
  • Immunocompromised
  • Debilitating chronic diseases
  • Inadequate access to health care
  • Malnutrition
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12
Q

What are the different types of inflammatory responses to infection?

A
  • Suppurative (purulent) inflammation
  • Mononuclear and granulomatous inflammation
  • Cytopathic-cytoproliferative (viral change)
  • Tissue necrosis
  • Chronic inflammation and scarring
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13
Q

How are infectious agents diagnosed?

A
  • Gold standard has been culture
  • Now it is biologic or serologic identification
  • PCR
  • Molecular methods
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14
Q

Who is most likely to be infected with HSV2?

A
  • Women more than men due to it being easier to transmit from men to women during penile-vaginal sex
  • More common among non-hispanic blacks
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15
Q

What systemic symptoms show up in a HSV infection?

A
  • Fever
  • Malaise
  • Tender inguinal lymph nodes
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16
Q

When do the systemic symptoms show up in a HSV infection?

A
  • Only 1/3 of individuals are symptomatic

- Show up 3 to 7 days after transmission

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17
Q

What is the earliest lesion in HSV infection?

A
  • Red papules that progress to vesicles and then to painful coalescent ulcers
  • Easily visible on vulvar skin and mucosa, while cervical and vaginal lesions present with severe purulent discharge and pelvic pain
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18
Q

What is a simple screening test for HSV?

A
  • Tzanck Smear test
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19
Q

What is important to remember about HSV?

A
  • It is a latent virus meaning that it will persist indefinitely
  • Any decrease in immune function as well as stress, trauma, UV radiation, and hormonal changes can trigger reactivation of the virus and recurrence of the skin and mucosal lesions
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20
Q

What is the neonatal transmission of HSV associated with?

A
  • High mortality
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21
Q

What does HHV-1 cause?

A
  • Herpes simplex type 1
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22
Q

What does HHV-2 cause?

A
  • Herpes simplex type 2
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23
Q

What does HHV-3 cause?

A
  • Varicella-Zoster
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24
Q

What does HHV-4 cause?

A
  • Epstein-Barr
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25
What does HHV-5 cause?
- Cytomegalovirus
26
What does HHV-6/7 cause?
- Exanthem subitum | - Roseola infantum
27
What does HHv-8 cause?
- Kaposi sarcoma
28
What is CMV and what are some modes of transmission?
- Variety of manifestations depending on age of the host and immune status - Transplacental transmission (congenital) - Neonatal transmission (perinatal) - Genital transmission
29
What is the characteristic histologic appearance for CMV?
- Prominent intranuclear basophilic inclusions spanning half the nuclear diameter - Owl eye appearance
30
What does disseminated CMV cause?
- Focal necrosis with minimal inflammation in virtually any organ
31
What is congenital CMV?
- 95% are asymptomatic - If primary maternal infection, it causes cytomegalic inclusion disease that looks clinically like erythroblastosis fetalis
32
How does an infant with congenital CMV look?
- Intrauterine growth retardation - Hepatosplenomegaly and jaundice - Anemia - Bleeding due to thrombocytopenia - Encephalitis/microcephaly
33
What are some ways of vertical transmission for CMV?
- Placental-fetal transmission - Transmission during birth (birth canal) - Postnatal transmission (breast milk)
34
How will patients present with infectious diseases?
- Asymptomatic - Rash - Pruritus - Odor - Discharge - Pain - Mass/lesion - History of recurrence or medical condition, infertility
35
What is chlamydial infections due to?
- C. trachomatis - A small gram negative bacterium that is an obligate intracellular pathogen - Exists in two forms
36
What is the infectious form of chlamydia called?
- The elementary body which differentiates into a metabolically active form called the reticulate body
37
What are the diseases caused by C. trachamatis infection associated with?
- Different serotypes of the bacteria
38
What serotypes cause urogenital infections and inclusion conjuctivitis?
- D to K
39
What serotypes cause Lymphogranuloma venereum?
- L1, L2, and L3
40
What serotypes cause ocular infections of children and trachoma?
- A, B, and C
41
What is the most common bacterial STI in the world?
- Genital infection by C. trachomatis
42
What is an elementary body?
- Metabolically inactive infectious form in endosome
43
What is a reticulate body?
- Metabolically active form
44
What is the clinical presentation of C. trachomatis?
- Usually asymptomatic in women | - PID major complication
45
What are the best tests for C. trachomatis?
- Urine or swabs for nucleic acid amplification test (NAATs)
46
What is Neisseria gonorrhoeae?
- Aerobic bacteria with stringent growth requirements | - Organisms adhere to and invade non-ciliated epithelial cells
47
How does Neisseria gonorrhoeae present?
- Women are often asymptomatic - Untreated women may develop PID - Also can infect anus/rectum and pharynx
48
What are some complications of PID?
- Cervicitis - Vulvovaginal abscess - Fitz-Hugh-Curtis syndrome
49
What is Fitz-Hugh-Curtis syndrome?
- PID causes bowel obstruction, bacteremia/sepsis, peritonitis - Common symptoms include: severe pain in RUQ, fever, chills, headaches, and malaise
50
What can disseminated gonorrhea cause?
- Septic arthritis accompanied by a rash
51
What is dissemination of gonorrhea associated with?
- Lack of complement proteins that form the MAC
52
What is syphilis?
- A "chronic" sexually transmitted disease with varied clinical and pathological manifestations - Treponema pallidum is too slener to be seen on gram staining but can be visualized by silver stains and immunofluorescence techniques
53
What lesion is associated with syphilis?
- Chancre | - Occurs on the penis or scrotum in 70% of men and on the vulva or cervix in 50% of women
54
What does a chancre look like?
- Nontender, slightly elevate firm, reddened papule, up to several centimeters in diameter, that erodes to create a clean based shallow ulcer - Leads to a button like mass adjacent to the chancre
55
What is seen on histologic exam for syphilis?
- Proliferative endarteritis affecting small vessels with a surrounding plasma cell-rich infiltrate is characteristic of all stages of syphilis - Regional nodes are usually enlarged due to nonspecific acute or chronic lymphadenitis, plasma cell-rich infiltrates, or granulomas
56
What is seen in primary syphilis?
- Chancre
57
What is seen in secondary syphilis?
- Palmar rash - Lymphadenopathy - Condyloma latum - Neurosyphilis (asymptomatic)
58
What is the stage after secondary syphilis?
- Latent syphilis
59
What is seen in tertiary syphilis?
- Neurosyphilis: asymptomatic, meningovascular, tabes dorsalis, general paresis - Aortitis: aneurysms, aortic regurgitation - Gummas: Hepar lobatum, skin, bone, others
60
What is seen in the infantile form of syphilis?
- Rash - Osteochondritis - Periostitis - Liver and lung fibrosis
61
Shat is seen in the childhood form of syphilis?
- Interstitial keratitis - Hutchinson teeth - Eighth nerve deafness
62
What are some ulcerative sexually transmitted infections?
- Treponema pallidum - Chancroid - Granuloma inguinale - Chlamydia serovars L1-L3 --> Lymphogranuloma venereum
63
What is a chancroid (soft chancre) caused by?
- Haemophilus ducreyi | - Found in the tropics and subtropics
64
Who usually has a chancroid?
- People of lower socioeconomic groups | - Men who have sex with prostitutes
65
When does the chancre develop in chacroid?
- 4 to 7 days after inoculation
66
What does the chancre look like in chancroid?
- Tender erythematous papule involving external genitalia - In males, primary lesion is on the penis - In females, most lesions occur in the vagina or the periurethral area
67
What happens to the primary lesion in chancroid?
- It erodes and produces an irregular, painful ulcer | - Base of the ulcer is covered by shaggy, yellow-gray exudate
68
What happens 1 to 2 weeks after inoculation of chancroid?
- Regional lymph nodes enlarge and become tender
69
What can happen if chanroid is not treated?
- Enlarged nodes may erode the overlying skin to produce chronic, draining ulcers
70
What is granuloma inguinale?
- Sexually transmitted chronic inflammatory disease caused by Klebsiella granulomatis (minute, encapsulated coccobacilli)
71
What happens in untreated cases of granuloma inguinale?
- Development of extensive scarring | - Often associated with lymphatic obstruction and lymphedema of the external genitalia
72
How is diagnosis of granuloma inguinale made?
- Microscopic examination of smears or biopsy samples of the ulcer
73
What is lymphogranuloma venereum?
- L serotypes | - Sporadic in US, endemic in Africa, Asia, South American, Caribbean
74
What does lymphogranuloma venereum look like?
- Starts as small papule on genital mucosa or skin - 2-6 weeks later draining swollen nodes - Can cause fibrosis and strictures in anogenital tract
75
What is vulvobaginal candidias?
- Intense vulvovaginal pruritus, erythema, swelling, pain/dysuria/dyspareunia - Thick white vulvovaginal discharge described as "curd-like or cottage cheese-like"
76
How is diagnosis made for vulvovaginal candidias?
- Inspection - KOH test - Pap smear
77
What is the pathogenesis of candidias?
- It is normally there | - When you change the ecosystem (like lose the lactobacilli), it allows the yeast to infiltrate
78
Where else is a candida infection seen?
- Most common fungal infection in patients with AIDS and infection of the oral cavity, vagina, and esophagus are it most common clinical manifestations
79
What causes trichomonas vaginalis?
- Large flagellated ovoid protozoan
80
What is the presentation of someone with trichomonas vaginalis?
- Asymptomatic or, - Frothy yellow vaginal discharge - Dysuria - Dyspareunia
81
What will be seen on exam with trichomonas vaginalis?
- Fiery red vaginal and/or cervical mucosa (strawberry cervix)
82
What is Gardnerella vaginalis?
- Gram negative coccobacillus | - Main cause of bacterial vaginosis
83
How do patients with gardnerella vaginalis present?
- Thin, green-gray malodorous (fishy) vaginal discharge
84
What doe pap smears reveal in gardnerella vaginalis?
- Superficial and intermediate squamous cells covered with a shaggy coat of coccobacilli
85
What is molluscum contagiosum?
- Cutaneous or mucosal lesion caused by poxvirus
86
How is molluscum contagiosum transmitted?
- In children 2-12, through direct contact or shared articles and most commonly affects the trunk, arms, or legs - In adults, sexually transmitted and affect the genitals, lower abdomen, buttocks, and inner thighs
87
How is diagnosis made for molluscum contagiosum?
- Characteristic clinical appearance of pearly, dome-shaped papules with a dimpled center
88
What are the TORCH infections?
- Toxoplasma - Other (syphilis, HIV, listeria, VZV, parvovirus B19) - Rubella - Cytomegalovirus - Herpes
89
What are the clinical presentations of the TORCH infections?
- Fever - Encephalitis - Chorioretinitis - Hepatosplenomegaly - Pneumonitis - Myocarditis - Hemolytic anemia - Skin lesion

Endo/Repro (31 decks)

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