Quiz 1 Flashcards
(127 cards)
1
Q
The vulva is prone to skin infections due to:
A
constant exposure to secretions, moisture, and friction.
it is also sensitive to hormonal influences.
2
Q
DNA poxvirus spread through direct contact or shared items like towels or clothing:
A
MCV - Molluscum contagiosum virus
4 types - MCV-1 is MC
high incidence in children
virus gone when lesions are gone
3
Q
Waxing and waning inflammatory skin dz with scaling red plaques with silvery scales:
A
psoriasis
4
Q
Histological findings of psoriasis:
A
marked elongation of rete pegs (hyper-proliferative)
marked hyperkeratosis
loss of granular layer
vascular dilatation
5
Q
non-specific skin condition that is a consequence of chronic pruritus and scratching:
A
lichen simplex chronicus
may lead to leathery, brownish appearance of skin
mb treated with anti-anxiety meds to stop scratching
6
Q
histology of lichen simplex chronicus:
A
thickened epidermis
leukocyte infiltration of the dermis
elongated/widened/thickened rete ridges
7
Q
skin condition that causes irritation, ulceration, erythema, soreness, burning, and raw areas - on the limbs, trunk, mouth, and vulva:
A
lichen planus
8
Q
histology of lichen planus:
A
degeneration of basal cell layer
thickening of granular cell layer
infiltration of inflammatory cells into sub-epithelial CT
saw-tooth appearance of rate ridges
9
Q
thickening of the skin of the vulva and peri-anal area which appears pale or white in color:
A
lichen sclerosus
10
Q
Which of these is associated with the greatest risk of vulvar cancer -
lichen planus
lichen sclerosis
lichen simplex chronicus
A
lichen sclerosus - up to 5% of pts
11
Q
histology of lichen sclerosis:
A
edematous degeneration of basal layer atrophy of epidermis disappearance of rete ridges dermis replaced by CT band-like lymphocyte infiltrates
12
Q
Bartholin’s cysts are (common/rare), occur MC in the (young/old/all ages), and result from (hyperplasia/obstruction/atrophy) of the ducts.
A
common
all ages
obstruction
13
Q
Bartholin’s cysts are lined by _________ epithelium or by epithelium that shows _________ __________. The predominant organism is:
A
transitional (normal)
squamous metaplasia
E. coli (infrequently gonococcal)
14
Q
Bacterial STI’s:
A
Chalmydia (chl. trachomatis)
Gonorrhea (Neisseria gon.)
Syphilis (treponema pallidum)
Chancroid (haemophilus ducreyi)
15
Q
Viral STI’s:
A
HSV 1 & 2 (herpes simplex) HIV HPV (human papilloma) Heb B & C MCV (molluscum contagiosum)
16
Q
Fungal STI’s:
A
candidiasis
17
Q
Parasitic STI’s:
A
lice (Pthirus pubis)
scabies (Sarcoptes scabieii)
18
Q
Protozoal STI’s:
A
Trichomoniasis (Trichomonas vaginalis)
19
Q
Smears from _______ lesions may reveal characteristic multinucleated giant cells.
A
Genital herpes (HSV)
the nuclei have a ground-glass appearance
mb nuclear inclusion bodies
20
Q
gross appearance of MCV:
A
umbilicated erythematous papules
21
Q
HPV strains responsible for 90% of genital warts:
A
6 & 11
22
Q
HPV strains associated with 70% of cervical cancer:
A
16 & 18
23
Q
Most easily recognizable sign of genital HPV infection:
A
genital warts
(condyloma acuminata)
most people who acquire HPV never develop sx
24
Q
Histology of HPV:
A
acanthosis (diffuse epidermal hyperplasia)
hyperkeratosis
cytoplasmic vacuolation
25
spiral-shaped, gram neg highly mobile bacterium (assoc w/syphilis):
treponema pallidum
26
Syphilis infection may be characterized by a (painful/painless) (chancre/chankroid).
Painless
| chancre
27
The 3 MC vaginal infections, accounting for 10M office visits per year:
bacterial vaginosis (BV)
trichomonas
candida
28
Vaginal infection characterized by no odor and low pH:
candida
29
Vaginal infection characterized by fishy odor and high pH:
BV
| trichomonas
30
The discharge assoc w/candida has a characteristic ________ appearance.
cottage cheese
31
The discharge assoc w/trich has a ________ appearance.
frothy
32
Commonly, the only symptoms of BV are:
| Histological findings:
discharge and odor
| clue cells - epithelial cells coated with bacteria "shimmering"
33
Characteristic histo findings of trich:
flagellates
34
Signature characteristic of neisseria gonorrhea:
| pathognomonic?
gram neg diplococci
NOT pathognomonic
35
Vulvar intraepithelial neoplasia (VIN) is characterized by:
the presence of hyper pigmented skin plaques
[varieties of colors - red, white, yellow, multi]
10-30% assoc w/a primary squamous neoplasm
36
More than 90% of all cases of VIN & assoc cancer contain DNA of which HPV strains?
16, 18, 31, 45
37
Vulvar carcinoma represents ___% of all genital cancers in women, the majority >____ yrs.
3%
| >60yrs
38
85% of vulvar carcinomas are:
SCC
39
The less common 15% of vulvar carcinomas are:
basal cell carcinoma
melanoma
adenocarcinoma
40
Vulvar tumors (assoc w/cancer) often reveal accumulation of:
p53 protein
[noted in papillary serous carcinoma]
41
T/F: Well differentiated vulvar carcinoma is typically positive for the presence of HPV.
FALSE!
Poorly differentiated reflects greater dysplasia, and is assoc with HPV.
42
Distal metastases of vulvar carcinoma typically involve:
lungs and liver
43
Why did adenocarcinomas of the vagina receive special attention?
Because of increased frequency of clear cell adenocarcinoma in young women whose mothers had been treated with diethylstilbestrol (DES) during pregnancy.
44
Histology of clear cell adenocarcinoma:
vacuolated clusters of tumor cells
| gland-like structures
45
5th most deadly cancer in women, worldwide:
cervical cancer (1st in developing countries)
[8th MC cancer of women in the US/2nd worldwide]
46
Cervical cancer risks:
* early age of 1st intercourse
* multiple sex partners
* male partner w/multiple prior sex partners
* persistent detection of high-risk HPV (high viral load)
* presence of cancer-assoc HPV strains
* exposure to OCP
* tobacco use
* history of STI
* multiple births
47
CIN stands for:
| and was developed to emphasize:
cervical intraepithelial neoplasia
the spectrum of cellular abnormalities in the development of cervical carcinoma; to standardize description, characterization, treatment
48
Mild dysplasia:
```
CIN1
LSIL (low-grade squamous intraepithelial lesions)
```
49
Moderate dysplasia:
CIN2
| HSIL
50
Severe dysplasia:
CIN3 (carcinoma in situ)
| HSIL
51
Term to describe cellular changes - enlarged nuclei, stains with a halo-like appearance:
koilocytosis
characteristic of ASC-US
atypical squamous cells of undetermined significance
52
Condition in which endometrial glands and stroma of the uterus are found and flourish outside the uterine cavity:
endometriosis
MC site - ovaries
53
Common symptoms and sequelae of endometriosis:
```
dysmenorrhea
chronic pelvic pain
dyspareunia
infertility
pelvic cysts
```
54
What is a "chocolate cyst"?
endometrioma - an ovarian cyst formed due to ectopic endometrial tissue that bleeds within the ovary. rupture may lead to peritonitis.
55
Ectopic endometrial tissue within the myometrium:
| appearance:
adenomyosis
thick, spongy myometrial wall (muscular layer of uterus)
leads to uterine enlargement and irreg bleeding
56
Inflammation or infection of the endometrium:
endometritis
57
MC cause of endometritis:
childbirth related - d/t retained placental fragments or iatrogenic infx during delivery or abortion
non-childbirth related mb PID
58
Acute endometritis is characterized by:
micro-abscesses or neutrophils within the endometrial glands
| majority of cases are poly-microbial
59
Gold standard for dx of endometritis:
endometrial biopsy
60
Chronic endometritis is characterized by:
plasma cells in the stroma
| [lymphs, eos, & lymphoid follicles mb seen]
61
Etiology of chronic endometritis:
infx (typically w/PID)
intrauterine growths
foreign body
tissue damage d/t radiation
1/3 have no identifiable etiology
62
Infx of the upper genital tract not assoc w/pregnancy or surgery:
PID - pelvic inflammatory dz
aka salpingitis - bc infx of oviducts is MC, and most sequalae result from destruction of tubal architecture.
63
MC cause of PID infx:
BACTERIA
also mb viral, fungal, or parasitic
64
rate of infertility 2° to PID:
1 in 4
also 6-10x greater risk of ectopic pregnancy
65
MC GYN cancer in the US:
```
endometrial cancer (adenocarcinoma)
35K diagnosed each year
```
66
Risk factors for endometrial cancer:
```
nulliparity
obesity (esp abd fat)
DM / hyperglycemia
HTN
peak age - 55-65
```
67
Histology to differentiate endometrial adenocarcinoma from hyperplasia:
Glandular architecture is preserved but the tissue is confluent without intervening stroma
68
Benign smooth muscle tumors of the uterus:
leiomyomas (fibroids)
found in the myometrium of the corpus
69
Gross appearance of leiomyomas:
```
discrete
well-circumscribed
round
firm
gray-white
vary in size
```
70
Histology of leiomyomas:
whorled pattern - characteristic
uniform muscle cell size/shape
oval nuclei
71
Histology of leiomyosarcoma:
```
greater density of cells
more pleomorphism
hyperchromatic
some cells w/irreg nucleus
spindle-shaped cells
```
72
T/F: leiomyosarcomas typically form from transition of leiomyomas.
FALSE
transition from the benign to the malignant is uncommon. leiomyosarcomas form independently.
73
PCOS can develop when the ovaries are stimulated to produce what?
Excessive amounts of male hormones [esp testosterone] by releasing excess LH from ant pituitary.
One of the MC female endocrine d/o's and causes of infertility.
74
Sx of PCOS:
```
hirsutism
acne
disrupted menses
infertility
insulin resistance
inc wt, cholesterol, trig, hyperglycemia
inc incidence of DM
```
75
Hallmark lab finding of PCOS:
LH > FSH 3:1 or higher
76
PCOS found in ___% of women presenting with anovulation.
5-10%
77
Ultrasound finding in PCOS:
"string of pearls" sign
78
Over 90% of ovarian cancers are classified as ________ and arise from __________________.
epithelial
| the surface of the ovary (or mb fallopian tubes)
79
Psammoma bodies are:
| and are associated with:
small calcifications in the ovaries
ovarian serous cystadenocarcinomas (and other cancers)
80
Ovarian germ cell tumors often called dermoid cysts:
ovarian teratomas
contain skin, hair, sebum, teeth
81
The absence of one or both testes from the scrotum:
Cryptorchism
MC birth defect of male genitalia
3% full-term male births
30% premature males births
2/3 unilateral
82
In ___% of cases of cryptorchism, an undescended testis can be palpated in the inguinal canal.
90%
the remaining minority - in abdomen or nonexistant
83
2nd MC male birth defect, urethra that involves an abnormally placed urinary meatus:
hypospadias
ventral line
1st degree - cosmetic
1st/2nd degree - surgical repair
3rd degree - test hormones, endocrine, karyotype; intersex?
84
Rare male birth defect involving urethral opening on the dorsum of the penis:
epispadius
also occurs in females
some of urethra extending beyond external tissue
possibly small or bifid phallus
85
Condition where foreskin cannot be fully retracted over the glans:
phimosis
86
Condition where foreskin becomes trapped behind the glans:
paraphimosis
87
T/F: Both phimosis and paraphimosis are considered risk factor for development of penile cancer.
True
88
An abnormal enlargement of the vein draining the testicles:
Varicocele
present in ~15% of adult male pop.
largely post-pubertal
incidence increases w/age
89
98% of idiopathic varicoceles occur on the (left/right).
Left - due to testicular vein connecting to left renal vein at 90deg, vs right testicular vein draining directly into IVC at less than 90deg.
90
Accumulation of fluids around a testicle caused by fluid secreted by the tunica vaginalis:
Hydrocele
91
Etiology of hydrocele:
```
trauma
hernia
orchitis
cancer
lymphatic impairement - via chronic infx, parasite
```
92
PE to differentiate hydrocele from tumor:
transilluminate (hydrocele WILL transmit light)
93
Condition that occurs when the spermatic cord twists, cutting off the blood supply to the testicle:
Testicular torsion
94
MC underlying cause of testicular torsion:
congenital malformation know as "bell-clapper deformity"
| typically surface rotates toward midline
95
In testicular torsion, ischemia may lead to necrosis in ____ hrs.
5-6 hours from onset of pain
may decompress spontaneously
absence of cremasteric reflex
96
Gonococcal urethritis is caused by:
Neisseria gonorrhoeae
GRAM-NEG DIPLOCOCCI!! :)
both intra- & extra-cellular
97
Non-gonococcal urethritis (NGU) is MC caused by:
Chlamydia trachomatis
gram-neg obligate intra-cellular bacteria
98
Triad of sx assoc w/reactive arthritis (Reiter's syndrome):
* inflammatory arthritis of large jts (SI, knees, back)
* inflammation of the eyes (conjunctivitis, uveitis)
* urethritis in men / cervicitis in women; mucocutaneous lesions
99
T/F: Reactive arthritis is positive for rheumatoid factor.
False
seronegative for RF
positive for HLA-B27
100
Reactive arthritis assoc. rash on the soles of feet:
keratoderma blennorrhagica
101
80-20 rule for HSV:
HSV 1 - 80% oral / 20% genital
HSV 2 - 20% oral / 80% genital
102
Approx US pop. positive for HSV 1 by 4th decade?
| HSV 2?
1 - 65%
| 2 - 25%
103
Characteristic histological finding in HSV:
| Latent in:
Multinucleated giant cells
HSV 1 - trigeminal ganglia
HSV 2 - sacral ganglia
104
Histopathology of syphilis:
Treponema pallidum spirochetes
Gross - keratotic lesions, granuloma
105
Genital warts are caused by:
HPV - 6 & 11
106
It is estimated that ____ new cases of HPV-assoc penile cancers are dx in the US each year.
95% are:
>1000
SCC
107
HPV prevalence in penile cancer:
| Predominant strain:
40%
16 - 63%
108
The MC solid tumor affecting males aged 20–35 yrs:
primary testicular cancer
showing a progressive inc over the past 2 decades
109
Testicular cancer classifications/prevalence:
Seminoma - 35%
Embryonal carcinoma - 20%
Teratoma - 5%
Mixed cell types - 40%
110
Avg age of dx of seminoma:
40 years old
MC - mass felt on self-exam / 10-14% have no palpable mass
111
Blood tests in seminoma reveal:
PLAP (placental alk phosphatase) - 50%
hCG mb elevated
serum alphafetoprotein - not classically elevated
112
Microscopic eval of seminoma usu reveals:
```
sheet-like or lobular pattern of cells
fibrous stromal network
abundant clear to pink cytoplasm
abundant glycogen
prominent nuclei w/ 1 or 2 lg nucleoli
prominent nuclear membrane
```
113
Germ cell tumor that occurs in the ovaries and the testes:
Embryonal carcinoma
Avg dx at 31 yrs
10% of testicular germ cell tumors
20-66% of pts have mets at dx
114
Serology of embryonal carcinoma:
mb elevated hCG & AFP
115
Histopathology of embryonal carcinoma:
```
sheets of cells
primitive tubules
crowded, pleomorphic nuclei
primitive epithelial cells
nuclear atypia, overlapping
prominent nucleoli
mitoses common
```
116
Encapsulated tumor with tissue or organ components resembling normal derivatives of all three germ layers:
Teratoma
while tissue found is "normal" it is often present in an unexpected location
117
Review three layers of germ cells:
Mesoderm: immature cartilage
Endoderm: G.I. lining cells/glands
Ectoderm: epidermis with keratin
118
An inc in the # of prostatic stromal & epithelial cells, resulting in formation of lg, discrete nodules in the periurethral region of the prostate:
BPH
when sufficiently large, nodules compress urethral canal, causing obstruction
119
T/F: Elevated PSA in BPH reveals an increased risk of cancer.
False.
BPH may elevate PSA levels, d/t organ volume, inflammation, and UTI, but does not increase cancer risk.
120
A normal prostate is ___ cm in diameter:
3-4 cm
121
BPH is extremely common in men over ____.
50
122
Gross appearance of BPH:
enlarged prostate gland
multiple nodules of varying sizes
nodes vary from solid to cystic
partial to complete urethral obstruction
123
Histopathology of BPH:
glandular > stromal tissue
glands well-differentiated
corpora amylacea - small laminated pink concretions
124
Histopathology of prostatitis:
numerous small dark blue lymphocytes in stroma, btw glands
125
T/F: Most prostate cancers are aggressive, fast growing, with lots of symptoms.
False. Although it is one of the most prevalent cancers in men, many remain asx, undergo no therapy, & die of other causes.
However, more aggressive prostate cancers acct for more cancer-related deaths in US men than any other cancer except lung.
126
95% of prostate cancers are found to be:
adenocarcinoma
127
T/F: prostatic hyperplasia is a premalignant lesion.
False
