Week 4 - "Silent Shadow" Flashcards
1
Q
What is pelvic inflammatory disease?
Microbiology
A
An infectious and inflammatory disorder of the upper female genital tract, including the uterus, fallopian tubes and adjacent pelvic structures
2
Q
What is PID complicated by?
Microbiology
A
Some are often complicated by sexually transmitted infections (STIs)
Or other infections like bacterial vaginosis that are not STIs
3
Q
Why is most of time PID left untreated?
Microbiology
A
Most of them are asymptomatic, and people do not know they are infected
4
Q
What can untreated PID cause?
Microbiology
A
Tissue scarring and abscess formation which damages the reproductive system:
1. Infertility
2. Chronic pelvic pain
3. Ectopic pregnancy
4. Tubo-ovarian abscess
5
Q
How is infertility a complication of PID?
Microbiology
A
Untreated PID might damage the reproductive system and dramatically increase the risk of infertility
6
Q
How is chronic pelvic pain associated with PID?
Microbiology
A
Lasts for months or years, scarring of the fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation
7
Q
How can ectopic pregnancies be a complication of PID?
Microbiology
A
The scar tissue prevents the fertilized eggs from moving through the fallopian tube to uterus
8
Q
A
8
Q
How can tubo-ovarian abscess be a consequence of PID?
Microbiology
A
Untreated abscesses in fallopian tubes and ovaries could develop into life threating infection
9
Q
What % of untreated STDs progress to PID?
Microbiology
A
Up to 20% of untreated STDs
–> Untreated STD infection + inflammation = PID
10
Q
What are the causative agents of primary PID?
Microbiology
A
Greater than 90% of PID cases are caused by Chlamydia rachomatis and Neisseria gonorrhea which are also the leading causes of STDs
11
Q
What is the most common STD agent?
Microbiology
A
Chlamydia trachomatis
12
Q
What is polymicrobial PID?
Microbiology
A
30 to 40% of cases, may begin as an isolated infection with N. gonorrhea or C. tachomatis which causes inflammation of the upper genitelia tract that facilitates the involvement of other pathogens
13
Q
What are soem other examples fo causative agents in polymicrobial PID?
Microbiology
A
Gardenerella vaginalis, Haemophilus influenzae and anaerobes such as Peptococcus and Bacteroides species.
14
Q
How many STDs are acquired everyday world-wide?
Microbiology
A
1 million every day
15
Q
What period of time was there a drastic icrease in gonorrhe cases and why?
Microbiology
A
Flower-power era, co-exusted with HIV epidemic
16
Q
What are the symptoms of most STDs like?
Microbiology
A
The majority of STDs have no symptoms or only mild symptoms that may not be recognized as an STD –> silent infections
17
Q
What is the relation between STDs (such as Gonorrhea, HSV 2and syphilis) and HIV?
Microbiology
A
Gonorrhea, HPV 2 and syphilis increase the risk of HIV acquisition
18
Q
What is a major threat to reducing the impact of STDs worldwide?
Microbiology
A
Drug resistance, espcially with gonorrhea
19
Q
What is the most common affected population of new STDs?
Microbiology
A
15 to 24 years of age
20
Q
What are the common agents for STDs? (10)
Microbiology
A
- Chlamydia trachomatis
- Nisseria gonorrhea
- Trichomonas vaginalis
- Treponema pallidum
- Mycoplasma genitalium
- Ureaplasma urealticum
- Hemophilus ducreyii
- HIV
- HPV
- HSV
21
Q
What is C. trachomatis like?
Microbiology
A
Gram negative tiny bacteria, obligate inracellular
–> live in eukaryotic cells to use energy sources and amino acids
22
Q
What are Ν. gonorrhea like?
Microbiology
A
Gram negative diplococci bacteria
Fastidious non-motile bacteria & strict human pathogen
23
Q
What is trichomonas vaginalis?
Microbiology
A
Parasite, protozoa
24
What are mycoplasma genitalium and ureaplasma urealyticum?
| Microbiology
Tiny bacteria without a cell wall
25
What is hemophilus ducreyii?
| Microbiology
Gram negative coccobacilli
26
What does chlamydia trachomatis cause?
| Microbiology
1. Silent infections (asymptomatic): urethritis in 50% of emn
2. Cervicitis infection: 60 to 75% of women do not show symptoms
3. Contageous STD and increase in HIV acquisition
27
What can untreated chlamydia cause?
| Microbiology
PID,
Infertility,
Ectopic pregnancy
28
How are Chlamydia trachomatis infections treated?
| Microbiology
Curable with antibiotics
29
What is the lifecycle of chlamydia trachomatis like?
| Microbiology
Biphasic with two unique forms of the organism
30
What are the two unique forms of the chlamydia bacteria during its lifecycle?
| Microbiology
Elementary body (EB)
Reticulate Body (RB)
31
What is the elementary body of chamydia trachomatis?
| Microbiology
Infectious, extracellular form, metabolically inactive, non-replicative form and has a rigid cell wall
32
What is the reticulate body of chlamydia lifecycle like?
| Microbiology
Non-infectious, intracellular, membrane-bound, no rigid wall, metabolically active and replicate by binary fusion
33
What virulnce factor does Chlamydia contain in the outer membrane?
| Microbiology
LPS but no peptidoglycan, Chlamydia LPS has very weak activity as an endotoxin and does not induce innate immunity --> thus asymptomatic/silent infections
34
What is the pathogenesis of Chlamydia?
| Microbiology
1. Attachment of elementary body to cell surface --> attached to sialic acid receptors on the surface of columnar epithelial cells
2. Internalization by endocytosis and inhibition of ednosome fusion to lysosome
3. Transformation from EB to RB form
4. Replication of RB form by binary fission --> until apoptosis is caused
5. Immune evasion
35
Why is there no vaccine against Chlamydia?
| Microbiology
Due to its antigenic variation --> subvert host defenses
36
What is the treatment for Chlamydia?
| Microbiology
Azithromycin or Doxycycline for 7 days
37
How can Chlamydia be diagnosed in a lab?
| Microbiology
Chlamydia is obligate intracellular tiny bacteria so it can:
1. Grow in tissue culture cell lines and not on agar plates
2. Stained for inclusion bodies
3. NAAT
4. EIA: Enzyme immune assay
38
What family does Chlamydia belong to?
| Microbiology
Chalmydiaceae family
39
How are Chlamydia infections acquired?
| Microbiology
Direct contact with mucous membranes like the case in sexual contact
40
What other diseases can Chlamydia lead to?
| Microbiology
Trachoma: inflammatory granulomatous process of eye surface
Adult inclusion conjuctivitis
Neonatal conjuctivitis
Infant pneumonia
Urogenital infections
Lymphogranuloma venereum
41
What can Gonorrhea cause?
| Microbiology
1. Sterility
2. PID (in women)
3. Sponteneous abortions and ectopic pregnancies
4. Enhanced HIV transmission
42
What can maternal transmission of Gonorrhea lead to?
| Microbiology
Blindness in newborns
43
What is the incubation period of Gonorrhea?
| Microbiology
2 to 10 days
44
Which gended has a higher rate of Gonorrhea cases?
| Microbiology
MEN
45
What is the health disparity among races?
| Microbiology
Looking at data, the incidence of disease is higher among low class populations, due to the lack of education and awareness
46
47
What is the pathogenesis of Gonorrhea?
| Microbiology
It induces robust innate immune resposnses but suppresses adaptive immunity (thus no vaccine has been developed yet)
48
49
How is Gonorrhea retrived?
| Microbiology
Viable in neutrophils from gonorrhea discharge
It can survive in macrophages
50
How does N. gonorrhea evade killing by host defences?
| Microbiology
1. Immune evasion
2. Virulenece factors
3. IgA protease
51
How does immune evasion of Gonorrhea help evade killing?
| Microbiology
Antigenic variation (which is the factor that allows for recurrence of the infection) of proteins expressed on the surface; modifications of bacterial targets like LPS
52
What are the virulenece factors of Gonorrhea?
| Microbiology
1. Fimbriae
2. Pilli
3. Porins (outer membarne proteins)
4. LPS (reduces phagocytosis)
5. Lactoferrin utilization
6. Antioxidant and detoxification system
7. Type IV secretion system
53
What is the role of type 4 secretion system as a virulenece factor in Gonorrhea?
| Microbiology
It secretes chromosomal DNA into the environment.
This released DNA facilitates horizontal gene transfer, increasing genetic diversity and antibiotic resistance.
54
How does IgA protease help Gonorrhea evade killing by host defense?
| Microbiology
Facilitates bacteria adherence to mucosa by blocking IgA antibodies
55
What kind of agar is used for Gonorrhea culture?
| Microbiology
Chocolate agar due to iron
56
What is the main site of gonococcal infections?
| Microbiology
Genital tract
57
What are examples of disseminated gonococcal infections?
| Microbiology
Gonococcal pharyngitis
Neonatal opthalmia
Purulent eye infection
Gonococcal skin papules
Gonococcal arthiritis
Rectal gonorrhea
58
Which antibitics in gonorrhea resistant to?
| Microbiology
Penicillin
Erythromycin
Fluoroquinolones
59
What is the causative agent of Syphilis ?
| Microbiology
Treponema pallidium
60
What is venereal syphilis?
| Microbiology
An STI with incubation period around 21 days, but can range from 10 days to 90 days
61
What type of agent is Treponema pallidium?
| Microbiology
A motile spirochete bacteria, gram negatve but very thin t stain, visible under fluorescence and dark field microscopy
62
What is the importance of the helical structure of Treponema pallidum?
| Microbiology
Allows it to move in a corkscrew motion through mucous membranes or enter minuscule breaks in the skin
63
What are the virulenece factors of Treponema pallidum?
| Microbiology
Hyalorunidase which attached to variety of cells: epithelail, endothelial and fibroblasts
64
What is primary syphilis?
| Microbiology
Primary lesion called chancre appears at the site of inoculation, usually perists for 4 to 6 weeks and then heals spontaneously.
65
How is the primary lesion of primary syphilis cleared?
| Microbiology
Macrophages phagocyte Treponema and clear the primary chancre butTreponeam can spread by blood and lymoh through out the body
66
What is secondary syphilis?
| Microbiology
Generalized, non-tender lymphoadenopathy, parenchymal, constitutioal and mucutaneous manifestations of secondary syphilis usually appear 6 to 8 weeks after then chancre heals
(skin rashes and mucosal lesions)
67
What is latent syphilis?
| Microbiology
Positive serologic tests for syphilis, together with a normal CSF examination anf the absence of clinical manifestations of syphilis
68
What is the only way to diagnose latent syphilis?
| Microbiology
Serology tests will come back positive
69
What can untreated syphilis lead to?
| Microbiology
Tertiary syphilis
70
What is tertiary syphilis?
| Microbiology
Hyperimmune response that affects many organs including the skin. Treponema can move to the blood stream, spinal fluid and to other internal organs very rapidly via its internal flagella
71
What can tertiary syphilis lead to?
| Microbiology
Neurosyphilis (syphilis in CNS)
Aortitis/carditis
Gummas/skin lesions
72
What are gummas?
| Microbiology
Solitary lesions ranging from microscopic to several centimeters in diameter. They produce indolent, painless, indurated nodular or ulcerative lesions that may resemble other chronic granulomatous conditions, including TB, sarcoidosis, leprosy, and deep fungal infections
73
Why can Treponema not be cultured?
| Microbiology
It is fastidious and very sensitive
74
What are the diagnostic approaches to Syphilis?
| Microbiology
NAAT and sensitive PCR
Serologic testing
75
How is syphilis treated?
| Microbiology
Penicillin
76
What are the two types of serology used for syphilis?
| Microbiology
Nontreponemal and treponemal
77
What is the most widely used non-treponemal antibody test used for syphilis?
| Microbiology
Rapid plasma reagin and venereal disease research laboratory tests --> measure the IgG and IgM directed against the cardiolipin-lecithin-cholesterol antigen complex
78
What are treponemal tests used for?
| Microbiology
To measure antibodies to native or recombinant T pallidum antigens and include the FTA-ABS tests, and the TPPA test
79
What are the subspecies of Treponema pallidum?
| Microbiology
1. Treponema pallidum subspecies pallidum --> Syphilis STD
2. Treponema pallidum sbspecies carateum --> Pinta
3. Treponema pallidum subspecies endemicum --> Bejel (rare)
4. Treponema pallidum subspecies pertenue --> Yaws (rare)
80
What does hemophilus ducreyi cause?
| Microbiology
Chancroid
81
What is Chancroid?
| Microbiology
An STD characterized by genital ulcers and enlarged regional lymph nodes
The esion are similar to those caused by Siphylis but they are painful
They increase the risk of HIV
82
What is hemophilus ducreyi like?
| Microbiology
Gram negative coccobacili bacteria
83
How is Hemophilus ducreyi diagnosed?
| Microbiology
Culture or chocolate agar
Diagnosed by biochemical test
PCR and NAAT
84
What is the treatment for hemophilus ducreyi?
| Microbiology
Erythromycin
Trimethoprim - sulfamethaxazole orally x 10
OR
Amoxycillin-clavulan (augmentin) x7
85
What is mycoplasma genitalium?
| Microbiology
The main cause of non gonococcal urethritis (NGU), mucopurulent cervicits, endometritis and PID
They are tiny bacteria that lack a cell wall and infect ciliated epithelial cells
86
What are examples of mycoplsma genitalium virulence factors?
| Microbiology
The ability to adhere to host epithelial cells using the terminal tip organelle with its adhesins, the release of enzymes and the ability to evade the host immune response by antigenic variation
87
What does ureaplasma urealyticum cause?
| Microbiology
Non-gonococcal urethritis (NGU), renal calculi, neonatonal abscesses
88
What are ureaplamsa urealyticum?
| Microbiology
They are tiny bacteria that lack a cell wall and infect ciliated epithelial cells
89
What is the main virulence factor of ureaplasma urealyticum?
| Microbiology
The hydrolization of urea
90
What agar is specific to uregenital mycosplasma and ureaplasma?
| Microbiology
A7 agar --> shows fried egg colony morphology
91
What does Trichomonas vaginalis cause?
| Microbiology
Trichomoniasis, asymptomatic silent infection in 70% of the cases
92
What is trichomonas vaginalis?
| Microbiology
Anaerobic flagellated protozoan parasite
93
WHat are the symptoms of trichomonas infection?
| Microbiology
In females: strawberry cervix, itching and pain
In males: burning sensation and itching
94
What are important viruence factors of trichomonas parasite?
| Microbiology
Fagella and undulating membrane to allow for motility
95
What is the treatment for the trichomonas vaginalis protozoan?
| Microbiology
Metronidazole
96
What does brown discharge indicate?
| Microbiology
No infection, tends to be normal during menstrual cycle
97
What does white thick, creamy and clumpy discahrge indicate?
| Microbiology
Yeast infection
98
What does yellow discharge indicate?
| Microbiology
STDs (trichomonas, chlamydia, gonorrhea)
99
What does green discharge inidicate?
| Microbiology
STDs (trichomonas, gonorrhea, chlamydia)
100
What does smelly discharge indicate?
| Microbiology
STD (trichomonas) or bacterial vaginosis
101
What does pink discharge indicate?
| Microbiology
Cervical or endometrial cancer, vaginal infection (BV) or cervical erosion
102
What does orange discharge indicate?
| Microbiology
Vaginal infections
103
What are clue cells and what do they indicate?
| Microbiology
They are vaginal cells with bacteria stuck to them, they provide us with a clue hat there is something abnormal --> bacterial vaginosis
104
What is the vaginal microbiome like?
| Microbiology
It consists of many species of bacteria, viruses and yeast that colonize the vagina
105
Which is the dominant species of the vaginal microbiome?
| Microbiology
Lactobacillus species are the dominant colonizing bacteria in health adult women
106
What is reduced number of Lactobacillus indicative of?
| Microbiology
Increased vaginal pH and altered vaginal microbiome (dysbiosis)
107
108
What is the normal pH environment of the vagina like?
| Microbiology
Both the environmnet and the fluid are acidic
109
What pH do Lactobacilli thrive in?
| Microbiology
Low pH, below 4.5
110
What are the Lactoboacillus bacteria like?
| Microbiology
Gram positive bacilli, faculative anaerobic, non-spore forming bacteria
111
What do Lactobacilli produce?
| Microbiology
1. Lactic acid from sugars through fermentation --> contributes to low vaginal pH --> other bateria cannot thrive at low pH so protects from infections
2. Hydrogen peroxide (H2O2) which kills other bacteria
3. Bacteriocins that kill other bacteria
112
Where else are lactobacilli bacteria found in the body?
| Microbiology
Digestive system
Urinary system
Genital system
113
When does lactobacilli dominance develop?
| Microbiology
In adult women during child-bearing age
114
What is the environment/diversity of the vaginal microbiome in prepubertal girls and postmenopasual women?
| Microbiology
Increased diversity --> thin vaginal mucosa --> low levels of glycogen --> low activity of lactobacilli --> high pH --> diverse environment
115
How does a low pH allow for lactobacillus dominance?
| Microbiology
Low pH --> thick vagina mucosa --> deposition of glycogen --> more glycogen metabolized by lactobacilli into lactic acid (for energy) --> low pH --> bacteria cannot survive --> lactobacillus dominance
116
What is the effect of Lactobacilli towards pathogenic microorganisms?
| Microbiology
It has been shown to inhibit in vitro growth of pathogenic microorganisms --> any alterations in the vaginal environment would allow for such microorganisms to thrive and ths cause an infection
117
Is bacterial vaginosis a strictly STD related infection?
| Microbiology
No, it can be due to an alteration (dysbiosis is the enviornment) of any nature
It does increase the risk of STDs though
118
What is bacterial vaginosis?
| Microbiology
Bacterial infection that is not STDs, caused by imbalance in the maount of bacteria in the vagina
It does not cause dysuria, dyspareunia, pruritus or vulvar inflmmation
119
What are common agents that cause bacterial vaginosis? (8)
| Microbiology
Gardenerella vaginalis
Prevotella
Mobiluncus
Bacteroides
Peptococcus
Fusobacterium
Veillonella
Eubacterium
120
What is the most common cause of bacterial vaginosis?
| Microbiology
Gardenella vaginalis
121
What is Gardenella vaginalis like?
| Microbiology
Gram variabe coccobacilli, faculative anaerobic bacteria that grow on blood and chocolate agar as tint colonies
122
What are the characteristics of normal healthy vaginal discharge?
| Microbiology
Healthy cervicovaginal mucosa and a small amount of oforless, clear like vaginal discharge
123
What is vagina discharge like in the case of bacterial vaginosis?
| Microbiology
Heavy, milky, homogenous vaginal discharge with bublles of gaseous by-products of anaerobic bacteria, fishy odor
124
What is the microscopic results of bacterial vaginosis?
| Microbiology
Vaginal epithelial cells covered by coccobacilli --> a feature of clue cells
125
What infection shows up as yellow-green-gray discharge?
| Microbiology
Trichomoniasis
126
How is bacterial vaginosis diagnosed?
| Microbiology
Microscopic examinations (wet mount) of vagina discharge swabs to inspect the presnec of clue cells
Vaginal swabs are also cultred for microbiological investiagations
127
Which criteria are used to classify bacterial vaginosis?
| Microbiology
Nugent Scoring System
Amsel
128
What are the classifications of the Nugent Scoring System?
| Microbiology
Lactobacillus morphotypes
Gardenella and Bacteroides morphotypes
Curved gram-variable rods
129
What are the criteria of teh Amsel criteria?
| Microbiology
1. Thin, white, yellow, homogeneous discharge
2. Clue cells
3. pH of vaginal fluid > 4.5
4. Release of fishy odor
130
What are the characteristics of vaginal discharge in BV?
| Microbiology
Grey, homogenous, amine odor
131
What are the characteristics of vaginal discharge in gonorrhea?
| Microbiology
Greenish yellow, mucopurulent, odorless
132
What are the characeristics of vaginal dischage in chlamydia?
| Microbiology
Greenish yellow, purulent, odorless
133
What are the characteristsics of vaginal discahrge in Trichomonas?
| Microbiology
Grayish yellow, purulent, often mixed with bubbles, amine odor
134
134
WHat are the characteristics of vagina discahrge in candida?
| Microbiology
Whitish, cottage cheese-like consistency, odorless
135
WHat are the characteristics of vaginal dischareg in lactobacillus overgrowth?
| Microbiology
WHite, pasty, odorless
136
What are the characteristics of vaginal discahrge in treponema?
| Microbiology
Chancre ulcer no discharge
137
What are teh characteristics of vaginal discharge in hemophilus ducreyii?
| Microbiology
Typica chancroid ulcer, if severe infection vaginal discharge may be observed
138
What is cytolytic vaginosis?
| Microbiology
The overgrowth of lactobacilli bacteria, resulting in acidity and irritation
139
140
What are the signs of cytolytic vaginosis?
| Microbiology
Moderate to profuse discahrge which is usally white, thick, pastry and odorless
Itching
Burning
Pain
Irritation
141
How is cytolytic vaginosis diagnosed?
| Microbiology
MIcroscopic examinations
142
What is the treatment for cytolytic vaginosis?
| Microbiology
Treated with a baking soda rinse solution
143
What is vaginal candidiasis caused by?
| Microbiology
candida species, mainly Candida albicans
144
What are the symptoms of yeast infection, like the one cause by candida?
| Microbiology
Fungal infections, irritation, swelling, vaginal itching, and cheesy white vaginal discharge
145
What is herpes simplex virus?
| Microbiology
STI caused by HSV 1 and 2
146
How is HSV transmitted?
| Microbiology
Direct contact only
147
What is the incubation period of HSV?
| Microbiology
About 4 days
148
What are the symptoms of herpes simplex virus?
| Microbiology
Itchy, painful vesicles when burst form a painful ulcer
149
What kind of virus is HSV?
| Microbiology
Enveloped DNA virus taht can stay latent in human host
150
What is HPV?
| Microbiology
The most common sexually transmitted viral infection in the US
151
What are most HPV infections like?
| Microbiology
Asymptomatic and resove spontaneously
Can cause skin and plantar warts and geniral warts
152
What kind of virus is HPV?
| Microbiology
DNA virus from the papillomavirus family
153
Which cancer is associated with HPV?
| Microbiology
Cervical cancers due to HPV 16 and 18
154
What do the genital warts look like in HPV cases?
| Microbiology
Small bumps or group of bumps n the genital area, they can be small or large, flat or raised or shaped like a cauliflower
155
What are the common causes of genital warts? (HPV subtypes)
| Microbiology
HPV 6 and 11
156
What are the common causes of skin warts? (HPV subtypes)
| Microbiology
HPV 1 and 2
157
Which STIs can be transmitted transplacentally?
| Pharmacology
Treponema Pallidum
158
Which STIs can be transmitted during delivery from th emother to the child?
| Pharmacology
N. gonorrhea
159
How are bacterial STDs cured?
| Pharmacology
Antibiotics treatment is detected eraly enoug
160
What is the general aim of treatment in STDs?
| Pharmacology
To resolve symptoms and prevent complications and prevent risk of transmission and re-infection
161
162
What is different about the treatment of viral vs bacterial STDs?
| Pharmacology
Vira STDs cannot be cured even if detected early, unlike bacterial, their symptoms can ony be managed
163
164
How can we determine effectiveness of a drug?
| Pharmacology
Monitoring the levels of infection before and after treatment --> drug resistance problems can also be fetected this way
164
165
What is Acyclovir?
| Pharmacology
The prototype of synthetic nucleoside analogs
165
How is HSV infection transmitted?
| Pharmacology
Seual contact including oral sex or perinatally from mother to child
165
What is the treatment for primary HSV?
| Pharmacology
Oral antiviral therapy within 72 hours of lesion appearnce --> decrease in duraction and severity of illness by days to weeks and decreases in the risk of complications (like meningitis)
166
What are examples of antiviral agents that can be used to treat primary HSV?
| Pharmacology
1. Acyclovir (Zovirax)
2. Famciclovor (Famvir)
3. Valacyclovir (Valtrex)
167
Which is the antiviral drug of choice when it comes to treatment of primary HSV?
| Pharmacology
Acyclovir, becuase it is cheaper
168
What is the MOA of Acyclovir?
| Pharmacology
Inhibits viral DNA replication by acting as a false substrate for DNA polymerase, DNA poymerase is blocked and thus assembly of DNA stops
169
What is Valacyclovir?
| Pharmacology
A prodrug of ACV with higher bioavailability (50 to 60%)
170
What is Famciclovir?
| Pharmacology
A prodrug of penciclovir, bioavailability of 70%
Its active triphosphate form is more stable than that of Acyclovir in HSV-infected cells, longer duration of action
171
WHy is higher bioavailability a feature that we desire in pharamcological treatments?
SHortest doasge --> longest duration --> better compliance and less long term risks
172
What changes are made to he dosage if the HSV+ atient is also HIV+?
| Pharmacology
Dosage has to be higher
173
174
WHat are the side effects of Acyclovir?
| Pharmacology
Quite safe drug
Nausea, vomiting, headache and fatigue
Long term effects of high dosaeg can lead to neurotoxicity --> in elderly (confusion, tremors) and seizures
175
How are antivirals excreted?
| Pharmacology
Renal excretion so caution in case of renal impairement --> reduction of dosage may be required
176
How can antiviral therapy be optimised through the choice of drug?
| Pharmacology
For instance in patients with HIV as well as HSV, instead of bi valacyclovir (500 mg) we can give once Famciclovir (1000 mg)
--> Point is trying to find alternatives that allow for better compliance by being taken once daily
177
What happens during the initial phase of infection of Syphillis?
| Pharmacology
The organism (treponema pallidum) disseminates widely, setting the stage for subsequent manifestations (primary, secondary and tertiary phases)
178
Why is early treatment important is Syphilis infections?
| Pharmacology
If untreated, syphilis can have a number of significant late manifestations, including cardiovascular, gummatous and neurological
179
What is the drug of choice for syphilis treatment?
| Pharmacology
Parenterally-delivered Penicillin G for all sages of syphilis, dosage may ony change depending on the stage of syphilis
180
What is Penicillin G?
| Pharmacology
A beta lactam --> acts as a cell wall inhibitor
181
Who is penicillin therapy effective towards in the treatment of syphilis?
| Pharmacology
Treating maternal disease, preventing transmission to the fetus and also treating established fetus disease --> in addition to normal patienst suffering from syphilis
182
Which antibiotic types are indicated for the treatment of syphilis in the case the patient is allergic to penicillin?
| Pharmacology
Tetracyclines (Doxocycine)
3rd generation cephalosporine (Ceftriaxone) --> if allergy is not severe
183
What is the treatement of syphilis in prgenancy?
| Pharmacology
Desensitize and administer Penicillin G benzthine as a regimen of choice
AVOID Tetracyclines -->> teratogenic (affect bone development)
184
What is Benzylpenicllin benzathine?
| Pharmacology
Combination of penillin G with benzanthine
185
186
What is the purpose of benzanthine componenet in benzypenicillin benztahine?
| Pharmacology
It slowly releases the penicillin making the combination long acting and very effectiev against T. pallidum's slow growth rate
187
How is Benzypenicillin Benztahine administered?
| Pharmacology
IM in the buttocks or thigh region
188
WHat is the drug of choice when it comes to the treatment of syphilis?
| Pharmacology
Benzylpenicillin benzathine as it allows for prolonged antibiotic action (1 IM dose every 2 to 4 weeks)
Also wide therapeutic range --> safe
189
What are the side effects of Penicillin G Benzathine?
| Pharmacology
Hypersensitivity reactions (rashes to anaphylaxis)
Jarisch Herxheimer reactions
190
What are Jarisch Herxheimer reactions?
| Pharmacology
An inflmmatory recation to endoroxin-like products rleased by the death of the microorgansm during antibiotic treatment
191
How do Jarisch-Herxheimer reactions manifest?
| Pharmacology
A few hours after the first dose of antibiotic as fever, chills, hypotension, headache, tachycardia, hyperventilation, vasodialtion, myalgia, exacerbation of skin lesions
192
What are alternative treatment regimens for syphilis?
| Pharmacology
Doxocycine (tetracycline)
Ceftriaxone (3rd generation cephalosporin)
Amoxicillin & probenecid
193
Why is probenecid given with Amoxicilln in the treatment of syphilis?
| Pharmacology
It prevents renal excretion of penicllins by competing with the organic transporter in the peritubular capillaries that excretes them from the bood --> longer duration of action and reduced dosing frequency
194
How is neurosyphilis treated?
| Pharmacology
Neurosyphilis is the ate stage syphilis that has impacted the neurological function
IM Benzathine penicillin is ineffective becuase it does not cross the BBB
Instead iV treatment is preferred
195
Why is IV treatment of neurosyphilis preferred over IM?
| Pharmacology
The dose of IM benzanthine that is administered for other stages of syphilis does not produce measurabe CSF levels of drug, aqueous IV peniocillin has more chances of passing through the BBB
196
What are the approaches when treating Gonorrhea?
| Pharmacology
Treatment should :
1. Be highly effective at all anatomic sites of infection
2. Be well tolerated
3. Offer the feasibility of single-dose therapy
The selation of the actual regimen is based on drug resistance and the presence of co-pathogens
197
What are some examples of co-pathogens of Gonorrhea?
| Pharmacology
Chalmydia
Trachomatis
Mycoplasma genitallum
198
What is the drug of choice for Gonorrhea?
| Pharmacology
High dose of IM ceftriaxone as a single IM injection of 500mg or 1g (based on weight)
199
What are alternative treatment regimens to Gonorrhea?
| Pharmacology
Azithromycin plus gentamicin or gemifloxacin
200
When are alternative treatments for Gonorrhea used?
| Pharmacology
In patients who are severely allergic to cephalosporins
201
Which other STIs is Azithromycin also effective against?
| Pharmacology
Chlamydia which is a common co-pathogen of Gonorrhea, this way both can be treated
202
What is the goal of treatment when it comes to Chlamydia?
| Pharmacology
Prevent complicated infections related to Chamydia such as PID, infertility and ectopic pregnancies), decrease the risk of transmission, resolve symptoms and prevent re-infection
203
What is C. trachomatis susceptible to?
| Pharmacology
Tetracycline
Macrolides
Ony some Fluroquinolones
204
What is the preferred treatment for Chlamydia infections?
| Pharmacology
Doxocycline for seven days or Delayed release doxocycline which is just as effective and better tolerated
205
What is the alternative treatment for Chamydia?
| Pharmacology
Azithromycin or Levofloxacin
206
What is treatemennt of Chlamydia like in pregnancy?
| Pharmacology
Azithromycin or Amoxicillin, no Doxycycline because it is teratogenic
207
Why is treatment of Chlamydia important during pregnancy?
| Pharmacology
It prevents the transmission to infents during passage through the birth canal
208
What is the preferred treatment for trichomonas infection?
| Pharmacology
5-nitromidazole drugs like Metronidazole, tinidazole, secnidazole
--> single dose therapy is more convinient, oral > topical
209
What is Metronidazole?
| Pharmacology
A synthetic nitroimidazole
Antibitoc and antiprotozoal medication that is effective orally
210
What agents is Metronidazole effective towards?
| Pharmacology
Protozoa against Trichomonasvaginalis, amoebiasis, and giardiasis
211
What are common side effects of Metronidazole?
| Pharmacology
Nausea, metallic taste, epigastric distress/cramps and headaches
212
What should be avoided when taking Metronidazole?
| Pharmacology
Avoid alcohol as leads to disulfiram-like reactions
213
What is the MOA of Metronidazole?
| Pharmacology
Unionized metronidazole is intracellularly reduced to its active form leading to the production of toxic metabolites/reactive nitrosi radicals that damage DNA and proteins, inhibiting microbial nucelic acid synthesis and cell death
214
What medication is effective against Mycoplasma genitalium infections?
| Pharmacology
They have no cell wall --> so cannot targetted so penicillins and other beta-lactams are not useful
Usually susceptible to macrolides (Azithromycin)
215
What is the alternative treatment for Mycoplasma genitalium infectio?
| Pharmacology
Multi-dose doxycycline or moxifloxacin
216
What is PID like?
| Pharmacology
Usually a multi-agent disease, acute polymicrobial infections
217
What is the initial treatment of PID?
| Pharmacology
Combination parenteral regimen that provides antimicrobial coverage against a wide range of bacteria
E.g. Cefoxitin, doxycycline and metronidazole
218
When does the transition to oral therapy of PID happen?
| Pharmacology
After 24 hours of sustained clinical improvement, reflected by the resolution of symptoms
Doxocycline plus metronidazole
219
What is outpatient therapy of PID?
| Pharmacology
Single dose of IM of a long acting cephalosporin plus metronidazole
220
What is the treatment of vulvovaginal candidiasis?
| Pharmacology
Ora single dose of Fluconazole
Topical azole therapy (Clotrimazole, miconazole, terconazole)
221
What is the MOA of azole antifungals?
| Pharmacology
Inhibit ergosterol synthesis (principal in funga cell membrane) and inhibit cell membrane formation --> leads to cell leakage and death
222
What is the treatment of choice for the different STDs?
| Pharmacology
1. Syphilis: Benzathine penicillin
2. Gonorhhea: Ceftriaxone
3. Chlamydia: Doxocycline
4. Trichomoniasis: Metronidazole
5. Mycoplasma: Azithromycin
6. PID: Cephalosporin + Doxycycline + Metronidazoe
7. HSV: Acyclovir
223
Which bones does the bony pelvis consist of?
| Anatomy
2 hip bones
Sacrum
Coccyx
224
What are the bones that form the hip bones?
| Anatomy
Ilium
Ischium
Pubis
225
What are the anatomic features of the ileum?
| Anatomy
1. Lateral part of the pelvic girdle
2. The ala of the iulm forms the iliac crest
3. It connect with the ischium and the pubis and forms the superior part of he acetabulum
226
What are the anatomic features of the ischium?
| Anatomy
1. Posterior and inferior of the pelvic girdle
2. The ramus of the ischium connects with the inferior pubic ramus to form to ischiopubic ramus
3. Forms the inferoposterior part of the aetabulum
227
What are the anatomical features of the pubis?
| Anatomy
1. Anteriomedial part of the pelvic girdle
2. Articulates on the midline to form the pubic symphisis
3. The inefrior ramus connects with the ramus of the ischium to form theischiupubic ramus
4. The superior ramus forms the anterior part of the acetabulum
228
What is the pelvic outlet?
| Anatomy
The inferior opening of the pelvic, closed by funnel shaped muscle floor
229
Which muscles make up the floor of the pelvic outlet?
| Anatomy
Levator ani
Coccygeus
230
What are the sublayers of the evator ani?
| Anatomy
Puborectalis
Pubococcygeus
Iliococcygeus
231
What are the divisions of the true pelvis in males?
| Anatomy
Rectovesicular pouch (intraperitoneal fluid collection)
Pararectal fossa
Ischiorectal fossa
232
What are the divisions of the true pelvis in females?
| Anatomy
Rectouterine pouch (interperitoneal fluid and endometrial collections)
Vesicouterine pouch
Pararectal fossa
Ischiorectal fossa
233
What are the anatomical borders of the perineum?
| Anatomy
Posterior: tip of coccyx
Anterior: inferior borderof pubic symphysis
Lateral: Ischiopubic rami, iscial tuberosities, sacrotuberous ligaments
SUperior: pelvic floor (pelvis diaphragm, urogenital diaphragm)
Inferior: skin, superficial perineal (Colle's fascia)
234
Which ligament is associated with he anterior anatomica border f the perineum?
| Anatomy
Arcuate pubic ligament
235
What are the contents of the urogenital triangle in males?
| Anatomy
Penis
Scrotum (with testes and associated structures)
236
What are the contents of the urogenital triangle in females? (11)
| Anatomy
The vulva; including:
1. mons pubis,
2. labia majora,
3. labia minora,
4. clitoris,
5. vestibular
6. bulbs,
7. vulva vestibule,
8. Bartholin's glands,
9. Skene's glands,
10. urethra,
11. vaginal opening
237
What are the two subdivisions of the perineum?
| Anatomy
The urogenital triangle and the anal triangle
238
What are the contents of the anal triange?
| Anatomy
Anus
Ana canal
Ischioanal fossa
239
240
What is the pelvic floor?
| Anatomy
Fibromuscular section, inferior to the pelvic cavity
241
What is the function of the pelvic floor (diaphragm)?
| Anatomy
Prevent organ prolapse maintain urinary/fecal continence and separate the pelvic cavity from the peritoneum
242
What are the layers of the pelvic floor (from deep to superficial)?
| Anatomy
1. Pelvic diaphragm (floor)
a. levator ani
b. coccygeus (posterior to levator ani)
2. Urogenital diaphragm
a. deep transverse perineal muscle
b. urethral sphincter
3. Superficial perinea layer
a. ischiocavernosous
b. bulbocavernosous (male) & spongiosum (female)
c. external anal canal
d. superficial transverse perineal muscle
243
What do the openings in the pelvic floor allow passage for?
| Anatomy
Rectum
Vagina
Urethra
244
Explain the structures of pelvic diaphragm from a superior view? (image)
| Anatomy
Anal canal
Levator ani and sublyers
Anococcygeus body
Perineal body
Obtutaror internus
Obtutaor facsia
Coccygeus muscle
245
246
What is the obturator fascia?
| Anatomy
Space filled with fat lateral to the ana canal just below plevic diaphragm
247
What are the structures within pudendal canal? (Alcock's canal)
| Anatomy
Pudendal nerve
Internal pudendal artery and vein
248
What is the ischioanal (ischiorecta fossa)?
| Anatomy
Wedge-shaped space on each side of the anal canal
Extends from pelvic diaphgarm to the skin of ana region
249
What are the borders of the ischioanal fossa?
| Anatomy
Medially: soping levator ani muscle
external anal shincter
Laterally: obturator internus muscle & fascia
Ischium
250
What is the function of ischioanal fossae?
| Anatomy
Allows for expaansion at the rectoanal canal during defecation
251
What does ano-rectal mucosa damage lead to?
| Anatomy
Spread of infection into ischioanal fossa, such infections can spread in between sphicters and produce intersphincter fistulae (perianal fistulae)
252
What are the different types of abscesses that can be formed in the ischioanal fossa?
| Anatomy
1. Submucosa
2. Supralevator
3. Intersphincteric
4. Ischioanal
253
Where is the Pudendal canal (Alcock;s canal) found?
| Anatomy
In the lateral wals of the ischioanal fossa
254
What is the pudendal canal?
| Anatomy
Horizontal passage within the obturator internus fascia on the lateral wall of the ischioanal fossa
255
What is the main nerve innervation of perineum?
| Anatomy
Pudendal nerve (S2 to S4)
256
The pudendal nerve is a branch of?
| Anatomy
Sacral plexus in the pelvic cavity
257
How does the pudenda nerve exit the pelvic cavity?
| Anatomy
Through the greater sciatic foramen
258
How does the pudendal nerve enter the perineum?
| Anatomy
Lesser sciatic foramen
259
Which branches does the pudendal nerve give rise to?
| Anatomy
1. Inferior rectal
2. Perineal
a. Posterior scrotal/labial nerve
3. Dorsal nerve of penis / clitoris
260
What does the deep branch of the pudenda nerve supply?
| Anatomy
Superficial and deep transverse perineal muscle, bulbospongiosus, ischiocavernosus, sphincter of urethra, bulb of the penis, corpus cavernosum
261
What does the deep nerve of the penis or the clitoris supply?
| Anatomy
Corpus cavernosum, skin of penis or clitoris, vagina
262
What does the inferior rectal nerve supply?
| Anatomy
Externa anal sphincter msuce and skina round the anus
263
What does the superficial branch of the pudendal nerve supply?
| Anatomy
Skin of the scrotum or labia majora
264
What is the pudendal nerve block, why is it done?
| Anatomy
Anesthesia of the perineum during episiotomt can be obtained by injecting anesthetics via the vagina, into the pudenda canal to block the pudendal nerve
265
What are the branches of the internal pudendal artery? (6)
| Anatomy
1. Inferior rectal
2. Perineal
a. Posterior artery of scrotum/labia
3. Artery of bulb/vestibule
4. Urethral artery
5. Deep artery of penis/clitoris
6. Dorsal artery of the penis/clitoris
266
What are the perineal pouches? (from most deep to most superficial)
| Anatomy
1. Deep perineal pouch
2. Perineal membrane
3. Superficial perineal pouch
4. Perineal fascia
267
What structures does the deep perineal pouch contain?
| Anatomy
Urethra, external urethral sphincter, vagina, bulbourethral glands, deep transverse perineal musce
268
What is the perneal membrane perforate by?
| Anatomy
Urethra and vagina (females)
269
What does the superficial perineal pouch contain?
| Anatomy
Erectile tissue of penis and clitoris, ischiocavernosus, bulbospangiosis, superficial transverse perineal muscle, burtholoin glands
270
What are the sublayers of the perineal fascia?
| Anatomy
Deep: superficial perineal muscles, citoris/penis
Superficial: colle's fascia (continuous with scarpas on anterior abdomen)
camper's fascia
271
What are the exact contents of the superficial perineal pouch in males?
| Anatomy
1. Penile part of the urethra
2. Posterior scrota nerves, arteries and veins
3. Bulbospongiosus msucle
4. Ischiocavernosus muscle
272
What are the contents of the deep perineal pouch in males?
| Anatomy
1. Muscles of urogenital diaphragm
2. Membranous urethra
3. Dorsal nerve of the penis
4. Internal pudendal artery and vein
5. Bulbourethral glands
273
What are the contents of the superficial perineal pouch in females?
| Anatomy
Vagina
Urethra
Posterior labial nerves, arteries and veins
Greater vestibular gland (Barthaloin)
Bulbospongiosum
Ischiocavernosus
Cus of clitoris
Bulb of vestibule
274
Which pouch are the Bartholin gands located in?
| Anatomy
Superficial perineal pouch
275
What is the function of the Bartolin glands?
| Anatomy
They make a smal amount of mucus-like fluid to lubricate the vagina
276
What happens in Bartholinitis?
| Anatomy
The gland's duct gets blocked, mucus accumulates and forms a cyst
277
How are Barthlin cysts treated?
| Anatomy
Antibiotics
Cyst marsupialization
278
What are the contents of the deep perineal pouch in females?
| Anatomy
1. Muscles of urogenital diaphragm
2. Membranous urethra
3. Vagina
4. Dorsal nerve of the citoris
5. Interna pudenda artery and vein
279
What is the vagina?
| Anatomy
A muscular tube that extends upwards and backwards from the vulva to the uterus
280
How long is the vagina?
| Anatomy
8cm
281
What is the vagina penetrated by anteriorly?
| Anatomy
Uterine cervix
282
What is the normal pH of the vagina?
| Anatomy
4 to 4.5
283
What is the vaginal lumen devided into?
| Anatomy
4 Forinces: anetrior, posterior and 2 lateral
284
What is a vaginal forinx?
| Anatomy
Recess between the vagina nad the cervix
285
What is special about the posterior forinx?
| Anatomy
It is the deepest and lies below the rectouterine puch
286
What is the hymen of the vagina?
| Anatomy
A membrane that partiallycovers or surrounds the vaginal opening
287
What does hymen artesia lead to?
| Anatomy
Causes compete occlusion of the vagina, which obstructs blood flow at menarche, causing primary amenorrhea
288
What is the blood supply of the vagina?
| Anatomy
Vaginal artery from the inferior inguinal
Vaginal branch from the uterine artery
289
What are the relations of the vagina?
| Anatomy
Anterior: urethra and bladder
Posterior: rectum and anal canal
Superior: rectouterine pouch
Distal: pelvic floor and vulva
290
What is culdocentesis ?
| Anatomy
Checks for abnorma fluid in the abdominal cavity behind the uterus, accessed from the posterior fornix
291
What are the histological layers of the vagina?
| Anatomy
Lamina epithelialis
Lamina propria
Tunica muscularis
292
What is the epithelium of the vagina?
| Anatomy
Stratified squamous non keratinized
293
What is the tunica mucosa layer of the vagina like?
| Anatomy
The cells of nob-keratinized stratified squmous become filled with glycogen to manage activity
Thin walled veins of the mucosa and muscuar layers exude fluid into the epithelium
294
What is the tunica muscularis layer like?
| Anatomy
Has bundles of smooth muscle arranged in a circular manner near the mucosa and longitudially near the adventitia (inner cicrular, outer longitudinal)
295
What is the tunica adventitia of the vagina like?
| Anatomy
A coat of dense connective tissue rich in thick elastic fibers
1. Inner later of dense connective tissue
2. Outer layer of loose connective tissue
296
What is atrophic vaginitis?
| Anatomy
A condition in which the tissues lining the inside of the vagina become thin, dry and inflammed
297
What is vaginal epithelium dependnent on?
| Anatomy
It is hormone dependent, depends on hormones like estrogen
Atrophic vaginitis is triggered by decreased estrogen levels
298
What is the consequence of thinning of the vaginal epithelial lining?
| Anatomy
Vagina is more prone to infections
299
What is the lining of exocervix?
| Pathology
Non keratinizing stratified squamous epithelium
300
What is the lining of the endocervix like?
| Pathology
Simple columnar mucus secreting cells
301
What is the junction between exocervix and the endocervix called?
| Pathology
Squmocolumnar junction
302
What is the transformation zone?
| Pathology
The area where columnar epithelium abuts squamous epithelium
303
What is cervicitis?
| Pathology
Inflammatory conditions the cervix associated with a purulent vaginal discharge
304
305
306
307
What are the classifications of cervicitis?
| Pathology
Acute, chronic, infectious and non-infectious
308
What are the causative agents of infectious cervicitis?
| Pathology
Strep
Staph
Entercoccus
E. coli
Candida
STDs (Chlamydia, gonorrhea, HSV, HPV and trichomonas)
309
What are the causes of non-infectious cervicitis?
| Pathology
Irritation (perhaps from birth control devices)
Allergies (eg. latex rubber)
Hormonal imbalance
310
What is acute cervicitis caused by?
| Pathology
Usually caused by staph or strep
311
When is acute cervicitis commonly seen?
| Pathology
During the postpartum period
312
What are the characteristics of acute cervicitis?
| Pathology
Extensive infiltrate of polymorphonuclear leukocytes and stromal edema
313
When is chronic cervicitis commonly seen?
| Pathology
DUring reproductive years
314
What is chronic cervicitis?
| Pathology
Inflammation but severe enough to produce mucosal damage with hemorrhage
315
What are the characteristics of chronic cervicitis?
| Pathology
Hyperplasia and reactiv changes in both squamous and columnar mucosa
Eventually: columnar epithelium undergoes squamous metaplasia
316
What is HPV cervicitis?
| Pathology
Sexually transmitted DNA virus infection, usually infects lower genital tract --> espcially cervix (transitional zone)
317
What is the risk associated with persistent HPV cervicitis?
| Pathology
Increased risk for cervical dysplasia --> CIN/SIL
318
What is CIN/SIL?
| Pathology
Cervical Intrepithelial neoplasia also known as squamous intraepithelial lesion
--> A spectrum of intraepithelial changes that begin with minimal atypia and progress through stages of more marked intraepithelial abnormalities to invasive squamous cell carcinoma (precursor for cervical cancer)
319
What makes CIN/SIL high risk?
| Pathology
The type of HPV that is affecting the patient
320
Which are the high and low risk HPV types?
| Pathology
High risk --> 16 and 18 (31, and 33 as well)
Low risk --> 6 and 11 (genital warts, condylomas)
321
What are the risk factors of CIN?
| Pathology
1. Early age of first sexual intercourse
2. Mutiple sexual partners
3. Male partner with multiple previous sexual partners
4. Persistant infection by high risk stains of HPV
322
What are co-risk factors of CIN?
| Pathology
1. Immune status (whether the patient is immunocompromised or not)
2. Co-infection with other sexuallt transmitted agents (gonorrhea or chlamydia)
3. Smoking
4. Low social economic class
5. OCPs
323
How are OCPs a co-risk factor of CIN?
| Pathology
They change the susceptibility of cervical cells to reinfection of high risk HPV strains
324
What is the pathogenesis of CIN/SIL?
| Pathology
1. Sexual activity
2. HPV
3. Basal cell of squamous epithelium
4. Episomal DNA replication
5. High or Low risk strains
6. If high risk: integration into cellular genome
7. E6 binds to p53 and E7 binds to Rb --> both inhibit their functions inactivating tumor suppressor genes
8. Inhibition of apoptosis --> continuous proliferation --> high grade intraepithelial lesions
9. Invasive carcinoma
325
What is the CIN grading like?
| Pathology
CIN 1 --> mild dyspasia (involves less than 1/3 of the thickness of epithelium)
CIN 2 --> moderate dysplasia (invoves less than 2/3)
CIN 3 --> severe dysplasia (involves slightly less than the entire thickness
326
What is the Bethesda system?
| Pathology
Low and High grade SIL
327
What is LSIL like?
| Pathology
Conditions that should rarely progress in severity and commonly reress and disappear --> equivalent to CIN 1
328
What is HSIL?
| Pathology
Corresponds t more severehistologic lesions (CIN 2 and 3)
Tend to progress an require treatment
329
What is the morphology of CIN like?
| Pathology
1. Koilocytic changes (immature squamous cells with dense irregularly staining cytoplasm and perinuclear clearing --> halo),
2. disordered cell maturation,
3. nuclear enlargement,
4. hyperchromasia and atypia,
5. coarse chromatin and increased mitotic activity
330
What is CIS?
| Pathology
Involves the entire thickness of the epithelium
331
What is the relationship between garding and progression?
| Pathology
The higher the grading of dysplasia --> the more ikely it will progress to carcinoma and less likely to regress
332
What are the different techniques of screening for CIN/SIL?
| Pathology
Pap Smear (convectional or liquid base)
HPV Molecuar testing (high risk strains)
Co-testing
333
What is the aim of screening for CIN/SIL?
| Pathology
Can be detected early and thus prevented from progressing into carcinoma
334
What can be seen in a Pap smear?
| Pathology
Different types of squamous cells and different types of endocervical glandular cells
335
What are the limitations of pap smears?
| Pathology
1. Sampling error (inadequate sampling of transformation zone)
2. Interpretation error
3. Difficulty in identifying glandular abnormality
4. A Pap smear is a screening and not a diagnostic test
336
What are the steps following an abnormal pap smear?
| Pathology
Followed by HPV DNA testing and colposcopy
337
What is the purpose of colposcopy?
| Pathology
We visualize the cervix by magnifying lens, apply acetic acid and take biopsy from abnrormal cells which have picked up the dye
338
What are the different treatment options of CIN II and III?
| Pathology
Cryosurgery
Conization
339
What are ways of preventing CIN/SIL?
| Pathology
Vaccines which have been created and they specifically target high risk strains
Gardasil, Gardasil 9 and Cervarix
340
When is the optimal time to take the HPV vaccine?
| Pathology
Prior to an individual's sexual debut
341
Why should HPV vaccines be given to both males and females?
| Pathology
In females, to prevent and in males because they can be carriers who spread it
342
Why should vaccinated females still be screened for HPV?
| Pathology
Vaccines do not cover all high risk subtypes of HPV
343
What is the target population of cervical carcinomas?
| Pathology
Middle age women --> around the age of 45
344
What do cervical carcinomas present as?
| Pathology
Vaginal bleeding (post coital bleeding) or discharge (leukorrhea), dyspareunia and dysuria
Advanced cases: hydronephrosis due to tumor extension to ureter
345
What is the key risk factor for cervical carcinomas?
| Pathology
Persistent HPV infections
346
What are co-risk factors of cervical carcinomas?
| Pathology
1. Immunodeficiency (HIV)
2. Co-infections
3. Smoking
347
What are the most common subtypes of cervical carcinomas?
| Pathology
Squamous cel carcinoma
Adenocarcinoma
Adenosquamous
Small cell neuroendocrine carcinoma
348
What is the gross appearance of squamous cell carcinoma?
| Pathology
Friable mass protruding from the cervix
349
What is the histological appearance of squamous cell carcinoma?
| Pathology
Nests and sheets of epithelial cells with squamous differentiation in subepithelaila region invading the stroma
Keratin pearls
350
What is the prognosis of cervical cancer like?
| Pathology
Prognosis depends on:
1. Stage TNM
2. Type of cancer (adenosquamous and neuroendocrien are worse)
351
What are the treatment options for cervical cancer?
| Pathology
Early: surgery (remova of uterus)
Advanced: radiation and chemotherapy
352
What are endocervical polyps?
| Pathology
Benign polypoid masses seen protruding from the endocervical mucosa
353
What are endocervical cysts composed of?
| Pathology
Cystically dilated spaces filled with mucinous secretions
354
WHat is the surface epithelium of endocervical polyps like?
| Pathology
Mucus secerting columar cells with edematous stroma and scattered mononuclear cells
355
What is the endocervical polyp like if it superimposed with chronic inflammation?
| Pathology
Squamous metaplasia and ulcerations
356
357
What are the symptoms of endocervical polyps?
| Pathology
They may bleed --> No malignant potential
358
What are Bartholin cysts?
| Pathology
Cystic dilation of Bartholin gland
359
What are bartholin glands?
| Pathology
They are located on each side of the vaginal canal, they produce mucus that lubricates the canal and drains via ducts into the ower vestibule
360
How do bartholin cysts arise?
| Pathology
Due to infammation and obstruction of the draining duct --> dilation adn cyst formation
361
What is the target population of bartholin cysts?
| Pathology
Women of the reproductive age
362
What are teh clinica presentation of bartholin cysts?
| Pathology
Painful unilateral cyst lesion at ower vestibule at the vaginal canal
363
What happens if the bartolin cyst is left untreated?
| Pathology
May be complicated by abscesses
364
What are treatment options of bartholin cysts?
| Pathology
Antibiotics or drainage
365
What are condylomas?
| Pathology
Warty lesions of the vulva skin, STD
366
What are the subtypes of condylomas?
| Pathology
Condyloma accuminatum
Condyloma latum
367
What is the cause of condyloma accuminatum?
| Pathology
HPV related (6 and 11 --> low risk HPV strains) --> rarely proceed to carcinoma
368
What is the cause of condyloma latum?
| Pathology
Due to secondary syphilis --> rare but larger
369
What is Lichen sclerosus?
| Pathology
Thinning of the epidermis and fibrosis of the dermis
370
How does Lichen sclerosus present as?
| Pathology
White patch (leukoplakia) with parchment like skin --> red violet border
371
What is the target population of Lichen Sclerosus?
| Pathology
Postmenopausal women
372
Are lichen sclerosus benign or malignant?
| Pathology
Benign with a slight increased risk of squamous cell carcinoma
373
What is Lichen Simplex Chronicus?
| Pathology
Hyperplasia of vulvar squamous epithelium
374
How does Lichen simplex chronicus present?
| Pathology
Present as white patch (leukoplakia) with thick leathery skin and enhanced skin markings
375
What is lichen simplex chronicus associated with?
| Pathology
Chronic inflammation, irritation, pruritus with continuous rubbing
376
Is Lichen simplex chronicus benign or malignant?
| Pathology
Benign with no risk for squamous cell carcinoma
377
What is vaginitis?
| Pathology
Inflammation of the vagina associated with discahrge (leukorrhea)
378
What are the risk factors of Vaginitis?
| Pathology
1. Diabetes
2. Systemic antibiotic theraoy --> dysbiosis of microbial flora
3. Immunodeficiency and STDs
4. Pregnancy and recent abortion
379
What is candida albicans in terms of vaginal microbiome?
| Pathology
It is part of the normal microbial flora
380
How does Candida vaginitis present?
| Pathology
Symptomatic infection
Characterized by a curdy white discharge
381
What is trichomonas vaginalis?
| Pathology
A parasute that can be identified by microscopy
382
What is trichomonas vaginitis like?
| Pathology
Asymptomatic or watery, copious gray-green discharge
383
What is bacterial vaginosis?
| Pathology
Infection due to overgrowth of Gardenella vaginalis
384
What is bacterial vaginosis characterised by?
| Pathology
Fish odor discharge
385
What is vaginal adenosis?
| Pathology
Focal persistence of columnar eoithelium in the upper 1/3 of the vagina
386
What is the traget population of vaginal adenosis?
| Pathology
Females who were exposed to DES in utero
387
What can vaginal adenosis be complicated with?
| Pathology
Clear Cell Adenocarcinoma
388
What does vaginal adenosis present as?
| Pathology
As mucoid vaginal discharge or post coita bleeding
389
What is the clinical appearance of vaginal adenosis?
| Pathology
Red granular area which stands out from the pale pink vaginal mucosa
390
What is the histological appearance of vaginal adenosis?
| Pathology
Endocervical type mucous glands on vaginal surface or in laminate propria
391
What is the most common type of vaginal carcinoma?
| Pathology
Squamous Cell Carcinoma
392
What is vaginal carcinoma related to?
| Pathology
HPV
393
What is the precursor lesion of Vaginal carcinomas?
| Pathology
VAIN --> vaginal intraepithelial neoplasia
394
Whrcome at are sarcoma botryoides?
| Pathology
Maignant mesenchymal proliferation of immature skeletal muscle
395
What is the target population of sarcoma botryoides?
| Pathology
Encountered in infants and children under the age of 5
396
What do sarcoma botryoides manifest as?
| Pathology
Soft polypoid masses (grape-like masses) and bleeding from the vagina
397
What is the microscopic appearance of Sarcoma Botryoides?
| Pathology
Eosinophilic strap-like cytoplasm, spindle shaped cells
398
Where else can sarcoma botryoides occur or appear?
| Pathology
Urinary bladder and bile ducts
399
