EndoRepro > Week 1 > Flashcards

Week 1 Flashcards

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1
Q

What are the general epidemiology, etiology, and symptoms for urogenital dysfunction?

A
  • Epidemiology: 10-60% woman, elderly
  • Etiology: vaginal delivery, aging, estrogen deficiency, neurological/psychological disease
  • Symptoms: frequency, nocturia, dysuria, incomplete emptying, incontinence, urgency, recurrent infections, dyspareunia, prolapse
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2
Q

For stress incontinence:

  • Provide pathophys and etiology
A
  • Stress incontinence
    • Pathophysiology: increases in abdominal pressure (cough, laugh, lifting) → loss of urine
    • Etiology: pelvic floor damage OR weak sphincters
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3
Q

For urge incontinence:

  • Provide pathophys and presentation
A
  • Urge incontinence (OAB)
    • Pathophysiology: involuntary bladder contractions → loss of urine (complete emptying)
    • Presentation: Urinating 15-20 times a day
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4
Q

For mixed incontinence:

  • Provide pathophys
A
  • Mixed incontinence
    • Pathophysiology: combination of stress and urge incontinence
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5
Q

For overflow incontinence:

  • Provide pathophys and etiology
A
  • Overflow incontinence (Chronic urinary retention)
    • Pathophysiology: outlet obstruction OR bladder underactivity → loss of urine
    • Etiology: post-surgery, aging, medication (antidepressants), neurological disorders, bad bladder habits
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6
Q

For functional/transient incontinence:

  • Provide description, epidemilogy, and etiology (be specific with etiology)
A
  • Functional/transient incontinence
    • Description: patient unaware that he/she needs to urinate → leakage
    • Epidemiology: elderly
    • Etiology: UTI, restricted mobility, constipation, medications, psych/cognitive deficiency
      • Drugs include: diuretics, antipsychotics, alpha-blocking agents
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7
Q

What are some other cuases of urinary incontinence?

A
  • Other causes of urinary incontinence: urethral diverticulum, genitourinary fistula (pregnancy or past surgery), congenital abnormalities (bladder extrophy, ectopic ureter), detrusor hyperreflexia
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8
Q

How do you diagnose urinary incontinence? Be specific about indications, technique, and what the results of this diagnostic test mean.

A
  • Diagnosis: Postvoid Residual Volume (PVR), urinalysis
    • PVR
      • Indications: symptoms of incomplete emptying, diabetes mellitus, past hx of urinary retention, failure of drug therapies, pelvic floor prolapse, past surgery
      • Technique: ultrasound or catheterization
      • Results: PVR < 50 – normal; PVR > 200 – not normal
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9
Q

What are non drug or non-surg treatments for urinary incontinence?

A
  • Treatment
    • Fluid management – avoid caffeine/alcohol, or drinking lots of fluid at night
    • Bladder retraining – regular voiding by clock
    • Physiotherapy – pelvic floor exercises, vaginal cones (weights to build strength)
    • Pessaries – devices that correct prolapse and hold up bladder
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10
Q

Provide drugs that can be used for urinary incontinence.

A
  • Treatment
    • Medications – oxybutynin (muscarinic (M3) antagonist → treats OAB), tolteridine (muscarinic (M3) antagonist → treats OAB), flavoxate (anticholinergic → relax smooth muscles), imipramine (beta agonist → treats OAB)
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11
Q

Provide surgical options for urinary incontience. What is the gold standard?

A
  • Treatment
    • Surgery: Burch repair, Marshall-marchetti-krantz repair, Sling (gold standard), injections (botox @ bladder or ureter)
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12
Q

What are the 4 types of prolapse?

A

Prolapse

  • Types:
    • Cystocele – protrusion of the bladder
    • Rectocele – protrusions of the rectum
    • Apical prolapse – uterine OR vaginal vault prolapse
    • Procidentia – total prolapse of bladder AND uterus (rectocele may be present)
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13
Q

What is the epidemiology, pathophys, etiology, and treatment of prolapse?

A
  • Epidemiology: common
  • Pathophysiology: damage to pelvic floor structures → loss of support → prolapse
  • Etiology: childbirth, aging, chronic stress/strain, congenital abnormalities
  • Treatment:
    • None – can be asymptomatic
    • If symptomatic (not emptying properly)
      • Pessary - devices that correct prolapse and hold up bladder
      • Surgery
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14
Q

What is the grading scale of prolapse?

A
  • Grading
    • Grade I: Into the vagina but not to the introitus
    • Grade II: To the introitus (vaginal opening) with strain
    • Grade III: Through the introitus with strain
    • Grade IV: Through the introitus at rest
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15
Q

For Normal, provide:

  • Description of stroma and terminal duct lobular unit
A
  • Consists of stroma: connective and fatty tissues, nerve and vessels
  • Terminal duct lobular unit – most active part of breast tissue
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16
Q

What is this an image of?

A

Normal breast: Ducts lined by double layer of epithelial cells and surrounded by layer of myoepithelial cells

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17
Q

What is this an image of?

A

Normal breast

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18
Q

For fibrocystic change breast disease:

  • Provide a description
  • Age of onset?
A
  • Most common benign breast disorder
  • 20-40 y/o woman
  • Hormone medicated
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19
Q

What is this?

A

Fibrocystic change: Bilateral, lumpy-bumpy, Blue domed cysts

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20
Q

What is this?

A

Fibrocystic change breast disease: Dilation of duct lobules, stromal fibrosis

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21
Q

What is this?

A

Fibrocystic changes breast disease: apocrine metaplasia

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22
Q

What is this?

A

Fibrocystic change breast disease: ductal ectasia

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23
Q

Describe breast abscess:

  • Description:
  • Complication
  • Gross appearance
A
  • Painful lump of inflammatory/purulent tissue
  • Complication: fistula formation
  • Gross: Unilateral, fibrous cavity with pus
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24
Q

What is this?

A

Breast abscess: Fibrous capsule with inflammatory infiltrates

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25
For fibroadenoma: * Descirption:
* Most common benign neoplasm of breast * Tumor of fibrous stroma and duct epithelium
26
What is this?
fibroadenoma of breast: Mobile, spherical, well circumscribed lesion
27
What is this?
Fibroadenoma * Loose/dense textured stroma * May have hyperplastic ducts
28
For Phyllodes tumor: * Age? * Malignancy potential? * Description? * Gross
* 60s – common age * May be malignant * Similar to fibroadenoma with increased cellularity and cytologic atypia * Gross: palpable mass
29
What is this?
Phyllodes tumor (breast disease): leaflike growth pattern
30
Name 4 benign diseases of the breast
Phyllodes tumor, fibroadenoma, breast abscess. fibrocystic change
31
What is adenosis of the breast? Name three types
Adenosis: Adenoma, Sclerosing adenosis (1), radial scar (2) * Description: Proliferation of glands
32
What is this?
Sclerosing adenosis of the breast
33
What is this?
Radial scar of the breast
34
What are two types of hyperplasia (proliferative breast disease without atypia)? Describe it
Hyperplasia: Papilloma (2), Usual ductal hyperplasia (UDH) (1) Descritpion: proliferation of normal looking cells
35
What is this?
Usual ductal hyperplasia of breast: growth is irregular into duct
36
What is this?
Papiloma of breast
37
How likely is it for proliferative disease without atypia of breast to develop into cancer?
Slightly likely only
38
How likely is it for proliferative disease with atypia of breast to develop into cancer?
Moderately likely
39
What are the two diseases under hyperplasia (proliferative disease with atypia)? Describe.
Hyperplasia: atypical ductal hyperplasia (1), atypical lobular hyperplasia (2) Description: Proliferation of irregular looking epithelial cells
40
What is this?
ADH: Growth is from peripheral inwards
41
What is this?
atypical lobular hyperplasia
42
What are the two types of carcinoma in situ for breast? Describe.
Carcinoma in situ: Duct (4 subtypes shown) and Lobular subtypes Descsirption: Malignant proliferation of cells that has not breached the basement membrane
43
What is this?
Ductal carcinoma in situ of the breast
44
What is this?
Lobular carcinoma in situ of the breast
45
Describe Paget's disease of the breast.
Eczema – like nipple disease associated with DCIS
46
What is this?
Paget's Disease of the breast: large clear cells in the epidermis
47
For invasive ductal carcinoma: provide a general description.
* Most common breast cancer * Gross: hard-mass
48
What is this?
Invasive ductal carcinoma of the breast: duct structures in dense fibrous tissue (desmoplasia)
49
What is this?
Invasive lobular carcinoma of the breast: single file pattern of infiltration
50
For paraphimosis of the penis, provide: * Description? * Pathophys? * Clinical stuff? * Picture?
51
For Peyronie disease of the penis, provide: * Description? * Pathophys? * Clinical stuff?
52
For penile fracture, provide: * Description? * Pathophys? * Clinical stuff? * Picture?
53
For carcinoma in situ and SCC of the penis, provide: * Location? * Painful? * Resolves? * Color of lesion? * Appearance? * Picture?
54
For licehn planus of the penis, provide: * Location? * Painful? * Resolves? * Color of lesion? * Appearance? * Picture?
55
For pearly penile papules, provide: * Location? * Painful? * Resolves? * Color of lesion? * Appearance? * Picture?
56
For HPV, provide: * Location? * Painful? * Resolves? * Color of lesion? * Appearance? * Picture?
57
For HSV, provide: * Location? * Painful? * Resolves? * Color of lesion? * Appearance? * Picture?
58
For syphilis, provide: * Location? * Painful? * Resolves? * Color of lesion? * Appearance? * Picture?
59
What is the presentation of carcinoma in situ (two types)? What are the complications associated with this?
* Carcinoma in situ of penis (CIS) * Presentation * Erythroplasia of Queyrat when on glans penis of uncircumcised men * Bowen disease when involves the penile shaft * Complications: can progress to SCC in untreated
60
What is the presentation, diagnosis, and risk factors of SCC of penis?
* Squamous Cell Carcinoma of penis (SCC) * Presentation: disease of older (\>60) men * Diagnosis: biopsy * Risk factors: circumcision practice, hygienic standard, phimosis, number of sexual partners, HPV infection, exposure to tobacco products
61
What is the pathophys of HSV?
* Initiates replication in epithelial cells at site of entry → damages the cells → enters peripheral sensory nerves → transports in retrograde manner to sensory root ganglia → latent phase → recurrent and reactivation → transportation to mucosal and skin surface
62
For lichen simplex chronicus: provide presentation, treatment, and pathology (gross and micro)
* Lichen simplex chronicus * Presentation: pruritis * Tx: topical steroids * Pathology: * Gross: thickened ruggated skin, red/white (pic) * Micro: squamous hyperplasia (pic)
63
For lichen sclerosus: provide presentation, treatment, and pathology (gross and micro)
* Lichen sclerosus * Presentation: inelastic skin, pruritus, burning, dyspareunia (painful sex), post-menopausal women * Tx: topical steroids * Pathology: * Gross: skin is thin, white (tissue paper like), * Micro: thinning of the epidermis, lymphocytes in lower layers, red/white/blue layers (pic)
64
For Condyloma acuminatum: provide pathophys, presentation, treatment, and pathology (gross and micro)
* Condyloma acuminatum * Pathophysiology: HPV (types 6 or 11) infection → warts * Presentation: non-painful, cauliflower like outgrowths * Tx: chemical/surgical removal * Pathology: * Gross: cauliflower warts * Micro: papillomatosis, koilocytes (squamous cells with peri-nuclear halo – white around nucleus) (picx2)
65
For bartholin gland cyst: provide pathophys, presentation, complications, and treatment.
* Bartholin gland cyst * Pathophysiology: blockage of gland → cysts * Presentation: palpable/visible protrusion on the labia major, reproductive age * Complications: infection → abscess * Tx: incision/drainage
66
What are two types of vulvular dystrophy?
Lichen sclerosus and licehn simplex chronicus
67
For embryonal rhabdomyosarcoma of the vulvovaginal area, provide epidemiology and pathology (gross and micro)
* Embryonal Rhabdomyosarcoma * Epidemiology: \< 5 y/o * Pathology: * Gross: bleeding of grape like mass of vagina/penis * Micro: proliferation of mesenchyme → immature skeletal muscle (pic) * Lower power slides – show nodules
68
For clear cell adenocarcinoma of the vulvovaginal area, provide risk factors and pathology (micro)
* Clear cell adenocarcinoma * Risk factors: DES (diethylstilbestrol) in utero [funfact: daughters born between 1938 and 1973 were exposed] * Pathology: * Micro: adenocarcinoma with clear cytoplasm (pic) * May present with adenosis of squamous epitheliuem to columnar glandular
69
For Paget's disease of the vulvovaginal area, provide presentation and pathology (gross and micro)
* Paget’s Disease * Presentation: pruritis * Pathology: * Gross: well demarcated lesions, often erythematous around vulva * Micro: Intra-epithelial clusters of malignant appearing cells * PAS stain: mucin positive, s100 negative
70
For melanoma cancer of the vulvovaginal area, provide epidemiology, diagnosis, and pathology (micro)
* Melanoma * Epidemiology: 50+, white * Diagnosis: look for ABCDE lesion * Pathology: * Micro: expansion of the epidermis with increased N/C ratios, s100 marker (pic)
71
For squamous cell cancer of the vulvovaginal area, provide epidemiology, risk factors (go into depth for these), presentation, and pathology (gross and micro)
* Squamous cell cancer * Epidemiology: poor, old, dirty * Risk factors * Old: Granulomatous venereal disease, HPV, diabetes, obesity, co-existing vulvar dystrophies (lichen sclerosis) * In HPV related: VIN is precursor lesion * In non-HPV related: vulvar dystrophies is precursor lesion * Young: smoking, CIN (cervical interepithelial neoplasia) * Presentation: pruritis, late to metastasize * Pathology: * Gross: ulcerated, raised, kissing lesions * Micro: increased cellularity, N/C ratio, penetrating basement membrane (pic)
72
What is this?
Condyloma acuminatum Micro: papillomatosis (on the left), koilocytes (on the right) (squamous cells with peri-nuclear halo – white around nucleus)
73
What is this?
* Lichen sclerosus: thinning of the epidermis, lymphocytes in lower layers, red/white/blue layers
74
What is this?
* Lichen simplex chronicus thickened ruggated skin, red/white
75
What is this?
* Lichen simplex chronicus: squamous hyperplasia
76
What is this?
Squamous cell cancer of the vulvovaginal area: increased cellularity, N/C ratio, penetrating basement membrane
77
This is what melanoma looks like. Where is this located and what tells you that this is a melanoma?
Melanoma of the vulvovaginal area: expansion of the epidermis with increased N/C ratios, s100 marker
78
What is this?
Paget's Disease: Intra-epithelial clusters of malignant appearing cells
79
What is this?
Clear cell adenocarcinoma of the vulvovaginal area: adenocarcinoma with clear cytoplasm
80
What is this?
* Embryonal Rhabdomyosarcoma: proliferation of mesenchyme → immature skeletal muscle * Lower power slides show nodules!
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