YEAR 2 NOTES PDF

Diseases of male reproductive system 1. ★ Describe the pathophysiology of BPH a. BPH occur in men who are 60 years old and above b. The main cause is hormonal imbalance. As men get older, the production of testosterone decreases...

Diseases of male reproductive system 1. ★ Describe the pathophysiology of BPH a. BPH occur in men who are 60 years old and above b. The main cause is hormonal imbalance. As men get older, the production of testosterone decreases causing the increase of oestrogen to testosterone ratio. c. Oestrogen stimulate the upregulation of androgen receptors at the median lobe of the prostate d. As testosterone arrived at the prostate, it will be converted to DHT by 5a-reductase and DHT will bind to the androgen receptors and stimulate the proliferation of glandular and stromal cells and inhibit apoptosis e. As the number of cells increase, the size of median lobe is also increase f. Since median lobe surround the prostatic part of urethra, this will cause bladder outlet obstructions g. Patients will experience symptoms like nocturia, urinary retention, dribbling and urgency 2. State one drug that often used to treat and its MOA a. Finasteride. It inhibit the action of 5a-reductase from converting testosterone to DHT 3. ★ Classified the symptoms may experienced by the patients Voiding symptoms Storage symptoms Hesitancy Nocturia Dribbling Urgency Retention frequency 4. ★ List 5 complications of BPH a. Urethral obstruction b. Bladder atony  c. Trabeculation of bladder d. Bladder hypertrophy e. Hydronephrosis f. Bilateral hydroureter 5. ★ Give 4 microscopic findings and 5 gross appearance of the prostate Microscopic findings Nodules of glands Intervening stroma Glands with various size Inflammation 6. Describe the pathophysiology of prostate adenocarcinoma a. Starts with the glandular epithelium b. It will disrupt the architecture of the prostate by forming abnormal glands within the pre-existing glands with these characteristics: i. Large nuclei ii. Prominent nucleoli iii. Loss of basal cells c. Can metastasis to bones and cause osteoblast or osteoclast 7. ★ State 5 methods to diagnose prostate adenocarcinoma a. Digital rectal examination b. Transrectal ultrasound c. Prostate specific antigen d. MRI e. Biopsy 8. ★ What is gleason score and how is it being applied in prostate adenocarcinoma? a. It is an assessment to identify the aggressiveness of the cancerous cells b. By investigating the microscopic findings  c. E.g. grade 1 cells are well differentiated with normally formed glands d. E.g. grade 5 cells are poorly differentiated with abnormally formed glands 9. State 3 possible causes of masses in testes a. Epididymitis b. Vascular torsion or hydrocele c. Testicular tumour 10. ★ List and classified the types of testicular tumours Germ cell tumours Nor-germinal tumours 1. Seminoma Leydig cells tumour 2. Spermatocytic carcinoma Sertoli cells tumour 3. Choriocarcinoma 4. Yolk sac tumour 5. Embryonal carcinoma 6. Teratoma 11. What is the tumour marker used to detect seminoma? a. None since the tumour do not secretes any tumour marker 12. Is seminoma treatable? a. Yes even when it is malignant  13. ★ Describe the histopathological findings and gross appearance of the tumour Cells have the appearance of fried-egg looking cells Clear cytoplasm Well defined borders Presence of lymphocytes No production of B-hCG and a-fetoprotein Bulky mass Gray-white in colour No hemorrhage or necrosis 14. Describe the gross appearance and histopathological findings of embryonal carcinoma Gross appearance (the opposite of Histopathological findings seminoma) Small Hemorrhage Necrosis Gray-white in colour  Tumour is made up from various type of cells: ○ Tubular ○ Glandular ○ Papillary No distinctive border Highly anaplastic cells 15. ★ List down tumour markers used for diseases of male reproductive system a. hCG to detect choriocarcinoma, yolk sac tumour and embryonal carcinoma b. AFP to detect yolk sac tumour Diseases of vulva, vagina and cervix 1. Neoplasm of vulva is known as vulvar intraepithelial neoplasia (VIN). Describe the clinical features of this disease and the possible causative organism a. Formation of anogenital warts (e.g. condyloma lata, condyloma acuminata) b. By HPV 6 & 11 2. Is VIN considered as malignant? a. No 3. What is the most common causative agent of vaginitis? a. Gardnerella vaginalis 4. List down other possible organisms that can cause vaginitis: a. Mycoplasma hominis b. Candida albicans (fungal infection) c. Trichomonas vaginalis 5. What are cervical polyps and what are the clinical features shown by patients? a. A benign growth at the cervix. b. Often asymptomatic c. Might be due previous inflammation d. Patients often present with vaginal bleeding between menses, after sexual intercourse 6. What is the most common type of cervical carcinoma? a. Squamous cell carcinoma 7. Between SCC and adenocarcinoma, which one has better prognosis and why? a. SCC because the symptoms can be seen earlier while adenocarcinoma can only exhibit the symptoms while at the late stage 8. What are the predisposing factors of cervical carcinoma? a. Cervical intraepithelial neoplasia [premalignant condition] b. Sexual behavior: i. Sexual intercourse at an early age ii. Multiple sex partner iii. Sex partner is an individual with multiple sex partner c. HIV infection d. Chlamydia infection e. On oral contraceptives 9. What is cervical intraepithelial neoplasia? a. It is the premalignant condition that caused by infection of HPV 16 or 18 10. What are the symptoms shown by patients? a. Depends on which stage the patient is currently at b. At early stage: i. Bleeding between menses ii. Postcoital which is the spotting after sexual intercourse iii. Dyspareunia  iv. Leukorrhea c. At late stage: i. Foul smelling cervical discharge ii. Pelvic pain d. Metastasis cancer: i. Obstructive uropathy ii. Back pain 11. ★ Describe the morphological features of CIN for each stage CIN I CIN II CIN III Mild dysplasia Moderate dysplasia Severe dysplasia Koilocytic changes at Koilocytic changes Affects all layers of the superficial layer of occurred almost at all epithelium the epithelium layers of epithelium The tumour is made up from various type of cells No maturation of cells No differentiation of cells Carcinoma in situ can be seen As time goes by, it may invade the endocervical glands and metastasis 12. During the bimanual examination, the cervix is notably palpable. Why? a. Because the tumour is encircling the cervix and causing the cervix to enlarge. This condition is known as barrel cervix 13. What are the diagnostic methods you would suggest to patients to prevent this? a. Routine pap smear- starting from the 1st year of sexual intercourse b. Colposcopy c. HPV vaccination d. Using protection during sexual intercourse Diseases of uterus 1. What is the name of the disease in which a benign tumour grows inside the uterus? a. Leiomyoma 2. Describe what is leiomyoma a. It is a benign tumour that grow inside the uterus b. Arised from the smooth muscle layer of myometrium 3. What are the risk factors of leiomyoma? a. Genetic b. Oral contraceptives c. Oestrogen 4. What are the signs & symptoms often presented by the patient? a. Asymptomatic but b. Menorrhagia c. Metrorrhagia 5. ★ Describe the gross appearance and histopathological findings of the tumour Whorling bundle of smooth muscle cells Foci of fibrosis Hemorrhage Cystic degeneration Circumscribed mass Grey-white in colour May scatter along the uterine lining Firm  6. ★ What is endometriosis? a. A condition which the ectopic endometrial tissue is outside of the cavity of uterus and able to respond to the cyclical hormonal stimulation 7. ★ What are the possible causes (6) for this condition? a. Implantation theory- menstrual endometrium reflux through the fallopian tube b. Coelomic metaplasia theory- peritoneum is lined with coelomic mesothelium and might have undergo metaplasia to be converted to endometrial-like tissue c. Menstrual endometrial tissue has been embolized outside of the uterus d. Chemical substance might have induce this condition e. Oestrogen influence f. Impaired T cells and NK cells 8. ★ What are the clinical features/symptoms shown by the patients? a. Period pain- dysmenorrhea b. Painful intercourse- dyspareunia c. Excessive menstrual bleeding- menorrhagia d. Chronic pelvic pain e. Abdominal pain f. Chocolate cysts of ovaries 9. ★ Biopsy has been done. State your macroscopic and microscopic findings Macroscopic findings Microscopic findings  Blackish, dark red, bluish cystic area Scarring Formation of plaque Powder burnt area Endometrium lining can be seen that made up from columnar epithelium Formation of papillae Cells are polyhedral shape Formation of endometrial glands Formation of stroma Hemosiderin 10. State 2 differential diagnosis of endometriosis a. Chronic PID b. Malignant ovarian tumour Diseases of pregnancy 1. What is gestational trophoblastic disease? a. It is a disease in which trophoblastic tissue has proliferated abnormally and formed molar tissue that developed into edematous villi that has the appearance of grape-like and filled with fluid. 2. State the type of GTD a. Hydatidiform mole b. Choriocarcinoma 3. What is the type of hydatidiform mole? a. Complete mole b. Partial mole 4. Describe the pathogenesis of complete mole a. Complete mole occur when fertilisation occur between sperms and an ovum that lack the maternal genetic material b. In this condition, there are two possible outcomes, c. The first one, a single sperm has fertilised with an ovum that lacked maternal genetic material. This will cause the paternal genetic material to duplicate and as a result formed an embryo with the karyotype of 44, XX d. In the second scenario, 2 sperms has fertilised the empty ovum and form an embryo with heterozygous karyotype which are either 44, XY or 44, XX e. But the embryo would not survive long since it lacks the maternal genetic material and die early f. The remaining trophoblastic tissue will proliferate abnormally and formed molar tissues that developed into edematous villi with grape-like appearance and filled with fluid 5. What are the possible complications (2) from this disease? a. Choriocarcinoma b. Invasive mole 6. State one observation regarding the investigation of the founding of embryonic tissue in complete mole a. No formation of embryonic tissue, no formation of placenta 7. State one observation regarding the investigation of the founding of embryonic tissue in PARTIAL MOLE a. There would a formation of embryonic tissue but it is non-viable because of genetic abnormalities 8. Describe the pathogenesis of partial mole a. Partial mole occur when fertilisation happened between a normal ovum (contained the maternal genetic material) with a sperm that duplicates its genetic material or fertilisation by 2 sperms b. In the first situation, as the paternal genetic material duplicated, the embryo has a abnormal karyotype which is triploid in number  c. In the second situation, each sperm contribute one set of paternal genetic material and as it combines with maternal genetic material the embryo would presented with triploid number of chromosome d. The possible karyotypes are as below: i. 69, XXX ii. 69, XXY iii. 69, XYY e. The embryonic tissue did formed but the embryo died short after due to genetic abnormalities f. The remaining trophoblastic tissue will proliferate abnormally and formed molar tissue that developed into edematous villi 9. ★ Now differentiate between complete mole and partial mole Complete mole Partial mole Fertilisation Fertilisation of a single sperm with an Fertilisation of a single sperm with a ovum that lacked the maternal normal ovum but the paternal genetic genetic material material duplicates Fertilisation of 2 sperms with an ovum Fertilisation of two sperm with a that lacked the maternal genetic normal ovum material Karyotypes of the embryo Diploid number of chromosomes: Triploid number of chromosomes: ○ 44 + XX ○ 69 + XXX or, ○ 69 + XXY or, ○ 69 + XYY Presence of embryonic tissue No formation of embryonic tissue at There is formation of embryonic all tissue but it is non-viable because of genetic abnormalities Formation of edematous villi Diffuse and circumscribed Formed focally Proliferation of trophoblast Diffusely and severely Focally and mildly tissue Level of hCG Highly elevated Elevated but less than complete mole 10. What are the clinical features of patients present with hydatidiform mole? a. Vaginal bleeding b. Passing of tissue fragments c. Elevated hCG d. Enlargement of uterus more than normal during pregnancy 11. What is choriocarcinoma?  a. It is a malignant neoplasm that arises from the trophoblastic tissue from the previous or abnormal pregnancy b. The tumour entirely composed of cytotrophoblast or syncytiotrophoblast c. It is highly invasive and widely metastasis d. But the good news is, it is highly sensitive to chemotherapy 12. What are the clinical features of the patient? a. Patient usually complaint of irregular spotting of brown fluid after pregnancy b. High level of hCG c. Endometrial gland hyperplasia d. Decidual endometrium e. Ovarian cyst f. Enlargement of breast nodules 13. Can gestational choriocarcinoma be cured? a. Yes, 100% Diseases of fallopian tubes & ovaries 1. State 4 types of ovarian cyst a. Luteal cyst b. Corpus luteum cyst c. Follicular cyst d. Polycystic ovarian cyst 2. ★ State 4 risk factors of polycystic ovarian disease a. Obesity b. Hirsutism c. Anovulation d. Oligomenorrhea 3. State 4 risk factors of ovarian tumours a. Old age, women that already in menopause b. Consume fertility drugs c. On HRT that require the oestrogen d. Nulliparity  e. Genetic factors i. BRCA-1 ii. BRCA-2 iii. HER2NEU iv. P53 gene 4. What are the symptoms of a patient with ovarian tumour? a. Abdominal swelling b. Early satiety c. Weight loss d. Abdominal pain e. Change in bowel habit, e.g. constipation 5. ★ State the classes of ovarian tumour and their components Surface epithelial tumours Germ cell tumours Sex cord stromal tumours Cancerous cells that metastasis to ovaries 1. Serous tumour 1. Dysgerminoma 1. Sertoli-leydig cell 1. Krukenberg tumour 2. Endometrioid tumours 2. Endodermal sinus tumour 3. Brenner tumour tumour 2. Granulosa-theca cell 4. Mucinous tumour 3. Non-gestational tumour choriocarcinoma 4. Teratoma 5. Embryonal carcinoma 6. Yolk sac tumour 6. What is the most common ovarian tumour? a. Serous tumour 7. How do we identify the neoplasm of the tumour of a serous tumour? a. Benign Borderline Malignant 1. The covering lining of 1. The covering ciliated 1. Complex papillary the tumour is ciliated epithelium has nuclear structure with border epithelium stratification and thicker 2. No atypical 2. Has nuclear atypical 2. Has cellular atypical 3. Papillary structure is 3. Complex papillary 3. Stromal invasion present structure 4. No stromal invasion 4. No stromal invasion b. State one histological finding of serous tumour  Psammoma bodies 8. Describe the pathogenesis of endometrioid tumour a. The shedded endometrial lining is flowing retrograde into the pelvic organs, become attached and grow as a tumour 9. What is the female version of seminoma? a. Dysgerminoma 10. Why is dysgerminoma considered treatable? a. Because it is radiosensitive 11. ★ What are the tumour markers (2) secreted by endodermal sinus tumour? a. A1-antitrypsin b. A-fetoprotein 12. What is the difference between gestational choriocarcinoma and no gestational choriocarcinoma? a. Non-gestational choriocarcinoma is not radiosensitive b. Consider as aggressive c. Can be fatal d. But still secrete hCG same like gestational choriocarcinoma Common diseases of breast 1. What is fibrocystic disease of the breast? a. It is a benign tumour grow inside the breast 2. State 5 clinical features present by patients of fibrocystic disease of breast a. Formation of lump b. Nipple discharge c. Calcification upon mammography d. Apocrine metaplasia e. Fibrosis  3. What is fibroadenoma? a. Benign growth of breast 4. Describe the hallmark of fibroadenoma a. Moveable lump called breast mouse 5. List 5 risk factors of breast cancer a. Female b. Obesity c. High fat diet d. Genetic (BRCA-1, BRCA-2) e. Early menarche, late menopause 6. List 4 types of breast carcinoma a. Ductal carcinoma in situ b. Invasive ductal carcinoma c. Lobular carcinoma in situ d. Invasive lobular carcinoma 7. State the histopathological finding of ductal carcinoma in situ Malignant cells are proliferating without breaching the basal membrane 8. Describe the clinical features of breast of invasive ductal carcinoma (3 nipples, 2 skin, 1 LN) a. Hard, irregular lump b. Retracted nipple c. Nipple in different direction d. Peau d’orange, dimpling of skin e. Enlarged axillary due to spreading to lymph nodes  f. Paget’s disease 9. What is paget’s disease a. Ulceration and inflammation of nipples due to the spreading 10. State the prognostic methods used to assessed breast tumour a. TNM staging b. As long as the cancerous cells not yet metastasis to lymph nodes, patients has a better prognosis 11. What are tumour markers used? a. Oestrogen b. Progesterone c. HER2NEU 12. State 5 diagnostic methods can be used to diagnose breast cancer i. Mammography ii. Ultrasound iii. Biopsy iv. Needle aspiration v. Gene detection (BRCA-1, BRCA-2)