USPS® Forced Meter Migration - How to Know if Your Postage Meter Will Soon be...
Pathology Review-Term4
1. Tip for Success in life….!
"Powered by intellect,
Driven by Values..!”
Life motto of Infosys founder and Chairman, Narayana Murthy. INDIA
1
2. T4W1: Week overview:
2013 Term 4 CPC 1 Title: MSK
System: Rheumatology
Aim: To train students in:
History taking + clinical examination of patient with joint pain ;
pathology of physiology
of rheumatological diseases; process of care + population health
especially in rural and remote areas
Learning 1. Demonstrate competency in history taking & clinical examination
Outcomes: of patients
Students will be
presenting with joint pain
able 2. Describe the Pathophysiology of
to
• Rheumatoid arthritis (RA)
• Sero-negative arthritis
• Osteoarthritis (OA), • Gout
3 Describe differential diagnoses for patients presenting with joint
pains.
4 Formulate a first line management plan for patients
presenting with joint pains, demonstrating a knowledge of
indications and side effects of commonly used medications
prescribed for treatment of joint pain.
3. CPC 4.1 – MSK-Rheumatology
– Scenario 1:
Rheumatoid A Ms F.M. 19 year old student
Gouty Arthritis Mr J.W. 45 year old foot, 1st metatarsal
– Scenario 2:
Osteoarthritis Mrs N.M 69y retired Sports teacher.
– Scenario 3:
• Notes to Tutors:
– Discuss DD - variety of clinical scenarios.
– Remember/revise serious causes of acute joint pain esp.
septic arthritis, rheumatic fever (Jones criteria).
– DD to include fibromyalgia, polymyalgia rheumatica,
SLE etc.
• Investigations:
– FBC, RFT, ESR/CRP, ALP, Auto Ab.P, RF & Anti-CCP,
HLA B27,
3
6. Degenerative - Inflammatory
•
•
•
•
•
•
•
Both sexes equal.
Pain through the day
No morning stiffness.
Stiffness, less pain.
Bony swelling.
No soft tissue swelling
Uni/Bilateral,
Asymmetrical.
•
•
•
•
•
Females more.
Morning stiffness >1h.
Less with movement.
Pain & redness
Inflammation &
swelling of soft tissue.
• Late bone swelling.
• Bilateral, Symmetrical.
6
9. Osteoarthritis: Ankylosis
• varus deformity of the
knee and collapse of
the joint space with
destruction of the
medial cartilage and
the subchondral
cortex (open
arrowheads).
9
16. “To be a great champion you
must believe you are the best. If
you’re not, pretend you are….!”
– Muhammad Ali
Fake it until you make it….!
17. T4W2: Week overview:
2013 Term 4 Title: Renal Disease (Glomerulonephritis)
CPC 2
System: Nephrology – Renal Disease
Aim: • Clinical, Pathology & population study of patients with kidney
function disorders.
• Pathology & clinical diagnosis of patient with chronic illness—chronic
kidney diseases
Learning 1. Demonstrate competency in history taking & clinical examination of
outcomes:
patients with renal disease.
The student 2. Describe the Investigation and first line management of UTIs,
will be able to
recurrent UTIs, acute and chronic renal failure including chronic
kidney disease.
3. Outline the basic sciences relating to fluid balance, kidney function,
urine production & urination (including bladder & urethra).
4. Outline the autonomic nervous system + signs of autonomic
neuropathy
5. Describe the Pathophysiology & Pathology of renal disease
(nephrotic, nephritic & renal failure acute & chronic).
6. Outline the different types of glomerulonephritis.
7. Describe the epidemiology, community & rural health issues in
renal disease, renal dialysis & transplantation.
18. Renal Case Scenarios
1. 35y female, Tired for years, Worsened since
two months. She has noted swelling of her
legs and puffiness around eyelids. MGN
2. 2 year old boy presents with sudden onset
polyuria, proteinuria following mild fever. MCD
3. 8 year old girl presents with fever, oliguria,
smoke coloured urine & hypertension following
upper respiratory tract infection. PGN
4. 49y, nephrotic syndrome non-responsive. FSGS
5. 18y male recurrent painless hematuria, 3-6
days, usually following fever, URTI. IgA
25. Nephritic
Nephrotic
•
•
•
•
•
• Proteinuria (“nephrotic
range” >3.5g/24h)
• Edema
(retention+Hypoalbumi
nemia)
• Hyperlipidemia
• Lipiduria
• Protein casts.
Oliguria
Hematuria
Non selective Proteinuria.
GFR , Cr , BUN
Edema (salt and water
retention)
• Hypertension
• RBC & Protein casts.
urine
urine
26. Minimal Change GN:
Synonyms:
Nil disease, lipoid nephrosis, foot process
disease
Incidence:
80% of nephrotic syndrome in children
(1-8 yrs.), mostly male. Adults in 2nd-3rd
decade.
Etiology:
Idiopathic. Loss of net negative charge
destruction of podocyte foot processes.
Clinical
Features:
Nephrotic syndrome. History of recent
URI in 30%. Association with Hodgkin’s
lymphoma. Overlap with FSGS patients.
Lab
Features:
Nephrotic urine (polyuria, Selective
proteinuria. (albuminuria).
Pathology:
Normal Microscopy. IF - Negative.
EM loss of foot processes.
Clinical
Course:
Spontaneous remission in 25-40%.
Complete remission in 65-70% of patients.
Steroid resistant patients may progress to
FSGS.
Normal Microscopy
Loss of foot process - EM
27. Focal Segmental GN: Adults
Synonyms:
Focal segmental Sclerosis
Incidence:
10 - 35% of nephrotic syndrome in
adults.
Etiology:
Idiopathic - ? Auto Immune. No deposits.
(Similar to minimal change).
Clinical
Features:
Nephrotic syndrome. History of recent
URI in 30%. Association with Hodgkin’s
lymphoma. Overlap with MCD patients.
Lab
Features:
Nephrotic urine (more, clear) Selective
proteinuria. No specific laboratory
findings.
Podocyte damage, Segmental collapse of
glom. increase in matrix (pink).
Pathology:
Clinical
Course:
Spontaneous remission 30% , 50%
progression to chronic renal failure, 20%
rapid progression.
28. Membranous GN:
Synonyms: membranous GN
Incidence:
40-60 Years, 50% of adult nephrotic
syndrome.
Wireloop
Etiology:
Immune complex deposition. Idiopathic in most
patients, associated with infections, drugs,
carcinomas, and heavy metals.
Clinical:
Nephrotic syndrome in 80%, asymptomatic
proteinuria in 20%. Microscopic hematuria.
Lab:
Non-selective proteinuria ± hematuria.
Path:
Diffuse, uniform BM thickening with
subepithelial projections (“spikes”). Diffuse,
coarsely granular IgG and C3 deposits along
basement membranes. Electron-dense
subepithelial deposits.
Clinical
Course:
Excellent prognosis in children. Some
adults develop ESRD. Exclusion of other
diseases is required.
29. Acute Post Strept, Diff, Prol GN:
Synonyms: Acute proliferative glomerulonephritis,
acute post-infectious GN.
Incidence:
Etiology:
children (3-14). Sporatic, mostly winter and
spring.
Glomerular trapping of circulating immune
complexes. (Group A, Beta-hemolytic
streptococci, type 12).
Clinical:
Acute nephritic following strep. pharyngitis or
pyoderma. (Other infections rare)
Lab:
Nephritic urine (little, dark, smoky) RBC
casts, non selective proteinuria. Decreased
serum complement. Evidence of strep inf.
Path:
Enlarged, hypercellular glomeruli with
endothelial and mesangial cell
proliferation, neutrophils, IgG and C3 in
very coarsely granular pattern along
GBMs. Discrete, subepithelial “hump-like”
deposits.
Clinical
Course:
Children - Excellent prognosis. Adults Worse prognosis, some develop
progressive disease.
30. IgA Nephropathy (Berger’s)
• Commonest form of GN – Nephritic.
• Young 15-30y, males, Asia-Pacific.
• IgA deposits in mesangium, High
serum IgA, varied severity
• Episodic asymptomatic hematuria
• microscopic hematuria (40%)
• Bouts of macro hematuria (40%)
• Nephritic or Nephrotic (rare).
• Renal failure (10%)
• Slowly progressive CRF in 1/3
patients.
IgA dep.
Normal
IgA dep.
32. Acute Tubular Necrosis:
• Necrosis of tubular cells –
fall of as casts.
• Most common cause of
ARF.
• Ischemic (patchy PCT &
DCT)
– Hypovolemia
– Shock
• Toxic (PCT only)
– Drugs…
– Toxins – Mercury, CCL4,
Radiocontrast.
33. Acute Tubular Necrosis(ATN): toxic
Necrotic PCT
(no nuclei)
Glom. Norm
Normal DCT
(Pro. cast inside)
PCT early necrosis
34. “Look at the sky. We are not alone.
The whole universe is friendly to us
and conspires only to give the best to
those who dream and work.”
- Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.
35. T4W3: Week overview:
2013 Term 4 CPC 3 Title: Male Genitourinary
System:GU + Renal
Aim: Understanding pathology ,presentation and clinical
diagnosis of patients with urinary obstruction & urinary
tract infections.
Learning 1. Demonstrate competency in history taking & clinical
outcomes: examination of patients with urinary symptoms.
The student will be 2. Demonstrate competency in the clinical examination of
able to the abdomen and pelvis
3. Describe the Laboratory investigations for patients
with bladder outflow obstruction and haematuria
4. Demonstrate competency in debating the use of the
PSA in
individual patients and as a screening test.
5. Describe the first line management of prostate cancer
and BPH
6. Describe the anatomy and histology of bladder, urethra +
prostate;
36. Week Learning outcomes:
2013 Term 4 CPC 3 Title: Male Genitourinary
System:GU + Renal
Aim: Understanding pathology ,presentation and clinical
diagnosis of patients with urinary obstruction & urinary
tract infections.
Learning 7. Describe the pathology of BPH, prostate cancer, renal
outcomes: and bladder tumours ,and renal and bladder calculi
The student will be 8. Outline the Professional, ethical & legal issues in
able to diagnosis & management of patients with benign
prostatic hyperplasia (BPH) and prostate cancer
9. Outline the Epidemiology & Public Health issues of BPH
and prostate cancer
37. SAQ: UT Obstruction
• What are differential diagnosis?
• What complication he has? Or he may develop?
• Should PSA be tested for all? Diagnostic levels?
• When is biopsy indicated?
• Does BPH lead to Carcinoma?
• What is the best screening test for Ca?
• What investigations are available?
• BPH & Carcinoma – microscopy?
• Gleason grading of prostate carcinoma?
38. Self Assessment:
•
•
•
•
•
•
Common obstructions of LUT – age
Etiology, pathogenesis, morphology: BPH
PSA levels in diagnosis – debate.
Cystic diseases of Kidney – ADPKD
Urinary Tract Infections – Microbiology.
Nephrolithiasis – common stones
morphology.
• Transitional cell carcinoma – brief
• U:C ration – significance, diagnosis.
39. Core Learning Issues: (CLI)
Major:
• Disorders of Prostate – Prostatitis, BPH & Ca.
• Nephrolithiasis: Features, Types, Pathogenesis.
• Tumors of Kidney. – RCC, TCC, Wilms.
• Urinary Tract Infection – Common Microbiology.
Minor:
• hematuria, strictures, obstructions, polyps.
• Tumors of Urinary tract and bladder.
• Kidney Cysts, Hydronephrosis, Recurrent UTIs,
Pyelonephritis, renal abscess, Congenital
disorders of kidney.
40. When you lose,
don’t lose the lesson!
Lao Tzu
Everyone makes Mistakes,
only intelligent learns from it.
42. Nephrolithiasis:
• Usually unilateral, small 1-3 mm,
• Flank pain & tenderness – renal
capsule.
• Passage marked by Paroxysmal,
intense colicky pain in the back
(loin) with radiation to anterior
(renal or ureteral "colic“)
• “writhing in pain, pacing about,
and unable to lie still”
• Hematuria macro/micro
• Larger stones that cannot pass
produce hydronephrosis or
hydroureter.
43. Levels - Clinical symptoms
• Ureteropelvic junction - deep flank
pain No radiation. Distension of the
renal capsule. (Symp. T11-L2)
• Ureter – Acute, severe, colicky pain
in the flank and ipsilateral lower
abdomen with radiation to the
testes/vulva (ilioinguinal n.). nausea
/ vomiting.
– Upper ureter – cholecystitis.
– Middle – appendicitis
– Distal ureter – Pelvic Infl. Dis.
• Ureterovesical junction - Cause
irritative voiding, urinary frequency
and dysuria.
Calcium Oxalate
44. Nephrolithiasis: Organic matrix(3%) + salts
(97%) ~
• Calcium stones (80%): oxalate/phosphate/urate
salts.
Calcium Oxalate
– Increased gut absorption or defective tubular
reabsorphtion of calcium – Common, high pH.
– Hyperparathyroidism (10%)
– Hyperuricosuria – high pH
• Struvite Stones (15%) magnesium ammonium
phosphate (triple phos). Staghorn stone.
– Chronic UTI with gram-negative rods (split urea) pH
>7
– Proteus, Pseudomonas, and Klebsiella (not E. coli).
• Uric acid stones (6%):
– pH <5.5, high protein (meats), malignancy, 25% have
gout.
57. Transitional cell Neoplasms:
90% of bladder ca. Males 3:1 Fem, 50-70y
Painless hematuria, Malignant cells in urine
Papillary(low gr), Flat / Infiltrative (high gr)
Risk F: β-naphthylamine. Cigarette smok,
chronic cystitis, schistosomiasis
58. “No one who does good work will
ever come to a bad end, either here
or in the world to come”
– Bhagavad Gita 6:6
59. T4W4: Week overview:
2013 Term 4 CPC 4 Title: Epididymo-Orchitis
System: Male Genital System
Aim: Clinical, Pathology & Population study of patients with male genital
system disorders & sexually transmitted disease (STD) using a case
of epididymo-orchitis with a differential diagnosis of testicular
torsion and testicular tumour.
Learning Outcomes 1. Demonstrate competency in history taking & the clinical
The student will be
examination of male patients with genital disorders
able to 2. Outline the Laboratory investigations and first line
management of common infections including STIs.
3. Outline the Investigations and first line management of
testicular torsion and testicular carcinoma
4. Outline the anatomy and histology of male genital system.
5. Describe the Microbiology of common STIs; Pathology of
Penis & testicular disorders including torsion and tumours.
6. Relate the Professional, Ethical & Legal issues in diagnosis &
management of patients with STIs.
7. Describe the Epidemiology & Public Health issues of STIs,
testicular torsion, testicular cancer.
60. CPC4.4:Testes: Common presentations.
Torsion 12y boy, woke up in the night with sudden
severe scrotal pain. O/E tender, swollen testes
high up in the scrotal sac does not allow to
touch.
Seminoma 35y man, dragging sensation in scrotum since 6
weeks. O/E enlarged, smooth, non tender, firm
testes on one side.
28y man, severe aching pain in the left groin
Ep.Orchitis radiating to the scrotum since 3 days with
associated fever and rigors. O/E a 4 cm, hot,
swollen, tender, (left epididymis & testis).
35y man, smoker, chronic cough, presents with
Hernia
recurrent attacks of sharp pain in right groin with
small painful bulge, disappears on laying down.
Bowen/EQ 68y male, erythematous, irregular, raised papule
on penis/glans since 6 months.
64. Bowen’s & Erythroplasia of Queyrat:
•
•
•
•
•
Epithelial hyperplasia & dysplasia.
HPV type 16, 18
On Glans: Erythroplasia of Queyrat
On Shaft : Bowens Disease.
Premalignant Sq. Cell Ca.
65. Carcinoma Penis: (Sq cell)
Hygiene, smegma irritation
Smegma carcinogen?
Smoking is a risk factor*
HPV 16, 18 *
Circumcision known to prevent.
Phimosis increases risk.
Starts as erythroplakia/leukoplakia.
Well diff. sq.ca – Epithelial pearls.
Slow growth, Good prognosis
Inguinal & iliac LN spread.
70% 5 year survival.
66. Cryptorchidism: “undescended testes”
Normal descent: 3m to pelvis, 9m to scrotum.
Non descent 5% at birth, 1% at 1y (10% bilateral)
Cause: Hormonal, intrinsic & mechanical.
Common in Patau, Prader willi sy. etc.
Atrophy, - sertoli & Leydig cell hyperplasia.
3-5 fold increase in Germ cell Malignancy – even in the other testes.
(not in other types of atrophy)
Orchiopexy – reduces risk of sterility & cancer.
Normal
Abdominal
- 3m
Inguinal
Suprascrotal
- 9m
Normal
Atrophy
~ 1 year
67. Testes Atrophy:
Normal
Bilateral in Hypopituitarism, Chronic
Alcoholism, chemotherapy or
radiation.
Hormonal, infection, Cryptorchidism.
Mumps – Patchy.
Sertoli only, Leydig cell hyperplasia.
high chance of neoplasms.
Atrophic
Normal
Spermatogne
sis
Few Leydig
cell cluster
outside
Atrophy
Sertoli only
inside,
Leydig cell
Hyperplasia
outside
68. Hydrocele:
Common, Clear Fluid in
Tunica vaginalis.
Cong./Acquired (inflam).
Varicocele:
Engorged spermatic
cord veins (pampiniform
plexus). Common cause
of infertility oligospermia.
Primary / Secondary
Spermatocele:
Epididymis dilatation
trauma/infection,
multilocular, sperms.
Hematocele:
Blood in tunica vaginalis.
Trauma, tumours.
69. To measure the man,
measure his heart.
-- Malcolm Stevenson Forbes
70. Epididymo-Orchitis:
Symptoms:
• Testicular pain - unilateral
• Erythema / oedema of the scrotum
• Urethritis, dysuria / urethral discharge.
Etiology:
• Gonococcal – Neisseria gonorrhoeae.
Non Gonococcal - (chlamydia, Mycoplasma..)
Gross: swollen, hot, Acute inflammation, edema
Micro: Edema, neutrophils, necrosis.
Investigations:
• Exclude torsion/trauma in <30 years,
• Microbiology: C/S, Elisa, etc.
71. Genital herpes:
STD - HSV (Herpes Simplex
Virus) type 2.
Itching closely grouped
vesicles surrounded by
erythema.
Vesicles burst to form painful
ulcers.
Multinucleate giant cells with
viral inclusion.
72. Syphilis:
Treponema pallidum
Primary chancre on penis:
ulcerated nodule inguinal
lymphadenitis
Secondary stage:
condylomata lata, (2-8w)
Painless, broad, moist Grey
white to red plaques. Highly
infectious.
Tertiary stage: gumma,
often in the testis
77. Embryonal Ca.
Children (Yolksac/Endodermal sinus)
• Pink AFP globules in cells.
• Schiller-Duvall bodies (embryo like)
Adults: Embryonal Ca.
• Primitive, pleomorphic cells in clusters,
embryoid structures.
Pathology: Germ cell tum.
Clinical: painless swelling of testes.
malignant, poor prognosis,
metastases.
Gross: Hemorrhagic, necrotic tum.
Micro: Pleomorphic cells, embryoid
structures.
78. “Strength does not come from
winning,
Struggles & Hardship develop
strength.
- - Arnold Schwarzenegger
Bodybuilder, Actor & Leader.
79. T4W5: Week overview:
2013 Term 4 CPC 5 Title: Breast Cancer
System: Breast
Aim: Clinical, Pathology & population study of patients breast
disease
1. Demonstrate competency in history taking & the
clinical examination of patients with breast
disease.
2. Describe the first line investigation and
management of patients with breast disease or
symptoms.
Learning outcomes
The student will be 3. Describe the Pathophysiology of breast
disease (benign and malignant)
able to
4. Outline the basic sciences relating to function of
the breasts.
5. Describe the Epidemiology and aetiology of breast
disease in Australia and world wide.
6. Illustrate the advantages and disadvantages of
the breast screening program in Australia
80. Case studies:
• 22year female, noticed small mobile round
lump in her right breast, lower inner quadrant.
• 39year female, multiple small lumps, irregular,
firm, tender more during mid cycle.
• 41year female, two left axillary LN, no pain, no
breast mass. mild loss of weight.
• 34year female, diffuse firm left breast. FNAC
reports abnormal cells. No LN.
• 39year female, painful lump, chronic pus
discharge from nipple.
• 71year old female. Rough, red scaling pruritic
patch on left nipple and areola.
• 26y nurse, right breast lump 5m, firm irregular,
6cm firm, fixed lump.
• Fibroadenoma
• Fibrocystic dis
• Ca breast.
• DCIS
• Duct ectasia
• Paget’s dis
• BRCA Ca.
81. Self assessment:
•
•
•
•
•
•
•
•
•
Clinical features of benign, malignant & reactive…
Breast cancer screening guidelines.
Hyperplasia / tumour features.
Familial vs Non familial breast Ca features.
Screening Mammogram – policy, procedure &
interpretation.
Fibrocystic disease, fibroadenoma & cancer.
Breast cancer common types & features (gross,
microscopy, complications etc.)
Duct carcinoma, lobular carcinoma, other types.
BRCA testing in familial breast ca.
86. FibroCystic Disease: types
Non prol. / low grade
Prol. / High grade
A. Simple Fibrocystic change.
B. Lobular hyperplaisa without atypica (adenosis)
C,D - Ductal hyperplasia without atypia (E. with atypia - cribriform)
F. Lobular hyperplasia.
88. Fibroadenoma
Pathology: Benign tumor of acini tissue (gland & stroma)
Clinical: Well demarcated, mobile, round/nod (mouse)
Gross: Capsulated, firm grey, nodular tumour, cysts+/-.
Micro: Compressed slit like ducts/glands in cellular stroma.
89. Giant Fibroadenoma
• Pathology: Benign(young) to malignant(adult) tumor of acinii.
• Clinical: young (Low grade) /adult (high grade)*, unilateral macromastia,
recurrent, metastasis 15%.
• Gross: Large 10-15cm . Giant. With linear “leaf-like” clefts and slits –
Giant/Juvenile in young - Phyllodes tumor in adult.
• Micro: Both stroma & glands are hypercellular & pleomorphic. glands
show branching..
90. Etiology of Breast Carcinoma:
• HER2/NEU
• RAS & MYC
• BRC A1, A2.
Environment
Hormone
Genetics
• Estrogen therapy.
• Family history – First degree
• Alcohol, Smoking.
relative.
• High fat diet,
• Premenopausal & bilateral.
Obesity.
• Early menarche/Late menopause.
• Overexposure to oestrogens and underexposure to progesterone
• No definite relationship to oral contraceptives
• Some tumours contain hormone receptors and respond to hormone manipulation
• No good evidence for viral involvement
91. Pathogenesis of Breast Cancer.
Duct Ca. in-Situ
DCIS
Hyperplasia Dysplasia DCIS Carcinoma
Fibrocystic change Cancer
93. Infiltrating Duct Carcinoma: Breast Ca.
(NOS or Classic or typical “Schirrhous carcinoma”)
Note: Fibrotic tumor, radiating fibrous scar around
resulting in nipple retraction & skin pulling (puckering)
97. If through a broken heart
you become a better person then,
thank him for breaking your heart!
~ Oswald Chambers
98. T4W6: Week overview:
2013 Term 4 CPC 6 Title: Female Gynaecological 2
System: Female genital tract
Understanding pathology & clinical diagnosis of female patients with
Aim:
abnormal vaginal discharge
Learning Outcomes
(The student will be
able to..)
1. Demonstrate competency in History taking & clinical examination of
patients with an abnormal vaginal discharge.
2. Demonstrate competency in the Physical examination of abdomen
and pelvis.
3. Outline the Investigation and first line treatment of common causes
an abnormal vaginal discharge including pelvic inflammatory
disease.
4. Outline the anatomy and histology of female genital tract
5. Describe the difference in presentation in STIs in women and men
6. Discuss the screening program for cervical cancer in Australia
7. Construct a management plan for patients with normal and abnormal PAP
smears
8. Relate the Professional, ethical & legal issues in diagnosis &
management of victims of violent crime.
9. Describe the Epidemiology & Public Health issues of cervical cancer and
STIs.
98
99. Case studies:
Trauma • 8year girl, vaginal bleeding and discharge.
Chlamy.. • 21year female, itchy vaginal discharge foul
smelling.
Candida • 26 year old thick white cheesy discharge.
Gonoco.. • 25 year old, whitish yellow pus discharge.
DUB • 31year female, irregular heavy bleeding.
CaCx • 34year female, irregular & post coital bleeding.
Molar preg. • 28y G2 P1, second trimester vaginal bleed.
Endo.. Ca • 69year female, vaginal bleeding
103. HPV: Condyloma acuminatum
A
B
C
Ano-genital wart, soft,
HPV 6 & 11, STI, Benign,
A. Small, warty, Cauliflowerlike growth.
B. Koilocytes: peri nuclear
halo + viral particles
C. Mild Dysplasia. (Cx. CIN-1)
10
116. Endometrial Hyperplasia & Polyp:
• Hyper-estrogenemia.
• Hyperplasia of endometrium, may form
polyp.
• Common cause of uterine bleeding - DUB
• Risk of malignancy – more with
atypical/dysplasia.
11
122. T4W7: Week overview:
Term4 CPC 7 Title: Female Gynaecological 2
System
Aim:
Learning
Outcomes:
The student
will be able to
Female genital tract
Understanding pathology & clinical diagnosis of female patients with
abnormal vaginal bleeding
1. Demonstrate competency in History taking & the clinical examination
of patients with abnormal vaginal bleeding.
2. Demonstrate competency in history taking and clinical examination of
patients with menopausal symptoms
3. Outline the Investigation and first line management of patients
with abnormal vaginal bleeding: menopausal symptoms.
4. Illustrate the advantages and disadvantages of HRT
5. Outline the anatomy and histology of the female genital tract; the
physiology of menstrual cycle and menopause including
anovulatory menstrual cycles and polycystic ovarian syndrome
6. Describe the pathology of common disorders of the uterus and
ovaries including polyps, tumours -both benign and malignant.
7. Relate the Professional, ethical & legal issues in diagnosis &
management of patients with abnormal vaginal bleeding.
8. Describe the Epidemiology & Public Health issues of menopause, ovarian
123. Core Learning Issues:
Pathology Major CLI:
• Ovary – disorders overview.
• PolyCystic Ovary Syndrome (PCOS)
• Tumors of Ovary – overview (common: Cystadenoma,
dermoid cyst)
• Gestational Pathology – Overview
Pathology Minor CLI:
• Ectopic pregnancy.
• Eclampsia & Pre-Eclampsia, Gestational tumours.
• Disorders of placenta, Hydatidiform mole,choriocarcinoma.
• Other tumours of ovary – teratocarcinoma,
12
137. What am I doing? - Where am I going?
(Where I want to be in 5 years?)
“Identifying your Goal is like identifying the
North Star, you fix your compass on it and then
use it as the means of getting back on track when
you tend to stray”
-- Marshall Dimock
138. "I learned that good judgment
comes from experience and
that experience grows out of
mistakes!"
– Omar Bradley
139. Education is what remains after we have
forgotten all the facts taught in the class!
--
140. “A man must be big enough to admit his
mistakes, smart enough to profit from
them, and strong enough to correct
them!”
--John C. Maxwell
141. Wish you all Success,
Health, & Happiness
in life.
Need help for exams?
You can still contact me..