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116 Cards in this Set
- Front
- Back
What nodes does the proximal 2/3 of the vagina/uterus drain to?
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Obturator, external iliac, and hypogastric nodes
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What is the round ligament of the uterus?
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Connects uterine fundus to labia majora. Derived from the gubernaculum. Travels through the inguinal canal.
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Which ligament contains the uterine vessels?
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Cardinal ligament (cervix to side wall of pelvis)
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3 causes of neurological disease leading to erectile dysfunction?
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Autonomic diabetic neuropathy, MS, and damage from radical prostatectomy
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Where do the acrosome and the tail of sperm come from?
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Acrosome comes from Golgi and tail forms from the centrioles.
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What accounts for 90% of male infertility?
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Seminiferous tubule dysfunction. Associated with varicocele, Klinefelter's, and orchitis.
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What is Leriche syndrome?
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Aortoiliac atherosclerosis. Cause of vascular insufficiency leading to ED (decreased penile blood flow, calf claudication, etc)
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How does hypothyroidism lead to ED?
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Primary hypothyroidism --> increased TRH levels --> increased release of PRL --> shuts down GnRH axis
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What does spermiogenesis refer to?
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Spermatid to spermatozoa. Involves loss of cytoplasmic contents and gain of acrosomal cap. No change in genetic material (both N).
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What happens between the primary and secondary spermatocytes?
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Meiosis 1. Primary spermatocyte is 4N. Secondary spermatocyte is 2N.
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What does progesterone do to the uterus?
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Decreases myometrial excitability/prevents contractions. Stimulates endometrial glandular secretions and spiral artery development.
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Potency of 3 estrogens?
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Estradiol > estrone > estriol
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How is estriol formed?
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Fetal zone of the adrenal cortex makes DHEA-S, fetal liver makes 16-OH-DHEA-S, placenta makes estriol, and maternal liver conjugates estriol and excretes it in urine.
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4 causes of decreased SHBG?
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Androgens, obesity, insulin, and hypothyroid.
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What is Mittelschmerz?
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Blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis. Mittelschmerz is German for "middle pain" (middle of menstrual cycle).
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Most common site of fertilization?
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Ampulla (upper end) of fallopian tube.
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Site of progesterone production.
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Corpus luteum for the 1st trimester (due to stimulation by hCG producted in the syncytiotrophoblast), then the placenta for the 2nd/3rd trimesters.
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Best test to confirm menopause?
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Increased FSH (due to loss of negative feedback by estrogen).
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Main type of estrogen post-menopause?
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Estrone. Due to peripheral conversion of androgens.
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Cause of thick neck in Turner's syndrome?
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Cystic hygroma (lymphangioma often in posterior neck) --> causes webbed neck.
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What is a Barr body?
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Inactive X chromosome. NOT seen in Turner's syndrome (XO).
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Disease? Male with low testosterone and inhibin, eunuchoid body shape, gynecomastia, developmental delay, and presence of Barr body?
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Klinefelter's syndrome. (XXY)
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Common cause of 2nd trimester recurrent miscarriage?
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Bicornuate uterus (incomplete fusion of paramesonephric duct)
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Cause of mortality in pre-eclampsia/eclampsia?
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Cerebral hemorrhage and ARDS.
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Seizure prevention with pre-eclampsia?
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Delivery! But otherwise IV magnesium sulfate and diazepam. Also bed rest, salt restriction, treat HTN.
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What does 2 sperm + an empty egg cause?
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Complete mole! 46XX or 46XY. Increased hCG, uterine size. Risk of conversion to choriocarcinoma. NO fetal parts.
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Risk factors for endometrial hyperplasia?
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Granulosa cell tumor, PCOS, HRT, anovulatory cycles
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Age cutoff for premature ovarian failure?
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40 yo w/ signs of menopause
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Common causes of anovulation?
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PCOS, obesity, HPO axis, premature ovarian failure, hyper-PRL, thyroid disorders, eating disorders, Cushing's syndrome, adrenal insufficiency
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Values for oligo and polyhydramnios?
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< 0.5 L or > 1.5-2 L
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Attachment of placenta to lower uterine segment with occlusion of internal os and painLESS bleeding?
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Placenta previa.
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Risk for placenta previa?
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Multiparity or prior C-section.
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Premature detachment of placenta from implantation site with painFUL bleeding in 3rd trimester?
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Abruptio placentae.
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Risks for abruptio placentae?
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Smoking, HTN, cocaine use, AMA, trauma, chorioamnionitis
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Defective decidual layer allows placenta to attach to myometrium without separation of placenta after birth?
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Placenta accreta.
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Risk factors for placenta accreta?
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Prior C-section, inflammation, and placenta previa.
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Treatment for PCOS?
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Weight loss, OCPs, gonadotropin analogs, clomiphene, spironolactone (for hirsutism), surgery
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What causes a theca-lutein cyst?
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Gonadotropin stimulation (so they're often multiple/bilateral). Associated with choriocarcinoma and moles.
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2 hormones that contribute to BPH?
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Estradiol (age related increase in sensitization) with DHT (growth promoting effects)
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Increased free vs bound PSA?
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Total PSA is increased in both BPH and prostate cancer. BPH: greater increase in free PSA. Cancer: decreased free fraction.
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What is seen in the transitional vs periurethral zone in BPH?
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Transitional zone: glandular hyperplasia.
Periurethral zone: stromal hyperplasia (leads to urethral obstruction) |
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Lobes of BPH vs prostate cancer?
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BPH: lateral and middle (periurethral)
Cancer: posterior (peripheral) |
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Hallmark of prostate cancer on histology?
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Perineural invasion. Also vascular and capsular invasion, etc.
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Hormones that contribute to cryptorchidism?
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Possible defect in androgen and hCG levels. Most spontaneously descend in 3 mo.
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Drugs that can cause gynecomastia?
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Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole, Leuprolide, Flutamide
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Pathology of lactiferous sinus of breast?
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Intraductal papilloma, breast abscess, mastitis
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Pathology of nipple?
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Paget's disease, breast abscess
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Pathology of terminal duct?
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Tubular carcinoma
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Pathology of breast stroma?
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Fibroadenoma, phyllodes tumor
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Pathology of lobules of breast?
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Lobular carcinoma, sclerosing adenosis
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Pathology of major duct in breast?
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Fibrocystic change, ductal cancer
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Different types of fibrocystic breast disease?
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Sclerosing adenosis (intralobular), epithelial hyperplasia (terminal duct lobules), fibrosis (stroma), cystic (ductal dilation)
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Drainage of inner and outer breast quadrants?
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Inner --> internal mammilary nodes
Outer --> axillary nodes |
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What is an easy way to distinguish testicular tumors from other testicular masses?
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Transillumination (hydrocele and spermatocele). Note: varicocele does not transilluminate.
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What is a unique histological finding of Leydig cell tumors?
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Reinke crystals: cytoplasmic protein crystals. Golden brown color overall.
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Most common testicular cancer in older men?
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Testicular lymphoma (non-germ cell tumor)
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Name for when the orifice of the prepuce is too small to retract over the head of the penis?
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Phimosis. Often associated with infection.
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Name for red velvety plaques on the penis and their location?
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Erythroplasia of Queyrat/erythroplakia. Usually involves glans.
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2 precursors to SCC of the penis?
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Bowen's disease and erythroplasia of Queyrat
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Gray solitary crusty plaque on shaft of penis or scrotum?
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Bowen's disease
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Multiple papular lesions on penis of young man?
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Bowenoid papulosis (considered CIS but almost never invasive)
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Histological lesions that resemble primitive glomeruli?
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Schiller-Duval bodies. Seen in yolk sac (endodermal sinus) tumors.
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Which testicular cancer is painful?
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Embryonal carcinoma. Often have glandular/papillary morphology with bulky hemorrhage and necrosis.
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Most common testicular tumor?
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Seminoma. See lobules of "fried egg" cells, lymphocytes or granulomas. Very radiosensitive.
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Use of exemestane/anastrozole in women?
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Treat ER-positive breast cancer (aromatase inhibitor)
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What are the two mechanisms of Leuprolide?
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Acts as a GnRH agonist when used in a pulsatile manner (ie: for infertility) or as an antagonist when used in a continuous manner (ie: for prostate cancer, uterine fibroids)
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Contraindications of estrogen use?
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ER positive breast cancer, history of DVT
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Estrogen partial agonist on bone?
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Raloxifene
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Partial estrogen agonist at receptors in hypothalamus?
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Clomiphene. Stimulates ovulation (tx for infertility, PCOS)
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Finasteride vs Flutamide?
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Finasteride (5-alpha-reductase inhibitor) is used in BPH and for male pattern baldness. Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor and is used for prostate cancer.
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PGE2 analog used to induce labor?
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Dinoprostone
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Beta-2 agonists that relax uterus and reduce premature delivery?
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Ritodrine and terbutaline.
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Alpha 1 receptors on prostate vs vasculature?
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Alpha 1 A, D found on prostate (and selectively inhibited by tamsulosin). Alpha 1 B found in vessels.
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Grape like mass of vagina with spindle shaped tumor cells that stain desmin positive?
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Sarcoma botyroides (rhabdomyosarcoma variant)
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Fibroadenoma is common with which medication?
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Cyclosporine
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Bloody nipple discharge --> think?
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Intraductal papilloma. In lactiferous sinus region of breast.
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Phyllodes tumor characteristics?
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Large bulky mass of connective tissue, leaf-like projections, lobulated. Hypercellular stroma with mitoses.
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Meds that cause galactorrhea?
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OCPs, phenothiazines, methyldopa, H2 blockers, anxiolytics
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What do Paget cells look like?
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Large cells in epidermis with clear halo.
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Subtype of DCIS with caseous necrosis?
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Comedocarcinoma.
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Bilateral breast cancer?
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Invasive lobular. Orderly rows of cells or concentric circles (bull's eye).
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Rock hard breast mass with stellate shape?
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Invasive ductal cell carcinoma.
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Meigs' syndrome?
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Triad of ovarian fibroma or tumor, ascites, and hydrothorax (R pleural effusion)
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What is struma ovarii?
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Type of ovarian teratoma that contains functional thyroid tissue and can present as hyperthyroidism.
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Where are Call-Exner bodies?
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Small follicles filled with eosinophilic secretions. Seen in Granulosa cell tumors.
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Which ovarian tumor looks like bladder tisue (Walthard's rests: transitional-like epithelium)?
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Brenner tumor
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Which ovarian tumor has intestine-like tissue?
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Mucinous cystadenoma. Multilocular cyst lined by mucus secreting epithelium.
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What findings are in mucinous cystadenocarcinoma?
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Pseudomyxoma peritonei: intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor. "Beach ball" appearance.
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Pulling sensation in groin: which ovarian tumor?
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Fibroma (non-germ-cell)
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Bilateral ovarian tumors?
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Serous cystadenocarcinoma.
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Which chromosomes are commonly involved in translocations?
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13, 14, 15, 21, 22 (cluster during meiosis)
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What happens between a primordial germ cell, an oogonium, and a primary oocyte in prophase?
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2 cycles of mitosis
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Resting stage of primary oocyte until just before ovulation?
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Diplotene stage of prophase 1.
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Follicle with primary oocyte surrounded by layer of flat epithelial (follicular) cells?
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Primordial follicle
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Primary oocyte surrounded by stratified layer of granulosa cells and well defined zona pellucida?
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Primary follicle
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Oocyte surrounded by zona pellucida where egg is off center and fluid has accumulated within layers of granulosa cells?
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Secondary (antral) follicle
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Which meiosis involves exchange of genetic material between homologous chromosomes?
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Meiosis 1
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What happens in the ovary without FSH stimulation?
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Primary follicles die and become atretic.
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Order of ovarian follicle development?
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Primordial, primary, secondary/antral, pre-ovulatory
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What happens to the corpus luteum if fertilization does not occur?
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The lutean cells degenerate (luteolysis) and form a mass of fibrotic scar tissue (the corpus albicans).
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3 phases of fertilization process?
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1. Penetration of the corona radiata
2. Penetration of the zona pellucida 3. Fusion of the oocyte and sperm cell membranes |
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Drainage of distal 1/3 of vagina/vulva/scrotum?
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Superficial inguinal lymph nodes
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Which ligament contains the ovarian vessels?
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Suspensory ligament of the ovary (ovary to lateral pelvic wall)
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Which ligament travels through the inguinal canal?
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Round ligament of the uterus
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Fallopian tube epithelium?
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Simple columnar epithelium, ciliated
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Uterus epithelium?
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Simple columnar epithelium, pseudostratified, with tubular glands
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Top causes of seminiferous tubule dysfunction?
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Varicocele, Klinefelter's syndrome, orchitis
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What cells secrete androgen binding protein (ABP)?
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Sertoli cells
- maintains proper levels of testosterone |
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What produces primary spermatocytes?
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Spermatogonia (most primitive germ cells)
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Early vs late effects of DHT?
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Early: differentiation of penis, scrotum, and prostate
Late: prostate growth, balding, sebaceous gland activity |
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Estrogen's effect on prolactin?
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Estrogen stimulates prolactin secretion but blocks its action at the breast.
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Metrorrhagia vs Menometrorrhagia?
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Metrorrhagia: frequent but irregular menstruation
Menometrorrhagia: heavy, irregular menstruation at irregular intervals |
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Hormone changes in Klinefelter's syndrome?
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Low testosterone
High LH High estrogen |
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Hormone levels in PCOS?
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High LH
Low FSH High testosterone |
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Common ovarian cyst in pregnancy?
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Corpus luteum cyst
- caused by hemorrhage into persistent corpus luteum |
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Frequency of what type of cyst is increased with choriocarcinoma?
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Theca-lutein cyst
- high hCG production |