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354 Cards in this Set
- Front
- Back
Question
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Answer
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24-year-old male develops testicular cancer. Metastatic spread occurs by what route?
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Para-aortic lymph nodes (recall descent of testes during development).
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Woman with previous cesarean section has a scar in her lower uterus close to the opening of the os. What is she at ↑ risk for?
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Placenta previa.
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Obese woman presents with hirsutism and ↑ levels of serum estosterone.
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Polycystic ovarian syndrome.
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Pregnant woman at 16 weeks of gestation presents with an atypically large abdomen.
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High hCG; hydatidiform mole.
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55-year-old postmenopausal woman is on tamoxifen therapy. What is she at ↑ risk of acquiring?
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Endometrial carcinoma.
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Gonadal drainage Venous drainage
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Left ovary/testis → left gonadal vein → left renal vein → IVC Right ovary/testis → right gonadal vein → IVC
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Gonadal drainage Lymphatic drainage drainage
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Ovaries/testes → para-aortic lymph nodes
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Ligaments of the uterus/contents Suspensory ligament of ovaries
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Contains the ovarian vessels.
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Ligaments of the uterus/contents Contains the ovarian vessels.
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Suspensory ligament of ovaries
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Ligaments of the uterus/contents Contains the uterine vessels.
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Transverse cervical (cardinal) ligament
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Ligaments of the uterus/contents Transverse cervical (cardinal) ligament
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Contains the uterine vessels.
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Ligaments of the uterus/contents Round ligament of uterus
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Contains no important structures.
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Ligaments of the uterus/contents Contains no important structures.
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Round ligament of uterus
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Ligaments of the uterus/contents Contains the round ligaments of the uterus and ovaries and the uterine tubules and vessels.
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Broad ligament
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Ligaments of the uterus/contents Broad ligament
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Contains the round ligaments of the uterus and ovaries and the uterine tubules and vessels.
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innervation of the male sexual response
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Point and Shoot. -Erection is mediated by the Parasympathetics -Emission is mediated by the Sympathetis -Ejaculation is mediated by visceral and somatic nerves.
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Derivation of sperm parts
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-Acrosome is derived from the Golgi apparatus and -flagellum (tail) from one of the centrioles. -Middle piece (neck) has Mitochondria.
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Sperm food supply
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fructose.
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sperm locations from nothing to vagina
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SEVEN UP -Seminiferous tubules -Epididimys -Vas deferens -Ejaculatory ducts -(Nothing) -Urethra -Penis
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Sperm development what forms blood-testis barrier
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Junctional complex (tight junction) between Sertoli cells
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Sperm development Spermatogenesis begins at puberty with
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spermatogonia (type A and type B)
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Sperm development Full development takes
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2 months.
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Sperm development Spermatogenesis occurs in
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Seminiferous tubules
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Sperm development Blood-testis barrier what and why
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physical barrier in the testis between the tissues responsible for spermatogenesis and the bloodstream -to avoid autoimmune response
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Sperm development #N of Primary spermatocyte
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4N
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Sperm development #N of Secondary spermatocyte
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2N
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Sperm development #N of Spermatid (N)
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1N
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progression of cells to sperm and N number
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Spermatogonium 1° (diploid, 2N) Mitosis spermatocyte 2° (diploid, 4N) Meiosis I spermatocyte (haploid, 2N) Meiosis II Spermatid (haploid, N)
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Male spermatogenesis products/functions of products Androgen-binding protein (ABP)
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Ensures that testosterone in seminiferous tubule is high
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Male spermatogenesis products/functions of products Ensures that testosterone in seminiferous tubule is high
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Androgen-binding protein (ABP)
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Male spermatogenesis products/functions of products Inhibits FSH
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Inhibin
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Male spermatogenesis products/functions of products Inhibin
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Inhibits FSH
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Male spermatogenesis products/functions of products Testosterone
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Differentiates male genitalia, has anabolic effects on protein metabolism, maintains gametogenesis, maintains libido, inhibits GnRH, and fuses epiphyseal plates in bone.
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Male spermatogenesis products/functions of products Differentiates male genitalia
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Testosterone
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Male spermatogenesis products/functions of products has anabolic effects on protein metabolism
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Testosterone
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Male spermatogenesis products/functions of products maintains gametogenesis
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Testosterone
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Male spermatogenesis products/functions of products maintains libido
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Testosterone
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Androgens names
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Testosterone, dihydrotestosterone (DHT), androstenedione.
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Androgens Source
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-DHT and testosterone (testis), -androstenedione (adrenal).
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Androgens Targets
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Skin, prostate, seminal vesicles, epididymis, liver, muscle, brain.
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Androgens Function
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1. Differentiation of wolffian duct system into internal gonadal structures 2. 2° sexual characteristics and growth spurt during puberty 3. Required for normal spermatogenesis 4. Anabolic effects–– ↑ muscle size, ↑ RBC production 5. ↑ libido
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Androgens potency
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DHT > testosterone > androstenedione.
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Testosterone is converted to DHT by ?????? and inhibition by ??????
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the enzyme 5α-reductase, which is inhibited by finasteride.
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??????is converted to DHT by the enzyme 5α-reductase, which is inhibited by finasteride.
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Testosterone
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Testosterone is converted to ?????? by the enzyme 5α-reductase, which is inhibited by finasteride.
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DHT
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Testosterone and androstenedione are converted to estrogen in ????? by ??????
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adipose tissue by enzyme aromatase.
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?????? converted to estrogen in adipose tissue by enzyme aromatase.
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Testosterone and androstenedione
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Testosterone and androstenedione are converted to ??????? in adipose tissue by enzyme aromatase.
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estrogen
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Estrogen Source
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Ovary (estradiol), placenta (estriol), blood (aromatization).
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Estrogen Functions (10)
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1. Growth of follicle 2. Endometrial proliferation, 3. Development of genitalia 4. Stromal of breast 5. Female fat distribution 6. Hepatic synthesis of transport proteins 7. Feedback inhibition of FSH 8. LH surge 9. ↑ myometrial excitability 10. ↑ HDL, ↓ LDL
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Estrogen effects on LH
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LH surge (estrogen feedback on LH secretion switches to positive from negative just before LH surge)
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Estrogens potency
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Potency––estradiol > estrone > estriol.
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Estrogen levels in pregnancy
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50-fold ↑ in estradiol and estrone 1000-fold ↑ in estriol (indicator of fetal well being)
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Estrogen indicator of fetal well being
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1000-fold ↑ in estriol
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Progesterone Source
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Corpus luteum, placenta, adrenal cortex, testes.
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Progesterone Function (7)
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1. Stimulation of endometrial glandular secretions and spiral artery development 2. Maintenance of pregnancy 3. ↓ myometrial excitability 4. Production of thick cervical mucus, which inhibits sperm entry into the uterus 5. ↑ body temperature 6. Inhibition of gonadotropins (LH, FSH) 7. Uterine smooth muscle relaxation
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Progesterone mnemonic
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Progesterone Prepares for Pregnancy.
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Elevation of ?????? is indicative of ovulation.
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progesterone
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Follicular growth is fastest during
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2nd week of proliferative phase.
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stimulates endometrial proliferation.
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Estrogen
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maintains endometrium to support implantation.
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Progesterone
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?????progesterone leads to ↓ fertility.
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↓
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↓ progesterone leads to ??fertility.
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↓
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blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis.
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Mittelschmerz
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Mittelschmerz
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blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis.
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Oral contraceptives mech
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prevent estrogen surge, LH surge → ovulation does not occur.
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Ovulation steps
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Estrogen surge day before ovulation. Stimulates LH, inhibits FSH. LH surge causes ovulation (rupture of follicle). ↑ temperature (progesterone induced). Ferning of cervical mucosa.
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Meiosis and ovulation
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-1° oocytes begin meiosis I during fetal life and complete meiosis I just prior to ovulation -Meiosis I is arrested in prOphase for years until Ovulation. -Meiosis II is arrested in METaphase until fertilization. (An egg MET a sperm)
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hCG Source
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Syncytiotrophoblast of placenta.
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hCG Function
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1. Maintains the corpus luteum for the 1st trimester by acting like LH. In the 2nd and 3rd trimester, the placenta synthesizes its own estrogen and progesterone and the corpus luteum degenerates.
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Used to detect pregnancy because it appears in the urine 8 days after successful fertilization (blood and urine tests)
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hCG
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hCG wrt testing
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Used to detect pregnancy because it appears in the urine 8 days after successful fertilization (blood and urine tests) Elevated hCG in women with hydatidiform moles or choriocarcinoma.
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women with hydatidiform moles or choriocarcinoma.
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Elevated hCG
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Cessation of estrogen production with age-linked decline in number of ovarian follicles.
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Menopause
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Menopause what
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Cessation of estrogen production with age-linked decline in number of ovarian follicles.
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Menopause age
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Average age of onset is 51 years (earlier in smokers).
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Menopause hormonal changes
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↓ estrogen ↑↑ FSH ↑ LH (no surge) ↑ GnRH.
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Menopause clinical findings
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Menopause causes HAVOC: Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease.
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Bicornuate uterus mech
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Results from incomplete fusion of the paramesonephric ducts.
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Results from incomplete fusion of the paramesonephricducts. Associated with urinary tract abnormalities and infertility.
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Bicornuate uterus
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Bicornuate uterus complications
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Associated with urinary tract abnormalities and infertility.
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Abnormal opening of penile urethra on inferior (ventral) side of penis due to failure of urethral folds to close.
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Hypospadias
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Hypospadias what and mech
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Abnormal opening of penile urethra on inferior (ventral) side of penis due to failure of urethral folds to close.
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Abnormal opening of penile urethra on superior (dorsal) side of penis due to faulty positioning of genital tubercle.
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Epispadias
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Hypospadias
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Abnormal opening of penile urethra on superior (dorsal) side of penis due to faulty positioning of genital tubercle.
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Congenital penile abnormalities which is more common
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Hypospadias is more common than epispadias.
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Hypospadias complications and Tx
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Fix hypospadias to prevent UTIs.
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Exstrophy of the bladder is associated with ?????
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epispadias.
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????? is associated with epispadias.
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Exstrophy of the bladder
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Klinefelter’s syndrome phenotype/genotype
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[male] (XXY),
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[male] (XXY),
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Klinefelter’s syndrome
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Turner’s syndrome phenotype/genotype
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[female] (XO),
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[female] (XO)
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Turner’s syndrome
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Double Y males phenotype/genotype
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[male] (XYY),
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[male] (XYY)
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Double Y males
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Klinefelter’s syndrome appearance
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Testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution.
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Klinefelter’s syndrome lab findings
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Presence of inactivated X chromosome (Barr body).
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Klinefelter’s syndrome complications
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Common cause of hypogonadism seen in infertility workup.
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Turner’s syndrome appearance
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Short stature, webbing of neck,
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Turner’s syndrome lab findings
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No Barr body. ovarian dysgenesis (streak ovary)
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Turner’s syndrome complications
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-coarctation of the aorta, -most common cause of 1° amenorrhea. -Horseshoe kidney -cystic hygroma
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cystic hygroma
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a lymphatic malformation, is a benign proliferation of lymph vessels, fluid filled sacs that result from blockage of the lymphatic system
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a lymphatic malformation, is a benign proliferation of lymph vessels, fluid filled sacs that result from blockage of the lymphatic system
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cystic hygroma
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Pseudohermaphroditism what is it
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Disagreement between the phenotypic (external genitalia) and gonadal (testes vs. ovaries) sex.
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Female pseudohermaphrodite genotype/phenotype
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XX - Ovaries present, but external genitalia are virilized or ambiguous.
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XX - Ovaries present, but external genitalia are virilized or ambiguous.
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Female pseudohermaphrodite
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male pseudohermaphrodite genotype/phenotype
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XY - Testes present, but external genitalia are female or ambiguous
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Female pseudohermaphrodite mech
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excessive and inappropriate exposure to androgenic steroids during early gestation
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Female pseudohermaphrodite causes
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congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy).
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Female pseudohermaphrodite mech
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Most common form is androgen insensitivity syndrome (testicular feminization).
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true hermaphrodite genotype/phenotype
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(46,XX or 47,XXY) Both ovary and testicular tissue present; ambiguous genitalia. Very rare.
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Androgen insensitivity syndrome genotype/phenotype
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(46,XY) normal-appearing female; female external genitalia with rudimentary vagina; uterus and uterine tubes generally absent; develops testes
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Androgen insensitivity syndrome complications
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testes (often found in labia majora; surgically removed to prevent malignancy
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Androgen insensitivity syndrome Lab findings
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of testosterone, estrogen, and LH are all high.
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5α-reductase deficiency mech and clinical findings
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Unable to convert testosterone to DHT. Ambiguous genitalia until puberty, when ↑ testosterone causes masculinization of genitalia.
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5α-reductase deficiency lab findings
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Testosterone/estrogen levels are normal; LH is normal or ↑.
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Hydatidiform mole what is it
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A pathologic ovum (“empty egg”––ovum with no DNA) resulting in cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoblast).
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Hydatidiform mole lab findings
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High HCG
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Hydatidiform mole gross
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“Honeycombed uterus,” “cluster of grapes” appearance. Enlarged uterus.
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Most common precursor of choriocarcinoma.
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complete Hydatidiform mole
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complete mole wrt genotype origin fetus cancer
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Genotype of a complete mole is 46,XX and is completely paternal in origin (no maternal chromosomes); no associated fetus. increased risk of choriocarcinoma
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partial mole wrt genotype origin fetus cancer
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PARTial mole is made up of 3 or more PARTS (triploid 69XXY egg 23X and 2 sperm; may contain fetal PARTS. NO increased risk of cancer
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Preeclampsia what
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triad of hypertension, proteinuria, and edema
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Eclampsia what
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eclampsia is the addition of seizures
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Preeclampsia %'s and when
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7% of pregnant women from 20 weeks’ gestation to 6 weeks postpartum.
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Preeclampsia who is at increased risk
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↑ incidence in patients with preexisting hypertension, diabetes, chronic renal disease, and autoimmune disorders.
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Preeclampsia mech and associations
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-Etiology involves placental ischemia. -Can be associated with HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets).
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Preeclampsia clinical findings
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Headache, blurred vision, abdominal pain, edema of face and extremities, altered mentation, hyperreflexia;
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Preeclampsia Tx
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Delivery of fetus as soon as viable. Otherwise bed rest, salt restriction, and monitoring and treatment of hypertension.
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Preeclampsia lab findings
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thrombocytopenia, hyperuricemia. elevated Liver enzymes
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Eclampsia Tx
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a medical emergency, IV magnesium sulfate and diazepam.
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Abruptio placentae what
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premature detachment of placenta from implantation site.
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Abruptio placentae clinical findings
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Painful uterine bleeding (usually during 3rd trimester). Fetal death.
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Abruptio placentae associations and risk factors
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May be associated with DIC. ↑ risk with smoking, hypertension, cocaine use.
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premature detachment of placenta from implantation site.
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Abruptio placentae
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Placenta accreta what
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defective decidual layer allows placenta to attach directly to myometrium.
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Placenta accreta clinical findings
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Massive hemorrhage after delivery.
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Placenta accreta risk factors
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Predisposed by prior C-section or inflammation.
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defective decidual layer allows placenta to attach directly to myometrium.
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Placenta accreta
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Placenta previa what and findings
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attachment of placenta to lower uterine segment. May occlude cervical os. Painless bleeding in any trimester.
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Painless bleeding in any trimester.
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Placenta previa
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Ectopic pregnancy locations
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most often in fallopian tubes, confirm with ultrasound.
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Ectopic pregnancy clinical/Lab findings
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↑ hCG and sudden lower abdominal pain; Often clinically mistaken for appendicitis.
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Ectopic pregnancy risk factors
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predisposed by salpingitis (PID).
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Ectopic pregnancy confromation
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confirm with ultrasound.
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Polyhydramnios definition
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> 1.5–2 L of amniotic fluid;
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Polyhydramnios associations and complications
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associated with esophageal or duodenal atresia, causing inability to swallow amniotic fluid, and with anencephaly.
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Oligohydramnios associations and complications
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associated with bilateral renal agenesis or posterior urethral valves (in males) and resultant inability to excrete urine.
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oligohydramnios definition
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< 0.5 L of amniotic fluid;
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< 0.5 L of amniotic fluid;
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oligohydramnios
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> 1.5–2 L of amniotic fluid;
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Polyhydramnios
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Cervical pathology Dysplasia and carcinoma in situ describe and classification
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Disordered epithelial growth; begins at basal layer and extends outward. Classified as CIN 1, CIN 2, or CIN 3 (carcinoma in situ), depending on extent of dysplasia.
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Cervical pathology Dysplasia and carcinoma in situ associations and progression
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HPV 16, 18. May progress slowly to invasive carcinoma.
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Cervical pathology Invasive carcinoma what type
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Often squamous cell carcinom
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Cervical pathology Dysplasia and carcinoma in situ wrt testing
|
Pap smear can catch cervical dysplasia (koilocytes) before it progresses to invasive carcinoma
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Cervical pathology Invasive carcinoma wrt specific invasion
|
Lateral invasion can block ureters, causing renal failure.
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Endometriosis
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Non-neoplastic endometrial glands/stroma in abnormal locations outside the uterus.
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Non-neoplastic endometrial glands/stroma in abnormal locations outside the uterus.
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Endometriosis
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Endometriosis clinical findings
|
Characterized by cyclic bleeding (menstrual type) from ectopic endometrial tissu resulting in blood-filled “chocolate cysts.” In ovary or on peritoneum. Manifests clinically as severe menstrual-related pain.
|
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“chocolate cysts.”
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Endometriosis
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Endometriosis complications
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Often results in infertility
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Adenomyosis
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Endometriosis within the myometrium.
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Endometriosis within the myometrium.
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Adenomyosis
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Endometrial hyperplasia
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Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation.
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Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation.
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Endometrial hyperplasia
|
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Endometrial hyperplasia wrt complications
|
↑ risk for endometrial carcinoma
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Endometrial hyperplasia clinical findings
|
Most commonly manifests linically as vaginal bleeding.
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Endometrial carcinoma how common and who
|
Most common gynecologic malignancy. Peak age 55–65 years old
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Most common gynecologic malignancy
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Endometrial carcinoma
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Endometrial carcinoma clinical findings
|
Clinically presents with vaginal bleeding.
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Endometrial carcinoma Risk factors
|
prolonged use of estrogen without progestins, obesity, diabetes, hypertension, nulliparity, and late menopause.
|
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Endometrial carcinoma Typically preceded by
|
endometrial hyperplasia.
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Most common of all tumors in females
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Leiomyoma
|
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Leiomyoma how common and who
|
Most common of all tumors in females. ↑ incidence in blacks
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Leiomyoma gross findings
|
multiple tumors with well demarcated borders.
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Leiomyoma prognosis
|
Benign smooth muscle tumor; malignant transformation is rare. Does not progress to leiomyosarcoma
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Leiomyoma wrt estrogen
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Estrogen sensitive––tumor size ↑ with pregnancy and ↓ with menopause.
|
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Leiomyosarcoma gross
|
Bulky irregularly shaped tumor with areas of necrosis and hemorrhage
|
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Leiomyosarcoma cause and who
|
typically arising de novo (not from leiomyoma). ↑ incidence in blacks.
|
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Leiomyosarcoma Prognosis
|
Highly aggressive tumor with tendency to recur.
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Leiomyosarcoma clinical findings
|
May protrude from cervix and bleed.
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Polycystic ovarian syndrome lab findings
|
↑ LH, ↓ FSH, ↑ testosterone.
|
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Polycystic ovarian syndrome clinical findings
|
amenorrhea, infertility, obesity, and hirsutism.
|
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Polycystic ovarian syndrome mech
|
↑ LH production leads to anovulation, hyperandrogenism due to deranged steroid synthesis
|
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Polycystic ovarian syndrome Tx
|
Treat with weight loss, OCPs, gonadotropin analogs, or surgery.
|
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Ovarian cysts Follicular cyst
|
distention of unruptured graafian follicle. May be associated with hyperestrinism and endometrial hyperplasia.
|
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Ovarian cysts Corpus luteum cyst
|
hemorrhage into persistent corpus luteum. Menstrual irregularity.
|
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Ovarian cysts Theca-lutein cyst
|
often bilateral/multiple. Due to gonadotropin stimulation. Associated with choriocarcinoma and moles.
|
|
Ovarian cysts “Chocolate cyst”
|
blood-containing cyst from ovarian endometriosis. Varies with menstrual cycle.
|
|
Ovarian cysts distention of unruptured graafian follicle. May be associated with hyperestrinism and endometrial hyperplasia.
|
Follicular cyst
|
|
Ovarian cysts hemorrhage into persistent corpus luteum. Menstrual irregularity.
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Corpus luteum cyst
|
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Ovarian cysts often bilateral/multiple.
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Theca-lutein cyst
|
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Ovarian cysts Due to gonadotropin stimulation. Associated with choriocarcinoma and moles.
|
Theca-lutein cyst
|
|
Ovarian cysts blood-containing cyst from ovarian endometriosis.
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“Chocolate cyst”
|
|
Ovarian cysts Varies with menstrual cycle.
|
“Chocolate cyst”
|
|
Dysgerminoma what type of tumor
|
Ovarian germ cell tumor
|
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Ovarian germ cell tumors name them
|
Dysgerminoma Yolk sac (endodermal sinus tumor) Choriocarcinoma Teratoma
|
|
Ovarian non–germ cell tumors name them
|
1. Serous cystadenoma 2. Serous cystadenocarcinoma 3. Mucinous cystadenoma 4. Mucinous cystadenocarcinoma 5. Brenner tumor 6. Ovarian fibroma 7. Granulosa cell tumor
|
|
Yolk sac (endodermal sinus tumor) what type of tumor
|
Ovarian germ cell tumor
|
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Choriocarcinoma what type of tumor
|
Ovarian germ cell tumor
|
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Teratoma what type of tumor
|
Ovarian germ cell tumor
|
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Serous cystadenoma what type of tumor
|
Ovarian non–germ cell tumors
|
|
Serous cystadenocarcinoma what type of tumor
|
Ovarian non–germ cell tumors
|
|
Mucinous cystadenoma what type of tumor
|
Ovarian non–germ cell tumors
|
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Mucinous cystadenocarcinoma what type of tumor
|
Ovarian non–germ cell tumors
|
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Brenner tumor what type of tumor
|
Ovarian non–germ cell tumors
|
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Ovarian fibroma what type of tumor
|
Ovarian non–germ cell tumors
|
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Granulosa cell tumor what type of tumor
|
Ovarian non–germ cell tumors
|
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descrptions of Ovarian germ cell tumors Dysgerminoma
|
Malignant, equivalent to male seminoma. Sheets of uniform cells. ↑ hCG.
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descrptions of Ovarian germ cell tumors Yolk sac (endodermal sinus tumor)
|
Aggressive malignancy in ovaries (testes in boys) and sacrococcygeal area of young children. ↑ AFP.
|
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descrptions of Ovarian germ cell tumors Choriocarcinoma
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Rare but malignant; can develop during pregnancy in mother or baby. Large, hyperchromatic hyncytiotrophoblastic cells. ↑ hCG.
|
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descrptions of Ovarian germ cell tumors Teratoma types
|
Mature teratoma (“dermoid cyst”)––most frequent benign ovarian tumor. Immature teratoma– –aggressively malignant. Struma ovarii--contains functional thyroid tissue
|
|
Ovarian germ cell tumors ↑ hCG.
|
Choriocarcinoma and Dysgerminoma
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Ovarian germ cell tumors ↑ AFP.
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Yolk sac (endodermal sinus tumor)
|
|
90% of ovarian germ cell tumors
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Teratoma
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Struma ovarii
|
Teratoma contains functional thyroid tissue
|
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Ovarian germ cell tumors Teratoma contains functional thyroid tissue
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Struma ovarii
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Ovarian non–germ cell tumors Frequently bilateral, lined with fallopian tube–like epithelium. Benign.
|
Serous cystadenoma
|
|
Ovarian non–germ cell tumors malignant and frequently bilateral.
|
Serous cystadenocarcinoma
|
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Ovarian non–germ cell tumors multilocular cyst lined by mucus-secreting epithelium. Benign.
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Mucinous cystadenoma
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Ovarian non–germ cell tumors malignant. Pseudomyxoma peritonei
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Mucinous cystadenocarcinoma
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Ovarian non–germ cell tumors benign tumor that resembles Bladder epithelium.
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Brenner tumor
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Brenner tumor
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tumors that are part of the surface epithelial-stromal tumor group of ovarian neoplasms. benign tumor that resembles Bladder epithelium.
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Meigs’ syndrome
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triad of ovarian fibroma, ascites, and hydrothorax.
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triad of ovarian fibroma, ascites, and hydrothorax.
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Meigs’ syndrome
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Ovarian non–germ cell tumors bundles of spindle-shaped fibroblasts
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Ovarian fibroma
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Ovarian non–germ cell tumors secretes estrogen →precocious puberty (kids).
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Granulosa cell tumor
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Call-Exner bodies
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granulosa cells arranged haphazardly around a space containing eosinophilic fluid
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Pseudomyxoma peritonei
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intraperitonealaccumulation of mucinous material from ovarian (Mucinous cystadenocarcinoma) or appendiceal tumor.
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"jelly belly" aka
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Pseudomyxoma peritonei
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Pseudomyxoma peritonei aka
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"jelly belly"
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granulosa cells arranged haphazardly around a space containing eosinophilic fluid
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Call-Exner bodies
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Ovarian non–germ cell tumors endometrial hyperplasia or carcinoma in adults. Call-Exner bodies
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Granulosa cell tumor
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Breast tumors benign types
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1. Fibroadenoma– 2. Intraductal papilloma 3. Cystosarcoma phyllodes
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Breast tumors malignant types
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1. Ductal carcinoma in situ 2. Invasive ductal, 3. Comedocarcinoma 4. Inflammatory 5. Invasive lobular 6. Medullary 7. Paget’s disease of the breast
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Breast tumors most common tumor < 25 years
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Fibroadenoma
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Breast tumors Small, mobile, firm mass with sharp edges. ↑ size and tenderness with pregnancy. Not a precursor to breast cancer.
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Fibroadenoma
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Breast tumors benign tumor of lactiferous ducts; presents with serous or bloody nipple discharge.
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Intraductal papilloma
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Breast tumors large, bulky mass of connective tissue and cysts. Tumor may have “leaflike” projections. Some may be malignant.
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Cystosarcoma phyllodes
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Breast tumors Malignant tumors in general
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Common postmenopause. Arise from mammary duct epithelium or lobular glands. Overexpression of estrogen/progesterone receptors or erb-B2 (HER-2, an EGF receptor) is common;
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Breast tumors the single most important prognostic factor.
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Lymph node involvement
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Breast tumors early malignancy without basement membrane penetration.
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Ductal carcinoma in situ (DCIS)––
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Breast tumors The worst and most invasive.
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Invasive ductal, no specific type
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Breast tumors ductal, with cheesy consistency due to central necrosis.
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Comedocarcinoma
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Breast tumors lymphatic involvement; poor prognosis.
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Inflammatory
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Breast tumors often multiple, bilateral.
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Invasive lobular
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Breast tumors fleshy, cellular, lymphocytic infiltrate. Good prognosis.
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Medullary
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Breast tumors eczematous patches on nipple.
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Paget’s disease of the breast
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Paget’s disease of the breast description, cells, what it means, where is it also seen
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––eczematous patches on nipple. Paget cells––large cells with clear halo; suggest underlying carcinoma. 7. Paget’s disease of the breast––eczematous patches on nipple. Paget cells––large cells with clear halo; suggest underlying carcinoma. Also seen on vulva.
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Breast tumors risk factors
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Risk factors: gender, age, early 1st menarche (< 12 years old), delayed 1st pregnancy (> 30 years old), late menopause (> 50 years old), family history of 1st-degree relative with breast cancer at a young age.
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Breast tumors Risk is NOT increased by
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fibroadenoma or nonhyperplastic cysts.
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Common breast conditions Fibrocystic disease how common, and who
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Most common cause of “breast lumps” age 25–menopause.
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Common breast conditions Fibrocystic disease presentation and risk
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Presents with diffuse breast pain and multiple lesions, often bilateral. Usually does not indicate ↑ risk of carcinoma.
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Fibrocystic disease types
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1. Fibrosis– 2. Cystic– 3. Sclerosing– 4. Epithelial hyperplasia–
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Fibrocystic disease types hyperplasia of breast stroma.
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Fibrosis
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Fibrocystic disease types fluid filled.
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Cystic
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Fibrocystic disease types ↑ acini and intralobular fibrosis.
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Sclerosing
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Fibrocystic disease types –↑ in number of epithelial cell layers in terminal duct lobule.
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Epithelial hyperplasia
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Fibrocystic disease types ↑ risk of carcinoma with atypical cells. Occurs > 30 years.
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Epithelial hyperplasia
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Acute mastitis what/ mech
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Breast abscess; during breast-feeding ↑ risk of bacterial infection through cracks in the nipple; Staphylococcus aureus is the most common pathogen.
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Fat necrosis of breast
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A benign painless lump; forms due to injury to breast tissue.
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A benign painless lump; forms due to injury to breast tissue
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Fat necrosis of breast
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Gynecomastia mech and causes
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Results from hyperestrogenism (cirrhosis, testicular tumor, puberty, old age), Klinefelter’s syndrome, or drug induced (cimetidine, alcohol abuse, marijuana, heroin, psychoactive drugs, digitalis).
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Prostatitis clinical findings and causes
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Dysuria, frequency, urgency, low back pain. Acute: bacterial; chronic: bacterial or abacterial (most common).
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Benign prostatic hyperplasia mech
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May be due to an age-related increase in estradiol with possible sensitization of the prostate to the growth promoting effects of DHT.
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Benign prostatic hyperplasia prostate gross changes
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Characterized by a nodular enlargement of the periurethral (lateral and middle) lobes of the prostate gland, compressing the urethra into a vertical slit.
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Benign prostatic hyperplasia clinical findings
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↑ frequency of urination, nocturia, difficulty starting and stopping the stream of urine, and dysuria.
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Benign prostatic hyperplasia complications
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May lead to distention and hypertrophy of the bladder, hydronephrosis, and UTIs. Not considered a premalignant lesion.
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Benign prostatic hyperplasia labs
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↑ free prostate-specific antigen (PSA).
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Prostatic adenocarcinoma where and Dx
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Arises most often from the posterior lobe (peripheral zone) of the prostate gland and is most frequently diagnosed by digital rectal examination (hard nodule) and prostate biopsy.
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Prostatic adenocarcinoma Lab findings
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Prostatic acid phosphatase and PSA are useful tumor markers (↑ total PSA, with ↓ fraction of free PSA). Osteoblastic metastases in bone may develop in late stages, as indicated by an ↑ in serum alkaline phosphatase and PSA.
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↑ in serum alkaline phosphatase and PSA.
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Osteoblastic metastases from Prostatic adenocarcinoma
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Cryptorchidism what and complications
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Undescended testis (one or both); lack of spermatogenesis due to ↑ body temperature; associated with ↑ risk of germ cell tumors.
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Testicular germ cell tumors names
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-Seminoma -Embryonal carcinoma -Yolk sac (endodermal sinus) tumor -Choriocarcinoma -Teratoma
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Testicular non–germ cell tumors names
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-Leydig cell -Sertoli cell -Testicular lymphoma
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~95% of all testicular tumors
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Testicular germ cell tumors
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Seminoma how common and who
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most common testicular tumor, mostly affecting males age 15–35.
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Testicular germ cell tumors Malignant; painless testicular enlargement;
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Seminoma
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Testicular germ cell tumors Malignant; painful;
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Embryonal carcinoma
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Testicular germ cell tumors ↑ AFP
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Yolk sac (endodermal sinus) tumor
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Testicular germ cell tumors Malignant, ↑ hCG.
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all Choriocarcinoma 10% of Seminoma
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Testicular germ cell tumors Unlike in females, in males this tumor is most often malignant.
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mature teratoma
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Testicular non–germ cell tumors Benign, contains Reinke crystals
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Leydig cell
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Testicular non–germ cell tumors usually androgen producing, gynecomastia in men, precocious puberty in boys.
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Leydig cell
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Leydig cell tumor findings
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Benign, contains Reinke crystals; usually androgen producing, gynecomastia in men, precocious puberty in boys.
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Testicular non–germ cell tumors Benign, androblastoma from sex cord stroma.
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Sertoli cell
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Most common testicular cancer in older men.
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Testicular lymphoma
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Reinke crystals
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crystal-like inclusions in the interstitial cells of the testis (Leydig cells) and hilus cells in the ovary
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crystal-like inclusions in the interstitial cells of the testis (Leydig cells) and hilus cells in the ovary
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Reinke crystals
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Penile pathology Carcinoma in situ: names
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-Bowen disease -Erythroplasia of Queyrat -Bowenoid papulosis
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Bowen disease clinical findings, when and progression
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Solitary crusty plaque, usually on the shaft of the penis or on the scrotum; peak incidence in fifth decade of life; becomes invasive SCC in <10% of cases.
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Solitary crusty plaque, usually on the shaft of the penis or on the scrotum; peak incidence in fifth decade of life; becomes invasive SCC in <10% of cases.
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Bowen disease
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Erythroplasia of Queyrat
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Red velvety plaques, usually involving the glans; otherwise similar to Bowen disease
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Red velvety plaques, usually involving the glans; otherwise similar to Bowen disease
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Erythroplasia of Queyrat
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Bowenoid papulosis clinical findings, when and progression
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Multiple papular lesions; affects younger age group than the other two; usually does not become invasive.
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Multiple papular lesions; affects younger age group than the other two; usually does not become invasive.
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Bowenoid papulosis
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Penile pathology Squamous cell carcinoma (SCC) who
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Rare in circumcised men; uncommon in US and Europe, more common in Asia, Africa, and South America.
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Penile pathology Squamous cell carcinoma (SCC) associations
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Commonly associated with HPV.
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Rare in circumcised men; uncommon in US and Europe, more common in Asia, Africa, and South America. Commonly associated with HPV.
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Penile Squamous cell carcinoma (SCC)
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Antiandrogens names
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Finasteride Flutamide Ketoconazole, spironolactone
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Finasteride mech and clinical uses
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A 5α-reductase inhibitor (↓ conversion of testosterone to dihydrotestosterone). Useful in BPH. Also promotes hair growth––used to treat male-pattern baldness.
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Finasteride aka
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propecia
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propecia aka
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Finasteride
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Flutamide mech and clinical uses
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A nonsteroidal competitive inhibitor of androgens at the testosterone receptor. Used in prostate carcinoma.
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A nonsteroidal competitive inhibitor of androgens at the testosterone receptor. Used in prostate carcinoma.
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Flutamide
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A 5α-reductase inhibitor (↓ conversion of testosterone to dihydrotestosterone). Useful in BPH. Also promotes hair growth––used to treat male-pattern baldness.
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Finasteride (propcia)
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Antiandrogens mech/clinical use of Ketoconazole
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Inhibit steroid synthesis; used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
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Inhibit steroid synthesis; used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
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Ketoconazole as an Antiandrogen
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Antiandrogens mech/clinical use of spironolactone
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Inhibit steroid binding; used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
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Inhibit steroid binding; used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
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spironolactone as an Antiandrogen
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Leuprolide Mechanism
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GnRH analog with agonist properties when used in pulsatile fashion; antagonist properties when used in continuous fashion.
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Leuprolide Clinical use
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Infertility (pulsatile), prostate cancer (continuous–use with flutamide), uterine fibroids.
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Leuprolide Toxicity
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Antiandrogen, nausea, vomiting.
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GnRH analog with agonist properties when used in pulsatile fashion; antagonist properties when used in continuous fashion.
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Leuprolide
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Sildenafil, vardenafil Mechanism
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Inhibit cGMP phosphodiesterase, causing ↑ cGMP smooth muscle relaxation in the corpus cavernosum, ↑ blood flow, and penile erection.
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Sildenafil, vardenafil Clinical use
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Treatment of erectile dysfunction.
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Sildenafil, vardenafil Toxicity
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Headache, flushing, dyspepsia, blue-green color vision. Risk of life-threatening hypotension in patients taking nitrates.
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Headache, flushing, dyspepsia, blue-green color vision.
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Sildenafil, vardenafil Toxicity
|
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Inhibit cGMP phosphodiesterase, causing ↑ cGMP, smooth muscle relaxation in the corpus cavernosum
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Sildenafil, vardenafil
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Clomiphene Mechanism
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A partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and ↑ release of LH and FSH from the pituitary, which stimulates ovulation.
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Clomiphene Clinical use
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Treatment of infertility.
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Clomiphene Toxicity
|
Hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances.
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A partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and ↑ release of LH and FSH from the pituitary, which stimulates ovulation.
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Clomiphene
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Mifepristone aka
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RU-486
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RU-486 aka
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Mifepristone
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Mifepristone Mechanism
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Competitive inhibitor of progestins at progesterone receptors.
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Mifepristone Clinical use
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Postcoital abortifacient (prevents implantation).
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Mifepristone Toxicity
|
Heavy bleeding, GI effects (nausea, vomiting, anorexia), abdominal pain.
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Competitive inhibitor of progestins at progesterone receptors. Postcoital abortifacient (prevents implantation).
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Mifepristone (RU-486)
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dinoprostine
|
PGE2 analog causing cervical dilation and uterine contraction, inducing labor
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PGE2 analog causing cervical dilation and uterine contraction, inducing labor
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dinoprostine
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ritodrine/terbutaline
|
beta2-agonists that relax the uterus
|
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beta2-agonists that relax the uterus
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ritodrine/terbutaline
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Anastrazole
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aromatase inhibitor used in postmenopausal womaen with breats cancer
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aromatase inhibitor used in postmenopausal womaen with breats cancer
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Anastrazole
|
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Testosterone (methyltestosterone) Mechanism
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Agonist at androgen receptors.
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Testosterone (methyltestosterone) Clinical use
|
Treat hypogonadism and promote development of 2" sex characteristics; stimulation of -anabolism to promote recovery after burn or injury; treat ER-positive breast cancer (exemestane).
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Testosterone (methyltestosterone) Toxicity
|
Causes masculinization in females; reduces intratestic~~lar testosterone in males by inhibiting Leydig cells; leads to gonadal atrophy. Premature closure of epiphyseal plates. increase LDL, decrease HDL.
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Estrogens names
|
ethinyl estradiol, DES, mestrano
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Estrogens Mechanism
|
Bind estrogen receptors.
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Estrogens Clinical use
|
Hypogonadism or ovarian failure, menstrual abnormalities, HRT in postmenopausal women; use in men with androgen-dependent prostate cancer.
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Estrogens Toxicity
|
increase risk of endometrial cancer, bleeding in postmenopausal women, clear cell adenocarcinoma of vagina in females exposed to DES in utero, 1' risk of thrombi.
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Estrogens Contraindications
|
-ER-positive breast cancer.
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Progestins Mechanism
|
Bind progesterone receptors, reduce growth, and increase vascularization of endometrium.
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Progestins Clinical use
|
Used in oral contraceptives and in the treatment of endometrial cancer and abnormal uterine bleeding.
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Tamoxifen
|
Antagonist on breast tissue; used to treat and prevent recurrence of ER-positive breast cancer.
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Antagonist on breast tissue; used to treat and prevent recurrence of ER-positive breast cancer.
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Tamoxifen
|
|
Agonist on bone; reduces reabsorption of bone; used to treat osteoporosis.
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Raloxifene
|
|
Raloxifene
|
Agonist on bone; reduces reabsorption of bone; used to treat osteoporosis.
|
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Oral contraception Advantages
|
-Reliable (< 1% failure) -↓ risk of endometrial and ovarian cancer -↓ incidence of ectopic pregnancy -↓ pelvic infections -Regulation of menses
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Oral contraception disadvantages
|
-Taken daily -No protection against STDs -↑ triglycerides -Depression, weight gain, -nausea, hypertension Hypercoagulable state
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Hormone replacement therapy (HRT) used for
|
Used for relief or prevention of menopausal symptoms (hot flashes, vaginal atrophy, etc.) and osteoporosis (due to diminished estrogen levels).
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Hormone replacement therapy (HRT) toxicity
|
Unopposed estrogen replacement therapy (ERT) increases the risk of endometrial cancer, so progesterone is added.
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