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125 Cards in this Set
- Front
- Back
friedreich's ataxia
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spinal ataxia, AR, a/w hypertrophic cardiomyopathy
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digeorge syndrome, cardio involvement
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tetralogy of fallot, interrupted aortic arch (truncus arteriosus)
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transplant rejection 2 wks after transplant
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acute rejection; dense infiltrate of T-cells
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shigella vs salmonella
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shigella is much higher virulence (?) -- 100 orgs vs 10^6 (for salmonella) are sufficient for infection; c.jejuni (500), entamoeba histolytica, and giardia lamblia (both 1) are also capatable of causing diarrhea with a small inoculum
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shigella's toxin vs. c.dyphteria's toxin:
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shigella's shiga toxin cause inactivation of 60s ribosomal subunit; c.diphteria has AB-exotoxin which ADB ribosylates EF-2 preventing translation
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side effects of statins
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myopathy and hepatitis
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effects of femfibrozil on statins
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ingemfibrozil increases conc of statins --> increased risk of side effects (hepatitis, myopathy)
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side effects of fibrates
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increased cholesterol in bile --> cholesterol stones; also, myopathy (both direct and by potentiating statins)
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ace inhibitors and renal artery stenosis
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pts with RAS use ACE to maintain renal perfusion and GFR; ACEi --> block this effect --> reduce renal perfusion --> ARF
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angioedema
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side effect of ACEi tx; swelling of tongue, lips, eyelids, can cause difficulty breathing; from accumulation of bradykinin
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carvedilol
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unique beta blocker that nonspecifically antagonizes b1, b2, a1; proven mortality benefit in CHF (along with beta blockers in general)
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furosemide and CHF
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no mortality benefit (some studies even show mortality increase)
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mcc renal failure during pregnancy
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eclampsia, hypovolemic shock, ascending infections
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inflammatory carcinoma
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not a true morphologic subtype, but rather any rapidly growing, infiltrating breast cancer that occludes the dermal lympathics can cause swelling and redness; VERY AGGRESSIVE
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deep perineal space
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middle (muscle) layer of urogenital diaphragm. Contains two skeletal muscles (SPHINCTER URETHRAE and DEPP TRANSVERSE PERINEAL), along with the BULBOURETHRAL gland (Cowper's gland)
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oncogenesis of HPV
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viral proteins: E6 --| p53; E7--|p110 (Rb);
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SRY gene
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located on short arm of Y chromosome, produces TDF (testes-determining factor).
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MCC bacterial postatitis
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E.Coli (others: SSEEK PP)
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apocrine metaplasia of the breast
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benign change; breast epithelial cells --> sweat-gland-like cells; often seen in fibrocystic changes, also in normal breast
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factors that predispose to ectopic pregnancy
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PID and endometriosis
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males: complete androgen resistance vs 5a-reductase deficiency
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testosterone converted to DHT via 5a-reductase; testosterone necessary for wolffian duct differentiation, DHT for external genitalia; absence of 5a-REDUCTASE --> feminization until puberty, when inc testosterone causes virilization ("penis at 12 syndrome"; with ANDROGEN INSENSITIVITY, no goandal development (entire wolffian system degenerates)
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MCC maternal death in pre-eclampsia
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cerebral hemorrhage and pulmonary complications (ARDS)
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paramesonephric ducts
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F: uterine tubes, uterus, cervix, upper vagina; M: appendix of testes
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mesonephric ducts
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F: duct of gartner; M: epididymis, ductus deferens, seminal vesicle, ejaculatory duct
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cause of female pseudointersex (ovaries, no testes, masculinzation of female external genitalia)
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congenital adrenal hyperplasia --> excess androgens
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cause of male pseudointersex (46 XY, testes, no ovaries, stunted male external genitalia growth)
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inadquate prod of testosterone / MIF by testes, or due to 5-alpha reductase deficiency
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complete androgen insensitivity (CAIS)
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46XY with testes, female external genitalia, rudimentary vagina; MCC is mut in androgen receptor
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pouch of douglas
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aka rectouterine puch -- between uterus and rectum, collects peritoneal fluid, often a location for endometriosis
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processus vaginalis
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evagination of parietal peritoneum that descends thru inguinal canal w/ testes; mostly collapses --> tunica vaginalis; if remains patent, get HYDROCELE
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contents of spermatic cord
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ductus deferens, artery of ductus deferens, testicular artery and veins (2), pampiniform plexus (dilated in varicocele), lymphatics (drain testes to peri-aortic nodes)
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what structure contains ovarian vessels
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suspensory ligament of ovary
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what structure contains uterine vessels
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transverse cervical (cardinal) ligament
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what structure contains the round ligaments of the ovaries and uterus, along with uterine tubules and vessels?
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broad ligament
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from what is the acrosome derived, and what does it contain
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derived from golgi apparatus; contains hyaluronidase (dissolves corona radiata ECM) and acrosin (facilitates penetration of zona pellucida), both used in the acrosomal reaction
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where are a sperm's mitochondria
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in the middle piece (neck)
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trace path from spermatagonia to spermatid, noting ploidy
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spermatagonia (2N, diploid) --mitosis--> primary spermatocyte (4N, diploid) --meiosis--> secondary spermatocyte (2N, haploid) --meiosis--> spermatid(N, haploid)
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kartagener's syndrome
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defect in dynein; 1) dec mucus clearance --> sinus infections; 2) dec sperm motility --> infertility; 3) impaired dev patternig --> situs inversus; 3) bronchiectasis
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name the three steps of fertilization
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capacitation, acrosomal rxn, cortical reaction
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capacitation
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biochemical modification of sperm after it enters the uterus, prepares it for fertilization (?)
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acrosomal reaction
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as sperm nears corona radiata (layer of granulosa cells around ovum), acrosome release hyaluronidase to dissolve the corona radiata, allowing access to zona pelucida (mucopolysaccharides); acrosin from acrosome facilitates penetration of the zona
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cortical reaction
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after the first sperm fuses with the plasma membrane of the ovum, calcium-dependent release of granules causes thickened zona so that no more sperm can penetrate
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name the androgens in order of potency
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DHT (from t'one) > Testosterone (testes) > androstenedione (adrenals)
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effects of LH in women
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stimulates theca cells to produce androgen; stimulates granulosa cells to convert chol --> progesterone
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effects of FSH in women
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stimulates granulosa cell to: 1) chol-->progesterone; 2) androgen --aromatase--> estradiol; 3) secrete inhibin
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effect of estradiol in regulation of female hormone axis
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estradiol, produced by granulosa cells, inhibits FSH and GnRH release, and has variable effect on LH (normally inhibitory, but becomes positive feedback just before LH surge)
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effects of estrogen on breast
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stimulates stromal development of breast; also stims prolactin (milk production) but prevents milk release (--> builds stores for lactation)
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sources of estrogens
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1) ovary (estradiol); 2) placenta (estriol); 3) blood (aromatization)
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what does granulosa cell make?
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progesterone (from cholesterol), estradiol (from androgens from theca cells), and inhibin (for feedback)
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changes in theca/granulosa cells after follicular rupture
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ruptured follicle becomes corpus luteum; THECA cells begin secreting ESTROGEN, and GRANULA cells begin secreting PROGESTERONE
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life of corpus luteum
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if fertilized, grows for 3 months (maintained by hCG from embryo), then placenta takes over and corpus luteum degenerates
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proliferative phase of uterine cycle
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~follicular phase of menstrual cycle; estrogen from granulosa cells causes proliferation of endometrial glands, makes endometrium thicker and contractile
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secretory phase of uterine cycle
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~luteal phase of menstrual cycle; progesterone from corpus luteum causes cell proliferation and vascularization, but depresses uterine contractility
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what triggers menses?
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fall in LH --> fall in estrogne, accompanied by fall in progesterone ==> can't maintain endometrium ==> sloughs off
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progesterone and estrogen effects on uterine contractility
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estrogen INCREASES uterine contractility, progesterone DECREASES contractility
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effects of estrogen / progesterone on lactation during pregnancy
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both stimulate dev of mammary glands for lactation and stimulate prolactin, while oxytocin is inhibited, preventing milk letdown
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changes in prolactin / oxytocin after delivery
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internal stimulus for prolactin (estrogen/progesterone) falls, but suckling promotes increased prolactin release; oxytocin also released in response to suckling or crying --> milk letdown
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how does epithelium change as you go from vagina to fallopian tube?
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squamous at entry (vagina, cervix) --> columnar epithelium (secretory) --> cuboidal ovary; fallopian tubes are ciliated columnar (to move egg/zygote?)
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presentation and tx of primary dysmenorrhea
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painful menstruation b/c of PG-mediated contractions; ==> give NSAIDs
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source of hCG
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blastocyst after 8 days and syncytiotrophoblast of placenta --> maintains corpus luteum for first semester
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cancer risk in cryptorchidism
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increased risk of germ cell tumors, incl seminoma and embyronal carcinoma
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germ cell tumors of testes: benign or malignant; treatment options
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almost always malignant, tx by orchiectomy (except seminoma -- radiosensitive)
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mature teratomas in M/F
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M: Malignant; F: benign
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histo characteristics of choriocarcinoma
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consists of cells resembling syncitiotrophoblasts and cytotrophoblasts (--> inc hCG)
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sex cord tumors in males
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LEYDIG: like sertoli-leydig of ovary, benign, androgen producing, contain Reinke crystals; differential effects on old (gynecomastia) and young (precocious puberty) owing to different androgen responses; SERTOLI: aka androblastoma; benign, histologically looks resembles tubular and stromal elements
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which lobe/zone of prostate is characteristic for carcinoma?
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peripheral zone / posterior lobe
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cause of BPH
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increase in DHT or age-related increase in estrogens (promote DHT receptor expression)
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lobes/zones for BPH
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periurethral/transitional zones
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PSA in adenocarcinoma vs BPH
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elevated COMPLEXED PSA with malignancy, elevated FREE PSA with BPH
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serum marker of prostate adenocarcinoma invasion
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PROSTATIC ACID PHOSPHATASE indicates penetration of adjacent tissue; elevated ALK PHOS indicates bone met
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MCC vaginal discharge + clinical features
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gardnerella vaginitis, fishy amine odor (esp with KOH), clue cells (epithelial cells coated with bacteria)
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cause of lymphogranuloma venereum
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chlamydia trachomatis, serotypes L1-3
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condyloma lata vs condyloma acuminatum
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LATA: syphilis; gray, flattened, wart-like lesions; ACUMINATUM: HPV 6 an 11; multiple wart-like lesions w/ koilocytes
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donovan bodies
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multiple organisms filling large histiocytes, charcteristic of granuloma inguinale (caused by Donovania granulomatis, a g- rod)
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cause of endometritits
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s. aureus / strep, usually following intrauterine trauma IUD, pregnancy complications, etc.
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chocolate cysts
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ENDOMETRIOSIS (menstrual bleeding into ectopic endometrium)
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causes of endometrial hyperplasia
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excess estrogen secretion, 2' to {anovulatory cycles, PCOS, ovarian tumors like granulosa cell, or estrogen replacement therapy} ==> postmenopausal bleeding, carcinoma risk
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hormonal impact on leiomyomas
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estrogen-sensitive --> increase during preg, decrease with menopause
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cervical vs endometrial carcinoma
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CERVICAL: mid-aged women, early sex, lots of partners, smoking, HPV; ENDOMETRIAL: older women, nulliparity, estrogen stim, obesity (estrogen from adipose tissue?), DM, HTN
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most frequent site of endometriosis
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ovaries
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psuedomyxoma peritonei
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rupture/met of mucinous cystadenocarcinoma (ovarian epithelial tumor) --> large qauntities of intraperitoneal mucinous material; similar to mucinous release from appendix mucocele rupture or OVARIAN CYST
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dermoid cyst
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most frequent benign ovarian tumor; "mature teratoma" (but benign, unlike mature teratoma in men); lined by skin, hair, bone, teeth, cartilage, and various glandular tissues
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struma ovarii
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type of monodermal teratoma consisting entirely of thyroid tissue --> hyperthyroidism
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meigs syndrome
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triad of: 1) ovarian fibroma; 2) ascities; 3) hydrothorax; resolves upon tumor resection
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call-exner bodies
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GRANULOSA CELL TUMOR; small follicles filled with eosinophilic secretion;
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abrutio placentae vs placenta acrreta
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abrutio placentae causes ANTEpartum bleeding, fetal death, and DIC; placenta accreta causes impaired placental separation AFTER delivery --> POSTpartum bleeding (can be massive hemorrhage)
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toxemia of pregnancy
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tow forms: pre-eclampsia (w/ variant HELLP) and eclapmsia (preeclampsia + convulsions + DIC)
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sheehan syndrome
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postpartum anterior pituitary necrosis (from hypotension)
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blue dome cysts
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fluid-filled cysts seen in fibrocystic disease (most common disorder of breat, esp in 25-50yo F; benign, bilateral lumpy breasts w/ midcycle tenderness); only precancerous if demonstrate atypia
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fibroadenoma
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most common breast tumor in F < 25yo; BENIGN, firm, rubbery, painless, well circumscribed
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most common cause of breast mass in post-menopausal women
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carcinoma of breast
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most common site of breast cancer
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upper outer quadrant
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estrogen/progesterone involvement in breast cancer
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breast cancers that express estrogen/progesterone receptors have better prognosis (predict efficacy of anti-estrogen tx); oral contraceptives are NOT predisposing factors
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breast cancer with cells arranged in linear fashion -- "Indian-file"
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Invasive Lobular carcinoma
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risk factors for breast cancer
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Family Hx, inc reproductive yrs (early menarche, late menopause), late 1st pregnancy
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seminoma vs embryonal carcinoma (males)
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seminoma --> painLESS, elevated hCG, most common; embryonal carcinoma --> painFUL, elevated AFP, second most common
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choriocarcinoma
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germ cell tumor with elevated hCG; rare, but malignant; devs during preg in mom or baby from syncytiotrophoblastic cells
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germ cell tumors with elevated AFP
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yolk sac (endodermal sinus) tumors, maybe embryonal carcinoma; YOLK SAC: aggressive malignancy in babies/kids; histo: Schiller-Duval bodies (primative glomeruli)
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benign ovarian tumor representing bladder epithelium (transitional)
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Brenner
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benign breast tumor with serous or bloddy discharge
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intraductal papilloma
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serous vs mucinous cystadenoma/cystadenocarcinoma of ovary
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SEROUS: lined with fallopian tube-like epithelium (ciliated columnar); MUCINOUS: lined by mucus-secreting epithelium (columnar w/ apical mucin, NO CILIA)
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bilateral breast lesions with midcycle tenderness
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fibrocystic dz, most common in 25-50yo
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most common breast tumor < 25 yo
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fibroadenoma -- small, mobile, firm mass, estrogen-sensitive size, not premalignant
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fibrocystic disease vs tumor
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FIBROCYSTIC: b/l, multi-nodular, estrogen-sensitive-cycling of size, pain, engorgement; TUMOR: unilateral, uni-nodular, insensitive
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theca interna vs externa
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interna produces androgens; externa is fibrous, protective
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primary oocytes
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cells arrested in prophase of meiosis I (46, 4N) until puberty; at puberty, FSH --> some oocytes complete meiosis I --> secondayr oocytes --> begins meiosis II, halts in metaphase II until fertalization
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acute hemolytic transfusion reaction, what type of hypersensitivty, whats the mechanism
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type II (Ab-mediated); Anti-ABO antibodies bind erythrocytes --> Ag-Ab complexes activate complement --> anaphyatoxins (--> shock) and MAC ( --> cell lysis)
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measles vs rubella
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both present with rashes that start at head/neck and spread downward; RUBELLA also has generalized lymphadenopathy, esp postauricular and occiptal, with sequelae including polyarthritis and polyarthralgia
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vaginal flora of prepubertal girls
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colonic and skin flora (s.epidermidis); lactobacillus, candida, and strep only in women of child-bearing age
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complete vs partial mole
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complete is diploid, results from androgenesis (sperm fertilizing empty egg), no fetal parts, and 2% progress to choriocarcinoma; PARTIAL: triploid, egg + 2 sperm, fetal parts, rarely progresses to choriocarcinoma
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seminoma vs dysgerminoma
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age of presentation (men: 30s, women: 20s); frequency (m: 30% of testicular tumors, common; f: 1% of ovarian tumrs, rare)
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potential complications of cryptorchidism
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testicular carcinoma (unless surgically corrected; if b/l, sterility, infection
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diff in presentation b/w placenta previa and placenta abrutptio
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both can cause antepartum bleeding; PREVIA: any trimester, painLESS; ABRUPTIO: usu 3rd trimester, painFUL
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gestational vs ovarian choriocarcinoma
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BOTH: elev hCG, aggressive, malig; GEST: more common, from previous/current pregnancy; OVARIAN: from germ cells
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what causes fluctuation in leiomyoma size?
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estrogen -- increases in pregnancy, decreases post-menopausally
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schiller-duval bodies
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primitive glomeruli-like structures found in YOLK-SAC tumors
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risk of which tumor with cryptorchidism
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seminoma (male germinoma)
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name the ovarian epithelial tumors and their associated epithelial types
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1) serous (fallopian tube -- ciliated columnar); 2) mucinous (intestinal -- mucin-filled columnar); 3) brenner (bladder-like -- transitional)
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most common testicular cancer in older men
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testicular lymphoma
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name the three benign breast tumors and their defining features
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1) FIBROADENOMA (F<25yo, small firm welldemarcated mobile mass, inc size and tenderness during preg); 2) CYSTOSARCOMA PHYLLODES (leaf-like projections); 3) INTRADUCTAL PAPILLOMA (serous/bloody nipple discharge)
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what is the source of MIF
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sertoli cells
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when do spermatocytes / oocytes become haploid?
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at first meiotic division --> secondary spermocytes / secondary oocyte (ooctye frozen here until fertilization)
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meiosis changes in recruited oocyte during follicular phase
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goes from prophase of meiosis I (primary oocyte) to metaphase of meiosis II (secondary oocyte)
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from what cells does a gestational choriocarcionoma arise?
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trophoblast, usu after hydatidiform mole but also pregnancy
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viral cause of acute hemorrhagic cystisitis in kids
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adenovirus
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first-line drug for hypertension in pregnancy
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methyldopa
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