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181 Cards in this Set
- Front
- Back
- 3rd side (hint)
what is the difference in venous drainage from the left ovary/testis vs. the right ovary/testis?
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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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what lymph nodes do the ovaries/ testis drain to?
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para-aortic lymph nodes
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what does the round ligament connect? what structures are contained?
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connects the uterus to the labia majora; contains 0 structures
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what does the broad ligament contain?
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uterus, fallopian tubes, and ovaries to the pelvic side wall
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what is the pathway of sperm during ejaculation?
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Seminiferous tubules --> epididymis --> vas deferens --> ejaculatory ducts --> (nothing) --> urethra --> penis
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SEVEN UP
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is erection parasymp or sympathetic?
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parasympathetic
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point and shoot
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what drugs cause smooth muscle relaxation leading to vasodilation and erection?
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NO, sildenafil, vardenafil
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what is the effect of NE on erection?
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causing smooth muscle contraction and vasoconstriction leading to antierection
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what nerve controls ejaculation?
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pudendal (visceral and somatic nerves)
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what nerve controls emission?
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hypogastric nerve (sympathetic nervous system)
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where are mitochondria located in the sperm? what powers?
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middle piece; fructose (feeds on fructose)
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what is the sperm acrosome and flagellum derived from?
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acrosome is derived from the golgi apparatus
flagellum is derived from one of the centrioles |
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what types of cells are contained in the seminiferous tubules?
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spermatogonia (germ cells), sertoli cells, leydig cells (endocrine cells)
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what do spermatogonia produce?
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primary spermatogonia
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what is the main function of sertoli cells? what do they secrete?
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sertoli cells support sperm synthesis
secrete inhibin (inhibits FSH), androgen-binding protein to maintain testosterone levels, form blood-testis barrier |
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what do leydig cells secrete?
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testosterone
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where does sperm development occur?
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seminiferous tubules
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what cell do LH and FSH target in the male? what is the effect?
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LH - targets leydig cells causing testosterone release
FSH - targets sertoli cells to produce androgen binding protein and inhibin which feedbacks to inhibit FSH release from the anterior pituitary |
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what are the three forms of androgens in order of potency?
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DHT > testosterone > androstenedione
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what enzyme converts testosterone to DHT? what inhibits this enzyme?
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5-alpha reductase
inhibited by finasteride |
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what are the four primary functions of DHT?
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1. differentiation of PENIS, SCROTUM, PROSTATE
2. balding 3. increase sebaceous gland activity 4. increase prostate growth |
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what are the three types of estrogen in order of potency?
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estradiol (ovary) > estrone > estriol (placenta)
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what cells do LH and FSH act on in the female and what is there function?
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LH - stim. desmolase in the theca cell to produce androstenedione
FSH - stim. aromatase in the granulosa cell to convert androstenedione from the theca cell to estrogen |
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what form of estrogen increased most markedly in pregnancy?
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estriol (released from the placenta)
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what does an elevation of progesterone in the female indicate?
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ovulation - secretory phase
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what are the sources of progesterone?
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corpus luteum, placenta, adrenal cortex, testes
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estrogen and progesterone are elevated during which phases of the menstrual cycle, respectively?
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proliferative phase (follicular) and secretory phase (luteal)
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when does ovulation occur in the menstrual cycle?
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after the proliferative phase and at the beginning of the secretory phase
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what is the effect of progesterone on the endometrium?
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maintains to support implantation
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when is follicular growth fastest during the menstrual cycle?
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2nd week of the proliferative phase
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how long is the luteal phase?
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14 days
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how long is menstration?
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ovulation day + 14 days (luteal phase) = menstration
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during menstration, what is the source of the rise in progesterone?
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the corpus luteum
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what occurs the day before ovulation which leads to ovulation?
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estrogen surge stimulates the release of LH (estrogen changes from having a negative feedback on LH release to a positive feedback) --- this results in rupture of the graafian follicle (ovulation)
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what is mittelschmerz?
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blood from the ruptured follicle after ovulation causes peritoneal irritation that can mimic appendicitis
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in oogenesis, when do primary oocytes begin and complete meiosis I?
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meiosis I is started during fetal life and completed just prior to ovulation
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meiosis I is arrested in what phase of the cell cycle for years until ovulation?
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meiosis I is arrested in prOphase until Ovulation
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what phase of the cell cycle is meiosis II arrested in until fertilization?
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meiosis II is arrested in METaphase until fertilization
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a egg MET a sperm
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what happens to the secondary oocyte if fertilization does not occur?
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degenerates
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each oogonium gives rise to how many eggs?
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one
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where does fertilization most commonly occur?
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upper end of the fallopian tube
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how many days after fertilization does implantation occur?
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6 days
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what secretes hCG? when is it detectable in blood and urine?
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trophoblasts -- detectable in blood 1 week after conception and in urine 2 weeks after conception
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what induces lactation after labor and what maintains lactation?
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decrease in maternal steroids induces; suckling is required to maintain milk production
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what hormone is responsible for inducing and maintaining lactation?
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prolactin
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what is the function of oxytocin?
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milk letdown and may be involved in uterine contraction
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what cells of the placenta release hCG?
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syncytiotrophoblast
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what is the function of hCG?
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1. maintains the corpus luteum for the 1st trimester
2. used to detect pregnancy because can be found in urine 2 weeks after conception 3. there is elevated hCG in pathologic states |
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what is the average age of onset for menopause? what environmental influence decreases the age of onset?
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51 -- smoking decreases
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what hormone decreases during menopause and why?
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estrogen because there is an age-linked decline in the number of ovarian follicles
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what are the hormonal changes that accompany menopause?
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decreased estrogen, markedly increased FSH, increased LH (but no surge) and increase GnRH
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what health problems does menopause cause?
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Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease
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HAVOC
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what is the chrom. abn in klinefelter's syndrome?
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XXY
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what does klinefelter's show in the infertility workup?
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HYPOGONADISM, tall long extremities, gynecomastia, female hair distribution
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what is the chrom. abn in turner's syndrome?
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XO
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"Hugs and Kisses" from tina Turner
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what is the most common cause of primary amenorrhea?
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turner's
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does XYY males have nl fertility?
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yes
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what is traditionally assoc. with XYY males?
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antisocial behavior (but seen in only 1-2% of XYY males)
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what is a female pseudohermaphrodite? how does this result?
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XX - ovaries are present, but external genitalia are virilized or ambiguous
results from excessive exposure to androgenic steroids during early gestation |
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what is a male pseudohermaphrodite?
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XY - testes are present but external genitalia are female or ambiguous
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what is a true hermaphrodite?
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(46, XX or 47 XXY) both ovary and testicular tissue are present with ambiguous genitalia
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what are the sex chromosomes present in an individuals who appears to be female?
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46, XY
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what is the problem in androgen insensitivity syndrome?
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defect in androgen receptor resulting in normal appearing female
uterus and uterine tube are generally absent; develops testes (in labia majora) |
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what results from 5alpha-reductase deficiency?
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unable to convert testosterone to DHT
individuals have an ambiguous genitalia until puberty when there is an increase in testosterone that leads to masculinization |
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what is a hydatidiform mole?
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cystic swelling of the chorionic villi and proliferation of the chorionic epithelium
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identify the following differences betwee a complete and partial mole:
karyotype; hCG levels, uterine size, % that convert to choriocarcinoma, fetal parts?, components |
complete mole: 46, XX or 46, XY; markedly increased hCG levels; increase in uterine size; 2% convert to choriocarcinoma; no fetal parts; 2 sperm + empty egg
partial mole: 69, XXY; increase in hCG; no change in uterine size; rare conversion to choriocarcinoma; partial has fetal parts; 2 sperm + 1 egg |
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what is the most common cause of recurrent miscarriages in the first week of pregnancy? first trimester? second trimester?
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first weeks - low progesterone
first trimester - chromosomal abnormalities second trimester - bicornuate uterus |
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what is the triad of preeclampsia?
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hypertension, proteinuria, edema
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what is added to the preeclampsia triad to call it eclampsia?
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(triad includes hypertension, proteinuria, edema) + seizures
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what factors increase the incidence of preeclmapsia-eclampsia?
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preexisiting hypertension, diabetes, chronic renal disease, and autoimmune disorders
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what syndrome is associated with preeclampsia-eclampsia?
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HELLP syndrome - Hemolysis, Elevated LFTs, Low Plateletes
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HELLP
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what is the treatment for exclampsia-preeclampsia?
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deliver fetus as soon as viable; bed rest, salt restriction, treatment of hypertension; for seizures use IV magnesium sulfate and diazepam
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what is abruptio placentae? what increases the risk?
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premature detachment of placenta from the implantation site
increased risk with smoking, hypertension, cocaine use |
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what is placenta accreta? what predisposes?
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defective decidual layer allow placenta attachment to myometrium; poses difficulty at birth when placenta cannot be delivered and vessels remain dilated resulting in massive bleeding after delivery
predisposed in those with prior C section or inflammation |
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what is placenta previa? what predisposes?
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attachment of the placenta to the lower uterine segment which may obstruct the internal os
prior C section predisposes |
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what is the difference in the type of bleeding experienced in placenta previa vs. abruptio placenta?
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placenta previa - painless bleeding in any trimester
abruptio placenta - painful bleeding int he 3rd trimester |
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what is the most common site of ectopic pregnancy? what predisposes?
what is seen clinically? what is it often confused for? |
fallopian tubes; predisposed by PID
clinically you see lower ab pain with increase in serum hCG; often confused with appendicitis |
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what HPV serotypes are assoc. with cervical intraepithelial neoplasia?
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HPV 16, 18
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what is the typical change you see in cells infected with HPV? (these cells are detected with a pap smear)
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koilocytic change
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in what cells does cervical dysplasia begin?
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begins at basal layer of squamo-columnar junction and extends outward
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CIN can give rise to what type of invasive carcinoma?
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squamous cell carcinoma
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what is endometriosis?
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endometrial glands and stroma in locations outside the uterus (not neoplastic)
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what are chocolate cysts and how do they result?
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these are blood filled cysts that result from the cyclic bleeding of ectopic endometrial tissue in endometriosis
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where does endometriosis commonly occur and how does it manifest clinically?
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commonly occurs on ovaries or peritoneum
manifests as severe menstrual-related pain |
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what is adenomyosis?
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endometrial tissue within the myometrium
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excess stimulation by what hormone leads to endometrial hyperplasia?
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estrogen
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endometrial hyperplasia puts you at risk for what?
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endometrial carcinoma
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how does endometrial hyperplasia manifest clinically?
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postmenopausal vaginal bleeding
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what is the most common gyn malignancy?
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endometrial carcinoma
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how does endometrial carcinoma usually present?
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vaginal bleeding
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what is the age of peak occurance for endometrial carcinoma?
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55 - 65 years
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what are the two types of myometrial tumors?
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leiomyoma (fibroids)
leiomyosarcoma |
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what is the most common tumor in females? what race is at a particular risk?
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leiomyoma; blacks
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what happens to the size of a leiomyoma with pregnancy and menopause?
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estrogen sensitive therefore size increases with pregnancy and decreases with menopause
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does leiomyoma progress to leiomyosarcoma?
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no
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what does a leiomyoma look like grossly?
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usually multiple; whorled pattern of smooth muscle bundles
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how does a leiomyosarcoma usually arise? is it benign of malignant?
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de novo; malignant - high aggressive tumor with tendency to recur
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rank ovarian, cervical and endometrial tumors in order or incidence and worst prognosis
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incidence: endometrial > ovarian > cervical
worst prognosis: ovarian > cervical > endometrial |
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when does premature ovarian failure present?
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signs of menopause after puberty but before age 40
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increase production of what hormone leads to anovulation in polycystic ovarian syndrome?
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LH
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how does polycystic ovarian syndrome manifest clinically?
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enlarged, bilateral cystic ovaries with amenorrhea, infertility, obesity and hirsutism
also, insulin resistance |
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polycystic ovarian syndrome puts you at a higher risk of developing which type of cancer?
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endometrial cancer
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what is a follicular cyst?
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distention of an unruptured graafian follicle
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what is a corpus luteum cyst?
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hemorrhage into a persistent corpus luteum
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what is a theca-lutein cyst?
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often bilateral and multiple assoc with gonadotrophin stimulation
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what are the ovarian germ cell tumors? (4)
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dysgerminoma, choriocarcinoma, yolk sac (endodermal sinus tumor), teratoma
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what is the male equivalent of dysgerminoma? what marker is elevated?
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male equiv is seminoma
hCG is marker |
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is choriocarcinoma benign? what cell abnormality do you see with choriocarcinoma? what is the marker?
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no, rare but malignant
cell abn: large hyperchromatic syncytiotrophoblastic cells marker: hCG |
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what is a yolk sac tumor? what is the tumor marker?
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aggressive malignancy in ovaries of female and testes of boys
marker: AFP |
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what type of tumor comprises the vast majority of ovarian germ cell tumors?
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teratoma (90% of ovarian germ cell tumors)
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what is the most frequent benign ovarian tumor?
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mature teratoma or "dermoid cyst"
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what ovarian teratoma can present as hyperthyroidism?
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struma ovarii
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what are the ovarian non-germ cell tumors?
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serous cystadenoma
serous cystadenocarcinoma mucinous cystadenoma mucinous cystadenocarcinoma Brenner tumor Fibromas Granulosa cell tumor Krukenberg tumor |
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what type of epithelium lines a serous cystadenoma?
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fallopian tube-like epithelium
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what is a general ovarian cancer marker that is increased in serous cystadenomas?
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CA-125
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is serous cystadenocarcinoma malignant?
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yes, and freq. bilateral
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what are 2 risk factors for the development of serous cystadenocarcinoma?
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BRCA-1 and HNPCC
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what condition can result from mucinous cystadenocarcinoma?
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pseduomyxoma peritonei
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is a brenner tumor benign or malignant? what does it look like?
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benign; looks like bladder
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fibromas are made up of what cell type?
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bundles of spindle shaped fibroblasts
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what is meigs' syndrome?
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triad of ovarian fibroma, ascites and hydrothorax
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what does a granulosa cell tumor secrete?
what can it lead to in children? adults? what bodies are characteristic? |
estrogen
precocious puberty in children; endometrial hyperplasia or carcinoma in adults Call-Exner bodies which are small follicles filled with eosinophilic secretions |
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what is a Krukenberg tumor?
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GI (often stomach) mets to ovaries causing a mucin-secreting signet cell adenocarcinoma
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what are the three types of vaginal carcinoma?
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sqaumous cell carcinoma
clear cell adenocarcinoma sarcoma botryoides (rhabdomyosarcoma variant) |
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what is clear cell adenocarcinoma of the vagina assoc. with?
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affects women who had exposure to DES in utero
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what age is affected by sarcoma botryoides?
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< 4 years
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what clinical symptoms are seen with prostatitis?
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dysuria, frequency, urgency, low back pain
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what is the hormonal cause of benign prostatic hyperplasia?
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age-related increase in estradiol with possible sensitization of the prostate to DHT (promotes growth)
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which lobes of the prostate are enlarged in BPH? what occurs as a result?
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periurethral lobes - lateral and middle
compresses the urethra into a verticle slit |
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is benign prostatic hyperplasia a precancer?
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no
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what marker is increased with benign prostatic hyperplasia?
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increase in free prostate specific antigen
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how does the location of prostate adenocarcinoma differ from BPH?
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prostate cancer is more posterior while BPH is more central
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how is prostate adenocarcinoma most commonly diagnosed?
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a hard nodule is felt on digital rectal exam and through prostate biopsy
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what are the prostate adenocarcinoma tumor markers?
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prostatic acid phosphatase (PAP) and PSA (increase in total PSA but decreased fraction of free PSA)
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what is the most common site of prostate cancer metastasis?
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osteoblastic tumor on the spine
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what is cryptorchidism?
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undescended testis
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if you have cryptorchidism, what type of tumor are you at a higher risk of developing?
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germ cell tumors
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what are the testicular germ cell tumors?
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seminoma, embryonal carcinoma, yolk sac (endodermal sinus) tumor, choriocarcinoma, teratoma
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are testicular germ cell or non-germ cell tumors more common?
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germ cell (about 95% of all testicular tumors)
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what is the most common testicular tumor?
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seminoma
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which testicular germ cell tumor displays painless testicular enlargement?
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seminoma
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what is the histo buzz word for a seminoma?
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"fried egg" appearance
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are seminomas readiosensitive?
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yes
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which has a worse prognosis: seminoma or embryonal carcinoma? how does their presentation differ?
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embryonal carcinoma has a worse prognosis
presentation differs in that embryonal carcinomas are painful |
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what characteristic bodies do yolk sac tumors show on histology?
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Schiller-Duval bodies, primative glomeruli
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what marker is increased with a testicular choriocarcinoma?
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hCG
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what is the difference between a teratoma in males vs. females?
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in males: often malignant
in females: often benign |
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what are the testicular non-germ cell tumors?
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leydig cell, sertoli cell, testicular lymphoma
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what hormone do leydig cell tumors usually produce?
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androgen (gyecomastia in men, precocious puberty in boys)
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which testicular non-germ cell tumor displays Reinke cystals?
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leydig cell
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what is the most common testicular cancer in older men?
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testicular lymphoma
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what are tunica vaginalis lesions?
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lesions in the serous covering of testis
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what is a varicocele?
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dilated vein in pampiniform plexus
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what is a hydrocele?
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increase fluid secondary to incomplete fusion of processus vaginalis
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what is a spermatocele?
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dilated epidymal duct?
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what is bowen's disease?
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gray solitary gray plaque on the shaft of the penis
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what is erythroplasia of Queyrat?
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red velvety plaques, usually involving the glans
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what is bowenoid papulosis?
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multiple papular lesions -- occurs earlier than other subtypes
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where is squamous cell carcinoma of the penis more common? what group of people?
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asia, africa, s. america
uncircumsized men |
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what is peyronie's disease?
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bent penis due to acquired fibrous tissue formation
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what is the most breast tumor in those under 25?
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fibroadenoma
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is fibroadenoma a precursor lesion to breast cancer?
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no
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what are 3 benign breast tumors?
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fibroadenoma, intraductal papilloma, Phyllodes tumor
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which of the benign breast tumors responds to estrogen?
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fibroadenoma
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by how much does an intraductal papilloma increase the risk for carcinoma?
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1.5-2X increase
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what is seen clinically in a intraductal papilloma?
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serous or bloody nipple discharge because they typically occur beneath the areola
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what is characteristic of a Phyllodes tumor?
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LARGE mass of connective tissue and cysts
"leaf-like" projections |
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when does a Phyllodes tumor typically occur?
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6th decade of life
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when are malignant breast cancers most common?
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postmenopause
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what is the most important prognostic factor in malignant breast cancer?
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axillary lymph node involvement
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what type of breast cancer exhibit peau d'orange?
|
inflammatory type -- dermal lymphatic invasion by breast cancer
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what is the worst, most invasive, and most common type of malignant breast cancer?
|
invasive ductal
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what is clinically characteristic of Paget's disease?
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eczematous patches on nipple suggesting underlying carcinoma
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what are paget cells?
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large cell in the epidermis with a clear halo
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what is the most common cause of lumps in the breast from age 25 to menopause?
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fibrocystic disease
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what are the four histologic types of fibrocystic disease?
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fibrosis, cystic, sclerosing adenosis, epithelial hyperplasia
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what is the most common pathogen in acute mastitis?
|
S. aureus
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fat necrosis occurs as a result of what?
|
injury to breast tissue
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does fat necrosis form a lump that is painful or painless?
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painless
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gynecomastia results from elevations in what hormone?
|
estrogen
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what drugs can cause gynecomastia?
|
spironolactone, digitalis, cimetidine, alcohol, ketoconazole
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some drugs create awesome knockers
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