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76 Cards in this Set
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How do you differentiate true precocious puberty from pseudo precocious puberty/
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True: High Fsh/LH, increased further with GNRH test to stimulate.
Pseudoprecocious Puberty: Low FSH, Lh, SUPPRESSED DUE TO EXOGENOUS SOURCE |
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Precocious puberty dx, next step in evaluation?
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Wrist xray to diagnose bone age,
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Precocious puberty definition?
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Secondary sexual characteristics before 8yo in female, before 9yo in boys
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Causes of Pseudoprecocious Puberty?
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Exogenous steroids
McCune Albright adrenal tumors (testicular atrophy) Sertoli-leydig tumors, |
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Premature Ovarian Failure
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No menses for 12m or 6m in pt<40 y/o
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Hormone which causes increase in basal body temp?
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Progesterone,
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Basal body temp association with ovulation
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24hrs prior to ovulation ibcrease in basal body temp
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4 different options of emergent birth control
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1. Levonorgesterol (progestin dose ion 72hrs)
2. High dose mixed estrogen and progesterone 5 pills in 24 hrs of cop 3. Copper IUD 4. Mifeprostone (anti progestin) |
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Contraindications to OCP use?
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Migraine with Aura
Uncontrolled HTN hx of Enstrogen sens cancer history of DVT or inherited factor v leiden mutation smoker >35yo hepatic diease/neoplasm unknown cause of abnormal vaginal bleeding |
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Meds which reduce effectiveness of ocps?
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Antibiotics: Rifampin, griseofulvin
Anti-epileptics St. Johns Wort |
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bcgpqrs. unregulate enzyme synthesis, increase breakdown of meds
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Barbiturates
Carbamazepine Griseofulvin Phenytoin Quinidine Rifamipin St. Johns wort |
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Primary Amenorrhea
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No menses by age 16 with 2dary ex characteristics
No secondary sex characteristics by age 13 |
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First step up amenorrhea work up
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HCG
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Work up for secondary amenorrhea
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BHCG, PROLACTIN, FSH/LH, TSH, DHEAS TESTOSTERONE, PROGESTIN WITHDRAWAL TEST
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Primary amenorrhea, absent secondary sexual charcateristics, anosmia
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Kallman's Syndrome, x-linked hypogonadotropic hypogonadism.
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Initial step in management of women with secondary amenorrhea, new galactorrhea, and bhcg neg
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Tsh and Prolastin levels
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Menopause diagnosis?
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1 year of amenorrhea in a 45 yo woman is diagnostic.
>45 oligo menopausal symptoms can be assumed to be going thru <45 yo other etiologies ruled out via TSH HCG prolactin fsh |
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HRT for menopause
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ONLY TO TX MENOPAUSAL SYMPTOMS., not indicated for prevention of chronic disease
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Cons of HRT
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Increase risk of endometrial and breast cancer, and dvt doubles rx
-increased risk of stroke increased risk of heart disease increased risk of biliary disease |
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Other drugs for hot flashes, non hormonal?
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Desvenlafaxine
Venlafaxine |
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COMBO OCP ADVANTAGES?
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RELIABLE
REDUCED RISK OF endometrial ca and ovarian ca decreased rx of ectopic preg lighter less painful menses |
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Combo OCP disadvantages?
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estrogen se: bloating weight gain breast tenderness nausea headaches
Progesteron: s/edepression acne htn risk of dvt hypertriglycerides |
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Liver pathology associated with cop use
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Hepatic ADENOMA
REVERSIBLE CHOLESTASIS renal vein thrombosis |
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CI TO IUD PLACEMENT
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HX PID
current infection high risk of std uterus abnormailites copper allergy or wilsons dz no copper ius breast ca? no progesterone iud |
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primary amenorrhea workup after HCG
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H&P, LOOK for defects
hyper androgen? order testos dhea levels galactorrhea? prolactin and thyrotropin level Pelvic sono uterus absent? karyotype and check testosterone Uterus present? HCG FSH LEVELS FSH HIGH-ovarian dysgenesis look for turner karyotype 45xo FSH low, cranial MRI for pit or hypothalamic disease FSH normal, check prolactin or thyrotropin levels |
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Imperforate hymen
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Bluish bulge where vaginal orifice should be
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secondary amenorrhea workup
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bhcg
h&p prolactin, tsh, fsh (r/oovarian failure) hyperandg? dheas total test all norma;? h/o d&c? progestin withdrawal test to r/o ashermans |
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Features of Endometriosis
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dyspareunia, dysmenorrhea, dyschezia
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tx options for treating endometriosis?
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NSAIDS
COMBINED OCPS DOSED CONTINUOUSLY SO NO BLEEDING GNRH AGONIST-CONTINUOUS TO INDUCE MEDICAL MENOPAUSE LEUPROLIDE, NAFARELIN GOSERALIN PROGESTIN DANAZOLE ANDROGEN AROMATOSE INH ANASTROZOLE OR LETROZOLE USED WITH GNRH SURGERY? LAPAROSCOPY TO CONFIRM, ABLATE ECTOPIC TISSUE |
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First line tx for young, infertile female with obvious signs of endometriosis
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Continuous OCP if wants to get pregnant need laparoscopic lysis of adhesions
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MCC of abnormal uterine bleeding
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anovulation
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positive hcg, iupregnancy, closed os
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threatened abortion
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asymmetric Enlarged uterus. menometrorrhagia for months
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fibroids
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bleeding with severe mentrual pelvin pain
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endometriosis
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menorrhagia and perimenopausal
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endometrial hyperplasia
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AUB with menses too much bleeding
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bleeding d/o r/o vwb
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+bhcg sever pain no fetus
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ectopic pregnancy
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metrorrhagia after intercourse, no pain, normal sized uterus
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endometrial or cervical polyp
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depression constipation aub
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hypothyroidism
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PCOS
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HYPOTHAlamic pituitary disease, over production of LH--INCREASED ANDROGEN, AMENORRHEA AND INFERTILITY (ANDROGEN PEROPHERALLY CONVERTED TO ESTROGEN -INHIBITION OF FSH-AMENORRHEA)
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pcos dx?
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LH:FSH RATIO >3
High DHEA normal DHEAS Normal progestin challenge test Polycystic overies signs of virilization or hirsutism |
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PCOS TX?
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WEIGHT LOSS
OCP suppress lh and fsh, regulates cycle decreases excess estorgen (which is a risk of endometrial and breast ca METFORMIN WEUGHT LOSS AND HELPS REDUCE CV RISKS SPIRINOLACTONE NOT SAFE IN PREG STATIN CLOMIPHENE TO INDUCE OVULATION |
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PID TX?
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CEFTRIAXONE SINGLE DOSE METRONIDAZOLE 14 DAYS +DOXYCYCLINE FOR 14 DAYS
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inpatient pid tx?
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cefoxitin +doxy
clinda+gentamicin |
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Pelvic Prolapse
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pelvic pressure or heaviness, feels like sitting on an egg
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Pelvic Prolapse tx?
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mILD KEGALS
MODERATE PESSARY SEVERE SURGERY |
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Meds to tx PMD OR PMDD
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EXCERCISE, B6 OCPS PROGESTIN NSAIDS ssri =-ALPRAZOLAM
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TX FOR PRIMARY DYSMENORRHEA
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NSAIDS, OCPS
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mcc hirsutism in us
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PCOS
LH:FSH>3 DHEA HIGH TESTOSTERONE HIGH |
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SYPHILIS TX?
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Penacillin G
DOXYCYCLINE TETRACYLINE |
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Meds for PCOS
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WEIGHT LOSS EXCERCISE
METFORMIN OCPS CLOMIPHENE SPIRINOLCTONE |
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MCC FEMALE INFERTILITY
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ENDOMETRIOSIS
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AUB?
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BLEEDING >7DAYS OR MORE YHAN 80ML /CYCLE
TAMPON CHANGING LESS THAN EVERY 3HR |
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BV VS TRICH VS CANDIDA
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bv clue cells
trich flagellate organisms both have alkaline discharge candida normal ph 3.5-4.0 pseudohyphae on wet mount |
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Lymphogranulum venereum
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mistaken for IBD bc forms fistulas
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when is endometrial biopsy necessary part of a work up for AUB?
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>35yo or with rc for uterine ca
family hx, pcos, lynch syndrome, increased estrogen exposure |
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MOST IMPORTANT PROGNOSTIC FACTOR IN ENDOMETRIAL CA
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HISTOLOGICAL GRADE>MORE IMPT THAN DEPTH OF MYOMETRIAL INVASION
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mc malignancy of repro tract
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Endometrial>cervical>ovarian
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Most deadly?
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Ovarian>cervical>endometrial
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scc of vagina tx?
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stage i: surgical removal and radiation
stage i >2cm external beam radiation stage ii, iii, iv: external beam radiation |
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tx lichen sclerosis
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steroids always do punch biopsy first
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FIBROADENOMA WORK UP<35YO
mammogram not part of work up!!!!because dense tissues in patients younger than 35 so not very sensitive |
HAVE HER RETURN 10DAYS AFTER MENSTRUATION
Persists? FNA bENIGN MALIGNANT TX? CYSTIC CLEAR FLUID F/UP 1 MTH AND CYSTIC BLOODY, SEND FLUID COR OR EXCISIONAL BIOPSY |
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mc cause of bloody nipple discharge?
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intraductal papilloma, do biopsy
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MC BREAST CA?
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DUCTAL CA
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SEROUS OR BLOODY DC?
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INTRADUCTAL PAPILLOMA
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MC MASS IN 35-50
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FIBROCYSTIC CHANGE
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MC TUMOR IN TEEN AND YOUNG WOMEN
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FIBROADENOMA UNILATERAL
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RX FOR ENDOMETRIAL CA
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INCREASED ESTROGEN
OBESITY PCOS HTN HIGH FAT DIET FAM HX COLON CA |
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RX FOR BREAST CA
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NULLIPARITY
AGE OF MENARCHE YOUNGE AGE OF MENOPAUSE LATE BRCA1/2 INCREASED OVULATION |
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SERUM MARKER WITH ENDOMETRIAL CA, AND OVARIAN CA
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OVARIAN CA125
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cin 2 cervical lesion next step?
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Excise with leap or conization
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next step for ASCUS
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MONITOR 3-6MTH LOOK FOR HPV N THIN SMEAR
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ASGUS?
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COLPO WITH ECC
>35 YO NEED TO DO ENDOMETRIAL BIOPSY TOO |
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OVARIAN TUMOR WITH
PSAMOMMA ESTROGEN EXCESS ANDROGEN EXCESS |
EPITHELIAL
GRANULOSA CELL SERTOLI LEYDIG |
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DUCTAL CARCINOMA INSITU TX?
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LUMPECTOMY +/- RADIATION
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TX FOR LOBULAR CARCINOMA INSITU
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OBSERVATION +/- TAMOXIFEN OR RALOXIFENE
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