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160 Cards in this Set
- Front
- Back
With testicular cancer, how does mets spread?
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para-aortic lymph nodes
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Woman w/ previous cesarean section has a scar in her lower uterus clse to the opening of the os. What is she at increased risk for?
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Placenta previa
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Obese woman presents w/ hirsuitism and up levels of serum testosterone. What is the Dx?
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Polycystic ovarian syndrome
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Pregnant woman at 16 wks gestation presents w/ large abdomen. Whats teh Dx?
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Hydatidiform mole
high hCG |
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55 y/o postmenopausal woman w/ tamoxifen. What is she at increased risk for?
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endometrial carcinoma
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How does the gonad drain?
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Left-> renal vein-> IVC
Right-> IVC |
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Breakdown the following ligaments:
Suspensory ligament of the ovaries Transverse cervical ligament Round ligament of the uterus Broad ligament |
Suspensory- ovarian vessels
transverse cervical- uterine vessels Round- no important structures Broad- round ligaments; ovaries, and the uterine tubuels and vessels |
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How is the male sexual response stimmed?
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Erection- paras
Emission- symps Ejaculation- visceral and somatic Point and Shoot Paras Symps |
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Where are the parts of the sperm located?
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Acrosome from golgi, flagellum centriole
Middle has Mitochondria sperm food is fructose |
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What are the stages of sperm development?
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Spermatogonia (A and B)- diploid, 2N
1ry spermatocyte- diploid, 4N 2ry spermatocyte- haploid, 2N Spermatid- haploid, N Type A forms both A and B Spermatogenesis occurs in the seminiferous tubules. FSH stims sertoli cells to produce sperm |
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What are the functions of LH and FSH in men?
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LH- stims testosterone release from Leydig cells
Testosterone- differentiates male genitalia, anabolic on protein metab, maintains gametogenesis, maintains libido, inhibs GnRH, fuses epiphyseal plates in bone. FSH- stims ABP and Inhibin production from Sertolis ABP- Androgen binding protein. Ensures that testosterone in seminiferous tubule is high Inhibin- inhibits FSH |
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What are androgens?
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Testosterone, DHT, androstenedione
made in teste and adrenal acts on skin, prostate, seminal vesicles, epididymis, liver, muscle, brain - differentiate wolffian duct system into internal gonadal structures 2ry sex characteristics and growth spurt during puberty normal spermatogenesis Anabolic- increase muscle size, increase RBC production inicrease libido |
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What is the most potent androgen?
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DHT>testosterone>androstenedione
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What si the difference between Genetic Sex, Gonadal sex, and Phenotypic sex?
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Genetic- XY vs. XX
Gonadal- testes vs. ovaries Phenotypic- internal and external genitalia |
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What is the role of AMH and T in developing the male phenotype?
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AMH- suppresses meullarian grown
Testosterone stimis the wolffian duct regen. |
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what is cholesterol desmolase?
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enzyme of the first reaction of testosterone synth
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What part of the hypothalamus secretes GnRH?
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Arcuate nuclei of the hypothalamus
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What happens in puberty and GnRH?
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pulsatile GnRH begins in puberty. FSH and LH are secreted in a pulsatile manner.
GnRH up-regulates its own receptor in the ant. pituitary |
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How does FSH and LH change throughout life?
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FSH > LH in kids, but low levers
LH>FSH at puberty and reproductive years FSH>LH in senescense |
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How is estrogen produced?
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Desmolase triggers chol breakdown in the theca cells
Androstenedione is sent to the granulosa cell where aromatase converts the mofo. (Stimmed by FSH) |
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What is the role of FSH and LH in the female?
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Steroidogenesis in teh ovarian follicle and corpus leuteum
Follicular development beyond the antral stage Ovulation Luteinization |
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What are the actions of estrogen?
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maturation and maintenance of fallopian tubes, uterus, cervix, and vag
development of 2ry sex characteristics breasts up-regs egen, LH, and progerone receptors prolif of ovarian granulosa cells maintains pregnancy Lowers the uterine threshold to contractile stimuli during pregs stims PRL secretion; but blocks its action at the breast + feedback mid-cycle on LH for ovulation - feedback all other times. Fat distribution Hepatic synth of transport proteins increased myometrial excitability increased HDL, lowers LDL |
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What's the word on hormone replacement therapy?
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decreases hot flashes and postmenopausal bone loss
but can boost the risk of endometrial cancer, need progerone to keep this risk down. |
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What is the role of progerone?
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Stims endometrial glandular secretions and spiral artery development
Maintenacne of pregs decreases myometrial excitability thick cervical mucus which inhibs sperm. increases body temp inhibs LH, FSH uterine smooth muscle relaxation. |
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Go through the follicular phase of the menstrual cycle?
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primordial follicle develops to the graafian stage w/ atresia of the neighboring follicles
LH and FSH receptors are up-regged in theca and granulosa cells Estradiol levels increase and cause prolif of the uterus FSH and LH levels are suppressed by the negative feedback effect of estradiol on the ant. pit. low progerone fastest growth in 2nd wk of proliferative phase phase can change length |
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Breakdown ovulation?
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14 days before menses
burst of estradiol synth at the end of the follicular phase causes an LH surge egen goes down after ovulation, but goes up again in luteal phase increased cervical mucus less viscous, more penetrable |
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What is teh luteal phase?
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corpus luteum develops and synthesizes egen and progerone
vascularity and secretory activity of the endometrium increase basal body temp increases becasue of the effect of progerone w/o fertilization, luteum regresses w/ drop of progerone and egen |
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What is Mittleschmerz?
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blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis
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Meiosis and ovulation, lets rock
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1ry oocytes begin meiosis I during fetal life and complete meiosis I just prior to ovulation
arrested in prOphase til Ovulation Meiosis II is arrested in METaphase til fertalizatio (an egg MET a sperm) |
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hCG: what is its source and function?
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from the syncytiotrophoblast of the placenta
- maintains corpus luteum for 1st trimestor (acts like LH) 2nd and 3rd trimestor, synthes its own egen and progerone hCG helps detect prggers; in urine 8 days after fertilization Elevated hCG in hydatidiform moles or choriocarcinoma |
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What is the major placental egen?
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estriol
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What is the role of the fetal adrenal gland?
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supplements placental egen w/ it's own DHEA
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What is human placental lactogen?
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produced throughout preggers. acts like GH and PRL
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What is Parturition?
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in pregs, progesterone increases the threshold for uterine contraction
near term, egen/progertone ratio increases- uterus is more sensitive |
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Lactation
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Egens and progerone stim growth and development of breasts in preggers
lactation does not occur during pregs becaseu egen and progerone block it. after parturition, the levels decrease and lactation occurs. Ovulation is suppressed w/ lactation. PRL- inhibs GnRH and inhibs GnRH action on the pituitary, and antagonizes LH and FSH on the ovaries. |
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Menopause
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Cessation of egen w/ age linked delcine
smoking makes it earlier Decreased egen, superincrease in FSH, increase in LH, increase in GnRH HAVOC Hot flashes Atrophy of Vagina Osteoparosis Coronary artery disease |
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Hypospadias
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Abnl opening of penile urethra on ventral side
more common; fix to prevent UTIs |
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Epispadias
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Abnl opening of penile urethra on dorsal side
from faulty genital tubercle Extrophy of the bladder is associated with epispadia |
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Phimosis
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Can't retract foreskin
congenital inflamm |
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Peyronie disease
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old man fibrosis of dorsum of the penis
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Priapism
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intractable painful erection
clot of corpus cavernosa |
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Balanitis
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Inflam of the glans
poor hygeine |
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Syphilis
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Treponema, dark-field exam
primary chancre, painless superficially ulcerated, firm papule |
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Gonorrhea
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Neisseria gonorrhea
acute purulent urethritis can extend to prostate and smeinal vesicles |
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Chlamydia
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nongonococcal urethritis
epididymitis |
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Bowen Disease
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single erythematous plaque on shaft or scrote
50s 10% go invasive visceral malig |
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Erythroplasia of Queyrat
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single erythematous laque, glans or pepuce
uncircumcised men median incidence in 5th decade not associated w/ viseral maligs |
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Bowenoid papulosis
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histo is similar to Bowen and erythroplasia
wart like HPV16 |
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Penile carcinoma
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squamous cell
far east, africa central america poor personal hygiene and venereal disease HPV 16, 18, 31, 33 |
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What is XXY
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Klinefelters
small balls, eunuchoid, tall, long, gynecomastia, Barr body (inactive X) |
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What is XO
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Turners
Short, ovarian dysgenesis (Streak ovary) webbing of neck. Most common cause of 1ry amenorrhea no barr body |
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XYY
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Double Y
Normal phenotype tall, severe acne antisocial |
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Pseudohermaphroditism
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phenotypic (external) and gonadal (testes) aren't the same
Female- XX, Ovaries present, but external genitalia are virilized or ambiguous. CAH or exog androgens Male- XY; testes, but external genitalia are female or ambiguous; androgen insensitivity |
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True hermaphrodite
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46 XX
47 XXY Both ovaries and testicular tissue are present; ambiguous genitalia. Rare |
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Androgen insensitivity
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Defecct in androgen receptor -> normal-looking female
Testes in labia majora, surgically removed Testosterone, Egen and LH are all high |
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Bicornuate uterus
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incomplete fusion of the paramesonephric ducts
- bad urinary tract - infertile |
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5alpha-reductase deficiency
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can't convert testosterone to DHT
ambiguous genitalia til puberty |
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Cryptorchidism
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developmental failure of a testis to descend
increased incidence of germ cell tumros, seminoma and embryonal carcinoma associated w/ testicular atrophy and sterility |
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Torsion of the spermatic cord
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compromises blood supply
testicular gangrene |
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Hydrocele
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fluid fillilng and idstending the tunica vaginalis
idiopathic congenital or persistence of continuity of the tunica w/ peritoneal cavity can be 2ry to infection or lymph blockage transilluminates |
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Hematocele
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accumulation of blood distending the tunica vaginalis
trauma tumor |
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Varicocele
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varicose dilation multiple veins of the spermatic cord
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Spermatocele
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Sperm-containing cyst
intratesticular |
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Testicular atrophy
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unknown
Orchitis- mumps Trauma Hormonal excess or dificieny- hypothalmus, pituitary, hormonal therapy, cirrhosis Cryptorchidism Klinefelter chronic debilitating disease old age |
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Orchitis
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bacterial- epididymitis
viral- mumps syphilis bilateral-> sterility form atrophy of sminiferous tubules. Testosterone is decreased, pituitary FSH, LH increased |
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Epididymitis
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more common
N. gonorrhoeae C. trachomatis E. coli M. tuberculosis |
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Germinoma
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malignant
dysgerminoma (ovary); Seminoma (teste) 40% of cancers mid 30s peak Sheets of uniform cells Seminoma- painless enlargement of the testes increased hCG very radiosensitive Increased risk of cryptorchidism |
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Embryonal carcinoma
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malignant germ cell- yolk sack
2nd most common presents w/ pain or mets Glandular w/ papillary convolusions. worse prognosis than smeinoma often has increased hCG |
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Endodermal sinus
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malignant germ cell tumor
occurs in testes, ovaries, sacrococcygeal area of young children. Schiller-Duval bodies, primitive glomeruli peak in infancy and early childhood. Most common for this age increas in alpha fetoprotein |
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Teratoma
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Most common ovarian germ cell tumor
germ cell from two or more embryonic layers frequently malignant Mature- always malignant (ovarian dermoid cyst is always benign) Immature teratoma- malignant in women. Taratoma w/ malignant transformation- contains malginant tissue such as squamous cell carcinoma |
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Choriocarcinoma
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malignant germ cell tumor
analogous to choriocarcinoma of the ovary can occur as an element of other germ cell tumors peak incidence in the 2nd to 3rd decades characterized histologically by cells resembling large syncytiotrophoblasts and cytotophoblasts increased hCG |
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Mixed germ cell tumors
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combinations of germ cell tumor
variable porgnois determined by the least mature element can be teratocarcinoma - Teratoma, embryonal carcinoma, and seminoma - embryonal carcinoma and seminoma |
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Leydig cell tumor
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non-germ cell tumor derived from testicular stroma
- similar to sertoli-leydig cell tumor of ovary benign intracytoplasmic Reinke crystals androgen producing but produces androgens and estrogens and sometimes corticos - precocious w/ gynecomastia |
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Sertoli cell tumor
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non-germ cell tumor derived from the sex cord-stroma
benign paucity of endocrine manifestations |
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what are the differences between the peripheral zone and the central/transitional/periurethral
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Periurethral, transitional, and central zones are the areas of BPH
periperal zone drains into ducts of the urethral sinus close ot the verumontanum, site of carcinoma |
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BPH
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urinary tract obstruction
common, universal in elderly no relation to prostate cancer (increase in egens) hyperplasia of glandular and fibromuscular stromal elements characterized by a rubbery nodular enlargement of the gland. periurethral and transitional zones - frequency, dysuria, hesitancy (difficulty starting), UTI - incomplete bladder emptying - distention and muscular hypertrophy of the bladder; long duration, bands of enlarged bladder muscle form characteristic trabeculae - hydroureter and hydronephrosis |
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Prostate Cancer
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very common
older age group - indolend or aggressive course, which cna be predicted in part by the Gleason system of grading, based on differentiation arise most often from the peripheral group of glands rectal PSA is increased bony mets- increased alk phos |
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What is the most common teste cancer in old men?
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lymph
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Bartholin cyst
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bostruction of Bartholin ducts
2ry infecion by N. gonorhea and staph |
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vulvar dystrophies
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epitheliasl growth- leukoplakia, white patch-like lesion
Lichen sclerosus, hyperplastic dystrophy atypical hyperplastic- premalignant pruritus, leukoplakia |
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Candidiasis
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DM
pregs antibiotics OC immunosuppression White, patch-like mucosal lesions, thick white discharge,and vulvovaginal pruritus. |
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Trichomoniasis and vaginas
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second most common type of vaginitis
from trichomonas vaginalis |
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Gardnerella vaginitis
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Gardnerella vaginalis
sexula clue cells w dot-like organisms |
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Toxic Shcok syndrome and vaginas
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staph toxin in the tampon
vomiting, fever, diarrhea, renal failure and shock; generalized rash |
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Gonorrhea and vaginas
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PID
purulent acute inflamm, initially of the urethra, paraurethral and Bartholin glands, adn skene ducts - pharyngitis- oral - proctitis- anal - purulent arthritis- monoarticluar - Ophthalmia neonatorum- neonatal conjunctival infection |
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Chlamydia and vaginas
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Cervicitis- most common STD
PID; can be asymptomatic Lymphogranulma venereum- tropics from C. trachomatis L1, L2 or L3 small papule or ulcer, followed by superficial ulcers and elnargement of regional lymph nodes rectal stricture from inflamm. |
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HSV and vaginas
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Type 2
spread by sex vesicles and shallow ulcers that can involve the cervix, vag, clit, vulva, urethra, perianal skin Multinucleated giant cells w/ viral inclusions found in cytologic smears |
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Syphilis and vaginas
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treponema pallidum
firm, painless ulcer canyloma lata in 2ry, gray, flattened wart-like |
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Chancroid
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H. ducreyi
tropical areas soft and painful ulcerated lesion. |
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Granuloma inguinale
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Calymmatobacterium granulomatis, G- rod
STD Donovan bodies Papule that becomes ulcerated |
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Papillary hidradenoma
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benign tumor of the fvulva
apocrine sweat glands labial nodule; may ulcerate and bleed. |
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Condyloma acuminatum
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Benign squamous cell papilloma from HPV 6 and 11
venereal warts- vulvovag and perianal and cervical koilocytes expanded epithelial cells w/ perinuclear clearing. |
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Squamous cell carcinoma of the vulva
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most common malignant tumor of the vulva
peak occurrence in older women. preceded by premalignant changes graded as vulvar intraepithelial neoplasia 1-3 preceded by vulvar dystrophy HPV 16, 18, 31, 33 |
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Malignant melanoma of the vulva
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10% of vag tumors
|
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Clear cell adenocarcinoma of the vag
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increased incidecne in daughters of women who took diethylstilbestrol (DES)
vaginal is a benign condition mucosal columnar epithelial-lined crypts ina areas normally lined by stratified squamous epithellium, precursor of adenocarcinoma |
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Sarcoma botryoides
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rhabdomyosarcoma
<5 multiple polypoid masses resembling a "bunch of grapes" projecting into the vag, protrudes from the vulva. |
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Erosion of the cervix
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columnar epithelium replaced by squamous epitheilum-> erythematous area
manifestation of chronic cervicitis |
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Cervicitis
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Staph, enerococci, gardenerella vaginalis, trich, candida, chlamydia
involves the endocervix often asymptomatic can cause cervical discharge |
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Cervical polyps
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inflam porliferationso fthe cerivical mucosa
|
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Carcinoma in situ of the cervix
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squamocolumnar junction
HPV 16, 18, 31, 33 characterized by disordered epithelial growth manifest by loss of polarity and nuclear hyperchromasia, beginning a the the basal layer and extending outward dysplasia can progress through mild, moderate and severe forms to carcinoma in situ and is classified as Cervical iNtraepithelial neoplasia CIN3- Carcinoma in situ |
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Invasive carcinoma of cervix
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peak in middle-age groups
most often squamous cell carcinoma arises from CIN at the squamocolumnar junction - early sex and multiple partners prostitutes is common Koilocytes HPV integrates into the genome E6 and E7; p53 and Rb |
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Endometritis
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from intrauterine trauma from instrumentation (IUD), or complications of pregs. Postpartum retention of placental fragments
caused by staph aureus or strep Chronic endometritis is often related to TB |
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Endometriosis
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prolif of ectopic endometrial tissue
non-neoplastic - retrograde dissemination of endometrial fragments during menses, or blood or lymphatic dissemination. vaires w/ hormones. causes "chocolate" cysts occurs in the pelvic area; ovary is the most common site; uterine ligaments, rectovag septum, pelvic peritoneum and other sites Severe menstral pain infertility |
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Adenomyosis
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islands of endometrium in the myometrium
|
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Endometrial hyperplasia
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abnl prolif of endometrial glands
excess estrogen stimulation, anovulatory cycles, polycystic ovary disease, egen secreting ovarian tumors, granulosa cell tumor, egen replacement therapy postmenopausal bleeding can be a precursor lesion; depends on cellular atypia |
|
Endometrial polyp
|
benign
women >40 some uterine bleeding |
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Leiomyoma
|
most common uterine tumor and most common of all tumors.
increased in african lineage benign neoplasm, putative malignant transformation is rare occurs in multiple seperate foci Egen sensitive. tumore often increases in size during preggers, almost always decreases in size after menopause. can be intramural, in sumbendometrial or subperitoneal can cause increased menstral bleeding |
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Leiomyosarcoma
|
malignant tumor that is infrequent
arises de novo, not affiliated w/ leiomyoma |
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Endometrial carcinoma
|
increasing incidence
most common gyne malignancy peaks in older age group postmenopausal bleeding - endometrial hyperplasia precedes it prolonged egen stim, obesity, diabetes, hypertension (obesity may be the common link) |
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Salpingitis
|
inflam of ovaries and adjacent tissue (PID)
n. gnorrhoeae, C. trachomatis, various anarobes, strep and other trauma pyosalpinx- pus filled hydrosalpix- watery tuboovarian abscess |
|
Hematosalpinx
|
bleeding in tubes
ectopic pregs etiology |
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What tumors occur in the fallopian tube?
|
adenomatoid tumor
- frequent bengin tumore of the fallpian tubes Adenocarcinoma - most often results from direct extension or mets from tumors originating elsewhere |
|
Follicular cyst
|
distension of the unruptured grafian follicle
- hyperestrinism and endometrial hyperplasia |
|
Corpus Luteum cyst
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hemorrhage into a persistant mature corpus luteum
menstrual irregularity, occasionally w/ intraperitoneal hemorrhage |
|
Theca-lutein cyst
|
Gonatotrop stim;
choriocarcinoma or hydatidiform mole multiple and bilateral lined by e luteinized theca cells |
|
Chocolcate cysts
|
blood containing- usually from endometriosis
|
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PCOS
|
young women
infertility amenorrhea, infertillity, obesity, hirsuitism excess luteinizing hormone and androgens insulin resistance w/ increased risk of DM thickened ovarian capsule multple small follicular cysts containing granulosa cell layer and luteinized theca interna Cortical stromal fibrosis w/ islands of focal luteinization Rx- weight loss, OCPs, gonatotropin analogues, surgery |
|
Abruptio placentae
|
premature separation of the placenta
Painful antepartum bleeding and fetal death DIC Increased risk w/ smoking, HTN, cocaine use |
|
Placenta accreta
|
attachment of the placenta to teh myometrium (defective decidual layer)
- predisposed by endometrial inflamm and old scars from cesarean - impared placental separation after delivery/ w/ massive hemorrhage |
|
Placenta previa
|
attachment of placenta to lower uterine segment.
may occlude cervical os. Painless bleeding in any trimester |
|
Ectopic pregs
|
Fallopian tube
also in the abdominal cavity, cervix or ovary predisposed by salpingitis predisposed by endometriosis and postoperative adhesions - no obvious cause most common cause of hematosalpinx-> tubal rupture |
|
Toxemia of pregs
|
severe HTN
3rd trimester of 1st pregs affects the kidneys, liver, and CNS - Preeclampsia- milder form- HTN, albuminuria, and edema - Eclampsia- severe form of toxemia, convulsions/seizures, DIC; reverses rapidly when pregs ends; can be fatal |
|
What are some of the risk factors for preeclampsia/eclampsia?
|
pre-existing HTN, DM, autoimmune disease, chronic renal disease
Etiology- placental ischemia HELLP Hemolysis Elevated LFTs Low PLatelets |
|
What are the clinical features of eclampsia?
|
headache, blurred vision, ab pain, edema of face and extremities, altered mental status, hyperreflexia; lab findigns of Tpenia, hyperuricemia
|
|
What is the Rx for eclampsia
|
delivery of fetus as soon asa viable
bed rest, salt restriciton, monitoring and Rx of HTN. Eclampsia- medical emergency, IV magnesium sulfate and diazepam. |
|
Hydatidiform Mole
|
enlarged edamatous placental villi in loos stroma, looks like grapes
increase in hCG Honeycomb uterus occurs in early months of pregs vaginal bleeding, rapid increase in uterine size; can be mistaken for normal pregs, but uterus is too large - can go to choriocarcinoma Complete- 46 XX, all paternal Partial- tiploidy, embryo is present; fertilization of the ovum by two or more sperm. 69; two paternal |
|
Amniotic fluid embolism
|
tear in the placental membranes and rupture of maternal veins
sudden peripartal resp difficulty-> shock and death can cause DIC masses of debris and epi squamous cells in the maternal pulm microcirculation amniotic fluid aspiration syndrome- disease of the neonate, not moms. can't expel amniotic fluid at birth (premature, squamous epi cells of amniotic origin in fetal terminal air space and larger bronchi) |
|
Postpartum ant. pit. necrosis
|
Sheehan- severe hypotension from blood lost
insidious onset wks and months after birth that causes pit hypofunction |
|
Chorioamnionitis
|
premature rupture of membranes
caused by ascending infection of vag or cervix |
|
Gestational choriocarcinoma
|
aggressive malignant neoplasm
characterized by increased serum concentration of hCG. An important diagnostic sign early hematogenous spread to teh lungs responsive to chemotherapy greatly increased in incidence in asia and africa Preceded by: - hydatidiform mole (50%) - Abortion of ectopic (20%) - Normal pregs (20-30%) |
|
Polyhydraminios
|
lots of amniotic fluid
esophageal/duodenal atresia inability to swallow amniotic fluid, anencephaly |
|
Oligohydraminos
|
little amniotic fluid
renal agenesis posterior uretheral valves and inability to excrete urine |
|
Serous cystadenoma of the ovary
|
benign cystic tumor lined w/ cells similar to fallopina tube epithelium
20% of tumors bilateral |
|
Serous cystadenocarcinoma of the ovary
|
malignant
50% of ovarian carcinomas bilateral |
|
Mucinous cystadenoma
|
benign tumor characterized by multilocular cysts lined by mucus-secreteinig columnar epithelium and filled w/ mucinous material
|
|
Mucinous cystadenocarcinoma
|
malignant tumor
rupture or mets in pseudomyxoma peritonei w/ multiple peritoneal tumor implants. Produces large amounts of intraperitoneal mucinous material. Pseudomyxoma peritonei is also caused by mucinous cystadenoma, carcinomatous mucocele of th eappendix and other mucinous tumors |
|
Endometrioid tumor
|
histo resemblest he endometrium
malignant |
|
Clear cell tumor
|
rare tumor that is always malignant
|
|
Brenner tumor
|
rare, benign tumor
small islandss of epithelial cells; bladder transitional epithelium intersperse w/in a fibrous stroma |
|
Fibroma
|
solid tumor of bundles of spindle-shaped fibroblasts
Meigs- fibroma, ascites, hydrothorax |
|
Thecoma
|
demonstrates round lipid-containing cells in addition to fibroblasts
estrogen-secreting |
|
Granulosa cell tumor
|
egen secreting, precocious puberty
endometrial hyperplasia or endometrial carcinoma small cuboidal, deeply staingin granulosa cells Call-Exner bodies |
|
What tumors mets to the ovaries
|
Krukenberg tumors- signet ring cells from teh stomach
also from the GI tract, breast, endometrial |
|
strumo ovarii
|
monodermal teratoma
thyroid tissue-> hyperthyroidism |
|
What is Fibrocystic Disease of the breast?
|
common disorder of the breast
most common cause of a palpable breast mass in pts of reproductive age lumpy breasts w/ midcycle tenderness postulated to be due to increased activeity of, or sensitivity to, egen or to decreased progesterone activity bilateral - Nonproliferative forms (stromal fibrosis and cyst formation) have no increased risk of breast cancer hyperplastic epithelium demonstrates atypia - fibrosis Cysts- grossly visible , or only histo; blue fluid? apocrine metaplasia hyperplastic epithelium- cellulaar atypia: adenosis- small ducts and myoepithelial cells- sclerosing adenosis (increased acini and intralobular fibrosis) |
|
Fibroadenoma
|
Most common breast tumor in women younger than 25
benign firm, rubbery, painless, well circumscribed stromal cells are neoplastic ductal epithelial cells are reactive - intracanalicular- stroma compresses and distorts gland into slitlike spaces - Pericanalicular - glands retain shape |
|
Phyllodes tumor
|
large, bulky mass of variable malignancy w/ ulceration of overlying skin;
characterized by cystic spaces containing leaf-like projections from the cyst walls and myxoid contents |
|
Adenoma of the nipple
|
serous or bloody discharge and palpable mass, not malig
|
|
Intraductal papilloma
|
benign tumor of the lactiferous duct
clincaly - bloody discharge must be distinguished from carcinoma |
|
Carcinoma of the breast
|
2nd most common malignancy of women
most common cause of mass in postmenopausal pts upper outer quadrant mets to axilla, lung, liver, bone most often is invasive ductal carcinoma Egen and progerone receptors in some tumors but not in others, presence is correlated w/ a better prognosis; can use anti-egen thereapy Hyperexpression of C-erbB2(HER-2) is poorer prognosis |
|
What are the risk factors of breast carcinoma?
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age
FHx- p53, BRCA1,2 Hx of cancer in 1 breaset early menarche, late menopause Obesity Nulliparity First pregs after 30 High animal fat diet Proliferative fibrocystic disease w/ atypical epithelial hyperplasia |
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What are the types of malignant breast cancers?
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ductal insitu- early malig
invasive ductal- firm fibrous mass Comedocarcinoma- ductal w/ cheesy consistency from central necrosis Inflammatory- lymphatic involvement; poor prognosis Invasive lobular- multiple, bilateral Medullary- fleshy, cellular, lymphocytic infiltrate. Good prognosis Paget's- eczematous patches on nipple; large cells w/ clear halo; underlying carcinoma |
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What is finasteride?
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5alpha-reductase inhib- BPH
|
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What is flutamide?
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Non-steroidal inhib of agens at receptor
prostate carcinoma |
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Ketoconazole, spironolactone
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inhibit steroid synth; for PCOS hirsutism
|
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sildenafil, vardenafil
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inhib cGMP phosphodiesterast-> increase cGMP,
smooth muscle relaxatoin in corpus cavernosum -> erection SE- flushing, dyspepsia, blue-green color vision, risk of Hypotension w/ nitrates |
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Leuprolide
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GnRH analogue- agonist if pulsatile, antag if coninuous
agonist- infertility, antag- prostate cancer, fibrinoids tox- antiandrogen, nausea, vomiting when continuous-> initial burst of LH, FSH |
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Clomiphene
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parial agonsit of egen receptors in the pituitary gland. prevents inhibition-> increased LH and FSH-> ovulation
Rx of infertility Tox- Hot flashes, ovarian enlargement, mult simultaneous pregs, visual disturbances |
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Mifepristone (RU-486)
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competative inhibitor of progestins
Abortifacient (prevents implantation) TOx- heavy bleeding, GI (nausea, vomit, anorexia), ab pain |
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What are the advantages and disadvantages of OCs?
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advantage
reliable lower risk of endometrial, ovarian cancer decreased ectopic pregs decreased pelvic infections regulation of menses Disadvantages Taken daily no protection against STDs increased triglycerides Depression, weigh gain, nausea, HTN hypercoag |