Usmle Step 1 Fa Reproductive Pathology

Front 1

Hypospadias
(a) describe
(b) associations
(c) complications

Back 1

(a) urethra opens onto ventral surface of penis
(b) poorly developed penis that curves ventrally (chordee)
(c) infertility; increase risk of UTI's

Front 2

Epispadias
(a) describe
(b) associations
(c) complications

Back 2

(a) urethra opens onto dorsal surface
(b) extrophy of bladder
(c) infertility

Front 3

Phimosis
(a) describe
(b) complications
(c) treatment

Back 3

(a) prepuce orifice too small to be retracted normally
(b) hygiene interference; predispose to infx; if foreskin retracted over glans may lead to urethral constriction (paraphimosis)
(c) circumcision

Front 4

Bowen's disease
(a) description
(b) epidemiology
(c) gross
(d) microscopic
(e) outcome

Back 4

(a) penile carcinoma in situ
(b) mend>35; can be assoc w/visceral malignancy
(c) thick, ulcerated plaque usually on shaft or scrotum
(d) SCC in situ
(e) <10% progress to invasive SCC

Front 5

Squamous Cell carcinoma of penis
(a) epidemiology
(b) clinical presentation
(c) risk factors
(d) gross
(e) outcomes

Back 5

(a) 1% of cancer in men; 40-70YO; rare in circumsized men
(b) slow growing; not painful
(c) HYPV 16,18
(d) plaque progressing to ulcerated papule or fungating growth
(e) mets can go to local LN

Front 6

Erythroplasia of Queyrat; appearance

Back 6

Red velvety plaques usually involving glans; otherwise similar to Bowen's

Front 7

Bowenoid papulosis; appearance, epidemiology, outcome

Back 7

Multiple papular lesions; younger age group; usually not invade

Front 8

Peyronie's Disease

Back 8

Bent penis due to acquired fibrous tissue formation

Front 9

Prostate adenocarcinoma
(a) epidemiology
(b)clinical presentation/lobe of prostate involved?
(c) diagnosis
(d) metastasis
(e) treatment

Back 9

(a) >50YO; AA>caucasians
(b) urinary problems ; assoc w/posterior lobe enlargement
(c) PSA (incr total PSA, w/ decr fraction of free PSA); DRE
(d) mets via lymphatic or hematogenous route (bone w/osteoblastic mets indicated by back pain and incr alkP)
(e) surgery, rad, hormonal modalities

Front 10

Benign prostatic hyperplasia
(a) epidemiology
(b) possible etiology/lobe of prostate involved?
(c) clinical presentation
(d) complications
(e) diagnosis

Back 10

(a) common in M>50
(b) hyperplasia; possible due to DHT; middle and lateral lobes hyperplasia
(c) may narrow urethral canal; incr urinary frequency, nocturia, difficulty starting and stopping stream
(d) distention and hypertrophy of bladder, hydronephrosis and UTI's
(e) incr free PSA

Front 11

Acute prostatitis
(a) most common pathogens
(b) spread via?

Back 11

(a) same as UTI (E coli most common)
(b) direct extension or lymphatic/hematogenous

Front 12

Chronic prostatitis
(a) common causes
(b) presentation

Back 12

(a) bacterial and nonbacterial
(b) asymptomatic or present with lower back pain and urinary sx

Front 13

Cryporchidism
(a) cause
(b) most common location
(c) complications

Back 13

(a) failure of normal testes descent
(b) inguinal canal (more often on right); can be bilateral
(c) bilateral (infertility); incr incidence of testicular cancer

Front 14

Torsion
(a) clinical presentation
(b) complications

Back 14

(a) sudden onset testicular pain, and loss of cremasteric reflex
(b) compromise arterial/venous drainage (infarction)

Front 15

Testicular hydrocoele
(a) description
(b) precipitating events

Back 15

(a) patency of processus vaginalis remains
(b) inflammatory causes (epididymitis)

Front 16

Testicular varicocoele
(a) cause
(b) clinical presentation
(c) complications

Back 16

(a) dilatations of tributaries of testicular vein and pampiniform plexus "bag of worms"
(b) varicosities seen when standing but disappear when sitting down
(c) can cause infertility

Front 17

Spermatocoele

Back 17

Dilated epididymal duct

Front 18

Seminoma
(a) epidemiology
(b) histology
(c) prognosis
(d) treatment

Back 18

(a) 15-35YO M (most common testicular tumor)
(b) large cells in lobules w/"fried egg appearance"
(c) excellent (late mets)
(d) radiosensitive

Front 19

Embryonal carcinoma of testes
(a) clinical presentation
(b) histology
(c) outcome
(d) diagnosis

Back 19

(a) pain
(b) often glandular/papillary; can differentiate to other tumor
(c) malignant; high mortality; less radiosensitive (may require orchiectomy)
(d) incr serum AFP

Front 20

Choriocarcinoma
(a) epidemiology
(b) clinical presentation
(c) markers
(d) outcome
(e) treatment

Back 20

(a) 15-25YO
(b) gynecomastia' testicular enlargement
(c) elevated hCG
(d) disseminates hematogenously (lungs, liver, brain)
(e) orchiectomy or chemo

Front 21

Yolk sac (endodermal sinus) tumor
(a) epidemiology
(b) serum markers
(c) histology

Back 21

(a) rare; most common in children and infants
(b) high alpha fetoprotein (AFP)
(c) Schiller-Duval bodies, primitive glomeruli

Front 22

Testicular teratoma
(a) epidemiology
(b) clinical presentation
(c) histology
(d) prognosis
(e) treatment

Back 22

(a) any age but mostly infants/children
(b) testicular mass
(c) variety of tissues
(d) mature teratoma often malignant
(e) orchiectomy followed by chemo and rad

Front 23

Leydig cell tumor
(a) clinical presentation
(b) unilateral/bilateral
(c) treatment/prognosis

Back 23

(a) testicular enlargement; often androgen producing (gynecomastia in men precocious puberty in boys)
(b) unilateral
(c) usually curative w/surgery

Front 24

Sertoli cell tumor
(a) clinical presentation
(b) unilatera/bilateral
(c) outcome

Back 24

(a) testicular enlargement
(b) unilateral
(c) usually benign

Front 25

Testicular lymphoma
(a) epidemiology

Back 25

Most common testicular cancer in elderly men

Front 26

Klinefelter's Syndrome
(a) genetics
(b) pathophys
(c) clinical presentation

Back 26

(a) XXY; inactivated X chromosome (barr body)
(b) dysgenesis of seminiferous tubules, decr inhibin, incr FSH. Abnormal leydig cell fct; decr testosteron, incr LH and estrogen
(c) hypogonadism, eunuchoid body shape, tall long extremities, gynecomastia, female hair distribution

Front 27

Turner's Syndrome
(a) genetics
(b) clinical presentation
(c) pathophys

Back 27

(a) XO
(b) short stature; ovarian dysgenesis (streaks); webbed neck; preductal coarctation of aorta; most common cause of primary amenorrhea
(c) decr estrogen leads to incr LH and FSH

Front 28

Double Y males clinical presentation

Back 28

Phenotypically normal; tall; severe acne; antisocial behavior in 1-2% of men; normal fertility

Front 29

Female pseudohermaphrodite
(a) Genetics
(b) pathophys/cause
(c) internal/external genitalia/presentation

Back 29

(a) XX
(b) excessive/inappropriate androgens during early gestation (congenital adrenal hyperplasia, exogenous)
(c) ovaries but virilized/ambiguous external genitalia

Front 30

Male pseudohermaphrodite
(a) Genetics
(b) pathophys/cause
(c) internal/external genitalia/presentation

Back 30

(a) XY
(b) most common form is androgen insensitivity syndrome
(c) testes but female external genitalia (or ambiguous)

Front 31

True hermaphrodite
(a) genetics
(b) internal/external genitalia

Back 31

(a) either 46XX or 46XY
(b) both ovaries and testes; ambiguous genitalia

Front 32

Androgen insensitivity syndrome
(a) genetics
(b) cause/pathophys
(c) internal/external genitalia/clinical presentation
(d) sex hormone levels

Back 32

(a) 46XY
(b) defective androgen receptor
(c) normal appearing female; female external genitalia w/blunt vagina; uterus and uterine tubes absent; testes
(d) levels of testosterone, estrogen, and LH high

Front 33

5alpha reductase deficiciency
(a) defect
(b) clinical presentation
(c) sex hormone levels

Back 33

(a) unable to convert testosterone to DHT
(b) ambiguous genitalia until puberty when incr testosterone causes masculinization
(c) testosterone/estrogen levels normal; LH is normal or high

Front 34

Common cause of recurrent miscarriages: 1st weeks

Back 34

Low progesterone level (no response to beta hCG)

Front 35

Common cause of recurrent miscarriage: 1st trimester

Back 35

Chromosomal abnormalities (robertsonian translocation)

Front 36

Common cause of recurrent miscarriage: 2nd trimester

Back 36

Bicornate uterus

Front 37

Preeclampsia triad

Back 37

HTN, proteinuria, edema after 20wk gestation

Front 38

Eclampsia

Back 38

HTN, proteinuria, edema, seizures

Front 39

Etiology of preclampsia

Back 39

Placental ischemia (lack of trophoblast invasion of spiral arteries in myometrium) causing elaboration of factors leading to altered maternal endothelial fct (incr vascular tone, incr vascular permeability, coagulopathy)

Front 40

Complications of preeclampsia

Back 40

Hemolysis, Elevated LFT's, Low platelets

Front 41

Clinical features of preeclampsia

Back 41

HA, blurred vision, abd pain, edema, altered mentation, hyperreflexia

Front 42

Lab values in preeclampsia

Back 42

Thrombocytopenia, hyperuricemia

Front 43

Treatment of preeclampsia

Back 43

Delivery of fetus as soon as viable; bed rest, salt restriction, monitor/treat HTN
IV mgsulfate and diazepam to prevent and treat seizures

Front 44

Abruptio placenta
(a) description
(b) presentation
(c) complications
(d) risk factors

Back 44

(a) premature detachment of placenta from implantation site
(b) painful bleeding in 3rd trimester
(c) fetal death; DIC
(d) incr risk w/smoking, HTN, cocaine

Front 45

Placenta accreta
(a) description
(b) presentation
(c) complications
(d) risk factors

Back 45

(a) defective decidual layer; placenta attached to myometrium
(b) massive bleeding after delivery
(c) see above
(d) prior C section, PID

Front 46

Placenta previa
(a) description
(b) presentation
(c) complications
(d) risk factors

Back 46

(a) attachment of placenta to lower uterine segment
(b) painless bleeding in any trimester
(c) may occlude internal os
(d) prior C section

Front 47

Ectopic pregnancy
(a) clinical presentation/lab findings
(b) most common site
(c) risk factors

Back 47

(a) pain without bleeding; incr hCG; presents like appendicitis
(b) fallopian tubes
(c) PID

Front 48

Polyhydramnios
(a) define
(b) associations/cause

Back 48

(a) >1,5-2L of amniotic fluid
(b) esophageal/duodenal atresia (inability to swallow fluid); anencephaly

Front 49

Oligohydramnios
(a) define
(b) cause
(c) result

Back 49

(a) <0.5L amniotic fluid
(b) bilateral renal agenesis or posterior urethral valves; inability to secrete urine
(c) Potter's syndrome

Front 50

Condyloma acuminatum
(a) presentation
(b) histology
(c) distribution
(d) etiology
(e) complications

Back 50

(a) warts
(b) koilocytes, acanthosis, hyperkeratosis, parakeratosis
(c) vulva, perineum, vagina,cervix
(d) HPV 6,11 association
(e) incr risk ofcervical carcinoma

Front 51

Papillary hidradenoma
(a) description
(b) distribution

Back 51

(a) benign tumor similar to intraductal papilloma of breast
(b) occur along milk line

Front 52

Extramammary Paget disease of vulva
(a) presentation
(b) histology
(c) distribution
(d) assoc w/underlying tumor?

Back 52

(a) erythematous, crusted rash
(b) intraepidermal malignant cells w/pagetoid spread
(c) labia majora
(d) not assoc w/underlying tumor

Front 53

Candida vulvovaginitis
(a) description
(b) distribution
(c) risk factors

Back 53

(a) erythema, thick white discharge
(b) vulva and vagina
(c) common; esp in diabetics and after antibiotic use

Front 54

Embryonal Rhabdomyosarcoma
(a) epidemiology
(b) gross description
(c) histology

Back 54

(a) rare; affect female infants and young children
(b) grapelike, soft tissue mass protruding from vagina
(c) spindle cell tumor; + desmin (skeletal muscle origin)

Front 55

Clinical presentation of cervical carcinoma

Back 55

Postcoital bleeding, dyspareunia, discharge
May be asymptomatic

Front 56

Endometriosis
(a) description
(b) pathology
(c) clinical presentation
(d) complications

Back 56

(a) endometrial glands outside uterus
(b) red brown nodules (powder burns); ovarian "chocolate cysts"
(c) severe menstrual related pain; rectal pain and constipation
(d) may result in infertility

Front 57

Endometritis
(a) description
(b) pathology
(c) clinical

Back 57

(a) ascending infection of cervix
(b) ureaplasma, peptostrep, gardnerella, Bacteriodes, GBS, chlamydia
(c) assoc w/pregnancy or abortions; assoc w/PID and IUD's

Front 58

Adenomyosis

Back 58

Presence of endometrium within myometrium

Front 59

Leiomyoma
(a) description
(b) pathology
(c) clinical
(d) complications

Back 59

(a) benign smooth muscle tumor; grows in resp to estrogen; most common of all tumors
(b) well circumscribed; "whorled" white tan mass
(c) menorrhagia; abdominal mass; pelvic/back pain or suprapubic discomfort
(d) infertility; iron deficiency anemia (bleeding)

Front 60

Leimyosarcoma
(a) description
(b) epidemiology
(c) clinical presentation

Back 60

(a) highly aggressive bulky irregular shaped tumor w/necrosis and hemorrhage
(b) incr incidence in blacks
(c) may protrude from cervix and bleed

Front 61

Gynecological tumor incidence and prognosis(endo, ovar, cerv)

Back 61

Incidence: endo>ovar>cerv
Worst prognosis: ovarian>cervical>endometrial

Front 62

Sex hormone levels in premature ovarian failure

Back 62

Decr estrogen
Incr LH and FSH

Front 63

Endometrial hyperplasia
(a) describe
(b) etiology
(c) clinical presentation
(d) risk factors

Back 63

(a) abnormal endometrial gland prolif
(b) usually excess estrogen
(c) postmenopausal vaginal bleeding
(d) anovulatory cycles, HRT, PCOS, granulosa cell tumor

Front 64

Endometrial carcinoma
(a) epidemiology
(b) clinical presentation
(c) gross path
(d) micro
(e) risk factors
(f) most important prognostic factor

Back 64

(a) most common gynecological malignancy; peak at 55-65
(b) vaginal bleeding; typically preceded by endometrial hyperplasia
(c) tan polypoid mass
(d) endometriod adenocarcinoma
(e) unopposed estrogen; obesity; diabetes; HTN; nulliparity; late menopause
(f) myometrial invasion (stage)

Front 65

Polycystic ovary disease
(a) presentation
(b) lab/path
(c) etiology
(d) treatment

Back 65

(a) young, obese, hirsute females of reproductive age; oligomemnnorhea
(b) bilaterally enlarged, cystic ovaries
Elevated LH, low FSH, high testosterone
(c) incr LH stimulation leads to incr androgen synth
(d) wt loss, OCP's, gonadotropin analogs, clomiphene or surgery

Front 66

Cystadenoma
(a) description
(b) pathology

Back 66

(a) most common benign ovarian tumor
(b) unilocular cyst w/simple serous or mucinous lining

Front 67

Follicular cyst
(a) desciption
(b) associations

Back 67

Distention of unruptured graafian follicle
(b) hyperestrinism and endometrial hyperplasia

Front 68

Corpus luteum cyst complications

Back 68

Hemorrhage into persistant corpus luteum; menstrual irregularity

Front 69

Theca lutein cyst
(a) presentation
(b) etiology
(c) associations

Back 69

(a) often bilateral/multiple cysts
(b) gonadotropin stimulation
(c) choriocarcinoma and moles

Front 70

"chocolate cyst"

Back 70

Ovarian endometriosis

Front 71

Teratoma
(a) epidemiology
(b) lab/path
(c) treatment

Back 71

(a) 90% of all germ cell tumors; immature teratoma aggressivel malignant; mature benign
(b) contain 2-3 germ layers; immature contains primitive cells
(c) treatment

Front 72

Dysgerminoma
(a) epidemiology
(b) lab/pathology
(c) risk factors
(d) treatment
(e) tumor marker

Back 72

(a) mainly adults
(b) sheets of uniform cells (same as male seminoma)
(c) Turner's, pseudohermaphrotidism
(d) radiosensitive, so good prognosis
(e) hCG?

Front 73

Choriocarcinoma
(a) clinical presentation
(b) tumor marker
(c) histology
(d) associations
(e) treatment

Back 73

(a) malignant
(b) beta hCG
(c) large, hyperchromatic syncitiotrophoblastic cells
(d) incr frequency of theca-lutein cysts
(e) responsive to chemo

Front 74

Yolk sac tumor: tumor marker

Back 74

AFP

Front 75

Granulosa cell tumor
(a) clinical presentation
(b) microscopic
(c) complications

Back 75

(a) produces estrogen and can produce precocious puberty, irregular menses, or dysfunctional uterine bleeding
(b) polygonal tumor cells w/follicle like structures (Call Exner bodies-small follicles filled w/eosinophilic secretions)
(c) endometrial hyperplasia/cancer

Front 76

Sertoli Leydig cell tumor
(a) clinical presentation

Back 76

(a) androgen producing tumor; presents w/virilization in females

Front 77

Hydatidiform mole
(a) clinical presentation
(b) serum markers
(c) treatment

Back 77

(a) "size greater than date"; vaginal bleeding; passive of edematous grape like tissue
(b) beta hCG

Front 78

Partial hydatidiform mole
(a) Karyotype
(b) hCG
(c) uterine sz
(d) convert to choriocarcinoma
(e) fetal parts

Back 78

(a) 69XXY (2 sperm +1egg)
(b) incr
(c) nc
(d) rare conversion
(e) yes

Front 79

Complete Hydatidiform mole
(a) Karyotype
(b) hCG
(c) uterine sz
(d) convert to choriocarcinoma
(e) fetal parts

Back 79

(a) 46XX(or XY) both paternal
(b) highly elevated
(c) incr
(d) 2%
(e) no

Front 80

Struma ovarii

Back 80

Teratoma w/functional thyroid tissue (can present as hyperthyroidism)

Front 81

Clear cell adenocarinoma (vagina) risk factor

Back 81

Affect women who had exposure to diethylstilbestrol

Front 82

Serous cystadenoma
(a) epidemiology
(b) presentation
(c) micro

Back 82

(a) 20% of ovarian tumors
(b) frequently bilateral,
(c) lined w/fallopian tube like epithelium

Front 83

General ovarian cancer tumor marker

Back 83

CA-125

Front 84

Genetic risk factors for ovarian cancer

Back 84

BRCA1, HNPCC

Front 85

Serous cystadenocarcinoma
(a) epidemiology
(b) presentation
(c) histology

Back 85

(a) 50% of all ovarian tumors
(b) frequently bilateral
(c) psammoma bodies

Front 86

Mucinous cystadenocarcinoma
(a) possible serious consequence
(b) route of spread

Back 86

(a) pseudomyxoma peritonei-intraperitoneal accumulation of nmucinous material from ovarian tumor
(b) direct pelvic cavity seeding (like serous)

Front 87

Brennar tumor

Back 87

Benign ovarian tumor (bladder histology)

Front 88

Ovarian fibroma
(a) histo
(b) Meig's syndrome

Back 88

(a) bundles of spindle shaped fibroblasts
(b) Triad of ovarian fibroma, ascities, hydrothorax; pulling sensation in groin

Front 89

Krukenberg tumor

Back 89

GI malignancy that mets to ovaries causing mucin secreting sigment cell adenocarcinoma

Front 90

Fibroadenoma of breast
(a) characteristics
(b) epidemiology
(c) gross histo
(d) micro histo
(e) risk for malignancy?

Back 90

(a) small, mobile, firm w/sharp borders; incr sz and tenderness w/estrogen
(b) most common tumor in <25YO
(c) round/encapsulated
(d) glandular epithelial lined spaces w/fibroblastic stroma
(e) no

Front 91

Intraductal papilloma
(a) characteristics
(b) epidemiology
(c) gross histo
(d) micro histo
(e) risk for malignancy?

Back 91

(a) small tumor in lactiferous ducts; typically beneath areola; serous or bloody nipple discharge
(b) 20-50YO
(c) small, usually close to nipple
(d) multiple papillae
(e) slight incr

Front 92

Phyllodes tumor
(a) characteristics
(b) epidemiology
(c) gross histo
(d) micro histo
(e) risk for malignancy?

Back 92

(a) Large, bulky mass of CT and cysts leaflike" projections
(b) 6th decade
(c) irregular mass; often fungating or ulcerated
(d) myxoid stroma w/anaplasia
(e) some may become malignant

Front 93

Risk factors for carcinoma of breast

Back 93

Incr age
Nulliparity
Family hx
Early menarche
Late menopause
Fibrocystic disease
Previous hx
Obesity
High fat diet

Front 94

What is the most important prognostic factor for breast cancer?

Back 94

Axillary lymph node involvement

Front 95

BRCA1

Back 95

100% lifetime risk for breast cancer
Incr risk for ovarian CA (men at incr risk for prostate)

Front 96

BRCA2

Back 96

Incr incidence of breast CA only

Front 97

Ductal carcinoma in situ

Back 97

Fills ductal lumen

Front 98

Invasive ductal carcinoma in situ
(a) characteristics
(b) epidemiology
(c) prognosis

Back 98

(a) firm, fibrous mass; small glandular, duct like cells; foci of necrosis and calcification common
(b) most common breast CA
(c) worst and most invasive

Front 99

Protein/receptor changes associ w/breast cancer

Back 99

Overexpression of estrogen/progesterone rec
Overexpression of erb-2/Her-2( EGF receptor)

Front 100

Invasive lobular carcinoma of the breast
(a) presentation
(b) gross
(c) histology
(d) tumor markers?

Back 100

(a) often multiple/bilateral
(b) rubbery and ill defined
(c) small cells may be arranged in rows/rings; arise from terminal ductules
(d) assoc w/incr estrogen receptors

Front 101

Medullary carcinoma of the breast
(a) gross
(b) micro
(c) prognosis

Back 101

(a) fleshy mass
(b) large, pleomorphic cells jw/lyphocytic infiltrate
(c) good

Front 102

Comedocarcinoma
(a) gross
(b) micro

Back 102

(a) gocus of increased consistency in breast tissue
(b) typical duct epithelial cells proliferate and fill ducts;caseous necrosis (may discharge from nipple)

Front 103

Paget disease of breast
(a) epidemiology/prognosis
(b) gross
(c) histo

Back 103

(a) older women; poor prognosis
(b) skin of nipple and areola ulcerated/oozing
(c) ductal carcinoma (involving areolar skin) and large, hyperchromatic "paget cells"

Front 104

P'eau D'orange

Back 104

Dermal lymphatic invasion by breast cancer

Front 105

Colloid (mucinous) carcinoma
(a) epidemiology
(b) prognosis
(c) gross
(c) histo

Back 105

(a) older women
(b) slow growing better prognosis than ductal
(c) soft, large, gelatinous
(d) islands of tumor cells w/mucin

Front 106

Fibrocystic disease
(a) description/epidemiology
(b) clinical presentation
(c) risk to carcinoma

Back 106

(a) most common cause of breast lumps from age 25 to menopause
(b) premenstrual brast pain and multiple lesions
(c) usually not (except with epithelial hyperplasia histo type)

Front 107

4 histologic types of fibrocystic disease

Back 107

(1) fibrosis-hyperplasia of breast stroma
(2) cystic-fluid filled, blue dome
(3) sclerosing adenosis-incr acini and intralobular fibrosis
(4) epithelial hyperplasia-incr number of epithelial cell layers in terminal duct lobule (incr risk of carcinoma w/atypical cells)

Front 108

Acute mastitis
(a) describe
(b) usually pathogens
(c) treatment

Back 108

(a) fissures in nipples during nursing predispose to infx; breast abscess
(b) S aureus and strep
(c) Abs and surgical drainage

Front 109

Fat necrosis of breast
(a) presentation
(b) cause

Back 109

(a) benign, painless lump
(b) result from injury to breast tissue

Front 110

Mammary duct ectasia (plasma cell mastitis)
(a) epidemiology
(b) clinical presentation

Back 110

(a) 5th decade in multiparous women
(b) pain, redness, induration around areola w/thick secretion; usually unilateral
Skin fixation, nipple retraction, axillary lymphadenopathy can occur (distinguish from malignancy)

Front 111

Gynecomastia causes

Back 111

(a) hyperestrogenism (cirrhosis, testicular tumor, puberty, old age)
(b) Klinefelter's
(c) drugs (estrogen, mairjuana, heroin, psycoactive drugs, spironolactone, digitalis, cimetidine, alcohol, ketoconazole)