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122 Cards in this Set
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Defective residual layer seen in |
Placenta accreta/increta/percreta |
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Placenta attaches to myometrium without penetrating it |
Placenta accreta |
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Placenta penetrates into myometrium |
Increta |
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Placenta penetrates through myometrium, into serosa, can result in placental attachment to rectum or bladder |
Percreta |
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No separation of placenta after delivery leads to |
PPH -sheehans syndrome |
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Attachment of placenta to LUS over (or <2cm) internal os |
Placenta praevia |
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Fetal vessel run over or in close proximity to cervical os |
Vasa previa |
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Triad of membrane rupture, painless vaginal bleeding, fetal bradycardia ( <110beats/min) |
Vasa previa |
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Vasa praevia usually associated with which type of cord insertion |
Velamentous umbilical cord insertion (cord inserts in chorioamniotic membrane rather than placenta). Fetal vessels to placenta unprotected by Wharton jelly |
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Commonest site of ectopic pregnancy |
Ampulla of fallopian tube |
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BP >140/90mmhg after 20weeks gestation No proteinuria or end organ damage |
Gestational hypertension |
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Abnormal placental spiral arteries leading to endothelial dysfunction, vasoconstriction, ischemia |
Preeclampsia |
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In HELP syndrome blood smear show |
Schistocytes. Can lead to subcapsular hematomas- rupture- severe hypotension |
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Affects girls< 4years old, spindle shaped cells, desmin + , clear grape like polypoid mass emerging from vagina |
Sarcoma botryoides |
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Carcinoma in situ occurs where |
Basal layer of squamocolumnar (transformation zone) and extends outward. |
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CIN associated HPV |
16 and 18 |
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HPV 16 and 18 secrete which oncogenes |
E6 gene product (inhibits p53) and E7 (inhibits RB suppressor gene). Pathognomonic of HPV infection |
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Risk factors for CIN |
Multiple sexual partners Starting sexual intercourse at early age HIV infection |
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Diagnosis of invasive cervical cancer is by |
Colposcopy and biopsy |
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Lateral invasion of cervical cancer causes |
Blockage of ureters leading to renal failure |
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High LH/FSH, High androgens from theca interna cells, decrease follicular maturation, unruptured follicles +inoculation in |
PCOS |
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Cause of endometrial cancer in PCOS |
unopposed estrogen from repeated anovulatory cycles |
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Treatment of PCOS |
Weight reduction (decr peripheral estrogen formation), OCPs, clomiphine and metformin - induce ovulation, spironolactone, ketoconazole (antiandrogen) to treat hirsutism |
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Follicular cyst formed by |
Distention of unruptured graafian follicle. Associated with hyperestrogenism endometrial hyperplasia |
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Theca leutin cyst caused by |
Gonadotropin stimulation. Associated with choriocarcinoma and hydatiform moles |
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Risk for ovarian cancer |
Advanced age Infertility Endometriosis PCOS genetic predisposition (BRCA 1 or 2) |
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Relapse/ monitoring of ovarian cancer by measuring |
CA 125 levels |
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Pelvic pain, dysmenorrhea, dyspareunia, symptoms vary with menstrual cycle |
Endometriosis |
Chocolate cyst |
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Cystic hematoma common in age group |
10-30 yrs |
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Mature cystic teratoma 3(germ layers) may present with |
Pain 2 ovarian enlargement /torsion |
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Struma ovarii |
Monodermal form of cystic teratoma |
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Brenner tumor |
Solid tumor that is pale yellow-green appears encapsulated. Coffee bean |
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Bundle of spindle shaped fibroblasts - |
Fibroma |
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Meigs syndrome |
Ovarian fibroma, Ascites, hydrothorax |
Pulling sensation in groin |
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Granulosa cell tumors, may produce estrogen. Usually presents as abnormal uterine bleeding in postmenopausal women |
Thecoma |
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Malignant stromal tumor, produces estrogen or progesterone and presents with postmenopausal bleeding, sexual precosity(pre adolescent), breast tenderness. |
Granulosa cell tumors |
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Call Exner bodies (granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles) found in |
Granulosa cell tumors |
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Ovarian tumors with psammoma bodies |
Serous cystadenocarcinoma |
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Pseudomyxoma peritonei-intraperitoneal accumulation of mucinous material from ovarian or appendices tumor |
Mucinous cystadenocarcinoma |
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Sheets of uniform fried egg cells. Equivalent of Male seminoma. 30% germ cell tumors. hCG, LDH- tumor markers |
Dysgerminoma |
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Common tumor in Male infants, aggressive in ovaries or testes and sacricoccygeal area. Yellow, friable (hemorrhagic), solid mass. |
Yolk sac tumor |
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Presence of Schiller-Duval bodies (resemble glomeruli) |
Yolk sac tumor |
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Tumor markers in yolk sac tumor |
AFP |
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GI malignancy that metastasizes to ovaries- mucin secreting signet cell adenocarcinoma |
Krukenberg tumor |
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Extension of endometrial tissue (glandular) into uterine myometrium. Caused by hyperplasia of basal layer of endometrium |
Adenomyosis |
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Dysmenorrhea, menorrhagia, uniformly enlarged, soft, globular uterus |
Adenomyosis |
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Treatment of adenomyosis by |
GnRH agonist, hysterectomy or excision of organised adenomyoma |
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Treatment of endometritis |
Gentamycin +clindamycin/ampicillin |
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Treatment of endometriosis |
NSAIDs, OCPs, progestin, GnRH agonists, danazol |
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Breast lesion- presents with premenstrual breast pain or lumps, often bilateral and multi focal. Non proliferative lesion |
Fibrocystic changes |
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Most common organisms in lactation mastitis |
Staph aureus |
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Large breast mass of connective tissue and cysts with leaf like lobulations. May become malignant |
Phyllodes tumor |
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Drugs that causes gynecomastia |
Spironolactone Hormones Cimetidine Ketoconazole |
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Malignant breast tumors usually arise from |
Terminal duct lobular unit |
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Over expression of estrogen/progesterone receptors or c-erbB2 |
HER 2 and EGF receptor common |
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What's the prognosis in ER-, PR- and Her 2/Neu- (triple negative) |
More aggressive, poor prognosis |
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What is the most important prognostic factor in early stage disease |
Axillary lymph node involvement (upper outer quadrant) |
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Obesity risk factor for breast cancer because |
Adipose tissue converts androstenedione to estrone), increasing estrogen exposure |
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Microcalcifications on mammography seen in |
DCIS |
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Firm, fibrous, rock hard mass with sharp margins. Tumor deform suspensory ligament. Classic stellate infiltration |
Invasive ductal carcinoma |
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Decreased E cadherin expression in |
Invasive globular carcinoma |
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Fleshy, cellular, lymphocytic infiltrate in breast ca |
Medullary carcinoma |
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Dermal lymphatic invasion by breast carcinoma. Peau d' orange. Block lymphatic drainage |
Inflammatory breast ca |
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Abnormal curvature of penis due to fibrous plaque within tunica albuginea. Associated with erectile dysfunction |
Peyronie disease |
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Painful sustained erection >4hrs. Associated with sickle cell disease, blockage of venous drainage of carvenosum, medications like sildenafil, trazodone |
Ischaemic priaprism |
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Treatment for priaprism |
Corporal aspiration Intracavernosal phenylephrine Surgical decompression |
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SCC of penis associated with |
Uncircumcised males and HPV |
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In cryptorchidism testosterone levels are |
Normal (leydig cells unaffected by temperature) |
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Cryptorchidism associated with which tumors |
Germ cell tumors |
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Hormones changes in cryptorchidism |
Reduced inhibin (sertoli affected), high FSH, high LH, testosterone decreased in bilateral cryptorchidism, normal in unilateral. |
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Timeframe for orchidopexy testicular torsion |
Within 6hrs |
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Orchidopexy should be bilateral because |
Contralateral testes at risk of subsequent torsion |
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Varicocele more common on the left because |
High resistance to flow from the left gonadal vein drainage into left renal vein |
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Diagnosis of varicocele is by |
Palpation of bag of worms augmented by valsava maneuver. Can cause infertility because of high temperature |
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Treatment of varicocele |
Surgical ligation or embolization if associated with pain or infertility |
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Defect that causes congenital hydrocele |
Incomplete obliteration of processus vaginalis |
Most spontaneously resolve by 1year |
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Acquired hydrocele caused by |
Scrotal fluid collection 2 infection, trauma, tumor |
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Germ cell tumors risk factors in male |
Cryptorchidism Klinefelter syndrome |
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Most common testicular tumor,malignant, painless with homogeneous testicular enlargement. Doesn't occur in infancy |
Seminoma |
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Tumor similar to dysgerminoma in females, large cells in globules with watery cytoplasm and fried egg appearance |
Seminoma |
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Tumor marker in seminoma. What's the prognosis |
ALP. Excellent prognosis |
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Schiller Duval bodies resemble primitive glomeruli found in |
Yolk sac tumor (aggressive tumor) |
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Which hormone/enzyme elevated yolk sac tumor. |
AFP |
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Most aggressive tumor in boys <3yrs |
Yolk sac tumor |
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Mature teratomas in males compared to females are |
Malignant |
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Reinke Crystal's (eosinophilic cytoplasmic inclusions) seen in |
Leydig cell tumor |
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Leydig cell tumor produces androgens and estrogens, presents as |
Gynecomastia in men, precocious puberty in boys |
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Androblastoma from sex cord stroma seen in |
Sertoli cell tumors |
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Most common testicular cancer in old men. Arises from metastatic lymphoma to testes |
Testicular lymphoma |
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Enlargement of which lobes occurs in BPH |
Periurethral (Lateral and middle lobes) |
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Treatment of BPH |
alpha antagonists (terazosin, tamsulosin)- relaxation of smooth muscles 5 alpha reductase inhibitors- finasteride PDE-5 inhibitors- tadanafil Surgical resection. TURP |
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Warm, tender prostate with dysuria, frequency, urgency, low back pain |
Prostatitis |
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Most common org for prostatitis Older men Young males |
Older men- E. Coli Younger males- C. trachomatis, N.gonorrhoea |
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Prostate adenocarcinoma most often arises from which lobe |
Posterior lobe (peripheral zone) |
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Diagnosis Prostate Ca |
High PSA/ PAP Prostate biopsy |
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Bone metastases in prostate ca are |
Osteoblastic with elevated serum ALP and PSA |
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Mech of action for Leuprolide (GnRH agonist) |
Agonist in pulsatile fashion Antagonist in continuous fashion (downregulates GnRH receptors in ant pituitary causing reduced FSH/LH) |
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Leuprolide in continuous fashion (antagonist) is used in treatment of |
Uterine fibroids, endometriosis, precocious puberty, prostate cancer,infertility |
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Estrogen used in |
Hypogonadism or ovarian failure, menstrual abnormalities, hormone replacement therapy in postmenopausal women |
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Mech of action for clomiphine |
Estrogen receptor antagonist in hypothalamus. Prevent normal feedback inhibition. Increase release of LH and FSH, stimulates ovulation. |
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Clomiphene is used to treat |
Infertility due to anovulation eg PCOS |
Side effects-hot flashes, ovarian enlargement, multiple simultaneous pregnancies |
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Tamoxifen effect on breast |
Antagonist |
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Tamoxifen effect on bone |
Agonist |
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Tamoxifen side effects |
High risk of thromboembolic events and endometrial cancer. Prevent recurrence of ER/PR + breast cancer |
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Raloxifene primary used for |
To treat osteoporosis |
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Compared to tamoxifen, raloxifene has |
No increased risk of endometrial cancer |
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Mech of action for anastrozole |
Inhibit peripheral conversion of androgen to estrogen (aromatase inhibitors). Used in ER+ breast cancer |
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Combination of progesterone in HRT helps reduce |
Endometrial cancer |
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Progestins cause |
Thickening of cervical mucus, limiting access of sperm to uterus Inhibit endometrial proliferation- making it less suitable for embryo implantation |
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Terbutaline used in labour to |
Beta agonist to relax contraction frequency |
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Danazol-used for treatment of endocrine, hereditary angioedema. Mech of action |
Acts as partial agonist at androgen receptors |
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Side effects of danazole |
Weight gain, hirsutism, masculinization, reduced HDL levels, hepatotoxicity |
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Testosterone used to treat |
Hypogonadism Stimulate metabolism Recovery from burns Adverse effects Musculinization in females Gonadal atrophy Premature closure of epipyseal plates |
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Flutamide (antiandrogen) |
Non steroidal competitive inhibitor at androgen receptors. Used to treat prostate cancer |
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Mech of action for ketoconazole |
Inhibits steroid synthesis (inhibits 17,20 desmolase/ 17 alpha hydroxylase) |
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Anti androgenic mech of action for spironolactone |
Inhibits steroid binding 17, 20 desmolase/17alpha hydroxylase) |
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Tamsulosin |
Selective alpha1 antagonist inhibiting smooth muscle contraction |
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PDE 5 inhibitors- sildenafil, vardenafil, tadalafil cause |
Inhibit PDE 5- increase cGMP- prolonged smooth muscle relaxation in response to NO- increase blood flow in corpus cavernous of penis, decrease pulmonary vascular resistance |
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Tadanafil |
Used for BPH only |
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PDE 5 inhibitors not to be taken with nitrates because |
Life threatening hypotension |
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Mech of action for minoxidil |
Direct arteriolar vasodilator |
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Clinical use of minoxidil |
Androgenic alopecia Severe refractory hypertension |
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