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122 Cards in this Set
- Front
- Back
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Where can you find nicotinic ACh receptors in the body?
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NM Jn
Autonomic ganglion |
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What are the function of interleukins 1-5?
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IL-1: fever
IL-2: T cell stimulator IL-3: BM stimulator IL-4: IgE, IgG IL-5: IgA, ephils HOT T BONE STEAK |
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What changes in sleep patterns sexual anatomy are seen in the elderly?
|
Dec'd REM
Dec'd slow wave sleep Inc'd awakenings -Slower ejaculation/refractory period -Atrophic vaginitis in females (vaginal shortening, dryness( |
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What is the main difference between delirium and dementia?
Which is more commonly reversible? |
Delerium--reversible, rapid onset
Dementia--irreversible, no alterations of consciousness, long-term onset |
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What are the layers of the epidermis?
|
Californians like girls in string bikinis
Corneum Lucidum Granulosum Spinosum Basalis |
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What structures arise from the paramesonephric ducts?
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Fallopian tubes
Uterus Upper portion vagina |
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Which defense mechanism:
Involuntary withholding of a feeling from conscious awareness |
Repression
|
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Which defense mechanism:
A veteran that can describe horrific war details without any emotion |
Isolation
|
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Which defense mechanism:
A child abuser was himself abused as a child |
Identification
|
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Underlies all other defense mechanisms
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Repression
|
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Which defense mechanism:
May lead to multiple personalities |
Dissociation
|
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Which defense mechanism:
Adult whining, bedwetting, crying |
Regression
|
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What is the basic equation for cardiac output?
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CO= SV x HR
|
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What is the Fick principle?
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CO = Rate of Oxygen consumption/(arterial - venous O2 content)
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Describe flow of ions during a pacemaker action potential?
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Phase 4--baseline, slow inc in Na+ conductance to Phase 0 (calcium causes depol)
No plateau Repol = Phase 3 due to K+ permeability |
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What cellular changes (in ions) can increase contractility?
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Catechols--ANX, exercise, stress
Inc intracell Ca, dec in extracell Na--both accomplished by Digoxin |
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Which pathology:
Smudge cell |
CLL
|
|
Which pathology:
Port-wine stain in ophthalmic division of trigeminal nerve |
Sturge-Weber Syndrome (sp)
|
|
Which pathology:
S3 heart sound |
Dilated CM (LVH, VSD, PDA, MI, Mitral regurg)
|
|
Which pathology:
Adrenal hemorrhage a/w meningococcemia |
Waterhouse-Friedrichson
|
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Which pathology:
Ferruginous bodies |
Asbestos
|
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Which pathology:
Subepithelial humps on EM |
Post-strep GN
|
|
Which pathology:
Myocyte disarray |
Hypertrophic CM
|
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Which pathology:
Currant jelly stool |
Intussusception
|
|
Which pathology:
Sacroileitis |
Ankylosing spondylitis
|
|
Which pathology:
Adverse reaction from mixing succinylcholine with inhaled anesthetics |
Malignant hyperthermia
|
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Which HTN drug:
First dose orthostatic hypotension |
Alpha-1 blockers (zosins)
|
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Which HTN drug:
Hypertrichosis |
Minoxidil
|
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Which HTN drug:
Cyanide toxicity |
Nitroprusside
|
|
Where would you expect to find B cells and T cells in the spleen?
In the lymph nodes? |
B cells in follicles of spleen and LNs
T cells: PALS of spleen, paracortex of LNs |
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Which HTN drug:
Dry mouth, sedation, severe rebound HTN |
Clonidine
|
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Which HTN drug:
Bradycardia, impotence, asthma exacerbation |
beta-blockers
|
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Which HTN drug:
Reflex tachycardia |
Nitrates, vasodilators
|
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Which HTN drug:
Metabolic alkalosis |
Loop diuretics
|
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Which HTN drug:
Elevated anti-histone antibodies |
Hydralazine
|
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Which HTN drug:
Hypercalcemia |
HCTZ
|
|
Which cancer:
PSA |
CaP
|
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Which cancer:
AFP |
HCC, yolk sac tumors
|
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Which cancer:
CA-125 |
Ovarian Ca
|
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Which cancer:
Elevated Alk Phos |
Bony turnover, Pagets, Mets to Bone--CaP, Testicular Ca, Kidney Ca, Lung, Breast, Thyroid
|
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Which cancer:
CEA |
GI cancers--panc, stomach,
|
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Which cancer:
beta-hCG |
Choreoca
Hydatidiform mole |
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Which cancer:
S100 |
Astrocytome
Melanome Neuro syx |
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Study X shows that vitamin C can prevent coronavirus infections, but 10 other studies show no benefit.
What type of error is found in study X? |
alpha-error
|
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What structures are at risk for injury with an anterior shoulder dislocation?
|
Axillary n
Posterior circumflex artery Supraspinatus tendon |
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What is the rate-limiting step in purine synthesis?
|
Glutamine PRPP aminotransferase
|
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What is the rate-limiting step in pyrimidine synthesis?
|
CPSII
|
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Which anti-cancer drug:
Prevents breast cancer |
Tamoxifen
Raloxifene |
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Which anti-cancer drug:
Treatment for testicular cancer |
Cisplatin
Bleomycin Etoposide |
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Which anti-cancer drug:
Treatment for childhood tumors (Ewing's, Wilms', rhabdomyosarcoma) |
Dactinomycin
|
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Which anti-cancer drug:
Inhibits ribonucleotide reductase |
Hydroxyurea
|
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Which anti-cancer drug:
SE: Hemorrhagic cystitis |
Cyclophosphimide
|
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Which anti-cancer drug:
Antibody against Philadelphia chromosome |
Imatinib
|
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What drugs should not be given to sulfa allergic patients?
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Celecoxib
Loops diuretics, thiazide diuretics Probenecid Sulfonamides (TMP-SMX) Sulfonylureas |
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Describe differences in gonadal venous drainage (L vs R).
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Left ovary/testis-->Left gonadal vein-->left renal vein-->IVC
Right ovary/testis-->right gonadal vein-->IVC (RIGHT IS MORE DIRECT) Varicocele more common on left. |
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What do the superficial inguinal nodes drain?
|
Distal 1/3 of vagina/vulva/scrotum
|
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What do the obturator, external iliac, and hypogastric nodes drain?
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Proximal 2/3 of vagina/uterus
|
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What do the para-aortic lymph nodes drain?
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Ovaries/testes
|
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Describe the production of estrogen in women.
Begin at the level of the hypothalamus. |
Arcuate nucleus of Hthal-->PULSATILE GnRH
-->Pituitary: FSH, LH FSH-->Granulosa cell-->(+)Aromatase: Androstene dione-->Estrogen (Estradiol) LH-->Theca cell-->(+) Desmolase (a 17-alpha hyoxylase): Cholesterol-->Androstenedione-->Granulosa Cell |
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Estrogen:
Source (estradiol vs estriol) Function |
Source: Ovary (estradiol), placenta (estriol), blood (aromatization)
Fn: 1. Dev't genitalia, breast, female fat distribution 2. Growth of follicle, endometrial prolifern, myometrial excitability 3. Upreguln E2, LH, PG receptors; feedback inhibition of FSH, LH 4. STIMULATE PL secretion but BLOCKS action at breast 5. Inc'd transport of SHBG (sex hormone binding globulin), Inc'd HDL, dec'd LDL |
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Estradiol vs Estriol:
Potency Levels during Pregnancy Receptors |
Estradiol > estrone > estriol (potency)
Pregnancy: 50-fold inc in estradiol and estrone 1000-fold inc in estriol (indicator of fetal well-being---made by placenta) Receptors expressed in cytoplasm; translocate to nucleus when bound by ligand |
|
Progesterone:
Source Function |
Source: Corpuse luteum, placenta, adrenal cortex, testes
Fn: 1. Stimulates endometrial glandular secretions, spiral artery dev't 2. Maintenace of prgenancy 3. Dec'd myometrial excitability 4. Production of thick cervical mucus, inhibiting sperm entry into uterus 5. Inc'd temp 6. Inhibits LH, FSH 7. Uterine SM relaxation (prevents contractions) 8. Dec'd estrogen receptor expressivity |
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Outline the general hormone sequence of the female reproductive cycle.
|
FSH-->follicle maturation-->production of E2
E2-->LH surge-->ovulation and production of PG with E2 -->inhibit FSH, LH production -->Decline of corpus luteum-->no production of E2/PG -->Loss of FSH inhibition -->Increase in FSH (repeat cycle) |
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What are the 2 main phases of the menstrual cycle?
How long is each phase? |
2 phases (in order): Proliferative (follicular phase), Secretory (luteal) phase
Follicular phase varies Luteal phase = 14 days (always) |
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What hormone triggers ovulation?
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LH
|
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Which hypothalamic nucleus is involved in ovulation?
|
Arcuate nucleus
|
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What are the layers of the endometrium?
Which layers are shed during menstruation? |
Stratum basalis
Stratum spongiosum--shed Straum compactum--shed |
|
When does the basal body temperature increase in relation to ovulation?
|
24hrs prior to ovulation as PG increases
|
|
What hormone maintains pregnancy for the first 6-7 weeks?
Source? |
Corpus luteum produces progesterone and E2 in luteal phase for 13-14 days (luteal phase)
If beta-hCG from placenta present, lifespan of corpus luteum extends to 6-7 weeks until placenta is able to produce its own PG. |
|
Oogenesis:
Meiosis I vs Meiosis II-- Arrest Cells involved--haploid, diploid? |
Primary oocyte (4N) stuck in Meiosis I prOphase for years until Ovulation
Secondary oocyte (2N) stuck in Meisosis II METaphase until fertilization (An egg MET a sperm.) |
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Role of prolactin in pregnancy.
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Prolactin induces and maintains lactation
Decreases reproductive function (harder to get pregnant while breastfeeding) |
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Role of oxytocin in pregnancy.
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Helps with milk letdown, may be involved with uterine contractions
|
|
hCG:
Source Function |
Syncytiotrophoblast of placenta
-Maintains corpus luteum (and thus progesterone) for first trimester by acting like LH; in 2nd and 3rd trimesters, placenta makes its own estriol and PG and corpus luteum degenerates -Used to detect pregnancy because it appears early in urine -Elevated hCG in pathalogic states (hydatidiform moles, choriocarcinoma, gestational trophoblastic tumors) |
|
Premature ovarian failure:
Pathophys Presentation |
Premature atresia of ovarian follicles in women of reproductive age
Patient presents with signs of menopause after puberty but before age 40. Low E2, high LH/FSH |
|
Hormone replacement therapy:
Indications AE |
Used for prevention of menopausal syx (hot flashes, vaginal atrophy) and osteoporosis (inc'd E2-->dec'd oclast activity)
Unopposed ERT (estrogen replacement tx)-->inc'd risk endometrial ca; so PG is added Possible inc'd CV risk |
|
Estrogens (ethinyl estradiol, DES< mestranol):
Indications AE Contraindications |
Bind Estrogen receptors
Used in hypogonadosim or ovarian failure, menstraul abbnlts, HRT in postmenopausal women; in men w/androgen-dependent CaP AE: risk endometrial ca, bleeding in postmenopasual women, vaginal ca, inc'd risk thrombi Contraindications--ER poz BrCa, hx of DVTs |
|
Progestin:
Indications |
Bind PG-receptor-->reduce growth, inc'd vasc of endometrium
Used in OCPs, in tx of endometrial Ca, abnl uterine bleeding (Ex: medroxyprogesterone, IUDs) |
|
OCPs:
MOA Advantages, Disadvantages |
MOA: Prevent estrogen surge, thus prevents LH surge-->no ovulation
Advantages: Reliable (<1% failure) Dec'd risk endometrial/ovarian ca Dec'd incidence ectopic pregnancy Dec'd pelvic infections Regulation of menses Disadv: Taken daily No protection x STDs Inc'd TGs Depression, weight gain, nausea, HTN Hypercoagulable state**-->DVT, PE |
|
Mifepristone:
MOA Use |
Competitive inhibitor of progesterone receptors
Use: termination of pregnancy; administered with misoprostol (PGE1) |
|
Virus associated with cervical cancer.
Other risk factors. |
HPV 16,18
Smoking, multiple sexual partners; intercourse at early age |
|
Endometriosis:
Presentation Common Sites |
Cyclic bleeding from ectopic endometrial tissue resultingin blood-filled CHOCOLATE CYSTS
Manifests are menstrual-related pain; oftein results in infertility. Can be due to retrograde menstrual flow or ascending infection. Commonly in ovary/peritoneum |
|
Endometrial hyperplasia:
Cause Risks |
Excess Estrogen stimuln; inc'd risk endometrial carcinoma
Risk factors for it: anovulatory cycles, HRT, polycystic ovarian syndrome, granulosa cell tumor |
|
Endometrial carcinoma:
Presentation Risk factors |
Presents with vaginal bleeding; typically preceded by endometrial hyperplasia
Risk factors: -Prolonged use of estrogen without PG -Obesity -DM -HTN -Nulliparity -Late menopause |
|
Leiomyoma vs Leiomyosarcoma:
What are they? Effects |
Leiomyoma = fibroid--most comon of all tumors in females. Benign SM tumor. Malignant transformation rare.
Decrease w/menopause May lead to Fe-deficiency anemia (inc'd bleeding) Leiomyosarcoma: Bulky, irregular shaped tumors with areas of necrosis and hemorrhage, typically arises de novo May protrude from cervix and bleed. Must be removed! |
|
Leuprolide:
Pulsatile vs Continuous Administration-- Effects Indications AE |
GnRH analogs
-Stimulatory properties if used in pulsatile fashion--infertility -Antagonizing properties if used continuously--to induce menopause, tx prostate cancer, tx uterine fibroids Use in infertility AE: antiandrogen, nausea, vomiting |
|
What are the most common causes of anovulation?
|
PCOS, obesity, HPO axis abnlts, premature ovarian failure, hyper-PL
|
|
Which pathology:
Excess unopposed estrogen is main risk factor |
Endometrial hyperplasia and carcinoma
|
|
Which pathology:
Menorrhagia with enlarged uterus, no pelvic pain |
Leiomyoma
|
|
Which pathology:
Pelvic pain present only during menstruation |
Endometriosis
|
|
Which pathology:
Diagnosed by endometrial biopsy in clinic |
Endometrial hyperplasia/carcinoma
|
|
Which pathology:
Definitive diagnosis and treatment is by laporoscopy |
Endometriosis
|
|
Which pathology:
Menstruating tissue within myometrium |
Adenomyosis
|
|
Which pathology:
Malignant tumor of uterine smooth muscle |
Leiomyosarcoma
|
|
Which pathology:
Most common gynecologic malignancy |
Endometrial carcinoma
|
|
Polycystic ovarian syndrome:
Pathophys Presentation Treatment |
Inc'd LH production-->anovulation
Hyperadrogenism due to deranged steroid synthesis by theca cells Leads to enlarged, BILATERAL cystic ovaries manifesting with amenorrhea, infertility, obesity, hirsutism Inc'd risk endometrial cancer Tx: weight loss!, OCPs!, Gonadotropin analogs, clomiphene, surgery |
|
Clomophene:
MOA Indications AE |
Partial agonist at estrogen receptors in hypothalamus
Prevents feedback inhibition and increases release of LH and FSH from pituitary-->stimulates ovulation Use to tx infertility and PCOS AE: Inc'd risk multiple simultaneous pregnancies, hot flashes, ovarian enlargement |
|
What are the 4 main categories of ovarian tumors?
|
Epithelial--65% ovarian tumors, 90% of ovarian cancers
Germ cell Stromal Mets (GI, breast, endometrium) |
|
What are the main types of epithelial cell ovarian tumors?
|
My Med Students Consistently Beat Exams
***Serous ***Mucinous ****Endometroid Clear Cell Brenner Mixed |
|
What are the main types of germ cell ovarian tumors?
|
Teratoma***
Dysgerminoma*** Endometrial sinus Choriocarcinoma |
|
Dysgerminoma:
Characteristics |
Malignant, equivalent to male seminoma, but rarer
|
|
Choriocarcinoma:
Characteristics |
Rare, malignant; develop during prengancy in mother or baby
Large, hyperchromatic syncytiotrophoblastic cells. Inc'd hCG |
|
Yolk sac (endodermal sinus) tumor:
Characteristics |
Aggressive malignancy in ovaries (testes in boys)
Yellow, friable, solid masses, Schiller-Duval bodies (resemble glomeruli) ELEVATED AFP |
|
Teratomas:
Mature vs Immature vs Struma ovarii |
Mature: dermoid cyst--most frequent benign ovarian tumor
Immature teratoma: aggressively malignant Struma ovarii: contains fnal thyroid tissue, can present as hyperthy |
|
Serous cystadenoma vs cystadenocarcinoma:
Characteristics |
Serous cystadenoma: benign; lined w/fallopian tube-like epithelium.
Cystadenoca: malignant, bilateral; BRCA-1 risk factor. GENETIC! |
|
Mucinous cystadenoma vs cystadenocarcinoma:
Characteristics |
Mucinous Cystadenoma: multilocular lined by mucuse-secreteing epithelium. Benign, intestine-like tissue.
Cystadenoca: Malignant, intraperitoneal accumuln mucinous material from ovarian or appendiceal tumor |
|
Krukenberg tumor:
Characteristics |
GI malignancy that mets to ovaries, causing mucin-secreting signet cell adenoca
|
|
Which ovarian tumor:
Produces AFP |
Yolk sac tumor--AKA endodermal sinus tumor
|
|
Which ovarian tumor:
Estrogen secreting-->precocious puberty |
Granulosa theca cell tumor
|
|
Which ovarian tumor:
Intraperitoneal accumulation of mucin |
Mucinous cystadenocarcinoma
|
|
Which ovarian tumor:
Testosterone secreting-->virilization |
Sertoli-Leydig Cell tumor
|
|
Which ovarian tumor:
Psammoma bodies |
Serous cystadenocarcinoma
|
|
Which ovarian tumor:
Multiple different tissue types |
Teratoma
|
|
Which ovarian tumor:
Lined with fallopian tube-like epithelium |
Serous cystadenoma
|
|
Which ovarian tumor:
Ovarian tumor, ascites, pleural effusions |
Meig's Syndrome of Brenner tumor fibromas
|
|
Which ovarian tumor:
Call-Exner bodies |
Granulosa-theca cell tumor
|
|
Which ovarian tumor:
Resembles bladder epithelium |
Brenner tumor
|
|
Which ovarian tumor:
Elevated beta-hCG |
Choriocarcinoma
|
|
An obese woman presents with amenorrhea and increased serum testosterone.
Diagnosis? |
PCOS
|
|
A patient with PCOS is most at risk for developing which type of cancer?
|
Endometrial ca due to high E2
|
|
Why is progesterone used in combination with estrogen during estrogen-replacement?
|
To reduce incidence of endometrial hyperplasia/ca
|
|
Under what circumstances would you expect to see an elevated LH?
|
Menopause
PCOS Prior to ovulation (LH surge) Androgen-insensitivity syndrome |
|
What are the risk factors for ovarian cancer?
|
Lack of ovulation
|
