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Step2CK > Gyn Stepup > Flashcards

Gyn Stepup Flashcards

1
Q

when have all oocytes formed

A

20 weeks

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2
Q

what causes low FSH LH and androgens in 4-8 yr olds

A

GnRH suppression

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3
Q

When are initial pubertal changes

A

8-11 yrs

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4
Q

what time of day are hormones in kids highest

A

at night

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5
Q

normal events female puberty

A

adrenarche: adrenal androgens
gonadarche: FSH and LH activation
Thelarche: breast tissue
Pubarche: pibic hair
growth spurt
Menarche: onset menses

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6
Q

what happens in >50 y.o to LH and FSH

A

increase with onset of ovarian failure

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7
Q

Tanner I

A

raised nipple and no hair growth yet

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8
Q

Tanner 2

A

breast budding, areolar enlargement with slight growth of labial hair

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9
Q

Tanner 3

A

Further breast and areolar enlargement

more hair growth

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10
Q

Tanner 4

A

areola and nipple form above the breast

hair becomes coarse and spreads over pubic area

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11
Q

Tanner 5

A

areola recedes and nipple stays out

coarse hair extends to medial thighs

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12
Q

what causes central precocious puberty

A

early activation of hypothalamic pituitary gonadal axis

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13
Q

precocious puberty age in girls and boys

A

girls

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14
Q

isosexual precocious puberty

A

premature development appropriate for gender

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15
Q

heterosexual precocious puberty

A

virilization/,asculinization firls
feminization boys
girls with virilization is due to CAH, exposure to androgens or androgen secreting neoplasm

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16
Q

what is GnRH stimulation test

A

give GnRH:

  • if LH and FSH increase then central precocious puberty
  • if LH and FSH have no response then pseudoprecocious puberty ( peripheral autonomous secretion sex steroids)
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17
Q

labs that suggest ectopic hormone production causing precocious puberty

A

low LH and FSH with high estrogen

probably noeoplasm or exogenous consumption estrogen

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18
Q

which endocrine path can cause precocious puberty

A

chronic hypothyroid

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19
Q

what is used for Lh and FSH suppression

A

GnRH analogues

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20
Q

Tx for precocious puberty caused by CAH

A

cortisol replacement

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21
Q

complications of precocious puberty

A

short statures

social and emotional adjustment issues

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22
Q

what peaks right before ovulation

A

LH

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23
Q

when does progesterone peak

A

during the luteal phase or proliferative phase

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24
Q

which phase does ovulation occur in

A

right between end of follicular/proliferative and right before luteal/secretory

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25
Q

what peaks before LH

A

17B estradiol

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26
Q

when does body temp rise in menstrual cycle

A

with ovulation

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27
Q

which cells are regulate by LH

A

theca cells

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28
Q

which cells are regulated by FSH

A

granulosa cells

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29
Q

what stimulates endometrial proliferation

A

estrogens

induce the LH surge and hgih levels of Estrogen inhibit FSH secretion

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30
Q

role of progesterone

A 
stimulate endometrial glands development
inhibit contraction
increase cervical mucus thickness
increase basal body temp
inhibit LH and FSH secretion
maintain pregnancy
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31
Q

decreased levels progesterone leads to

A

menstruation

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32
Q

role of hCG

A

acts like LH after implantation fertilized egg

maintain corpus luteum viability

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33
Q

follicular phase

A

starts with menstruation.

FSH stimulates growth ovarian follicle (granulosa cells) which secete estradiol

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34
Q

role of estradiol in follicular phase

A

induce endometrial proliferation and increase FSH and LH

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35
Q

Luteal phase

A

the LH surge causes ovulation and the residual follicle (corpus luteum) secretes estradiol and progesterone to maintain endometrium
high levels estradiol inhibit FSH and LH

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36
Q

what happens when egg is notfertilized

A

corpus luteum degrades, progesterone and estradiol levels decrease and the endometrial lining degrades (menses)

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37
Q

fertilization

A

egg implants in endometrium and the endometrial tissue begins to secrete hCG to maintain corpus luteum
CL secretes progesterone until placenta can make it around 8-12 weeks

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38
Q

when does ovulation occur

A

14 days since 1st day of last menses

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39
Q

premature menopause

A

ovarian failure before age 40

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40
Q

what happens to FSH and LH in perimenopasual period

A

increase

but ovarian response decreases

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41
Q

signs of menopause

A 
hot flashes
breast pain
sweting
menstrual irregularity
amenorrhea
fatigue
anxiety
dyspareunia
urinary frequency
change in bowel habits
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42
Q

topical estrogen is contraindicated in what patients

A

any with a Hx of breast CA

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43
Q

what hormone is decreased in menopause

A

estradiol

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44
Q

what reduce osteoporosis and CV risks of menopause

A

raloxifene and tamoxifen

Selective E R modulators

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45
Q

what causes increased risk osteoporosis in menopause

A

decreased estrogen by ovaries

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46
Q

complications menoapuse

A

osteoporosis, CAD and dementia

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47
Q

most effective birth control

A

progestin implant

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48
Q

least effective Rx birth control

A

progestin OCP and regualr OCP

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49
Q

what birth control should be avoided in obese women

A

transderman contraceptive patch because diffusion into adipose tissue

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50
Q

how effective is lactation as birth control

A

95%

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51
Q

how effective are IUDs

A

99%

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52
Q

what is primary amenorrhea

A

no menses ever with normal secondary sexual characteristics age 16
13 if no sexual characteristics

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53
Q

secondary amenorrhea

A

absense of menses for 6 mo+ with prior Hx of menses

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54
Q

causes of secondary amenorrhea

A 
pregnancy
ovarian failure
hypothalamic or pituitary disease
uterine abnormalitiles
PCOS
anorexia
malnutrtion
thyroid disease
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55
Q

Ashermann syndrome

A

intrauterine adhesions from surgical procedure or possible infection

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56
Q

labs to order in amenorrhea

A 
b-hCG
TSH T4 T3
prolactin
FSH and LH
androgens
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57
Q

what is the progestin challenge

A

five progesterone and observe for bleeding for 5 days

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58
Q

Tx prolactinoma

A

dopamine agonists

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59
Q

XY patient with androgen insensitivity syndrome and has testicles, next step

A

remove testicles because of increased risk testicular cancer

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60
Q

primary amenorrhea with secondary sexual charcteristics

causes

A

look for anatomical abrnomatliies or XY genotype

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61
Q

steps for labs for secondary amenorrhea

A

check b-hCG
then check TSH, T4T3
then if normal check prolactin
then do progestin challenge

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62
Q

if progestin challenge is negative and have amenorrhea, now what

A

estrogen-progesterone challenge
if does cause bleeding check FSH and LH
if FSH and LH are hgiht- ovarian failure
if LH and FSH are low- hypothalamic pituitary dysfunction

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63
Q

labs for dysmenorrhea

A

bhCG and vaginal cultures
US for lesions
hysteroscopy if uterine pathology

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64
Q

Tx for dysmenorrhea

A

NSAIDs or OCPs

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65
Q

risk factor for severe pain with menses

A

family histroy

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66
Q

Tx for PMS or PMDD

A

exercise, Vit B6, NSAIDs, OCPs, progestines, SSRIs, alprazolam

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67
Q

when do mood Sx from PMS occur

A

second half of cycle

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68
Q

most common cause female infertility

A

endometriosis

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69
Q

what is endometriosis

A

endometrial tissue outside the uterus

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70
Q

causes of endometriosis

A

retrograde menstruation, vascular or lymphatic spread of endometrial tissue, iatrogenic from surgery or C section

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71
Q

risk factors fo endometriosis

A

FMH
infertility
nulliparity
low BMI

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72
Q

Signs Sx endometriosis

A

dysmenorrhea, dyspareunia, painful bowel movements
pelvic pain, possible infertility
uterine or adnexal tenderness
palpable adhesions

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73
Q

Labs in endometriosis

A

Bx of endometrial tissue
bhCG and UA
Ca-125 sometimes increased, but not sensitive

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74
Q

powder burn lesions

A

seen on laparascopy of uterus with endometriosis

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75
Q

Tx endometriosis

A

OCPs. progestins, danazol, GnRH agonists
ablation
hysterectomy

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76
Q

adenomyosis

A

endometrial tissue that invades myometrium causing uterine enlargement and cyclical pain

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77
Q

complications endometriosis

A

infertility

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78
Q

what are the parameters of defining abnormal mesnes

A

35 day intervals
lasting >7 days
blood loss 80 mL

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79
Q

labs in abnormal uterine bleeding

A 
bhCG
CBC with coag
TSH LH FSH
PAP smear
endometrial Bx
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80
Q

Tx abnormal bleeding

A

tx underlying disorder
OCPs can help
endometrial ablation

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81
Q

most common cause andogen excess in women

A

PCOS

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82
Q

what is produced in PCOS

A

excess LH induces overproduction androgens by ovaries

some have hyperinsulinemia

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83
Q

labs in PCOS

A 
increased LH
LH:FSH ration >2
increased DHEA
increased total testosterone
\+ progestin
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84
Q

what causes amenorrhea and infertility in PCOS

A

abnomral high LH levels and FSH inhibition by high estrogen

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85
Q

what causes cysts in PCOS

A

the androgen excess

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86
Q

what is helpful for pregnancy in PCOS

A

clomiphene (antiestrogen induces follicule stimulation and maturation)
metformin

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87
Q

complications PCOS

A

infertility, increased risk DM, HTN, ischemic heart disease, ovarian torsion, endometrial CA

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88
Q

what is greatest contributing factor to increased risk endometrial CA in PCOS

A

increased estrogens

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89
Q

Tx gardnerella vaginalis or BV

A

metro or clinda

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90
Q

what normal flora overgrowth do you Tx partners for

A

trichomonas, Tx with metro

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91
Q

on pap exam see cervical petechiae

A

trichomonas

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92
Q

thin white fishy odor vaginal discharge

A

gardnerella

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93
Q

malodorous frothy green discharge

A

trichomonas

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94
Q

clu cells

A

gardnerella

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95
Q

motile things on slide

A

trichomonas

96
Q

+ whiff test

A

gardnerella (with KOH)

97
Q

pseudohyphae with KOH

A

candida

98
Q

vaginal pH is 3.5-4.5 (normal) and has discharge

A

candida

99
Q

vaginal pH is more alkalotic >4.5 and has discharge

A

gardnerella or trichomonas

100
Q

Tx for gardnerella

A

metro

101
Q

Tx for trich

A

metro and Tx partner

102
Q

Tx for candida

A

topical clotrimazole, miconazole or nystatin

oral fluconazole

103
Q

signs Sx TSS

A

vomiting, diarrhea, sore throat, HA, high fever
macular rash
hypotension, shock, resp distress
desquamation palms and soles

104
Q

labs in TSS

A

vaginal culture shows staph aureus
dec platelets
inc AST and ALT
inc BUN and Cr

105
Q

Tx TSS

A

clinda or penicillinase R beta lactams like oxacillin and nafcillin
vanco if MRSA

106
Q

what causes cervicitis

A

N gon or C trach

107
Q

Signs Sx cervicitis

A

dyapreunia, bleeding after intercourse, purulent vaginal discharge
urethritis

108
Q

Dx cervicitis

A

gram stain for N gonn

enzyme immunoassays or PCR for both

109
Q

Tx cervicitis

A

ceftriaxone for N gonn

doxy or azithro for chlamydia

110
Q

do you T partners for cervicitis

A

yes

111
Q

complication cervicitis

A

PID or septic arthritis

112
Q

what reduces risk PID

A

barrier contraception

113
Q

labs for PID

A

bhCG
inc WBC and ESR
gram stain
culdocentesis

114
Q

Tx PID

A

empiric antibiotics doxy ceftriaone cefoxitin

Tx inpatient if high fever or young age

115
Q

complications PID

A

infertility from adhesions
chronic pelvic pain
tuboovarian abscess
increased risk ectopic pregnancy

116
Q

tubo ovarian abscess presentation

A

PID with signs of sepsis or peritonitis

117
Q

Tx tuboovarian abscess

A

IV hydration, IV antibiotics and surgical drainage

118
Q

primary syphilis

A

1-13 weeks post exposure

solitarty chancre that heals sponateously

119
Q

secondary syphilis

A 
as chancre heals
HA, malaise, fever, maculopapular rash on palsm and soles
lymphadenopathy
papules in moist areas condylma lata
resolve spontaneously
120
Q

tertiary syphilis

A

1-30 years later
granulmoatous skin bone and liver lesions (gummas)
loss of 2 point discrimination (tabes dorsalis) and argyll robertson pupils

121
Q

what lab will be + for life with sphyliiss

A

FTA-ABS

122
Q

Tx syphilis

A

Penicilin G, doxy or tetra

IV penicillin G for severe tertiary cases

123
Q

can you culture for syphilis

A

no

124
Q

complications syphilis

A

destruction from gummas
CV- aortic regurg and aortitis
neuro- cerbral atrophy, tabes dorsalis and meningitis

125
Q

which HPV assoc with cervical CA

A

16 18

126
Q

acetic acid on cervix and some cells turn white

A

HPV

127
Q

Tx HPV

A

podophyllin, trichloroacetic acid, topical 5-fluorouracil, alpha INF
cryotherapy
laser therapy

128
Q

what strains is HPV vaccine out for

A

6 11 16 18

129
Q

complicaitons HPV

A

vaginal scarring

possible increased risk cervical cancer

130
Q

chancroid

A

H ducreyi
painful ulcer with grayish base and foul odor
possible inguinal adenopathy and bubos

131
Q

gram stain of H ducreyi

A

gram neg rods

132
Q

Tx chancroid

A

ceftriaxone, erythromycin, azithromycin

133
Q

Lymphogranuloma venerium

A

L1 L2 L3 serotypes of C trachomatis

different from the one causes cervicitis

134
Q

signs Sx lymphogranuloma venerium

A

malaise, HA, fever, formation papule at site that is painless ulcer
after 1 month have significant inguinal buboes
can progress to bubo ulceration and elephatiasis
fistula and abscess formation

135
Q

labs in lymphogranuloma venereum

A

immunoassays for chlamydia

136
Q

Tx lymphogranuloma venereum

A

tetracycline
erythromycin
doxycyline

137
Q

what causes granuloma inguinale

A

Klebsiella granulmoatis

138
Q

signs Sx granuloma inguinale

A

papule on external genitatial and becomes painless ulver with beefy red base and irregular borders
mild lymphadenopathy

139
Q

Bx in granuloma inguinale

A

giemsa stain shows donovan bodies

red encapsulated intracellular bacteria

140
Q

Tx granuloma inguinale

A

doxy or TMP SMX for 3 weeks

141
Q

risk factors for fibroids (leiomyomas)

A 
nulliparity
african american
diet high in meats
alcohol
FMH
142
Q

signs Sx fibroids

A

menorrhagia, pelvic pressure or pain, urinary frequency or infertility

143
Q

what imaging is used for fibroids

A

transvaginal US or hysteroscopy

144
Q

Tx for fibroids

A

follow with US
FnRH agonists reduce bleeding and size but use only temporary
myomectomy for sypmotmatic
hysterectomy for those Sx and already had kids
Uterine artery embolization

145
Q

endometrial CA with no relation to excess estrogen

A

worse prognosis

146
Q

what is endometrial CA

A

adenocarcinoma of uterine tissue usually related to high exposure estrogen

147
Q

which syndrome inc risk endometrial CA

A

lynch syndrome II

148
Q

signs Sx endometrial CA

A

heavy menses, midcycle bleeding, postmenopasual bleeding, possible abdominal pain, ovaries and uterus feel fixed

149
Q

labs for endometrial CA

A

Bx to examen cells that show hyperplastic abnormal glands with vascular invasion
increased CA-125

150
Q

Imaging in endometrial CA

A

CXR and cT to detect mets

transvaginal US to detect mass and measure wall thickness

151
Q

most common cause vaginal bleeding in menopausal women

A

atrophic vaginitis

but still need endometrial Bx to rule out cA

152
Q

Tx endometrial CA

A

TAH BSO and lymph node sampling

if no kids yet and limited CA to lining, can shrink with progestins and do TAH BSO after childbirth

153
Q

adjuvant for endometrial CA

A

radiation for high grade

chemo for spread beyond uterus and cant have radiation

154
Q

which hormones are good for unresectable endometrial CA

A

progesterone and tamoxifen

155
Q

complications endometrial CA

A

local extension

mets to peritoneum aortic and pelvic lymph nodes, lungs and vagina

156
Q

most common cervical cancer

A

squamous cell

157
Q

risk factors cervical ca

A 
early first intercourse
tobacco
HPV 16 18 31 33
multiple sexual partners and high risk
history STIs
158
Q

when is first pap smear

A

21 years old

159
Q

screening with pap smears

A

21-29 years old every 3 years

women >30 every 5 years HPV

160
Q

see abnormal lesion on pap smear, next step

A

punch biopsy or cone biopsy

161
Q

imaging for cervical CA

A

CT MRI or US to determine extent

162
Q

Atypical squamous cells of undetermined significance

A

do HPV screening and pap smears in 6 and 12 months

HPV testing in 12 months again

163
Q

atypical squamous cells, cannot exclude HSIL

next step

A

do HPV screening, endocervical biopsy
repeat Pap in 6 and 12 months
repeat HPV in 12 months

164
Q

low grade squamous intraepithelal lesion on pap

next step

A

this is CIN 1
repear pap in 6 and 12 months
repeat HPV in 12 months
excision loop or leepprocedure or conization/laser therapy

165
Q

high grade squamous intraepithelial lesion on pap

next step

A

HSIL or CIN 2 or 3
excision by LEEP or conization or laster
repeat cytology every 6 months

166
Q

pap shows highly atypical cells with stromal invasion

A

squamous cell carcinoma

167
Q

cervical CA visible invasive lesions that involve uterus but to not extend into pelvic wall or lower third of vagina
Tx

A

radical hysterectomy with lympadenectomy or radiation and cisplatin chemo

168
Q

cervical cA lesions that extend to parametrial tissue, pelvic wall, lower 3rd vagina or adjacent organs
Tx

A

radiation and chemo

169
Q

what is a follicular cysts

A

from ovarian follicle and granulosa cells
may regress with cycles
have abdominal pain and gullness

170
Q

Tx for follicular cyst

A

obsercation

171
Q

corpus luteum cyst

A

from theca cells
or hemorrhagic corpus luteum
usually larger than follicular cysts and later in cycle
have abdominal pain and fullness but at greater risk of rupture
greater risk of torsion

172
Q

Tx corpus luteal cyst

A

obsercation, cystectomy if does not regress or significant hemorrhage

173
Q

mucinous or serous cystadenoma

A

from epithelial tissue resembles endometrial or tubal histo

can have psammoma bodies

174
Q

Tx mucinous or serous cystadenoma

A

unilateral SO or TAHBSO if postmenopausal

175
Q

what is an endometrioma

A

spread of endometriosis to ovary

abdominal pain, dyspareunia, infertility

176
Q

Tx endometrioma

A

OCPs, GnRH agonists, progestins, danazol

cystectomy or oophorectomy frequently required because reoccur

177
Q

Teratoma or dermoid cyst

A

from germ cells with multiple dermal tissues

rupture can cause peritonitis

178
Q

Tx for dermoid cyst

A

cystectomy with attempted presercation of ovary

179
Q

stromal cell tumor

A

granulosa, theca or sertoli leydig cells
secrete hormones
can cause precocious puberty or virilizaiton if sertoli leydig

180
Q

Tx stromal cell tumor of ovary

A

unilateral SO or TAH BSO if post menopasual

181
Q

most common CA of ovaries

A

epithelial

182
Q

risk factors ovarian CA

A

FMH
infertility
nulliparity
BRCA1 or 2

183
Q

Sx ovarian CA

A

abdominal pain, fatigue, weight loss, change in bowel habits, menstrual irregularity, ascites

184
Q

labs in ovarian CA epithelial origin

A

increased CA-125 in epithelial tumors

185
Q

labs in germ cell ovarian CA

A

increased AFP bhCG, LDH

186
Q

Tx epithelial ovarian CA

A

TAH BSO with pelvic wall sampling, appendectomy and adjuvant chemo

187
Q

Tx germ cell ovaraian CA

A

unilateral SP if limited
surgical debuking
chemo

188
Q

complications ovarian CA

A

prognosis is usually poor because at time of Dx pretty advanced

189
Q

US shows cystic ovarian mass with smooth lesion edges and few septa

A

benign

190
Q

US cystic mass show irregularity nodularity, multiple septa and pelvic extension

A

malignancy

191
Q

how to properly stage ovarian malignancy

A

surgical resection and histo staging

192
Q

what causes breast abscess

A

S aureus or strep or anaerobic subareolar infections

193
Q

breast abscesses are more common in which women

A

smokers

194
Q

painful mass in breast, fever with plapable red warm breast mass

A

breast abscess

195
Q

labs in breast abscess

A

increased WBCs, fine needle aspiration confirms

196
Q

Tx breast abscess

A

oral or IV antibiotic
incision and drainage of fluctuant masses
continue breast feeding

197
Q

what would a Bx of fibrocystic changes of breast show you

A

epithelial hyperplasia

198
Q

when should you start mammos

A

age 40 or 50 depending

199
Q

suspicious lesions on mammos are what

A

hyperdense regions or calcifications

200
Q

Tx for fibrocystic changes

A

caffeine and diet reduction
OCPs
progesterone
tamoxifen

201
Q

what is most common benign breast tumor

A

fibroadenoma from proliferation of single duct

usually

202
Q

fibroadenoma findings

A

solitary solid and mobile
well defined edges
Bx FNA will confirm

203
Q

Tx for fibroadenoma

A

surgical excision or US guided crytotherapy

204
Q

nonbloody nipple disharge

A

noncancerous pathology

205
Q

bloody or nonbloody discharge from nipple on stimulation

breast pain and palpable mass behind areola

A

intraductal papilloma

206
Q

Tx intraductal paiplloma

A

surgical excision

207
Q

most common malignant neoplasm of breast

A

fuctal CA

208
Q

risk Fx for breast CA

A 
FMH
BRCA 1 or 2
ovarian CA
endometrial CA
prior breast CA
increased estrogen exposure
early menarche, late menopause, nulliparity, late first pregnancy
increased age, obesity, alcohol, DES, industrial chemicals or pesticides
209
Q

palpable solid immobile breast lumo

A

breast CA

210
Q

peau dorange

A

lymhatic obstruction causing lympedema and skin thickening that makes breast look like orange peel

211
Q

most common site breast cancer

A

upper outer quadrant

212
Q

next step when find breast mass

A

biopsy FNA with US

core Bx is more definitive and determines if invasive

213
Q

most breast CA are detected how

A

screening mammos

214
Q

DCIS of breast

A

ductal carcinoma in situ

malignant cells in ducts without stromal invasion

215
Q

LCIS of breast

A

lobular
malignant cells in lobules without stromal invasion
can be multifocal
increased risk CONTRAlateral malignancy

216
Q

invasice ductal carcinoma

A

malignant cells in ducts with stromal invasions and microcalcifications
fibrotic response in breast tissue
most common invasive breast CA!!!!!!!

217
Q

findings in invasive ductal carcinoma

A

firm palpable mass with skin dimpling, nipple retraction

peau d’orange or nipple discharge

218
Q

invasive lobular carcinoma

A

malignant cells in breast lobules with infiltration and less fibrotic response in breat
bilateral and multifocal
slower mets
assoc with hormone replacement!!!!!!!

219
Q

paget disease of breast

A

malignant adenocarcinoma infiltrate epithelium of nipple and areola
usually ductal carcinoma

220
Q

signs of pagets of breast

A

scaly eczematous or ulcerated lesion on nipple and areola

preceded by pain, burning or itching

221
Q

inflammatory carcinoma of breast

A

subtype ductal characterized by rapid progression and angioinvasive behavior, poor prognosis

222
Q

signs inflammatory carcinoma of breast

A

breast pain, tenderness, erythema, warmth, pearu d’orange, lymphadenopathy

223
Q

medullary carcinoma of breast

A

well cicrumscribed rapid growth

better prognosis

224
Q

mucinous carcinoma of breast

A

well circumscribed slow growth
more common in older women
gelatinous in palpation

225
Q

tubular carcinoma of breast

A

tubular structures invading the stroma
usually in 40s
good prognosis

226
Q

what is used to determine extend of breast lesion

A

MRI

227
Q

what is used to determine possible mets of breast lesion

A

bone scan and cT

228
Q

Tx DCIS of breast

A

lumpectomy
maybe radiation
mastectomy in hight risk

229
Q

Tx LCIS of breast

A

close observation and tamoxifen or raloxifene

230
Q

Tx invascve carcinoma of breast

A

lumpectomy if early and focal
mastectomy for multifocal and radiation if > 5cm
sentinel lymph node Bx always
hormone or chemo for all node + cancers > 1cm and aggressive tumors

231
Q

negative FNA on solid breast mass

A

need more definitive Bx because 20% false negative

232
Q

Mab used in breast CA

A

trastuzumab anti Her 2 neu

233
Q

Tx inflammatory breast CA

A

mastectomy, radiation and chemo

234
Q

mets of breast CA

A

bone, thoracic cavity, brain and liver

235
Q

tumors with + Estrogen or progesterone R or her2neu

A

better prognosis

Step2CK (26 decks)

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