Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

USMLE: step 1 > Repro > Flashcards

Repro Flashcards

1
Q

What is the SHH gene responsible for? What can mutation cause?

A
  • Anterior posterior patterning at limb buds

- Holoprosencephaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the WNT7 gene responsible for?

A

Distal limb development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Role of fibroblast growth factor in development? Mutation?

A

Limb lengthening: mutation can cause achondroplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do mutations in HOX genes cause?

A

Synpolydactyly: fingers /toes in wrong place

  • Code for DNA binding TF
  • Vitamin A dysregulates HOX in pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is egg arrested in before fertilization?

A

Metaphase of meiosis II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does the trophoblast become?

A

The placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Vitamin deficiency causing neural tube defects?

A

Folate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do alar and basal plate give rise to?

A

Alar: sensory neurons (dorsal)
Basal: motor neurons (ventral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is embryo most susceptible to teratogens?

A

Embryonic period: weeks 3 - 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When do heart and limb development begin?

A

Week 4: 4 chambers, 4 limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When does gender development begin?

A

Week ten

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Derivatives of ectoderm and what do they become?

A
  1. Surface ectoderm: skin
  2. Neuroectoderm: Brain / spinal cord
  3. Neural crest: PNS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are melanocytes derived from?

A

Neural crest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does the mesoderm become?

A
  • Muscle, bone, connective tissue, CV, lymphatics, blood, kidneys, spleen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does endoderm become?

A

Gut, lungs, liver, pancreas, gallbladder, thyroid, parathyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is agenesis?

A

Absent organ from absence of primordial tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is aplasia?

A

Absent organ with present primordial tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Difference between deformation and malformation

A

Deform: extrinsic interruption after embryonic period
Malform: internal interruption during embryonic (3-8 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What do aminoglycosides cause?

A

Ototoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does cocaine cause?

A

Placental abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does Li cause?

A

Ebstein anomaly: atrialization of right ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Heparin or warfarin in pregnancy?

A

Heparin: does not cross placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Presentation of fetal alcohol syndrome?

A
  1. Small, widely spaced eyes
  2. Thin upper lip
  3. Smooth philtrum
    * ***Caused by failure of cell migration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does # chorions equal?

A

Number of placentas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Most common number of amnions / chorions in twins?

A

Monochorionic, diamniotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What cells release Bhcg?

A

Syncytiotrophoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the maternal and fetal components of placenta?

A

Maternal: decidua basalis
Fetal: Cytotrophoblasts/syncytiotrophoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What does the allantois become?

A

Urachus: urine out belly button if does not close

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What does the vitelline duct do?

A

Connect yolk sac to midgut lumen: poop out belly button if does not close

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What doe the allantois and the umbilical arteries become?

A

Arteries: MediaL umbilical ligament
Allantois: Median umbilical ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does 1st arch become?

A

Maxillary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What does 2nd arch become?

A

Stapedial and hyoid arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What does 3rd arch become?

A

Common and proximal internal carotid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What does fourth arch become?

A

Left: aortic arch
Right: Proximal right subclavian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What does 5th arch become?

A

Nothing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What does 6th arch become?

A

Ductus arteriosus and proximal pulmonary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a lump on side of neck that does not move when swallowing?

A

Branchial cleft cyst: from persistent cervical sinus derived from 2 - 4th cleft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What muscles does CN VII innervates?

A

Muscles of facial expression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What innervates muscles of mastication?

A

vIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Pouches involved in digeorge syndrome?

A

III and IV as they develop into thyroids and parathyroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Mutation seen in digeorge?

A

22q.11 deletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What does 22q.11 deletion cause?

A

Digeorge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What results in cleft lip?

A

Failure of fusion of maxillary and medial nasal processes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the default genital pathway?

A

Female with persistence of paramesonephric / mullerian ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What do the mullerian ducts become?

A

Fallopian tubes, uterus, upper 1/3 vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What allows for male development?

A
  • SRY gene on y chromosome producing testis determining factor
  • Allows testis to develop creating sertoli and leydig cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What secretes mullerian inhibitory factor?

A

Sertoli cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What secretes testosterone?

A

Leydic cells to promote wolffian growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What makes DHT?

A

5-alpha reductase makes this more potent testosterone from testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is DHT responsible for?

A

Prostate and male external structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What do the urogenital folds become?

A

men: ventral shaft penis
women: labia minora

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is hypospadias?

A

Urethral opening on underside of penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is epispadias?

A

Urethral opening on top of penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What happens when tunica vaginalis fails to fuse in man?

A

Risk of indirect hernia / hydrocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Venous drainage of left/right ovary/testis?

A

Left: gonadal vein, renal vein, IVC
Right: Gonadal vein, IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Which side is varicocele more common on?

A

Left: left gonadal - > renal - > IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Cancer leading to varicocele?

A

RCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Where do the ovaries and testis drain lymphatically?

A

Lumbar / Para aortic lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Where does lymph from distal vagina, vulva, and scrotum drain?

A

Superficial inguinal nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What lymphatics do the clitoris and glans penis drain do?

A

Deep inguinal nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Where does proximal 2/3 vagina drain?

A

Obturator, external iliac, and hypogastric nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Consideration of cardinal ligament in hysterectomy?

A

Need to ligate cardinal ligament to prevent bleeding but need to be careful not to ligate ureter as it is extremely close

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What vessels are in round ligament?

A

None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Pudendal nerve roots?

A

S2 - S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What does the ureter pass posterior to?

A

Man: vas deferans
Woman: uterine artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What do ovarian arteries arise from? Uterine?

A

Ovarian: directly from abdominal aorta
Uterine: Internal illiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What needs to be ligated in hysterectomy as the suspensory ligament is cut?

A

Ovarian vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Where are ciliated columnar cells found in female tract?

A

Fallopian tubes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Are meta and dysplasia reversible?

A

Yes: neoplasia is NOT reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What of sperm?

A 
"Seven UP"
Seminiferous tubules
Epididymis
Vas def
Ejaculatory ducts
Nothing
Urethra
Penis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Where do sperm mature / are stored?

A

Epididymis: reach full maturity in vagina with help of secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is ligated in male sterilization?

A

Vas def

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is diagnosis for present, non motile sperm?

A

Kartagener

  1. Situs inversus
  2. Chronic respiratory infx
  3. Infertility
    - Mutation in dynein arm for flagella
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What fracture damages posterior urethra?

A

Pelvic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Where does urine leak in urethral injury?

A

Retropubic space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What does NO release cause in penis?

A
  • Increased cGMP relaxing smooth muscle

- Increases blood flow = erection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Role of phosphodiesterase inhibitors in erection?

A

Stop breakdown on cGMP allowing erection to persist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Where does spermatogenesis occur?

A

Seminiferous tubules - takes 9 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Where are spermatogonia found?

A

Line seminiferous tubules maintaining gene pool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Function of sertoli cells?

A
  1. Inhibin and androgen binding protein
  2. Blood testis barrier
    - Protect from autoimmune attack
  3. Support and nourishment
  4. Mullerian inhibitory factor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Function of leydig cells?

A
  1. Testosterone production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What does inhibin do?

A

Release by sertoli stopping FSH secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What do FSH and LH stimulate in males?

A

LH: Leydig
FSH: Sertoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Negative feedback of testosterone?

A

LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Sertoli or leydig cells impacted by temperature?

A
  • Sertoli: sperm count will drop

- Leydig cells produces normal testosterone with increased temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is inferior to spermatic artery?

A

Ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Where do ovarian vessels lie?

A

Suspensory ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Where do uterine vessels lie?

A

Cardinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Impact of LH in women?

A

Acts on theca converting cholesterol to testosterone via desmolase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Function of FSH in women?

A

On granulosa cells to convert androgen to estrogen via aromatose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Functions of progesterone?

A
  1. Increasing endometrial secretions / spiral artery development
  2. Decreased myometrial excitability
  3. Negative FSH / LH feedback
  4. Maintenance of pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Where are eggs arrested between birth and pregnancy?

A

Prophase of meiosis 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Where are secondary oocytes arrested?

A

Metaphase II until fertilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What does rising estrogen cause increase in?

A

LH surge causing ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What divides follicular and luteal phase?

A

Ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Length of luteal phase?

A

Always 14 days, follicular phase can vary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Hormones high in follicular and luteal phase?

A

Follicular: estrogen
Luteal: progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Most common cause of irregular / heavy uterine bleeding?

A

Anovulation: unopposed estrogen continues to build up endometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is happening with lactation during pregnancy?

A
  • Prog and E2 are increasing breast growth however they inhibit prolactin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What regulates prolactin release from anterior pituitary?

A

Dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Function of HCG?

A

Keep corpeus luteum functioning to secrete progesterone until placenta can create its own

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Causes of excessively high HCG?

A
  1. Hydatidiform mole
  2. Choriocarcinoma
  3. Multiple gestations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is a good apgar score?

A

> 7,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Which immunoglobulin can cross placenta?

A

IgG

- IgA is what is found in breast milk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Vitamin deficiency if exclusively breast fed?

A

D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

FHS, LH, GNRH levels in menopause?

A

Elevated from loss of estrogen negative feedback

***FSH is higher than LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What organs does DHT stimulate?

A

Penis, Scrotum, Prostate

- Testosterone responsible for internal organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What does 5-a-reductase do?

A

Convert testosterone to DHT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What does finasteride do?

A

Inhibits 5-a-reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What do spermatids become?

A

Mature spermatozoa - vira spermiogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What leads to condyloma acuminatum?

A

6 / 11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Which are the low / high risk HPVs?

A

High: 16, 18, 31, 33
Low: 6, 11
***Based on DNA sequencing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is lichen sclerosis?

A
  • Thinning of epidermis and fibrosis of dermis
  • Presents with leukoplakia with parchment like skin
  • Benign with small risk of SCC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What is lichen simplex chronicus?

A
  • Hyperplasia of vulval epithelium
  • Leukoplakia w/ thick leathery skin
  • From chronic irritation
  • No risk of cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

2 etiologies of vulvar carcinoma?

A
  1. HPV - 16, 18, 31, 33 - younger females

2. Non HPV - lichen sclerosis - older females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What is extramammary paget’s?

A
  • Erythematous, itchy ulcerated skin on vulva
  • Carcinoma in situ with NO underlying carcinoma
  • **In breast means there IS cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

How to tell pagets from melanoma?

A

Paget’s: PAS +, Keratin +, S100 -

Melanoma: PAS - / Keratin - / S100 +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What is the vagina derived from?

A

Upper 2/3: Mullerian duct

Lower 1/3: urogenital sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What happens to vaginal lining in development?

A

Upper 2/3 from mullerian duct is originally columnar that is replaced by squamous migrating up from lower 1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What is adenosis? What is the risk?

A
  • Persistence of columnar cells up upper 2/3 vagina
  • Normally replaced by Squamous
  • Increased risk from DES in utero
  • Has increased risk of clear cell adenocarcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What does DES lead to increased risk in?

A
  • Adenosis progressing to clear cell adenocarcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is risk with DES in mother?

A

Breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Presentation of embryonal rhabdomyosarcoma?

A
  • Bleeding grape like mass protruding from vagina or penis

- Usually seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What is the following histology indicative of:

  • Cytoplasmic cross striations
  • Positive IHC staining for desmin and myogen
A

Rhabdomyoblast cells see in rhabdomyocarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Where do upper and lower vagina drain to?

A

Upper 2/3: illiac nodes

Lower 1/3: Inguinal nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Mutations involved in high risk HPV?

A

E6: knocks out p53
E7: knocks out retinoblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What does P53 do?

A
  • Regulate G1 - S phase in cell cycle

- Makes sure any damage is repaired before progress is allowed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What happens when p53 doesnt want cell to progress?

A
  • Calls in Bax
  • Bax knocks out BLC2 which was stabilizing mitochondrial membrane keeping cytochrome C inside
  • Cytochrome C activates apoptosis killing cell
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What does RB do?

A
  • Holds E2F: when RB is phosphorylated it releases it

allowing cell cycle to progress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Difference between CIS and dysplasia?

A

CIS is not reversible and will soon invade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Risk factors for cervical carcinoma?

A
  1. HPV: most important
  2. Smoking
  3. Immunodeficiency: aids defining illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What types of cancer does HPV cause?

A
  1. SCC

2. Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Where does cervical cancer invade?

A

Through anterior uterine wall into bladder causing hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What is next step after abnormal pap?

A

Confirmatory colposcopy and biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

2 limitations of pap?

A
  1. Does Not screen for adenocarcinoma

2. Not effective if you dont wipe transformation zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What does HPV vaccination cover?

A
  • 6, 11, 16, 18
  • Lasts 5 years
  • Still need paps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Hormonal impact on endometrium?

A

Grows with estrogen, prepares with progesterone, sheds with removal of P

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What is asherman syndrome?

A
  • Secondary amenorrhea from loss of basalis and scarring

- Usually from over aggressive D and C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What is regenerative layer of endometrium?

A

Basalis: grows to produce functionalis which sheds with menstruation

140
Q

What is anovulatory cycle?

A
  • Go through proliferative phase by no ovulation occurs
  • No secretory phase will occur
  • Leads to dysfunctional uterine bleeding in menarche and menopause
141
Q

What is required for diagnosis of chronic endometritis?

A

Plasma cell on histology

142
Q

Which drug can cause endometrial polyp?

A

Tamoxifen: anti estrogen in breast but pro in uterus

143
Q

What is adenomyosis?

A

Endometriosis that has involved the myometrium

144
Q

Risk of endometriosis?

A

Cancer at the site it has seeded

145
Q

What is endometrial hyperplasia?

A
  • Hyperplasia of endometrial glands relative to stroma
    due to unopposed estrogen
  • Presents as postmenopausal uterine bleeding
146
Q

Most important predictor for progression of endometrial hyperplasia to cancer?

A

Cellular atypia

147
Q

2 pathways of endometrial carcinoma? Histology? Cause?

A
  1. Hyperplasia: endometrioid histology seen
  2. Sporadic: serous / papillary histology seen
    - P53 mutations
    - Psammoma bodies can be seen
148
Q

2 types of cancer with psammoma bodies?

A
  1. Mesothelioma
  2. Sporadic endometrial carcinoma
  3. Papillary thyroid cancer
  4. Meningioma
149
Q

What is a leiomyoma?

A
  • Benign tumor of myometrial smooth muscle
  • MULTIPLE, 2hite whorled masses
  • From estrogen exposure
150
Q

What are multiple, white whorley masses indicative of?

A

Leiomyoma - benign process

151
Q

Difference in appearance between leiomyoma and leiomyosarcoma?

A

Leiomyoma: multiple, white whorled masses
- Pre menopause
Leiomyosarcoma: single mass with hemorrhage and necrosis
- Post menopause

152
Q

Most common presentation of leiomyoma?

A

Asymptomatic

153
Q

Do leiomyomas become sarcomas?

A

No, the sarcoma arises de novo

154
Q

What does a follicle consist of?

A

Oocyte surrounded by granulosa and theca cells

155
Q

Hormone impact on follicle?

A
  1. LH causes theca to make androgen
  2. FSH makes granulosa turn andro to estrodiol
  3. Estradiol allows oocyte to mature
156
Q

What happens if a follicle degenerates?

A

Becomes a follicular cyst

157
Q

Hormonal characteristic of PCOD?

A

LH:FSH > 2

158
Q

Why is FSH low in PCOD?

A
  • Androgens are being converted to estrogens in fat by aromatase
  • This estrione goes back to pituitary shutting down FHS
  • Follicles begin to degenerate as low FSH does not allow granulosa cells to make estradiol
159
Q

Classic presentation of PCOD?

A
  1. Hirsutism
  2. Obesity
  3. Infertility
  4. Oligomenorrhea
  5. Insulin resistance
  6. Risk of endometrial carcinoma from high circulating estrone
160
Q

What do germ cell tumors derive from?

161
Q

What do sex cord stromal tumors derive from?

A
  1. Granulosa
  2. Theca
  3. Fibroblasts
162
Q

3 categories of ovarian tumor?

A
  1. Germ cell
  2. Sex cord stromal
  3. Epithelial
163
Q

What is coelomic epithelium?

A

Epithelium lining the ovaries

164
Q

2 most common types of ovarian epithelial tumors?

A
  1. Serous
  2. Mucinous
    - Both are usually cystic
165
Q

What is a cystadenoma?

A
  • Benign ovarian tumor filled with water or mucous
  • Single cyst with simple flat lining
  • Usually premenopause
166
Q

What is the following indicative of:

- Complex cysts with thick shaggy lining

A
  • Cystadenocarcinoma: malignant

- Usually postmenopausal

167
Q

What is BRCA1 risk factor for?

A
  1. Breast cancer

2. Serous carcinoma of ovary and fallopian tube

168
Q

4 types of endothelial ovarian tumors

A
  1. Serous
  2. Mucinous
  3. Endometrioid
  4. Brenner tumor
169
Q

Characteristic of endometrioid ovarian tumor?

A
  • Usually malignant
  • Usually from endometriosis
  • 15% have endometrial carcinoma as well
170
Q

Cells in brenner tumor?

A

Urothelium

171
Q

What is ovarian tumor with urothelium in it?

A

Brenner tumor

172
Q

What is CA-125 a marker for?

A
  • Released by surface epithelial tumors
  • Can be used to monitor treatment / recurrence
  • **Not useful in screening
173
Q

Who are germ cell tumors seen in?

A

Reproductive age

174
Q

Types of germ cell tumors?

A
  1. Cystic teratoma
  2. Embryonal
  3. Yolk sac / endodermal sinus tumor
  4. Dysgerminoma
  5. Choriocarcinoma
175
Q

How to tell if cystic teratoma is benign or malignant?

A
  1. Immature tissue = malignant
    - Often have neuroectoderm
  2. Somatic malignancy = malignant potential
    - IE skin tissue in tumor could have squamous cell carcinoma
176
Q

What is struma ovarii?

A
  • Cystic teratoma of mainly thyroid tissue that can lead to hyperthyroid
177
Q

What is the following indicative of:

  • Large cells with clear cytoplasm and central nuclei
  • Elevated LDH
A

Dysgerminoma

- Looks like an oocyte

178
Q

Male equivalent of dysgerminoma?

179
Q

Prognosis for dysgerminoma?

A

Responsive to radiotherapy

180
Q

What is the following indicative of:

  • Elevated AFP
  • Schiller duval bodies - glomeruloid like structures
A

Yolk sac / endometrial sinus tumor

181
Q

Tumor often seen in kids?

182
Q

Characteristics of endometrial sinus tumor?

A
  1. Elevated AFP
  2. Yolk sac like
  3. Schiller duval bodies
  4. Common in kids
183
Q

Characteristics of choriocarcinoma?

A
  1. High BHCG
  2. Poor chemoresponse
  3. Tropho / syncytiotrophoblasts without villi
  4. Small and hemorrhagic with hematogenous spread
    - Placental cells are naturally programmed to find vessels
184
Q

Presentation of granulosa / theca tumor?

A
  • Estrogen production and signs of that excess
185
Q

Characteristics of sertoli leydig tumor?

A
  • Reinke crystals
  • Sertoli cells forming tubules
  • Hirsutism and virilization
186
Q

What are reinke crystals indicative of?

A

Sertoli leydig tumor

187
Q

Presentation of ovarian fibroma?

A

Meigs syndrome:

  1. Pleural effusion
  2. Ascites
188
Q

What is a krukenberg tumor?

A
  • Mucinous carcinoma that spreads to both ovaries

- Usually diffuse gastric carcinoma

189
Q

Characteristic cell of diffuse gastric carcinoma?

A

Signet ring cell: nucleus pushed to one side because cell is full of mucus

190
Q

What causes pseudomyxoma peritonei?

A
  • Mucinous carcinoma of the appendix
  • Makes abundant mucus in peritoneum
  • Also spreads to ovary
191
Q

Risk factors for ectopic?

A

Scarring from:

  1. PID
  2. Endometriosis
192
Q

Causes of spontaneous abortion?

A
  1. Chromosomal abnormalities
  2. Hypercoagulable state
  3. Congenital infection
  4. Teratogens
193
Q

What is placenta previa?

A

“preview of the placenta”

  • Has inserted near the cervical OS
  • 3rd trimester bleeding
  • Requires C-section so baby doesn’t compress placental blood supply as it moves through canal
194
Q

What is placental abruption?

A
  • Placenta separates from decidua prior to delivery
  • 3rd semester bleeding
  • Still birth
195
Q

What is placenta accreta?

A
  • Direct implantation of placenta into myometrium

- Inability to deliver placenta often resulting in hysterectomy

196
Q

To what layer does the placenta attach?

197
Q

What is preeclampsia?

A

Pregnancy induced:

  1. Hypertension
  2. Proteinuria
  3. Edema
    * *Caused by problem with placenta vascular interface
198
Q

What is fibrinoid necrosis of vessels in placenta associated with?

A

Preecplampsia

199
Q

What is eclampsia?

A
  • Preeclampsia + seizures
200
Q

What is HELLP?

A

Preeclampsia + :

  • Hemolysis
  • Elevated Liver enzymes
  • Low Platelets
  • Arises from small thrombi in liver vasculature
201
Q

What increases risk of SIDs?

A
  1. Smoking
  2. Prematurity
  3. Sleeping on stomach
202
Q

What are swollen and edematous villi with proliferation of trophoblasts indicative of?

A
  • Hydatidiform mole
203
Q

Presentation of mole?

A
  • Uterus larger than should be for date
  • BHCG higher than should be for date
  • Passage of grape like masses in second trimester: swollen villi
204
Q

What is snow storm appearance on ultrasound indicative of?

205
Q

Genetic composition of complete v. partial mole?

A

Complete: 46 chromosomes
Partial: 69 chromosomes

206
Q

Which mole shows fetal tissue?

207
Q

Which mole demonstrates greater villous edema?

208
Q

Which mole has greater trophoblastic proliferation?

209
Q

Which mole has risk for choriocarcinoma?

210
Q

What secretes bHCG?

A

Syncytiotrophoblasts

211
Q

How do pathways of choriocarcinoma respond to chemo?

A

Gestational (mole): well

Germ Cell tumor: poor

212
Q

Cause of hypospadias?

A
  • Failure of urethral folds to close

- On lower side of penis

213
Q

Cause and association of hypospadias?

A
  • Abnormal position of genital tubercle

- Associated with bladder exstrophy

214
Q

What is lymphogranuloma venereum?

A
  • Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes
  • Caused by chlamydia trachomatis
  • Causes fibrosis that can lead to rectal strictures
215
Q

What bowen’s disease?

A

CIS in shaft of penis that can lead to SCC

216
Q

What is cryptorchidism?

A

Failure of tisticle to descend from abdomen to scrotum

217
Q

What is the cremasteric reflex and when is it absent?

A
  • Scrotum rises when scrape inner thigh

- Testicular torsion

218
Q

What is hydrocele associated with?

A
  • Incomplete closure of processus vaginalis

- Blockage of lymphatic drainage

219
Q

What is a seminoma equivalent to?

A

Dysgerminoma

220
Q

How are germ cell tumors divided in males?

A
  1. Seminoma

2. Nonseminoma

221
Q

Characteristics of seminoma?

A
  • Chemo responsive
  • Late metastasis
  • Large cells with clear cytoplasm and central nuclei
  • Can release HCG
  • Homogenous mass no hemorrhage or necrosis
222
Q

Characteristics of male embryonal carcinoma?

A
  • Immature cells that may form glands
  • Hemorrhage and necrosis
  • Aggressive with hematogenous spread
  • Increased AFP / HCG
223
Q

Most common testicular tumor in kids? What is elevated?

A
  • Yolk sac

- AFP

224
Q

Which tumor is AFP classically elevated in?

225
Q

Difference between teratoma in males and females?

A

Benign in females, malignant in males

226
Q

What to think if testicular mass in > 60yo?

A

Diffuse large B cell lymphoma

227
Q

Presentation of acute prostatitis?

A
  1. Pain on urination
  2. Fever
  3. Chills
228
Q

What is risk for cancer in BPH?

229
Q

Where does BPH occur?

A

Periurethral zone of prostate

230
Q

What is hydronephrosis?

A
  • Dilation of kidney and ureter from backup of fluid

- Can occur in BPH

231
Q

Where does prostate cancer appear?

A
  • Posterior

- Does not produce urinary symptoms because of this leading to late presentation

232
Q

What is the grading scale for prostate cancer?

A

“Gleason grading scale”

- Based solely on architecture with atypia not a factor

233
Q

Where does prostate cancer like to spread?

A
  • Lumbar spine with osteoblastic metastasis

- Low back pain with increased alk phos

234
Q

What does alkaline phosphatase indicated?

A

Osteoblastic activity

235
Q

What is leuprolide?

A

GNRH agonist that will shut down HPA decreasing DHT cancer is dependant on

236
Q

Most common cause of nipple discharge of blood?

A

Intraductal papilloma

237
Q

What can a uniformly enlarged uterus be indicative of?

A
  1. Molar pregnancy

2. Adenomyosis

238
Q

Another name for leiomyomas?

239
Q

Do leiomyomas enlarge the uterus?

A

Yes but irregularly

240
Q

What is needed to treat PID?

A

Coverage of both:

  1. Gonorrhea: 3rd generation cephalo
  2. Chlamydia: azythro or doxy
241
Q

What does tetracycline cause in fetus?

A

Teeth staining

242
Q

What does chloramphenicol cause in fetus?

A

Gray baby syndrome

243
Q

What doe TMP sulfate cause in babies?

A

Neural tube defects

244
Q

What do aminoglycosides cause in fetus?

A

Ototoxicity

245
Q

What does valproate cause in pregnancy?

A

Neural tube defects

246
Q

Another name for measles and german measles?

A

Measles: rubeola
German: rubella

247
Q

Rubella presentation in adult?

A

Polyarthralgia

248
Q

Rubella presentation in kid?

A
  1. Deaf
  2. Cataracts
  3. Heart malformations
249
Q

What happens to urethral folds in women?

A

Do not fold forming labia minor - Hypospadias if dont fuse in male

250
Q

What does low serum AFP mean?

251
Q

What does elevated AFP mean?

A
  1. Neural tube defects
  2. Ventral wall defects
  3. Multiple gestations
252
Q

In utero lab values in downs?

A
  • Low AFP
  • Low unconjugated Estriol
  • Increased HCG
  • Increased inhibin
253
Q

What causes syphilis?

A

Treponema pallidum

254
Q

Diagnosis of syphilis?

A

Darkfield microscopy

255
Q

What is given to mimic LH surge in fertility therapy?

256
Q

What is menotropin?

A

Given in fertility therapy to mimic FSH and stimulate follicle

257
Q

What is the following indicative of:

  • Purulent vaginal discharge
  • Friable cervix with easy bleeding
A

Gonococcal cervicitis

258
Q

Diagnosis of gonorrhea?

A

DNA amplification

259
Q

What is cholelithiasis and who is it most common in?

A

Gallstones: “Fat, fertile, female, forty”

260
Q

What causes gallstones in pregnant ladies?

A

Estrogen: cholesterol hypersecretion
Progesterone: gallbladder hypomotility

261
Q

What is the egg arrested in prior to fertilization?

A

Metaphase of meiosis II

262
Q

Where are eggs arrested prior to ovulation?

A

Prophase Meiosis I

263
Q

3 ways DS occurs?

A
  1. Nondisjunction: trisomy
  2. Unbalanced translocation
  3. Mosaicism
264
Q

What can a germ cell tumor secrete causing signs of hyperthyroid?

A

HCG has same beta subunit as TSH

265
Q

What do kegels strengthen?

A

Levator ani muscle of the pelvic floor

266
Q

Turners presentation?

A
  1. Streak gonad
  2. Shield chest
  3. CV abnormalities: bicuspid / coarct
  4. Webbed neck
  5. Short stature
  6. Horseshoe kidney
  7. Low ears and hairline
267
Q

Epithelial cells in ovary?

268
Q

Where are call exner bodies seen?

A

Granulosa cell tumors - “cuboidal cells in sheets with gland like structures”

269
Q

Do you ligate the ovarian ligament or suspensory ovarian ligament?

A

Suspensory

270
Q

Where does the milk line run?

A

From the vulva to the axilla: breast tissue and pathology can hence happen anywhere along this line

271
Q

What is functional unit of breast?

A

Terminal duct lobular unit: lobules make milk which drain via duct to nipple

272
Q

Two layers of epithelium in TDLU?

A
  1. Luminal layer: innermost

2. Myoepithelial: muscle squeezing duct to propel milk

273
Q

Is galactorrhea sign of breast cancer?

A

No, usually from drugs, prolactinoma, or stimulation

274
Q

Normal cause of acute mastitis?

A

Staph aureus during breast feeding

275
Q

Common cause of periductal mastitis?

A
  • Specialized luminal epithelium requires vit A
  • Smoking leads to deficit so cannot maintain leading to squamous metaplasia
  • Squamous produces keratin plugging ducts = inflammation
  • Leads to mass in subareolar region
276
Q

Presentation of periductal mastitis?

A
  • Lump in areolar region from keratin block

- Fibrin and fibroblasts released for healing = contraction of nipple as myos pull in

277
Q

What is mammary duct ectasia?

A
  • Inflammation of wall of subareolar duct = dilation
  • Leads to brown / green nipple discharge
  • Mass can be felt as well
  • **Usually seen in postmenopausal women
278
Q

What is green brown nipple discharge characteristic of?

A
  • Mammary duct ectasia - mass in postmenopausal women that IS NOT cancerous
279
Q

Presentation of fat necrosis?

A
  • Mass on exam of calcification on mammogram from saponification and giant cells
280
Q

Cause of fibrocystic change?

A
  • Rise and fall of progesterone levels over time
281
Q

What is the most common change in premenopausal women?

A
  • Fibrocystic change with lumpy breast in upper/outer quadrant
282
Q

What is cystis with blue domed appearance indicative of?

A

Fibrocystic change

283
Q

Types of fibrocystic change and risk for cancer?

A
  1. Fibrosis, cysts, apocrine metaplasia: 0
  2. Ductal hyperplasia w/ sclerosing adenosis: 2x
    - Often calcified
  3. Atypical hyperplasia: 5x (both breasts)
    - Ductal or lobular
    * ***Not that these are future risk for cancers not that she currently has them
284
Q

Apocrine metaplasias risk for cancer?

285
Q

What is intraductal papilloma?

A
  • Normal epithelial and myo layers but has formed papillary projection into duct that often bleeds in nipple
  • Premenopausal
  • **If carcinoma no myoepithelial cells
286
Q

What is most common tumor in premenopausal women?

A

Fibroadenoma - benign neoplasm

287
Q

Characteristics of fibroadenoma?

A
  • Tumor of tissues and glands
  • Benign neoplasm in premenopause
  • Well circumscribed marble like mass that is estrogen sensitive
  • Grow and change in pregnancy, menopause, menstrual cycle
288
Q

Risk of cancer in fibroadenoma?

289
Q

What is a phyllodes tumor?

A
  • Fibroadenoma with overgrowth of fibrous part in leaf like projections
  • *Can be malignant unlike normal fibroadenoma
  • Post menopause
290
Q

Breast common stats in women?

A
  • # 1 cause cancer in women

- #2 cause of death

291
Q

How is DCIS usually detected?

A
  • Too small for mass

- Calcification on mammogram

292
Q

Benign breast changes with fat necrosis?

A
  1. Fat necrosis (saponification)

2. Sclerosing adenosis (2x risk cancer)

293
Q

What is paget disease of nipple?

A
  • DCIS that has climbed up duct to nipple
  • Presents with nipple ulceration and erythema
  • Always underlying carcinoma
294
Q

Benign cause of nipple retraction?

A

Periductal mastitis

295
Q

What is desmoplastic stroma indicative of?

A

Invasive ductal carcinoma

296
Q

Epithelial layers indicative of breast cancer?

A

Normally the TDLU has 2 cell types, in cancer it will only have one

297
Q

Cancer characterized by cells in dermal lymphatics?

A

Inflammatory breast cancer

298
Q

Who is medullary carcinoma of breast more common in?

A

BRCA1 mutations

299
Q

What is dyscohesive cells lacking E cadherin indicative of?

A

LCIS - E cadherin is usually holding the cells together

300
Q

Treatment of LCIS?

A

Tamoxifen with close follow up as is a risk factor for invasive carcinoma

301
Q

Appearance of invasive lobular carcinoma?

A
  • Grow in single file pattern as lack E-cadherin

- DO NOT form duct like structure

302
Q

Most important factor for breast cancer prognosis?

A
  • Metastasis

* ***Hard to detect so spread to axilla is most important

303
Q

What is sentinel node biopsy?

A
  • Assesses axillary nodes for spread of breast cancer

- Inject blue dye in breast and follow where it goes

304
Q

3 predictive factors in breast cancers response to treatment?

A
  1. ER - tamoxifen response (antiestrogenic)
  2. PR - tamoxifen response
  3. HER2/Neu - trastuzimab
305
Q

What indicates tumor responsive to trastuzumab?

A

Her2/neu positive

306
Q

What indicates tumor responsive to tamoxifen?

307
Q

What does BRCA1 put you at first for?

A
  1. Invasive medullary breast cancer
    - Other breast cancers as well
  2. Ovarian cancer
308
Q

Mutation in breast cancer in Males?

309
Q

Klinefelter genotype? Cause?

A
  • 47XXy occurring from non disjunction

- One usually becomes bar body

310
Q

Presentation of klinefelter?

A
  1. Tall
  2. Long limbs
  3. Developmental delay - learning and behavior
  4. Gynecomastia
  5. Feminine
  6. Euchenoid body appearance
  7. Dystrophic seminiferous tubules as sertoli dont make inhibin
  8. Cryptorchidism and infertility
311
Q

What causes marfan?

A
  • Defect in fibrillin gene
312
Q

Serology in klinefelter’s?

A
  • Sertolis not secreting inhibin = increased FSH
  • Leydig deficient in testosterone = increased LH
  • Increased E : T ratio
313
Q

Genotype in turner?

314
Q

Turner presentation?

A
  1. Short
  2. Shield chest
  3. Web neck
  4. Pre ductal Coarcted / bicuspid aorta
  5. Ovarian dysgenesis
  6. Cystic hygroma - neck mass
  7. Streak ovary: low E, high FSH / LH
    * Most common cause primary amenorrhea
315
Q

Why is turner so short?

A

Only one copy of SHOX gene which is responsible for long bone growth

316
Q

Difference in primary and secondary amenorrhea?

A

Primary: never had period
Secondary: had period then stopped

317
Q

What is female hermaphrodite? Cause?

A
  • XX genotype
  • External external genitalia or male like
  • Testosterone exposure of CAH
318
Q

Why do you have female external sexual characteristics in androgen insensitivity?

A

Testis produce some estrogen which is now unopposed since body cannot respond to angrogens

319
Q

What happens in 5-a-reductase deficiency?

A
  • Cannot convert T to DHT
  • Abnormal male externals until puberty
  • Normal T and maybe increased LH
320
Q

What is kallmann syndrome?

A
  • Low GNRH from failed migration
  • Defect in brain is next to smell center so have anosmia
  • Delayed or absent puberty: micro penis
  • Lack of secondary characteristics
321
Q

Difference in bleeding in placenta abrupta and previa?

A

Abrupta is painful, previa is not

322
Q

What does double bubble sign indicate?

A

Duodenal atresia

323
Q

Hormone ration diagnostic of PCOD?

A

LH:FHS > 3

324
Q

Most common cause of anovulation?

325
Q

Marker to monitor ovarian cancer?

326
Q

What are call exner bodies indicative of?

A

Granulosa cell tumor

“you need to call your granny”

327
Q

Presentation of leiomyoma?

A
  • Estrogen sensitive, abnormal bleeding in younger women
  • Whorled appearance
  • DO NOT move to sarcoma
328
Q

Treatment for fibroadenoma of breast?

A

Not malignant, give reassurance

329
Q

What is elevated placental alk phos indicative of?

330
Q

What causes insulin resistance in pregnancy?

A
  • HpL: human placental lactogen

- Mother is wanting to increase free glucose for baby and this helps

331
Q

What does HpL cause?

A

Increased insulin resistance during pregnancy / gestational diabetes

332
Q

What is mifepristone?

A

Progesterone antagonist that can be used in abortion

333
Q

What is misoprostol?

A

PGE1 analogs causing cervical softening and uterine contractions that can be used in abortion or to induce pregnancy

334
Q

Where are the sertoli cells found?

A

Within the seminifarous tubules

335
Q

What does inhibin regulate?

A
  • Decreases FSH

- Produced by sertoli cells in seminiferous tubules which are heat sensitive

336
Q

Clotting factor status in pregnancy?

A

Increased VII, VIII, X, VwF to prevent bleeding

337
Q

Protective factors for ovarian cancer?

A
  1. Multiparity
  2. Breast feeding
  3. Oral contraceptives
338
Q

Where is narrow high arched palate seen?

339
Q

Does adenomyosis lead to infertility and painful sex?

340
Q

Blood supply to uterus?

A
  • Uterine arteries off the internal iliac

- If ligated blood flow maintained from collateral circulation from ovarian

341
Q

Is HSV 2 lesion painful?

A

Yes - mulitple lesions

342
Q

Is Syphilis lesion painful?

A

No - usually single lesion

343
Q

Common bacteria in septic abortion?

344
Q

2 bugs implicated in PID?

A
  1. Gonorrhea

2. Chlamydia

345
Q

How does prostate cancer spread to spine?

A

Vertebral venous plexus

346
Q

Artery at risk of being cut in opening rectus abdominus?

A

Inferior epigastric

USMLE: step 1 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions