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1
Q

What do yo use for acne and hirsutism in PCOS?

A

OCP

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2
Q

What are exemestane and anastrozole?

A

Aromatase inhibitors

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3
Q

Diagnosis? Rupture of mucous producing tumor into peritoneal cavity

A

Pseudomyxoma peritoneii (jelly belly) MC from ovary or appendix

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4
Q

What do sertoli cells do?

A

Spermatogensis, inhibin & MIF production, increase SHBG to maintain local levels of testosterone

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5
Q

What do leydig cells do?

A

Testosterone production

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6
Q

What is the best marker for menopause?

A

FSH

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7
Q

How long are sperm viable for after vasectomy?

A

One month

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8
Q

What do the paramesonephric ducts make?

A

Uterus, fallopian tube, cervix, and upper part of vagina

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9
Q

Twins of different sexes are di or monozygotic?

A

Dizygotic and probably dichorionic and diamniontic

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10
Q

How do you differentiate psychogenic from other causes of impotence?

A

Psychogenic is sudden and will persist while others are more intermittent and slowly become persistent. Also night time erections in psychogenic

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11
Q

Diagnosis? Primary amenorrhea in developed girl

A

Imperforate hymen –> can get blood backed up in vagina (distension, back pain) aka hematocolpos

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12
Q

What do you see clenched hands with overlapping fingers?

A

Edwards (Trisomy 18)

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13
Q

What is congenital torticollis?

A

Head tilted to one side from trauma during birth or malposition in utero

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14
Q

What is messed up in inflammatory carcinoma of the breast?

A

Obstruction of lymphatic ducts

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15
Q

What are your hormone levels in klinefelters?

A

Increased FSH and LH (from lack of feedback inhibition since testosterone levels are low), high estrogen

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16
Q

What do fertility enhancing drugs increase the risk for?

A

Ovarian cancer

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17
Q

What is caudal regression syndrome?

A

Sacral agenesis due to maternal diabetes

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18
Q

What congenital abnormality do you see with maternal diabetes?

A

Caudal regression syndrome?

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19
Q

What do OCPs increase risk for?

A

Thrombotic events (MI, stroke)

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20
Q

BPH is often present with what?

A

Prostate cancer

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21
Q

What are Hox genes?

A

transcription regulators

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22
Q

What pw/ dyspareunia, dyschezia, dysmenorrhea, infertility and normal sized uterus?

A

Endometriosis

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23
Q

What causes skin retractions in breast cancer?

A

Invasion of suspensory cooper’s ligament

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24
Q

What causes nipple dimpling in breast cancer?

A

Tumor invading central region of breast

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25
Q

Where does fluid accumulate in hydrocele?

A

Tunica vaginalis

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26
Q

How do OCPs prevent pregnancy?

A

Feedback inhibition to lower serum gonadotropins

Also prevent sperm penetration into uterus and impair embryo implantation

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27
Q

What happens in cyrptorchidism?

A

Semniferous tubules atrophy from temperature induced damage. Inhibin production and because sertoli cells damaged sperm count decreases. Leydig cells normal so secondary sex characteristics normal.

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28
Q

What is choriocarcinoma?

A

Can develop during or after pregnancy in baby or mom. Spreads hematogenously to lungs. Syntio and cytotrophoblast prolif with no chorionic villi. Inc bHCG. Increased frequency of theca-lutein cysts
Can cause gynecomastia in males
Hyperthyroidism (hcG resembles TSH)

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29
Q

What does hPL do?

A

Increases insulin resistance , stimulates proteolysis and lipolysis, inhibits gluconeogenesis. The increase glucose is for baby and protein/FA for mom. Too much can lead to diabetes. Maternal insulin resistance is due to increase hPL, placental GH, estrogen, progesterone, GC

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30
Q

When is an embryo most susceptible to teratogens?

A

Weeks 3-8

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31
Q

What do pia and arachnoid derive from?

A

Neural crest

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32
Q

What do retina, optic nerve derive from?

A

Neuroectoderm

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33
Q

What does the pineal derive from?

A

Neuroectoderm

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34
Q

Where does the lens of the eye derive from?

A

Surface ectoderm

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35
Q

Where do the olfactory epithelium and organs of ear derive from?

A

Surface ectoerm

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36
Q

Where does notochord derive from?

A

Mesodermal

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37
Q

What are VACTERL defects?

A

Mesodermal defects: vertebral, anal, cardiac, tracheoesophgeal fistula, renal, limb defects

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38
Q

What drug causes limb defects (“flipper limbs”) in babies?

A

Thalidomide

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39
Q

What congenital defects does maternal diabetes cause?

A

Anencephaly, caudal regression syndrome, transposition of great arteries, sirenomelia (missing limb)

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40
Q

What is the MC monozygotic twin?

A

One placenta, two amnion (monochorionic, diamniotic), 4-8 days (after morula before blastocyst)

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41
Q

What secretes hCG?

A

Synctiotrophobllast (outer layer of chorionic villi)

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42
Q

What is the decidua basalis?

A

The endometrium during pregnancy. It is the maternal side of the placenta

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43
Q

What are the aortic arch derivatives?

A 
1 - Maxillary
2- Stapedial, hyoid
3 - Common carotid, proximal part of internal carotid
4 - Aortic arch, right subclavian
6 - PDA, pulmonary arteries
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44
Q

What are the branchial cleft derivatives?

A

1 - external auditory meatus

Rest obliterate

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45
Q

What does a persistent cervical sinus present as?

A

Branchial cleft cyst in lateral neck

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46
Q

What is the 1st branchial arch?

A

Mandible, malleus, mandibular ligament
Muscles of mastication, mylohyoid
CN V2 and V3

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47
Q

What is 2nd branchial arch?

A

Stapes, styloid, stylohyoid ligament
Stapes, stylohyoid, platysma
CN VII

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48
Q

What is 3rd branchial arch?

A

Stylopharyngeus

CN IX

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49
Q

What is 4th-6th branchial arch?

A

4th- Superior laryngeal, cricothyroid, pharyngeal constrictors
6th - Recurrent laryngeal, laryngeal muscles
Thyroid and cricoid cartilage

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50
Q

What do you see mandibular hypoplasia and facial abnormalities with?

A

Treacher Collins Syndrome (1st arch neural crest fails to migrate)

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51
Q

What tissue are the branchial arches from?

A

Mesoderm (muscles, arteries) and neural crest (bone, cartilage)

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52
Q

What do you see a fistula between tonsillar area and lateral neck?

A

Congenital pharyngocutaneous fistula (2nd pharyngeal arch)

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53
Q

What is the 1st branchial pouch?

A

Ear (eustachian tube, middle ear, mastoid air cells etc)

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54
Q

What is the 2nd branchial pouch?

A

Tonsils

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55
Q

What is the 3rd branchial pouch?

A

Inferior parathyroid and thymus

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56
Q

What happens in cleft lip?

A

Maxillary and nasal prominences don’t fuse

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57
Q

What happens in cleft palate?

A

Palatine processes don’t fuse with each other or with nasal septum

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58
Q

What is bicornuate uterus?

A

Paremesonephric ducts don’t fuse completely causing two uteruses and two vagina

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59
Q

What is the prostate derived from?

A

Urogenital sinus

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60
Q

What does the genital tubercle make?

A

Corpus cavernosum, glans penis (male)

Vestibular bulbs, glans clitoris (female)

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61
Q

What is gubernaculum in the female?

A

Round ligament and ovarian ligament

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62
Q

What nerve is responsible for erection?

A

Pelvic nerve, pudendal nerve

63
Q

What nerve is responsible for emission?

A

Hypogastric nerve

64
Q

What nerve is responsible for ejaculation?

A

Pudendal nerve

65
Q

What cells are temperature sensitive?

A

Sertoli cells (decreased inhibin and sperm production)

Remember leydig are not sensitive to temperature

66
Q

Where is estriol?

A

Placenta. It is an indicator of fetal well being

67
Q

Why are pregnant women more likely to get gallstones?

A

Estrogen induces cholesterol hypersecretion

Progesterone causes GB hypomotility

68
Q

What phase are you in if you see glands that secrete glycogen and spiral arteries in the endometrium?

A

Secretory

69
Q

What is Mittelschmerz?

A

Midcycle ovulatory pain due to peritoneal irritation from follicular sweling/rupture, fallopian tube contraction). Mimcs appendicits

70
Q

What is seen with menopause?

A

Hot flashes, sleep disturbances, osteporosis, vaginal atrophu, coronary artery diease

71
Q

What is spermiogenesis?

A

Maturation of spermatid (loss of cytoplasmic contents, gain acrosomal cap) into spermatozoan

72
Q

What is true hermaphroditism?

A

Ovotesticular with ambiguous genitalia. Both ovaries and testes

73
Q

What do hormone levels look like for androgen insensitivity?

A

Increased testosterone, estrogen and LH (estrogen increases because LH trying to stimulate testosterone)

74
Q

What is maternal death due to in eclampsia?

A

Stroke causing intracranial hemorrhage or ARDS

75
Q

Diagnosis: hemolysis, increased AST and ALT, thrombocytopenia?

A

HELLP

76
Q

What are placenta accreta, increta, percereta?

A

Accreta: attaches to myometrium
Increta: into myometrium
Percreta: through the myometrium into uterine serosa

77
Q

What presents with pruritus, vaginal pain, dyspareunia, atrophic white papules/macule lesions?

A

Lichen Sclerosus

78
Q

Which has increased risk for malignancy: lichen sclerosus or chornicus?

A

Sclerosus

79
Q

What do you treat for an early ectopic pregnancy (

A

MTX

80
Q

What does E6 do?

A

Inhibit p53

81
Q

What does E7 do?

A

Inhibit Rb

82
Q

What happens if SCC of cervix has lateral invasion?

A

Can block ureters and can cause renal failure

83
Q

What presents with leukocytosis, foul discharge, and uterine tenderness?

A

Endometritis

84
Q

What causes endometritis?

A

Retained products of conception, IUD, or previous PID that promotes infection (MC B. fragilis)

85
Q

What presents with cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility and normal sized uterus?

A

Endometriosis

86
Q

What presents with dysmenorrhea, menorrhagia and enlarged soft uterus?

A

Adenomyosis

87
Q

What causes adenomyosis?

A

Hyperplasia of basalis layer

88
Q

What are you at risk for if you have too much estrogen exposure without progesterone?

A

Endometrial hyperplasia and possibly carcinoma

89
Q

Who is more likely to get leiomyoma?

A

BLACKS and 20-40yo

90
Q

What is leiomyoma stimulated by?

A

Estrogen (increases with pregnancy and decreases with menopause)

91
Q

What presents with enlarged uterus or uterine mass with severe bleeding?

A

Leiomyoma

92
Q

What tumor has greatest incidence and worst prognosis?

A

Incidence: Endometrial

Worst prognosis: Ovarian

93
Q

What are the levels of hormones in PCOS?

A

REALLY increased LH
Increased FSH, testosterone, estrogen (from test. aromatization)
Increased insulin
Decreased progesterone

94
Q

What happens with PCOS?

A

Insulin and testosterone decrease SHBG –> Inc free testosterone
LH increases due to pituitary/hypothalamus dysfunction

95
Q

What is the treatment for PCOS?

A

Weight, hirsutism, acne: OCP, antiandorgen
Infertility: clomiphene citrate
Insulin resistance: metformin (dec insulin so dec testosterone and allows LH surge)
Endometrial protection: cyclic progesterone (antagonizes endometrial proliferation)

96
Q

What is a follicular cyst?

A

Distention of unruptured follicle. Aw/ hyperestrogenism and endometrial hyperplasia. MC ovarian mass in young women

97
Q

What is a theca lutein cyst?

A

Bialteral/multiple often. Due to gonadotropin stimulation. Aw/ choriocarcinoma and moles.

98
Q

What is a dermoid cyst (aka mature cystic teratoma)?

A

Mature germ cell teratoma with fat, hair, teeth, bits of bone and cartilage. Can have thyroid tissue and cause hyperthyroid (struma ovarii)
Common in 20-30yo women

Malignant in males (inc hCG) not in females

99
Q

What origin are majority of malignant ovarian neoplasms?

A

Epithelial

100
Q

Which benign neoplasm is lined with fallopian like epithelium?

A

Serous cystadenoma

101
Q

What is struma ovarii?

A

Functional thyroid tissue inside a germ cell tumor (cystic teratoma aka dermoid cyst)

102
Q

Looks like bladder. What looks yellow-tan, encapsulated and had coffee bean nuclei on H & E?

A

Brenner tumor

103
Q

What is Meigs syndrome?

A

Ovarian fibroma, ascites, and hydrothorax

104
Q

What has bundles of spindle shaped fibroblasts?

A

Fibromas

105
Q

What is a thecoma?

A

Benign. May produce estrogen. Presents as abnormal uterine bleeding in postmenopausal women.

106
Q

What is an immature teratoma?

A

Aggressive, contains fetal tissue & neuroectoderm

107
Q

What tumor produces estrogen/progesterone and pw/ abnormal uterine bleeding, sexual precocity, breast tenderness, and call-exner bodies?

A

Granulosa cell tumor
MC sex cord stromal tumor; ~50yo
Call Exner bodies resemble primordial follicles

108
Q

What has sheets of fried egg cells, high hCG and LDH?

A

Dysgerminoma
MC In adolescents
Remember equivalent to seminoma

109
Q

What is a yolk sac tumor?

A

In sacrococcyeal area in young children, aggressive
Yellow, friable solid mass
Schiller duvall bodies (resemble glomeruli)
Increased aFP
Common in boys

110
Q

What is vaginal SCC?

A

Usually secondary to cervical SCC. Primary are rare

111
Q

What has spindle shaped tumorcells that are desmin +?

A 
Sarcoma botryoides (rhambdomyoscaroma variant)
Girls
112
Q

What is a movable small painless firm mass in the breast?

A

Fibroadenoma (stromal tumor)

Not a precursor to breast cancer inc with estrogen
Compresses epithelium spaces

113
Q

What presents with serous or bloody nipple discharge?

A

Intraductal papilloma

In lactiferous sinus. Increased risk for carcinoma

114
Q

What is a large bulky mass with leaf like projects?

A

Phyllodes Tumor (stromal tumor)

May become malignant

115
Q

What breast cancer is most aggressive?

A

Triple negative: ER, PR, Her2/Neu

Increased risk in african americans

116
Q

What cas caseous ductal necrosis?

A

Comedocarcinoma

117
Q

What often shows up early as microcalcifications on mammography?

A

DCIS

118
Q

What presents with eczematous patches on nipples and large cells with clear halo on histology?

A

Paget’s disease (those are paget cells)

From underlying DCIS

119
Q

What is a rock hard mass with sharp margins and small glandular duct like cells? See stellate infiltration and desmoplastic stroma.

A

Invasive ductal

MC and worst

120
Q

What has orderly row of cells?

A

Invasive lobular

Bilateral with multiple lesions in same location

121
Q

What breast cancer is fleshy cellular with lymphocytic infiltrate?

A

Medullary

Good prognosis

122
Q

What is inflammatory breast cancer?

A

Dermal lymphatic invasion. Peau d’orange from neoplastic cells blocking lymphatic drainage

123
Q

What are the proliferative breast disease?

A

Fibrosis: hyperplasia
Cystic: fluid filled, blue dome
Sclerosis adenosis: inc acini and intralobular fibrosis, calcifications
Epithelial hyperplasia: inc epi cell layers in terminal duct lobule

124
Q

How do you treat endometritis

A

Gentamicin + clindamycin

125
Q

How do you treat mastitis?

A

Dicloxacillin

126
Q

What causes gynecomastia?

A

Sprionolactone, marjiuana, digitalis, estrogen, cimetidine, alochol, heroin, dopamine antagonists, ketoconazole

127
Q

What is prostatitis?

A

Acute: bacterial (E. coli)
Chronic: abacterial (MC)

Dysuria, frequency, low back pain, urgency

128
Q

What were the things to remember with cryptorchdism?

A

Testosterone normal (leydig not temperature sensitive)
Decreased spermatogensis (sertoli temp sensitive)
Increased germ cell tumor risk
Prematurity increases risk
Inc FSH, LH; Dec inhibin
Testosterone dec in bilateral

129
Q

What are the tumor markers for prostate adenocarcinoma

A

PAP and PSA

130
Q

What is a seminoma?

A

Malignant, painless, hematogenous, fried egg appearance, large cells in lobules with watery cytoplasm

Increased ALP
Radiosensitive, late metastasis, great prognosis

131
Q

What is embryonal carcinoma?

A

Malignant, hemorrhagic mass with necrosis, painful, glandular/papillary; WORST

Usually mixed w/ other tumor types
Inc hCG and normal AFP when pure , inc AFP if not pure

132
Q

What is golden brown and has reinke crystals?

A

Leydig cell tumor

Androgen producing (gynecomastia, precocious puberty)

133
Q

What is a sertoli cell tumor?

A

Androblastoma from sex cord stroma

134
Q

What is a testicular lymphoma?

A

MC in older men; usually form metastates. Aggressive

135
Q

What are SCC of penis?

A

Bowen: penile shaft, leukoplakia
Erythroplasia of Queyrat: glans, erythroplakia
Bowenoid papulosis: ressidh papules

Aw/ HPV

136
Q

What is mifepristone?

A

Progesterone receptor antagonist

137
Q

When are OCPs contraindicated?

A

Smokers > 35yo (inc CV events), history of thromboembolism or stroke, or estrogen dependent tumor

138
Q

What is terbutaline?

A

Beta-2 agonist, relaxes uterus during labor

139
Q

What is Danazol?

A

Partial androgen receptor agonist

Used for endometriosis, hereditary angioedema

140
Q

What do you use for anabolism to promote recovery after burn or injury?

A

Testosterone

141
Q

What do you treat male pattern baldness with?

A

Finasteride (DHT causes it)

142
Q

What is flutamide?

A

Testosterone receptor inhibitor (blocks androgen binding)

143
Q

What do you treat prostate carcinoma with?

A

Flutamide and Leuprolide

144
Q

What do ketoconaozle and spironolactone do?

A

Keto: inhibits steroid synthesis
Spironolactone: inhibits steroid binding

145
Q

Where does smooth muscle relaxation occur with PDE5 inhibitors?

A

Corpus cavernosum

146
Q

Side effects of PDE5 inhibitors?

A

Flushing, headache, dyspepsia, blue green color vision problem

Life threatening hypotension in patients on nitrates

147
Q

What causes candida vaginitis?

A

Antibiotics most commonly (suppress normal flora like lactobacillus)

Also OCP, steroid, diabetes, immunosuppresion

148
Q

What increases in Down Syndrome?

A

hCG and inhibin

149
Q

What is vaginal agenesis (MRKH syndrome or mullerian aplasia)

A

No upper vagina (short vagina) and variable uterine development. XX with normal ovaries and secondary sexual characteristics.

150
Q

What are soft compressible masses that transilluminate? Found in the neck.

A

Cystic hygromas (associated with Turners)

151
Q

What does mumps orchitis cause?

A

Leydig cell atrophy (decreased testosterone), seminiferous tubule atrophy, and infertility.

Treat with testosterone

152
Q

Why do you see atretic follicles?

A

Lack of FSH exposure causes primordial follicles to undergo apoptosis

153
Q

What is nandrolone?

A

A steroid (athletes take it)

USMLE Step 1 Quick Notes (17 decks)

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