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Step Uno > Reproductive > Flashcards

Reproductive Flashcards

1
Q

Shh genes in develoment

A

AP axis and polarizing activity

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2
Q

Wnt-7 in development

A

doral ventral paterning (from apical ectoderm)

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3
Q

FGF in developmnet

A

mesoderm proliferation to lengthen limbs (from apical ectoderm)

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4
Q

Hox in development

A

segmentation of embryo

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5
Q

when does hCG secretion begin?

A

within 1 week of development as the blastocyst implants

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6
Q

what week is gastrualtion?

A

3

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7
Q

kidney origin

A

mesoderm

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8
Q

parafollicular C cells of thyroid lineage?

A

neural crest

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9
Q

sex organ origins

A

mesoderm

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10
Q

adrenal chromaffin cells origin

A

neural crest

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11
Q

nucleus pulposus of disc origin

A

notochord

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12
Q

Mesodermal defects

A

VACTERL: Vertebral defects, Anal atresia, Cardiac defects, TracheoEsophageal fistula, Renal defects, Limb defects

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13
Q

blood cell origin

A

mesoderm

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14
Q

Agenesis vs Aplasia

A

Agenesis is due to lack of primordial tissue.

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15
Q

When is the fetus most suseptible to teratogens?

A

week 3-8

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16
Q

Teratogen: ACE inhib (1)

A

renal damage

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17
Q

Teratogen: Alkylating agents (1)

A

absecnce of digits

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18
Q

aorticopulmonary septum origin

A

neural crest

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19
Q

melanocyte embryonic lineage

A

neural crest

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20
Q

Teratogen: aminoglycoside (1)

A

CN 8 tox

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21
Q

Teratogen: carbamazepine (4)

A

Also fetal hydratoin syndrome: neural tube defects, craniofacial defects, fingernail hypoplasia, growth restriction

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22
Q

Teratogen: Diethylstibestol (2)

A

vaginal clear cell adenocarcinoma, mullerian anomalies

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23
Q

Teratogen: Lithium (1)

A

Ebstein’s anomaly (atrialized right ventricle) (Dr. Epstien has no heart)

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24
Q

Teratogen: Phenytoin (1…thing)

A

Fetal hydantoin syndrome: microcephaly, dysmorphic craniofacial features, hypoplasic nails, cardiac defects, growth retardation, retardation

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25
Q

Teratogen: Tetracyclines (1)

A

discolored teeth

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26
Q

Teratogen: Thalidomide (1)

A

FLIPPER LIMBS.

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27
Q

Teratogen: Valproate (1)

A

This inhibits folate uptake. Neural tube defects

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28
Q

Teratogen: Warfarin (4)

A

bone deformities, fetal hemorage, abortion, ophthalmoloigcal abnormalities

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29
Q

Leading cause of birth defects?

A

alcohol

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30
Q

Teratogen: cocaine (3)

A

fetal addiction, ab development, placenta abruptio

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31
Q

Teratogen: Smoking (4)

A

preterm labour, placental problems, ADHD, growth retardation

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32
Q

Teratogen: Iodine (1)

A

congential goiter aka hypothyroidism aka cretinism

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33
Q

Teratogen: Maternal diabetes (3)

A

caudal regression syndrome (anal atresia to sirenomelia LOOKS LIKE A MERMAID), congenital heart defects, neural tube defects

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34
Q

Teratogen: vitamin A excess (2)

A

spontaneous abortion and defects

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35
Q

Teratogen: X-rays (2)

A

microcephaly, mental retardation

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36
Q

Fetal alcohol syndrome

A

leading cause of congential defects: mental retardation, development retardation, microcephaly, holoprosencephaly, facial abnormalities, limb dislocations, heart/lung fistulas

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37
Q

What secretes hCG?

A

syncytiotrophoblast

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38
Q

umbilical vessels derive from?

A

allantois

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39
Q

umbilical vessels: number, connect, and oxygenation

A

two arteries which deliever deoxygenated blood from fetal internal iliac arteries.
one vein which brings oxygenated blood from placenta to IVC via ductus venosus

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40
Q

what is the urachal duct?

A

3rd week yolk sac becomes allantois becomes urachus which is a duct between yolk sac and bladder

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41
Q

patent urachus

A

urine discharge from umbiliicus

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42
Q

vesicourachal diverticulum

A

outpouching of bladder

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43
Q

vitelline duct function and destiny

A

7th week this duct which connects yolk sac to midgut lumen is obliterated

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44
Q

vitelline fistula

A

meconium discharge from umbilicus

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45
Q

meckel’s diverticulum

A

part of vitelline duct persists to from true diverticulum of ileum. often has gastric mucosa

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46
Q

what does the aortic arches become?

A

arterial system only

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47
Q

1st aortic arch

A

part of maxilliary artery (branch of exernal carotid)

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48
Q

2nd aortic arch

A

Stapedial artery and hyoid artery (Second = Stapedial)

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49
Q

3rd aortic arch

A

3 = C. Common Carotid, and proximal part of interal Carotid artery

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50
Q

4th aortic arch

A

4 limbs (ie systemic). Left: aortic arch. Right: proximal part of right subclavian

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51
Q

6th aortic arch

A

proximal part of pulmonary arteries and ductus arteriosis (left)

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52
Q

Brachial cleft origin

A

ectoderm

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53
Q

brachial arch origin

A

mesoderm and neuro

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54
Q

brachial pouch origin

A

endoderm

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55
Q

1st brachial cleft

A

external auditory meatus

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56
Q

2nd - 4th clefts

A

temporary cervical sinuses. may persists as branchial clet cysts in lateral neck

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57
Q

1st branchial arch cartilage

A

M’s: Meckel’s cartilage, Mandible, Malleus, incus, sphenoMandibular lig

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58
Q

1st branchial arch muscles

A

M’s: Muscles of Mastication (temporalis, masseter, lateral/medial pterygoid) Mylohyoid, anterior of digastric, tensor tympani, tensor veli palatini

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59
Q

Brachial Arch Nerves Mnemonic

A

Chew/V2-3 (1), Smile/7 (2), swallow stylishly/9-stylopharyngeus(3) or simply swallow/10 sup-lary (4) and speak/10-recurrent lar (6)

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60
Q

2nd arch cartilage

A

S’s: Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament

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61
Q

2nd arch muscles

A

S’s: stapedius, stylohyoid, posterior belly of digastric. (facial expression muscles)

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62
Q

3rd arch cartilage

A

greater horn of hyoid

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63
Q

3rd arch muscles

A

styleopharyngeus

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64
Q

congential pharyngocutaneous fistula

A

fistula between tonsillar area and neck. persistance of 3rd branchial cleft and pouch

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65
Q

4-6th arch cartilage

A

thyroid, cricoid, arytenoids, corniculate, cuneifrom

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66
Q

4-6th arches muscles

A

pharyngeal and larynx muscles

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67
Q

what makes posterior 1/3 of tongue?

A

brachial arches 3 and 4

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68
Q

1st branchial pouch

A

middle ear/eustachian tube/mastoid air cells

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69
Q

2nd branchial pouch

A

tonsil epithelium

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70
Q

3rd branchial pouch

A

thymus and INFERIOR parathyroids

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71
Q

4th branchial pouch

A

superior parathyroids

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72
Q

DiGeorge syndrome

A

failure of 3/4 branchial pouches = no t cells and hypocalcemia

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73
Q

MEN 2A

A

mutation to RET in neuracrest. Pheos, parathyoid tumors (3/4 branchial pouchs), parafollicular cell tumor from NC

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74
Q

cleft lip vs cleft palate etiologies

A

lip: fusion of maxillary and medial nasal processes
palate: fusion of lateral/medial palatine process, nasal septum

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75
Q

which sex is default?

A

female

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76
Q

mesonephric duct “wolffian” vs paramesonephric duct “Mullerian”

A

male vs female GU structures

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77
Q

SRY gene

A

on Y chrom produces testies determining factor

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78
Q

Sertoli cells secrete _____ and leydig cells secrete ______ which cause

A

Mullerian inhibitory factor which blocks paramesonephric duct
Androgens which develop mesonephric ducts

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79
Q

Bicornuate uterus

A

incomplete fusion of paramesonephric ducts. heart shaped uterus

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80
Q

Hypospadia (what is, and cause)

A

opening of penis inferiorily…. due to failure of urethral folds to close

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81
Q

Epispadia (what is, cause, and association)

A

opening of penis above. faulty positioning of genital tubercle, bladder exstrophy (outside body)

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82
Q

descent of the testes: gubernaculum and process vaginalis

A

anchors testes within scrotum and forms tunica vaginals

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83
Q

descent of the ovaries: gubernaculum and process vaginalis

A

ovarian ligament + round ligament of uterus. obliterated

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84
Q

Venous drainage of gonads

A

left -> left gonadal vein -> left renal -> IVC
right -> right gonadal -> IVC
(just like adrenal veins)

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85
Q

which gonadal vein has higher pressure and risk

A

left cause of 90 degree entry point. varicocele more common

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86
Q

ovaries/testicular lymphatic drainage

A

para aortic nodes

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87
Q

outside of vagina and scrotum lymphatic drainage

A

superficial inguinal nodes

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88
Q

inside of vagina and utereus lymph nodes

A

obturator, external iliac and hypogastric nodes

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89
Q

Suspensitory ligament of ovary contains

A

Ovarian vessels

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90
Q

Cardinal ligament contains

A

Uterine vessels

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91
Q

Round ligament contains

A

Artery of Sampson

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92
Q

Broad ligament contains

A

Ovaries, Fallopian tubes and round ligament

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93
Q

Vagina and ectocervix histology

A

Stratified squamous

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94
Q

Endocervix histology

A

Simple columnar

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95
Q

Uterus histology

A

Simple columnar tubular glands

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96
Q

Fallopian tube histology

A

Simple columnar ciliated

97
Q

Ovary histology

A

Simple cuboidal

98
Q

Route Sperm takes

A

Seven up: seminiferous, epididymis, vas deferens, ejaculatory duct , (nothing), urethra, penis

99
Q

Erection pathway

A

Parasympathetic via pelvic nerve. Increase NO then cGMP.

100
Q

Emission (penis) pathway

A

Sympathetic via hypogastric nerve

101
Q

Ejaculation pathway

A

Visceral and somatic nerves via pudendal nerve

102
Q

Sildenafil and vardenafil

A

Inhibit cGMP breakdown so you won’t have a limp dick

103
Q

Sertoli cell function (6)

A

Inhibin which blocks FSH
Androgen binding protein to maintain high androgen
Tight junctions to create blood tested barrier
Nourish developing sperm
Antimullerian hormone
Temp sensitive

104
Q

Sperm development

A

Spernatagonium-tight junction-> primary (diploid)-> seconday (haploid ) spermatocyte -> split into spermatid-> (lumen) spermatozoon

105
Q

Ant pituitary on testies

A

LH- stims leydigs to make testosterone

FSH- stims sertoli go make ABP and Inhibin

106
Q

Hypothalamus released _______ to stim AP to stim testies

A

GnRH

107
Q

what converts testosterone to DHT? what inhibits it

A

5alpha-reductase. Finasteride

108
Q

what makes estrogen peripherally?

A

testosterone is converted to estrogen in adipose and leydig by aromatase

109
Q

what does exogenous testosterone do?

A

inhibit hypothalamus so less LH less testosterone in testicle and tiny balls

110
Q

estrone vs estradiol vs estriol potency

A

estradiol > estrone >estriol

111
Q

estradiol source

A

ovary

112
Q

estriol source

A

placenta

113
Q

androstenedione source

A

adrenal (weak ass testosterone)

114
Q

what indicates fetal well being?

A

1000X estriol

115
Q

estrogen effects on prolatin

A

upregulates it but blocks effects at breast

116
Q

estrogen effect on LH and FSH

A

feedback inhib

117
Q

carrier of estrogen and special fact

A

SHBG upregulated by estrogen

118
Q

what makes progestrone?

A

corpus luteum, placenta, adrenal cortex, testes

119
Q

high progesterone means what?

A

ovulation

120
Q

progestrone effects

A

maintain prego, decrease myometrial excitability, thick cervical mucus to block sperm, inhibit LH/FSH, decrease estrogen receptor

121
Q

how is estrogen made in ovaries

A

pulsatile GnRH promotes LH and FSH. LH activates Desmolase in Theca cells to Cholestrol –> Androstenedione. transported to granulosa cell which under influence of FSH aromatase makes estrogen

122
Q

tanner development stages

A

I: childhood II: public hair, breast buds III: public hair darkens, penis longer, breast larger IV: penis wider, darker scrotum, raised areolae, development of glans V: adult

123
Q

Stable vs unstable period of menstrual cycle

A

Variant follicular stage + 14 day luteal phase

124
Q

What stimulates endometrial growth?

A

Estrogen

125
Q

Estrogen during menst cycle

A

Slowly rises to peak at ovulation to promote continuous endometrial growth. Then falls and peaks again with progesterone

126
Q

Progesterone during men cycle

A

Rises after ovulation to maintain endometrium then falls off.

127
Q

LH during men cycle

A

One sharp peak at ovulation

128
Q

FSH during men cycle

A

Small FSH peaks preceded both estrogen peaks

129
Q

Describe ovulation

A

Increased GnRH on ant pit causing estrogen surge. Causes LH surge causes ovulation. Then temp increases causing progesterone surge.

130
Q

Mittelschmerz

A

Ovulation blood causes peritoneal inflammation mimicking appendicitis

131
Q

When does the egg pause?

A

Prophase I till puberty. Metaphase II after ovulation

132
Q

Fertilization timing and location and implant timing

A

Within a day of ovulation at upper end (ampulla) of Fallopian tube. Implants six days later

133
Q

Lactation initiation and maintenance

A

After labor progesterone drops so lactation not inhibited. Need suckling to maintain to stim nerves and oxytocin and prolactin

134
Q

hCG function

A

Maintain corpus luteum

135
Q

Pathological hCG elevation (3)

A

Dysgerminoma, choriocarcinoma, hydatidiform mole

136
Q

Menopause indicator

A

High FSH

137
Q

What causes menopause?

A

Low estrogen due to decline in ovarian follicles

138
Q

Klinefelter syndrome

A

XXY. Eunuch body type (the spider) but tall long, boobs. High FSH and estrogen in male.

139
Q

Turner syndrome

A

XO. Short, streak ovary, shield chest, bicuspid aortic valve, webbing of neck due to lymph problems, horseshoe kidney, coarctation of aorta.

140
Q

XYY male

A

Very tall, antisocial, acne

141
Q

How do testosterone and LH react to each other?

A

T stims T recept which inhibits LH. LH stims T release.

142
Q

what is a pseudohemaphrodite? male vs female

A

disagreement between internal and external genetalia. XY but looks like a female (but with testes) or XX but looks male

143
Q

true hermaphrodite

A

both ovary and testies. 46 XX or 47 XXY

144
Q

androgen insensitivity syndrome

A

XY female with rudimentary vagina. testes in labia

145
Q

kallmann syndrome

A

defective migration of GnRH cells and olfaction bulb. anosmia, no secondary sexual characteristics, no GnRH

146
Q

Honeycombed uterus or cluster of grapes

A

hydratidiform mole

147
Q

hydratidiform mole precursor of

A

choriocarcinoma

148
Q

abnormal vaginal bleeding and high beta-hCG

A

hydatidyl mole (cystic swelling of chorionic villi)

149
Q

snow storm appearance

A

hydatidiform mole

150
Q

treatment of hydatidiform mole treatment

A

treat like abortion: dialation, curettage, and methotrexate

151
Q

complete hydatidyl mole: hCG, uterine size, cancer, fetal parts, components, karyotype

A

very high hCG, leads to choriocarcinoma, no fetal parts, 2 sperm + empty egg, 46 XX/XY (normal), uterine enlarged

152
Q

partial hydatidyl mole: hCG, uterine size, cancer, fetal parts, components, karyotype

A

slightly high hCG, 69 XXX/XXY/XYY, normal uterus, rare cancer, yes fetal parts, 2 sperm + 1 egg

153
Q

preeclampsia features

A

hypertension, proteinuria, edema

154
Q

eclampsia features

A

preeclampsia + seizures

155
Q

HELP syndrome

A

Hemolysis, Elevated Liver enzymes, Low Platelets seen in pregnancy and associated with preeclampsia

156
Q

preeclampsia presentation

A

headache, blurred vision, ab pain, facial edema and limbs, altered mentation, hyperreflexia.

157
Q

preeclampsia mortality risk

A

cerebral hemorrhage and ARDS

158
Q

treatment for preeclampsia

A

deliever as soon as possible, MgSO4 (for seizures), and rest

159
Q

abruptio placentae

A

detachment of placenta. associated with cocaine, smoking, and hypertension, and DIC. life threatening for both

160
Q

painful bleeding in 3rd trimester

A

Abruptio placenta

161
Q

massive bleeding after delievery

A

placenta accreta

162
Q

painless bleeding during any trimester

A

placenta previa

163
Q

placenta accreta

A

placenta stuck to myometrium due to failure of decidual layer (previous C section). massive bleeding after birth

164
Q

placenta previa

A

placenta blocks cervical os. painless bleeding any trimester

165
Q

retained placental tissue may cause

A

hemorrage or infxn

166
Q

ectopic pregnancy common site

A

fallopian tubes

167
Q

ectopic pregnancy clues

A

history of amenorrhea, low hCG, sudden ab pain like appendeciitis, no chorionic villia

168
Q

ectopic pregnancy risk factrs

A

history of infertility, PID (Salpingitis), ruptured appendix, tubal surgery

169
Q

cause of poly vs oligo hydramnios

A

poly can’t swallow, oligo cant pee (or placental insufficency)

170
Q

HPV 16 inhibits

A

p53 by E6

171
Q

HPV 18 inhibits

A

RB by E7

172
Q

cervical in situ carcinomas

A

CIN 1,2,3 (progressively worse)

173
Q

risks for cervical cancer

A

multiple sexual partners, smoking, early sex, HIV

174
Q

cervical koilocytes

A

squamous cell carcinoma of cervix

175
Q

most common carcinoma of cervix and cause what?

A

SCC. can block ureters

176
Q

endrometritis treatment

A

gentamycin + clindamycin with or without ampicillin

177
Q

endrometriosis

A

ectopic endometral tissue (ovary or peritoneum). chocolate cysts

178
Q

abnormal cyclical bleeding, painful intercourse, infertility, severe menstrual pain

A

endrometriosis

179
Q

endometriosis treatment

A

oral contraceptives, NSAIDS, leuprolide, danazol

180
Q

Endometriosis vs Adenomyosis?

A

endometriosis is ectopic extra uterine. adenomyosis is in myometrium so uterus is enlarged. requires hysterectomy

181
Q

what causes endometrial hyperplasia? presentatoin?

A

excess estrogen, postmenopausal bleeding

182
Q

prolonged use of estrogen without progestins?

A

endometrial carcinoma

183
Q

most common gynocological malignancy

A

endometrial carcinoma

184
Q

leiomyoma

A

fibroid. benign tumor of smooth muscle which swells with estrogen. doesn’t progress. more common in blacks

185
Q

leiomyosarcoma

A

highly agressive tumor of myometrium

186
Q

gynecological tumor epidemiology

A

incidence: endomet > ovary > cervical (in US, cerv worldwide)
worse prognosis: ovarian > cervical > endometrial

187
Q

causes of anovulation ranked: name first 4

A

pregnancy, polycystic ovarian syndrome, obesity, HPO axis problem, premature ovarian failure, hyperprolactinemia, thyroid disorder, eating disorder, cushings, adrenal insufficency

188
Q

polycystic ovarian disease etiology

A

high LH leads to anovulation, low progesteron and theca cell androgen production (via high estrogen). associated with insulin resistance

189
Q

bilateral ovarian cysts, hirsutism, amenorrhea, infertlity

A

polycystic ovarian disease

190
Q

polycystic ovarian disease can lead to

A

endometrial cancer due to high estrogen

191
Q

treatment of polycystic ovarian disease

A

weight loss, low dose OCP or medroxyprogestrone, spironolactone (hirutism antag), clomiphine (help infertility), metformim (if diabetic too)

192
Q

most common ovarian mass in young women

A

follicular cyst (distended graafin follicule that is unruptured) due to high estrogen

193
Q

cyst associated with high GnRH

A

theca-lutein cyst

194
Q

most common ovarian germ cell tumor

A

teratoma

195
Q

teratoma types

A

mature (dermoid cyst): most common; immature teratoma: agressive; struma ovarii: has thyroid tissue (hyper thyroid)

196
Q

dysgerminoma

A

female version of seminoma. rare, sheets of uniform cells. turner sydrome. rare

197
Q

choriocarcinoma

A

malignancy of trophoblastic tissue with no chorionic villi. high hCG. endometriosis assocaition. Met to lungs

198
Q

yolk sac tumor

A

aggressive tumor of ovaries or testes. yellow, friable solid mass. high AFP. have Duval bodies which look like glomeruli.

199
Q

Krukenberg tumor

A

GI malignancy that mets to ovaries. mucin-secerting signet cells in ovaries

200
Q

serous cystadenoma vs adenocarcinoma

A

45% ovarian tumors each. fallopian tube-like lining. carcinoma has psammoma bodies. risks are BRCA1/2,HNPCC. frequently bilateral

201
Q

mucinous cystadenoma/adenocarcinoma

A

mucus secreting tumors

202
Q

CA-125

A

marker for ovarian cancer progression (not for screening)

203
Q

Brenner tumor

A

Benign, unilateral, looks like bladder. pale-yellow-tan gross and encapsulated coffee bean on H&E

204
Q

Meigs syndrome

A

triad of ovarian fibromas, ascites, and hydrothorax

205
Q

Granulosa cell tumor

A

secretes estrogen, causes precocious puberty, endometrial hyperplasia.

206
Q

Call-Exner bodies

A

small follicles filled with eosinophilic secretions found in granulosa cell tumors

207
Q

vaginal squamal cell carcinoma

A

usually secondary to cervicall SCC

208
Q

vaginal clear cell carcinoma

A

DES exposure in utero

209
Q

vaginal sarcoma botryoides

A

girls under the age of 4. spindle-shapped tumors that are desmin positive

210
Q

most common breast tumor

A

fibroadenoma (benign)

211
Q

benign breast tumor: small, mobile, firm mass with sharp edges. increases in size with estrogen

A

fibroadenoma

212
Q

benign breast tumor which is small and grows in the lactiferous ducts typically beneath areola. has bloodly discharge from nipple

A

intraductal papilloma

213
Q

large bulky breast tumor with lots of connective tissue and cysts. “leaf like” projections

A

phyllodes tumor. some may become malignant

214
Q

most important factor regarding the prognosis of malgnant breast cancer?

A

axillary lymph node mets

215
Q

most common location of breast cancer

A

upper-outer quadarnt

216
Q

Ductal carcinoma in situ

A

non-invasive tumor which fills ductal lumen (its just an early lesion, it will progress)

217
Q

comedocarcinoma

A

DCIS with caseous necrosis

218
Q

worst breast cancer

A

invasive ductal carcinoma

219
Q

most common breast cancer

A

invasive ductal

220
Q

breast cancer: firm, fibrous, “rock hard” mass with sharp margins and small, glandular duct-like cells

A

invasive ductal carcinoma

221
Q

breast cancer with “stellate” morphology

A

invasive ductal

222
Q

breast cancer with “indian file” orderly row of cells

A

invasive lobular

223
Q

the bilateral breast cancer

A

invasive lobular

224
Q

breast cancer that is fleshy, cellular, lymphocytic? prognosis?

A

medullary. good.

225
Q

breast cancer with skin involvement. “orange peel” skin

A

Inflammatory breast cancer

226
Q

Eczematous patches on nipple. Distinctive large cells with clear halo

A

Paget’s disease of the breast.

“I can see your halo! HALO! HALOOOOO!”

227
Q

Fibrocystic disease

A

most common cause of breast lumps. change size but are safe. different types

228
Q

infxn risk during breast feeding

A

acute mastitis. S. aureus

229
Q

drugs which give guys bitch tits (gynecomastia)

A

Some Drugs Create Awkward Knockers: Spironolactone, Digitalis, Cimetdine, Alcohol, Ketoconazole

230
Q

is BPH hypertrophy or hyperplasia?

A

hyperplasia (more cells)

231
Q

how to diagnose prostate adenocarcinoma

A

high PSA or PAP followed by biopsies. osteoblastic mets in bone develop in late sage causing lower back pain (Alk Phos signifies this)

232
Q

cryptorchidism

A

undecent of one or both testes. leydigs work fine but sertolis don’t. impaired spermatogenisis

233
Q

varicocele

A

enlargment of testicles (#1) due to venous blockage. “bag of worms” appearance

234
Q

testicular tumor painless homogeneous enlargment, most common, large cells with watery cytoplasm, “Fried egg” appearance. high alk phos

A

seminoma, treat with radiation

235
Q

yolk sac tumor in males

A

same as females. yellow egg. “duval bodies that look like glomerulii (high AFP)

236
Q

male choriocarcinoma

A

high hCG which mets to the lungs. gynecomastia

237
Q

male teratoma

A

malignant unlike female version

238
Q

malignant painful male testicular tumor

A

embryonal carcinoma

Step Uno (30 decks)

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