Reproductive- FA Flashcards
HER-2 has worse prognosis than Estrogen receptor positive in breast cancer. What molecule is HER-2? function?
tyrosine kinase receptor
=> promotes cell growth and proliferation
trastuzumab is antibody that targets HER-2, inhibiting cell growth
: antibody mediated cytotoxicity
Difference between partial vs. complete abruptio placentae?
complete: concealed hemorrhage
partial: apparent hemorrhage
Danazol
- MOA
- indications
- side effects
- androgen partial agonist
- endometriosis (reducing dysmenorrhea by negative feedback to FSH/LH-> inhibiting mestural cycle), hereditary angiodema
- heptatoxicity, hirsutism, masculization, also pseudomotor cerebri (so random)
Most effective emergency contraceptive?
copper IUD: local inflammation toxic to sperm and ova
Gubernaculum consists of which two ligaments in female? what is its function in male?
female- ovarian ligament and round ligament
*ligaments in upper region of uterus
male- holds testes within scrotum
Above which artery does the round ligament travel?
artery of Sampson
: tiny vessels that form anastomosis of uterine and ovarian artery
Leydig cell tumor
- histologic finding
- phenotypes- kid vs. adult
- Reinke crystals: eosinophilic cytoplasmic inclusions
- adult: gyenocomastia (estrogen from testosterone via aromatase)
- kid: precocious puberty (testosterone)
What is treatment for seizure prevention in preeclampsia? what is definitive treatment?
seizure prevention- 1st line: IV MgSO4, 2nd line: BDZ
definitive treatment: immediate delivery
*In fact, definitive treatment for all hypertensive complications of pregnancy (pre/eclampsia, HELLP) is immediate delivery of fetus
Disorders of Sex Development (DSD): explain each
- 46 XX DSD
- 46 XY DSD
- 46 XX DSD- ovary present, ambiguous external, virilization, excess androgen
- 46 XY DSD- testes present, ambiguous external (or female). Androgen insensitivity
- Bottomline: GONAD INTACT, EXTERNAL GENITALIA MESSED UP. It is matter of ANDROGEN (female- too much, male- too less)
Common theme of Klinefelter and Turner?
Hypergonotrophic hypogonadism
Klinerfelter: level of
- FSH
- LH
- estrogen
- testosteron
- FSH: high
- LH: high
- hypergonatrophic
- testosteron: low (Leydig not functioning)
- estrogen: high -> gynecomastia
- this is bit complicated. But bottomline is that
Dysgenesis of semiferous tubules
-> decreased inhibin -> high FSH -> more AROMATASE synthesis by FSH -> relative increase of estrogen by PERIPHERAL TISSUE
What estrogen form is predominant in ovary? What about adipose tissue?
17-beta estradiol (highest potency)
vs. adipose tissue: where estrone is predominant (2nd potency)
prolactin vs. oxytocin: which one induces milk letdown?
oxytocin
Clomiphene
- MOA
- indication
- side effects
- SERM, estrogen antagonist in HYPOTHALAMUS
- > reduced negative feedback -> increased FSH/LH
- > ovulation
- indicated for PCOS (anovulation)
- side effects: visual disturbance, hot flashes
Why tamsulosin is helpful in treating BPH without causing systemic vasoconstriction?
selective alpha agonist for alpha1-A/D
alpha1-B receptor is in vasculature: so no vasoconstriction
phenotype of 5alpha-reductase deficiency in male?
- internal genitalia
- external genitalia
internal genitalia intact
ambiguous external genitalia UNTIL PUBERTY
After puberty, testosterone can promotes masculinization
Role of DHT during
- early development
- late development (after puberty)
- early development
: external genitalia development, prostate DEVELOPMENT - late development (after puberty)
: balding, SEBACEOUS GLAND ACITIVTY, prostate GROWTH
Blood smear finding in HELLP syndrome?
Schistocyte
Low platelet => platelet used up for thrombi
-> shistocyte -> hemolysis
Describe gross features of fetal alcohol syndrome. These defects are due to defect in what embryological step?
- smooth philtrum
- thin vermilon border (upper lip)
- microcephaly (holoprosencephaly for severe form)
- small palpebral fissures (small eye opening)
due to cell migration defect
hCG level in ectopic pregnancy?
lower than expected rise in hCG
blood at urethral meatus. diagnosis?
urethral injury
Two different mechanisms that may cause
- anterior urethra damage
- posterior urethra damage
- anterior urethra damage: perineal straddle injury
: falling onto bicycle bar
-> bicycle bar press urethra against pubic symphysis
-> damage ANTERIOR side of urethra by pubic symphysis - posterior urethra damage: pelvic fracture
pelvic bone on posterior side can damage urethra from back
(there is good figure in picture folder)
histology
- ovary
- ectocervix
- endocervix
- transformation zone
- ovary: simple cuboidal
- ectocervix: squamous
- endocervix: columnar
- transformation zone: squamocolumnar, most common area for cervical cancer. Pap smear should have this cell type to be valid
Different mechanisms for contraception by using
- progestin
- antiprogestin
- progestin: thick cervical mucus, preventing sperm entrance => contraception before fertilization
- antiprogestin: inhibition of maintaining thick uterus wall => contraception after fertilization (termination of pregnancy)
Name of antiprogestrin for emergency contraception?
ulipristal
*Uli= sounds like URgenet
Ploidy and chromatids for
- spermatogonium
- spermatozoon
- spermatogonium: 2N,2C (diploid)
- GONIum= GOINg to be sperm. so before meiosis
- spermatozoon: 1N,1C (haploid)
What type of epithelium lines the uterus in the proliferative phase? In the secretory phase?
proliferative phase: columnar
secretory phase: coiled glands
prostate is derived from what embryological structure?
urogenital sinus
- gland= sinus
What is the gene responsible for proper organization along the dorsal-ventral axis?
Wnt-7
What is the gene responsible for lengthening of limbs?
FGF, through stimulating mitosis of mesoderm
FGF= fibroblast GROWTH factor -> limb GROWTH
Chorionic villi: name and location of two parts? role of each?
- cytotrophoblast: highly mitotic, cells division, inner layer
Cytotrophoblast, Cells - syncytiotrophoblast: beta-hCG, outer layer
SYNcytiotrophoblast, SYNthesizes hormone - hormone outside, cells inside
Phenotypes of endometriosis
- dyschezia: pain with defecation
- dysmenorrhea
- dyspareunia: pain with sex
- retroverted uterus: adhesion
- PAINFUL things in endometriosis
most common site of endometrial tissue growth in endometriosis?
ovary
What is amniotic band syndrome? what type of error in organ morphogenesis?
entrapment of fetal parts (hands, feet) in fibrotic amniotic bands
this is example of disruption: secondary breakdown of PREVIOUSLY NORMAL structure
notochord arises from which embryological layer?
mesoderm
- way to remember: notochord stimulates differentiation of overlying ectoderm into neural plate. So it is gotta be one layer below= mesoderm
What is Peyronie disease ?
abnormal penile curvature caused by a tunica albuginea fibrous plaque => erectile dysfunction
clear cell carcinoma of the vagina: due to exposure to what teratogen in utero?
Diethylstilbestrol
*also causes congenital Müllerian anomalies
what is Metrorrhagia ?
frequent or irregular mesnturation
What GI maliganancy is associated with ovarian cancer?
Lynch syndrome
- also associated with endometrial and skin cancer
Twinning: define when it occurs
- Dichorionic/ Diamnionic
- Monochrionic/ Diamnionic
- mono/mono
- mono/mono, conjoined
- Dichorionic/ Diamnionic
1. 2 eggs/ 2 sperms
2. before morula (day4) - Monochrionic/ Diamnionic
: between morula and blastocyst (4-8 days) - mono/mono
:after blstocyst (8-12 days) - mono/mono, conjoined
: too late: embryonic disc is formed, >13 days
During the third week of fetal development, what structure forms the allantois? Into which part of the fetus does it then extend? what does it become eventually?
yolk sac -> allantois -> it extends to urogenital sinus
- > allantois becomes urachus, , duct between bladder and umbilicus
- FA p. 572
During which week of development can the first male/female characteristics be distinguished?
10 wks, when genitalia shows to have characteristics
A woman receives antibiotics for mastitis but does not improve. Why are you worried?
Inflammatory breast cancer is often mistaken for mastitis (or Paget disease), so you should do an urgent workup for this diagnosis
What is triad of Meigs syndrome? what sensation pts complain?
triad
- ovarian fibroma
- ascites
- pleural effusion
patients complain pulling sensation in groin
Which part of 3rd and 4th brachial pouch give rise to inferior and superior parathyroid respectively?
dorsal wings
Pregnant mom is exposed to a teratogen that lead shielding could have blocked. What birth defects could occur?
Microcephaly and intellectual disability
: this teratogen is X-ray
urethra is derived from what embryological layer?
endoderm
What hormone is produced by thecoma? What is a common presentation?
- estrogen (it is like benign version of granulosa cell tumor)
- Although thecoma sounds like theca interna cell neoplasm, it is actually granulosa like
- pts commonly present with postmenopausal uterine bleeding
From which branchial arch subset is the cricothyroid muscle derived?
4th
- all intrinsic muscles of larynx EXCEPT CRICOTHYROID is derived from 6th
What germ layer gives rise to the adrenal cortex?
mesoderm
mandibular hypoplasia and facial anomalies: diagnosis? what defect in embryology?
Treacher Collins syndrome
: due to failure of first brachial arch migration
micrognathia, glossoptosis, cleft palate, and airway obstruction: diagnosis? what defect in embryology?
Pierre Robinson sequence
: due to failure of first brachial arch function
- similar defect with Treacher Collins, yet completely different phenotypes
How may varicocele result in infertility?
limited blood drainage
- > increased scrotum temperature (blood is warm!)
- > decreased spermatogenesis
What is common site of metastasis in choriocarcinoma? how does it spread (lymph? or blood?)
lung -> may cause hemoptysis
spread hemtogenously
- one of 4 exceptions of carcinoma
- RCC
- HCC
- Choriocarcinoma
- follicular cell carcinoma of thyroid
Both complete hydatidifrom mole and choriocarcinoma can result in high hCG in lab. How to differentiate these two?
complete hydatidifrom: cystic swelling of chorionic villi
choriocarcinoma: no chorionic villi
* think like this: in choriocarcinoma, neoplasm is pretty advanced and chorionic villi is gone
Barr body
- what is it
- describe histologic finding
- what disease?
- inactivated X chromosome
- dumbbell shaped extension nucleus
: looks like tiny spot is coming out from nucleus, localizing in the edge (google it) - Klinefelter
- No Barr body in Turner. just one X is missing
Which nerve mediates erection, emission, ejacuation
erection: Parasympathetic, Pelvic
emission: Sympathetic, Hypogastric
ejacuation: Somatic, Pudendal
Point SHoot, SPoon
Two types of ovarian cyst? Each is associated with what other conditions?
- follicular: associated with hyperestrogen (so endometrial hyperplasia)
- many follicles are making cyst. Remember estrogen is required to mature follicles and induce ovulation. So hyperestrogen leads to make more follicles
- theca-lutein cyst: Due to gonadotropin stimulation. associated with choriocarcinoma or hydatidiform moles
- Luteinized follicles are making cyst. Remember choriocarcinoma or hydatidiform moles are associated with trophoblast, which exists only when fertilization occur, thus leuteinized follicles
What is the most common benign ovarian tumor in female age of 10-30?
MATURE cystic teratoma
Why OCP can be helpful in endometriosis
OCP -> negative feedback to FSH/LH
- > inhibit ovulation/ menstural cycle
- > reduce pain in dysmenorhhea
What is the most common testicular cancer among older men? Is it aggressive or indolent?
Testicular lymphoma (it is NOT a primary tumor but arises when lymphoma metastasizes to the testes)
aggressive
High testosterone. What lab test helps distinguish a defect in the androgen receptor from a testosterone-secreting tumor?
LH test
- defective androgen receptor: no negative feedback, high LH
- testosterone secreting tumor: negative feedback still intact, low LH
How to treat androgen insensitivity syndrome, 46XY?
testes are often present in labia majora
surgical removal to prevent malignancy
What is thought to be the etiology of preeclampsia?
Abnormal placental spiral arteries leading to maternal endothelial dysfunction, vasoconstriction, and ischemia
-> HTN, proteinuria (ischemic renal damage), end organ dysfunction
cryptorchidism: level of
- inhibin
- testosterone
- LH
- FSH
- inhibin: sertoli cells not functioning due to high temperature, also aspermatogenesis
- testosterone: can be normal (leydig cell is not affected by high temperature)
can be decreased in bilateral cryptochidism - LH: high
- FSH: high
clear cell adenocarcinoma of vaginal tumor is associated with in utero exposure of what chemical?
DES (diethylstilbestrol)
maternal diabetes: oligo or polyhydramnios? why?
polyhydramnios
: maternal diabetes -> neural tube defect (anancephaly)
-> defect in swallowing center
Effect of testosterone therapy on serum lipid- LDL and HDL?
high LDL, low HDL => premature CAD
: opposite with estrogen!
(estrogen is beneficial in terms of lipid)
From which fetal structure are the umbilical arteries and veins derived?
allantois
What is the most common risk factor for cervical cancer?
multiple sexual partners
lack of barrier contraceptive (condom) is next
What germ layer gives rise to the upper vagina? The lower vagina?
upper: mesoderm ( mullarian duct)
lower: endoderm (derived from urogenital sinus)
Explain how pregnancy can result in transient hyperthyroidism
beta-hCG has alpha subunit equivalent to TSH
best serum test to confirm that menopause
FSH: decreased estrogen reduces negative feedback on FSH
Differentiate Tanner stage 4 and 5 in female
stage 4:
- pubic hair growth, but spares medial thigh
- raised areola, mound on mound
stage 5:
- pubic hair extends to medial thigh
- flattened areola
Cardinal ligament connects which two parts?
CERVIX to lateral side wall of pelvis
Define Menorrhagia
Heavy menses with greater than 80 mL blood loss or menses that last for more than 7 days.
REGULAR mens cycle
(vs. menometrorrhagia, irregular heavy menses)
Major source of beta-hCG during 8-10 wks? After 10 wks?
8-10wks: when beta-hCG peaks, synthesized from Corpus Luteum
After 10wks: placenta takes it over.
Most common age group for dysgerminoma?
adolescents
Most common age group for yolk sac tumor?
<3 yrs old
- everything is YOUNG in YOlk sac
- alpha-fetoprotein (feto=young)
- young age group
What happens in 4 wks of embryology
upper/lower limb buds formation
heart beating
4 limbs and 4 chambers of heart during 4 weeks
Explain how anemia develops during pregnancy
relative dilution effect
plasma level increases (by 50%) more than RBC (by 30%)
- this makes sense: it is easier to get volume overloaded than making new cells
During which part of the menstrual cycle is follicular growth fastest?
2nd week of follicular phase
- It is not first week. follicular maturation peaks before ovulation, thus 2nd week
Embryological origin
- upper 1/3 vagina
- lower vagina
- upper 1/3 vagina: Mullerian duct, mesoderm
- Mullerian, Mesoderm
- lower vagina: urogenital sinus ,endoderm
- urogEnital sinus, Endoderm
What is full score of APGAR? what is cut off for further evaluation? What is cut off for pulse between score 2 and score 1?
- 10 points total
- score <7 requires further evaluation
- pulse >100: score 2, pulse <100, score 1, score 0 is for no pulse
Which form of estrogen has the greatest increase during pregnancy?
estriol: x1000 folds, compared to other forms, estradiol or estrone, which typically show x50 folds increase
What form of estrogen is indicator for fetus well being?
estriol
* estriol is mostly in placenta, healthy placenta, healthy baby, more estriol
genotypes of Turner?
45 XO
45 XO/46 XX : mosaicism due to mitotic error
Embryological layer origin
- follicular cells of thyroid
- parafollicular cells of thyroid
- follicular cells of thyroid: endoderm
- parafollicular cells of thyroid: neural crest (P in MOTELPASS)
Which internal organs (5) are derived from mesoderm?
spleen, kidney, adrenal cortex (vs. medulla- neural crest), ovaries, testes
Embryological later origin
- epidermis
- dermis
- epidermis: ectoderm
- dermis: mesoderm
how to calculate gestational and embryonic ages?
- gestational age: since last mens
- embryonic age: since conception (gestational age- 2wks)
Explain mechanism of development of hypotension in HELLP syndrome
hepatic subcapsular hematoma
-> rupture -> hypotension
Name three hormones that share same alpha subunit of beta-hCG
FSH, LH, TSH (can cause transient gestational hyperthyroidism)
Phenotypes of 47XYY? (5)
very tall
normal fertility, learning disability, acne, autism
vs. Klinefelter
woman who has not had her period for 8 weeks presents with severe LLQ pain without vaginal bleeding. Diagnosis?
Ectopic pregnancy
- not always accompanied by vaginal bleeding; the key is pain (with or without bleeding) and amenorrhea
From which branchial arch subset is the lesser horn of the hyoid derived? what about greater horn of hyoid?
lesser- 2nd arch
greater- 3rd arch
lesser- less number than greater, so 2nd for lesser and 3rd for greater
Is multiparity or nulliparity cause of endometrial cancer? why?
nulliparity
- It is true that estrogen is higher during pregnancy, but RELATIVELY higher PROGESTERONE is opposing action of estrogen (progesterone INHIBITS ENDOMETRIAL HYPERPLASIA).
two methods are used to diagnose cervical dysplasia?
Colposcopy and biopsy
Biopsy first, followed by colposcopy
Define terms: malformation vs. deformation
- malformation: intrinsic failure of development during embryonic period (3-8wks)
- deformation: extrinsic failure after embryonic period
Placenta accreta/increta/percreta is associated with what endocrine disorder?
Placenta accreta/increta/percreta
- > no separation of placenta after delivery
- > postpartum bleeding
- > Sheehan syndrome
When is embryonic period? what is happening during this period?
3-8 weeks
oraganogenesis
*this is the time when organ development is mostly affected by teratogens
umbilical arteries shunt deoxygenated blood to the placenta out of which arteries in the fetus?
Fetal internal iliac arteries
3-year-old girl presents with a clear grape-like polypoid mass emerging from her vagina. Diagnosis?
sarcoma botryoids (embryonal rhabdomyosarcoma variant)
sarcoma botryoids: what is histologic marker?
desmin
- desmin is transcription factor only found in immature muscle cells
palpitations, sweating, weight loss, and a low level of thyroid-stimulating hormone. What ovarian pathology may be responsible?
struma ovarii: mature teratoma with FUNCTIONAL thyroid tissue
Level of FSH in PCOS?
FSH is also increased with lesser extent than LH
=> it is RATIO of LH:FSH that matters. Due to high LH, even with elevated FSH, ovulation does not occur in PCOS
What two phenotypes may be seen in most severe form of fetal alcohol syndrome?
- lung-heart fistula
- holoprosencephaly
history of cervical carcinoma now has oliguria and a creatinine of 4.0 mg/dL (high). What is the likely cause?
LATERAL invasion of cervical carcinoma
-> blocking ureters -> hydronephrosis and postrenal renal failure
Pilots, especially those flying at night, are not allowed to take PDE-5 inhibitors before or during the flight. Why might this be?
PDE-5 inhibitors can cause blue-green vision impairment. This is called cyanopia
How would intelligence test look like in Klinefelter?
impaired. It may be normal too.
So it is both.
But always keep in mind that intellectual disability is possible in Klinefelter
How is progesterone drop after delivery associated with lactation?
progesterone inhibits prolactin
drop in progesteron -> disinhibition of prolactin
-> lactation
*conversely, estrogen stimulates prolactin
What germ layer gives rise to the endocardial cushions?
ectoderm
Histologic finding for granulosa cell tumor
microfollicular pattern surrounded by eosinophilic fluid.
: Call-Exner bodies
mesonephric duct gives rise to what structures?
SEED and trigone of bladder
S- seminal vesicles E- ejaculatory tract E- epidymis D- ductus deferans Trigone of BLAADER
- prostate is completely independent structure. It arises from urogenital sinus with DHT
Risk of which breast cancer genotype is increased with African American background?
triple negative (negative for ER, HER2, PR-progesterone receptor)
- African, breast cancer, but cleanest one
- triple negative is MORE AGGRESSIVE than other positives
Why increased risk for DVT/PE during pregnancy
hypercoagulability due to stasis
physiologically it minimizes blood loss during delivery
How to treat lactational mastitis?
antibiotics and KEEP BREASTFEEDING
- Continuing breastfeeding helps clearing out infection, while not harming baby
From which branchial arch subset is the posterior belly of the digastric muscle derived? what about anterior bell of digastric muscle?
anterior bell of digastric muscle: 1st
posterior bell of digastric muscle: 2nd
Ectoderm gives rise to what big three embryological origins?
surface ectoderm
neuroectoderm
neural crest
Leiomyoma (fibroid) is tumor of what type of cell in endometrium?
smooth muscle
vasa previa
- what is it
- etiology
- classic triad
- fetal vessels runs over cervical os
- umbilical cord inserted to chorioamniotic membrane, not placenta
- classic triad
1. fetal bradycardia
2. PAINLESS vaginal bleeding (it is fetal blood, not mom’s)
3. membrane rupture
Epithelial histology of fallopian tube?
CILIATED simple columnar epithelium
- think fimbriae of fellopian tube. Ciliated.
Normal appearing woman, scant sexual hair, no ovaries/ no uterus, rudimentary vagina, mass in labia majora
- What disorder is this? what genotype? explain each phenotype
46 XY, androgen insensitivity syndrome
- AMH => no ovaries, no uterus rudimentary vagina (upper 1/3 is from Mullerian duct, so it is messed up, while lower 2/3 is intact)
- insensitivity to androgen receptor
=> scant sexual hair
=> no male external genitalia
=> mass in labia majora: testes in labia majora, which is equivalent to scrotum in male. - Looks like Female, but has nothing inside and XY chromosome.
Gyenocology tumors: order worst to best prognosis, what about incidence? (US. vs. worldwide)
- cervical cancer
- ovarian cancer
- endometrial cancer
prognosis (worst -> best)
- ovarian > endometrial > cervical
incidence (most common -> least common)
- U.S.
endometrial > ovarian > cervical
- Worldwide: lack of HPV vaccination/screening
cervical > endometrial> ovarian
hemoptysis is associated with what gynecologic cancer? why?
choriocarcinoma, often spread to lung hematgenously
A pregnant woman has evidence of virilization during her pregnancy. Fetal androgens are detected in her blood. What is the likely diagnosis?
Placental aromatase deficiency in her fetus (fetal androgens can cross the placenta and cause maternal virilization)
Female: embryological origin of Bartholin glands and Gartner duct?
Bartholin glands: urogenital sinus
Gartner duct: remnant of mesonephric duct
What germ layer gives rise to the aorticopulmonary septum?
ectoderm
A woman has low human chorionic gonadotropin levels for gestation. Name three scenarios that could result in this observation.
- ectopic/failing pregnancy
- Edwards syndrome
- Patau syndrome
What structure do the urogenital folds develop into in male? female?
- male: ventral shaft of penis
- hypospadias is result of failure closure of urogenital folds
- female: labia minora
A woman has vaginal bleeding, enlarged uterus, pelvic pressure/pain, theca-lutein cysts, hyperthyroidism, and hyperemesis. Diagnosis?
hydatidiform mole
all phenotypes are result of high beta-hCG
Embryology: when does heart start to beat? when is cardiac activity visible by transvaginal ultrasound
- week 4: heart starts beating
- week 4, 4 chambers
- week 6: cardiac activity visible by transvaginal ultrasound
fully developed secondary sex characteristics with primary amenorrhea. ovaries are functional. diagnosis?
Mayer-Rokitansky-Küster-Hauser syndrome
: Müllerian agenesis
- mullerian agensis
=> no uterus -> primary amenorhhea
=> ovaries are still intact (ovaries are derived from mesoderm) -> fully developed secondary sex characteristics
What germ layer gives rise to the parotid glands?
ectoderm
immature teratoma is derived from what embryologic layer?
neuroectoderm
teratoma: male vs. female- what is big difference?
female- mature teratoma is benign, immature teratoma is malignant
male- even mature teratoma is malignant
Two cancers originated from neuroectoderm?
- ewing sarcoma
- immature teratoma (female ovarian cancer)
histologic finding of leydig cell tumor?
Reinke crystals: eosinophilic cysoplasmic inclusions
Most common testicular cancer in older man?
metastatic lymphoma
: usually diffuse large B cell lymphoma
Which hormone is responsible for growth spurt and closure of epiphyseal plate (thus short stature in precocious puberty)?
estrogen
- NOT testosterone. testosterone is indirectly causing it as it gets converted to estrogen. but it is ESTROGEN that is directly associated with it.
difference between fibroadenoma and fibrocystic change?
fibrocystic change is often bilateral, while fibroadenoma is focal, solitary lump
- they both present as mass with increased tenderness with high estrogen
Does adenomyosis present as painful mens?
yes.
Along with endometriosis, adenomyosis also give dysmenorrhea. But not dyspareunia (painful intercourse) as adenomyosis is limited to myometrium
when is onset of pre-eclampsia?
after 20 weeks of gestation
most common condition for bloody discharge from nipple?
intraductual papilloma
marker for seminoma
placental ALP
Which structure is remnant of Mullerian duct in male?
appendix testis
- little tiny thing coming out from testis (like ductus arteriosus) google it.
