Term
| What is the most common form of cancer in women in the US? |
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Definition
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Term
| Since the breast is simple a modified sweat gland, what germ layer does it rise from? |
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Definition
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Term
| What is the name of the node normally identified to determine metastasis in breast cancer? |
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Definition
| Sentinel node, normally in the axillary areas |
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Term
| Which of these arteries supply the breast - internal thoracic, axillary artery, adjacent intercostals artery? |
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Definition
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Term
| Which route does veinous and lymphatic drainage follow when removing fluid from the breast? |
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Definition
| The same routes as the arteries, primarily towards the axilla |
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Term
| Why is Batson’s plexus significant in breast and pelvic cancers? |
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Definition
| Venous channels branch between the thoracic, abdominal, and pelvic organs which all extend to the vertebra and skull - this leads to easy routes of metastasis to vertebra, skull, and CNS |
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Term
| Which level of lymph nodes receive most of the drainage from the upper extremity - level 1, 2, or 3? |
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Definition
| Level 1 which is lateral to the pectoralis minor |
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Term
| True or False: Early full term pregnancy is protective against breast cancer. |
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Definition
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Term
| Which nerves are the primary sensory innervatino of the breast tissue? |
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Definition
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Term
| Since the glandular tissue of the breast is not completely developed until pregnancy occurs, what is the term of the initial secretion of milk that contains high IgA, lipids, proteins, lactose, and plasma/lymphocytic cells? |
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Definition
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Term
| Are infants who are breastfed healthier than non-breastfed? |
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Definition
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Term
| Abnormal secretion of prolactin can cause amenorrhea, infertility, and osteoporosis by inhibiting what hormone? |
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Definition
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Term
| What hormones have a positive and negative effect on prolactin release by the anterior pituitary? |
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Definition
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Term
| During pregnancy initially there is a rise in prolactin but there is no lactation, why is that and when does it resolve? |
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Definition
| There is no lactation initially because of E/P, but after delivery there is a drop in E/P and prolactin can act on the breast(and also suppresses ovulation). |
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Term
| What is the most common breast abnormality? |
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Definition
| Lump, that can either be cyst, fibroadenoma, cancer. |
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Term
| What is the difference between sexual orientation and behavior? |
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Definition
| Orientation - self-ID based on identity, behavior, desires; behavior - gender of one’s partners |
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Term
| Which of the following apply to the LGB population of patients - higher levels of unmet healthcare needs, higher CVD risks, higher substance use and abuse, higher levels of STDs/risk factors, greater mental health issues, lower disclosure rates due to lack of comfort or poor treatment from doctor? |
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Definition
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Term
| Thanks to the classic work of Jost, sexual differentiation of somatic tissue is entirely controlled by what? |
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Definition
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Term
| True or False: WNT-4 is a female specific signaling molecule and duplication of the gene that produces it masculinizes XX individuals. |
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Definition
| False, feminizes XY patients |
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Term
| How do the SRY gene and the SOX9 transcription factor gene relate to disorders of sexual development in general? |
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Definition
| Loss-of-function or point mutations in those genes cause DSDs |
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Term
| What is the most frequent cause of human intersexuality and what does it do? |
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Definition
| CAH, which is auto recessive and has a defect in the 21-hydroxlase enzyme in most cases, causes an accumulation of androgens that virilize the XX fetus and risk salt-wasting problems, which is treated with gluco/mineralocorticoid treatment. |
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Term
| What are the causes of feminized XY and masculinized XX patients? |
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Definition
| Test synthesis defect or androgen resistance; excess of androgens |
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Term
| Androgen resistant patients, which is x-linked, have normal testes but female external genitalia, describe what differs in complete, partial, and mild AR? |
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Definition
| Complete - female phenotype, two testes, no uterus, elevated LH; Partial - micropenis, no utuerus, elevated LH; Mild - phenotypic men with azoospermia(no sperm production) and elevated LH. |
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Term
| The current method for the gender ID for DSD patients is to go by gender of rearing because the gentalia are crucial to adjustment, however, there is believe that a child should be raised according to prenatal androgens, why? |
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Definition
| Because it reflects brain masculinization |
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Term
| What is the diagnosis for these classical symptoms - nervousness, heat intolerance, weight loss, increased apetite? |
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Definition
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Term
| What is the diagnosis for these classical symptoms - polyuria, polydypsia, and polyphagia? |
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Definition
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Term
| What is the diagnosis for these classical symptoms - squeezing chest pain, with or without radiation to jaw or arm? |
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Definition
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Term
| What is an occipital headache? |
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Definition
| A classic pituitary headache that occurs between the eyes, originating in the occipital lobe which contains the visual processors |
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Term
| True or False: Pituitary tumors cause a loss of hormones in the following sequence - GH, gondaotropins, TSH, ACTH. |
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Definition
| True, except for lymphocytic hypophysitis which is characterized as follows - TSH, ACTH, GH, Gonado |
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Term
| Symptoms of excess or lack of pituitary hormones is frequently related to a patient’s ___________. |
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Definition
| Age, for example excess GH in child gives gigantism, in adult gives acromegaly; GH deficiency in child = short, in adult = few signs, fatigue; prolactinoma in menstruating female causes ameno/galactorrhea, in menopausal woman only sign may be headache. |
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Term
| EPI stims which of the following - glycogenolysis, glucogenesis, lipolysis, insulin secretion by pancreas? |
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Definition
| All except insulin secretion, it inhibits it. |
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Term
| Serotonin is an important ____________ messenger in the brain and neurotransmitter in the gut. |
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Definition
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Term
| Describe the synthesis of 5-HT and its process of removal from the plasma. |
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Definition
| 5-HT is made by EC cells throughout the entire GI, it is then eliminated partly by SERT transporters on mucosal enterocytes, the 5-HT in circulation is sequestered by platelets, remaining 5HT goes to portal blood and metab by liver to 5-HIAA, finally low plasma levels of 5HT are maintained by endothelial cells of lung with MAO that create 5-HIAA. |
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Term
| True or False: most drugs that cause vasodilation usually have headache as a side effect. |
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Definition
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Term
| Describe the 2 step process of alcohol metabolism that accounts for 80-90% of processing. |
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Definition
| Alcohol->alcohol dehydrogenase in liver->acetaldehyde->aldehyde dehydrogenase in mitochondria->acetic acid |
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Term
| The microsomal ethanol oxidizing system account for 10-20% of alcohol processing to acetaldehyde and utlitizes the CYP450 2E1 enzyme, however, CHRONIC administration of alcohol results in elevated levels of 2E1 enzyme, so how does this affect metabolism of other drugs? |
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Definition
| It increases there rate of metabolism |
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Term
| What OTC pain med causes the most common form of acute liver failure in the US by creating toxic metabolites? |
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Definition
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Term
| Acute administration of alcohol can decrease metab of other drugs due to competition for what enzyme? |
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Definition
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Term
| Although purines are metabolized in all tissues, urate is produced only in tissues with xantine oxidase which is primarily in what two organs? |
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Definition
| Liver, small intestine; however, only 8-12% or uric acid is actually excreted |
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Term
| Describe the pathology of Gout in one brief sentence. |
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Definition
| Uric acid builds up in acidic peripheral joints where the resulting crystals are eaten by synoviocytes which emit inflammatory mediators. |
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Term
| Why is disulfiram used in management of alcohol abuse? |
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Definition
| It inhibits aldehyde dehydrogenase which creates a toxic level acetaldehyde to build up and make people have flushing, nausea, and vomiting |
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Term
| Describe the drugs used to treat an ACUTE gout case. |
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Definition
| Colchicine prevents phagocytosis of urate crystals by leukocytes(but causes GI toxicity), non-aspirin NSAIDS/glucocorticoids reduce the inflammation and inhibit crystal phagocytosis. |
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Term
| Describe the drugs used in CHRONIC management of gout. |
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Definition
| Allopurinol prevents purine formation by blocking xantine oxidase, Probenecid/sulfinpyrazone increase uric acid secretion |
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Term
| True or False: drugs used to treat gout chronically can also treat it acutely. |
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Definition
| False, These drugs are of no value in acute gout and may actually worsen the attack due to abrupt changes in blood urate concentration. |
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Term
| The absorptive phase during nutrient absorption/anabolism is activated by an _________ in the insulin:glucagons ratio, and the post-absorptive phase during fasting/catabolism is activated by ____________ in the insulin:glucagons ratio. |
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Definition
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Term
| Directly mobilizing fuels via gluconeogenesis and lipolysis can be attributed to what hormone and neurotransmitter released during stress? |
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Definition
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Term
| How does stress and the resulting EPI release affect insulin and glucagons secretion? |
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Definition
| EPI inhibits insulin secretion; EPI increases glucagons directly and indirectly via the decrease in serum insulin |
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