1
Q
site of nutrient and gas exchange between fetus and mother
A
placenta and umbilical cord
2
Q
fetal portion vs maternal portion of the placenta comes from
A
fetal; chorionic sac
maternal; decidua functionalis (functional layer of endometrium)
3
Q
female and male reproductive tract embryonic structures “ultimate overview”
A
mesoderm (epithelium), mesenchyme and primordial germ cells
4
Q
germ cells
A
develop wk 4 in yolk sac; migrate out of hindgut and get incorporated into primary sex cords at wk 6
into secondary sex cords into oogonia
oogonia get covered by cuboidal epithelium to become primary follicles
5
Q
when do female characteristics start to develop in embryo
A
wk 7
6
Q
paramesonephric ducts (mullerian ducts)
what do the distal and proximal ends become?
A
develop lateral to mesonephric kidneys from invaginations of mesothelium
distal ends fuse to form uterovaginal primordium (ultimately divide into uterus and vagina)
proximal ends form ovarian tubes
7
Q
xx vs xy
A
xx= female
xy=male
8
Q
primary sex cords in males during embyro- what happens
A
have outer cortex and inner medulla; cortex will regress and medulla becomes testicular tissue via the Y chromosome
9
Q
when does testosterone start developing from testes in embryo to develop male genitals
A
wk 7
10
Q
descent of testis in embryo
A
During embryonic development, the testes descend from the posterior abdominal wall through the inguinal canal into the scrotum, guided by the gubernaculum.
mesonephric kidneys atrophy at wk 7 and gubernaculum form (attached to developing testis)
gabernacula guide testes down through inguinal canals
fully descend into scrotum at or after birth
11
Q
leydig cells and sertoli cells in embryo
A
leydig: devleop ot of seminiferous tubules; secrete testosterone
sertoli: produce mullein inhibiting substance to block formation of female structure
spermatogonia from primordial germ cells also develop
12
Q
mesonephric ducts (wolffian ducts) in male embryo become what
A
proximal to distal: epididymis, vas deferens, ejactulatory duct
lateral outgrowth become seminal vesicles
many outgrowths form prostate
13
Q
male vs female reproductive tract embryo
what are the 2 ducts
A
Both sexes start with two paired ducts: the mesonephric (Wolffian) and paramesonephric (Müllerian) ducts.
In males, testosterone promotes Wolffian duct development (into vas deferens, epididymis, seminal vesicles), while Müllerian Inhibiting Substance (MIS/AMH) causes regression of the Müllerian ducts.
In females, absence of AMH and testosterone allows Müllerian ducts to develop into the fallopian tubes, uterus, cervix, and upper vagina, while the Wolffian ducts regress.
14
Q
when does gonadal ridge form
A
wk 5
15
Q
spermatogenesis steps
A
Spermatogenesis Steps:
1. Spermatogonia (diploid, 2n) — stem cells located in the basal layer of the seminiferous tubules undergo mitosis to maintain the stem cell pool and produce primary spermatocytes.
- Primary spermatocytes (diploid, 2n) — enter meiosis I, where homologous chromosomes separate.
- Secondary spermatocytes (haploid, n) — result from meiosis I; these quickly enter meiosis II.
- Spermatids (haploid, n) — result from meiosis II; immature sperm cells with single sets of chromosomes.
- Spermiogenesis — transformation of spermatids into mature, motile spermatozoa (loss of cytoplasm, development of tail, condensation of nucleus).
- Spermatozoa — mature sperm released into the lumen of seminiferous tubules and transported to the epididymis for further maturation and storage.
spermatogonia –> primary spermatocyte –> first meiotic division –> two secondary spermatocytes –> second meiotic division –> four spermatids –> four sperm or spermatozoa
16
Q
steps of oogenesis
A
- Oogonia (diploid, 2n)
Multiply by mitosis during fetal development. - Primary oocytes (diploid, 2n)
Enter meiosis I during fetal life but arrest at prophase I until puberty. - At puberty, each menstrual cycle:
A primary oocyte completes meiosis I, producing:
Secondary oocyte (haploid, n) (large cell)
First polar body (small, usually degenerates) - Secondary oocyte begins meiosis II but arrests at metaphase II until fertilization.
- If fertilization occurs:
Secondary oocyte completes meiosis II, producing:
Ovum (haploid, n) (mature egg)
Second polar body - If no fertilization:
Secondary oocyte degenerates.
primary oocyte in primary follicle –> first meiotic division –> secondary oocyte in mature follicle and first polar body –> second meiotic division –> mature oocyte and second polar body
17
Q
phases of the menstural cycle
A
Menstrual Phase (Days 1–5):
- Shedding of the functional layer of the endometrium → menstrual bleeding.
Follicular (Proliferative) Phase (Days 6–14):
- FSH stimulates growth of ovarian follicles.
- Developing follicles produce estrogen → rebuilds the endometrial lining.
- Estrogen peaks → triggers LH surge around day 14.
Ovulation (Day 14):
- LH surge causes release of the secondary oocyte from dominant follicle.
Luteal (Secretory) Phase (Days 15–28):
- Corpus luteum forms → secretes progesterone (and some estrogen).
- Progesterone maintains and thickens endometrium, preparing for implantation.
- If no fertilization → corpus luteum degenerates → drop in progesterone and estrogen → menstruation starts.
18
Q
hormones of mensutaral cycle
A
FSH- from anterior pituitary; stimulate follicle growth
LH- from anterior pituitary; triggers ovulation and corpus luteum formation
estrogen- from developing follicles; proliferation of endometrium
progesterone- from corpus luteum; maintains secretory endometrium (will degrade to corpus albicans if not fertilized)
19
Q
when does hCG take control to prevent corpus luteum from degeneration when fertilized
A
wk 20
20
Q
fertilization
enzyme?
A
sperms acrosome; acrosome reaction
digests zona pellucida of ovum via hyaluroniadse released from the acrosome
sperm penetrates zona pellucida in zona reaction and egg becomes impermeable to another sperm
oocyte arrested in metaphase; completes second meiotic division to become mature oocyte with a second polar body
nucleus of mature oocyte becomes female proneuclaus and sperm also becomes a pronucleus and its tail degenerates
membranes of 2 pronuclei break down and chromosomes arrange for mitotic division/ 23 chromosomes in each pronucleus combine- zygote of 46 chromosomes
cleavage; to get blastomere
21
Q
what happens to the oocyte when its fertilized by sperm
A
it was arrested in metaphase; so it completes its second meiotic division to become a mature oocyte with a second polar body
22
Q
sperm fertilizes egg
A
🧬 Steps of Egg Fertilization:
1. Sperm Capacitation
Sperm undergoes biochemical changes in the female reproductive tract, gaining the ability to penetrate the egg.
- Acrosome Reaction
Enzymes from the sperm’s acrosome digest the zona pellucida (glycoprotein shell) of the oocyte. - Sperm Penetration & Fusion
One sperm fuses with the oocyte membrane; its nucleus enters the oocyte. - Cortical Reaction (Block to Polyspermy)
Oocyte releases enzymes that harden the zona pellucida, preventing entry of additional sperm. - Completion of Meiosis II
The secondary oocyte, previously arrested at metaphase II, completes meiosis → forms ovum + second polar body. - Pronuclear Fusion (Syngamy)
Male and female pronuclei fuse → form a diploid zygote (2n). - Zygote Formation & Cleavage Begins
The zygote starts mitotic divisions (cleavage), beginning embryonic development.
23
Q
blastomere
A
A blastomere is one of the early cells formed by cleavage (mitotic division) of the fertilized egg (zygote).
After fertilization, the zygote divides into 2, then 4, then 8, 16, etc.
Each of these resulting cells is called a blastomere.
Blastomeres are totipotent in the earliest stages (can become any cell type in the body or placenta).
They eventually compact and form the morula, then the blastocyst.
So in short:
➡️ Blastomeres = Early embryonic cells formed by cleavage of the zygote.
24
Q
zygote
A
diploid cell from union of sperm and ovum
25
morula
12-15 blastomeres
26
blastocyst
fluid filled cavity to seperate blastomere into trophoblast (becomes the embryonic part of placenta) and inner cell mast or embyroblasy (becomes the embryo)
27
implantation; normal vs ectopic
normal: endometrial epithelium of uterus; 6 days after fertilization
ectopic: usually ampulla or isthmus of fallopian tubes etc
28
gastrulation
process of bilaminar embryonic disc becoming trilaminar
beginning of morphogenesis (body form)
29
inner cell mast
part of blastocyst that becomes bilaminar embryonic disc (epiblast and hypoblast). gives rise to germ layers that will form tissues and organs of embryo
30
epiblast and hypoblast (bilaminar disc)
epiblast: floor of amniotic cavity
hypoblast: roof of exocoelomic cavity
31
trilaminar disc
what structures do they become
ectoderm: epidermis, CNS, PNS, retina of eye
mesoderm: smooth muscle coats, CT, vessels, cardiovascular system, blood cells, bone marrow, skeleton, striated muscle, reproductive and excretory organs
endoderm: epithelial linings of respiratory passages and GI tract, glands opening into GI tract, and glandular cells of organs (liver, pancreas)
32
amniotic cavity
A fluid-filled space that forms between the epiblast and trophoblast during early embryogenesis (around day 8 post-fertilization).
Surrounded by the amnion, a thin membrane derived from epiblast cells.
Expands to enclose the growing embryo/fetus entirely.
33
amniotic fluid
Initially derived from maternal plasma; later includes fetal urine, secretions from fetal lungs, skin, and amniotic membrane.
Provides a protective cushion, regulates temperature, allows fetal movement and lung development, and prevents adhesion of the amnion to the embryo.
Continually circulated as the fetus swallows and urinates the fluid.
34
yolk sac
First extraembryonic membrane to form (around day 8).
Derived from the hypoblast.
Functions:
Early nutrient transfer before placental circulation is established.
Site of primordial germ cell origin.
First site of hematopoiesis (blood cell formation).
Contributes to the gut tube.
35
allantois
Outpouching of the hindgut into the connecting stalk (around day 16).
Functions:
Involved in early fluid exchange and waste removal.
Contributes to formation of the urachus, which becomes the median umbilical ligament in adults.
Plays a role in blood vessel development of the umbilical cord.
36
allantois function
blood formation and urinary bladder development
37
yolk sac gets incorporated into what and becomes what
into primitive gut --> epithelium of trachea, bronchi, lungs, digestive tract
38
cranio-caudal folding
Occur due to rapid growth of the neural tube and somites.
Head fold moves the cardiogenic area and oropharyngeal membrane ventrally and caudally.
Tail fold moves the connecting stalk and cloacal membrane ventrally and cranially.
Together, they help transform the embryo from a flat disc into a C-shaped structure.
39
lateral folding
Caused by growth of the somites and lateral plate mesoderm.
The sides of the embryo fold ventrally, enclosing the yolk sac and forming the gut tube.
Fuse at the midline to create a closed body wall, enclosing the coelomic cavity.
40
head and tail fold vs lateral folds in embroyo
craniocaudal: forms head, tail regions, repositions membranes
lateral: lateral --> ventral; forms gut tubes; closes body wall
41
fetal organ development and the week of gestation
wk 4: heart, forebrain, upper and lower limbs, ears, eye lens
wk 6: external auditory canal
wk 7: intestines, bone ossification
wk 8: digits, external genitalia
42
ovary attached to uterus via
broad ligament
43
whats in cortex of ovary
interstitial cells that secrete estrogen
primordial ovarian follicles
and follicles that have undergone atresia and degeneration
44
ovary structure
-germinal epithelium
-tunica albuginea
-cortex
-medulla
Germinal Epithelium: A single layer of cuboidal to squamous epithelial cells covering the outer surface of the ovary; despite the name, it does not give rise to germ cells but plays a role in surface repair after ovulation.
Tunica Albuginea: A dense connective tissue layer beneath the germinal epithelium that protects the ovary.
Cortex: The outer region of the ovary containing developing follicles, corpora lutea, and stromal cells.
Medulla: The central part of the ovary composed of loose connective tissue, blood vessels, lymphatics, and nerves.
45
development of an egg (oogenesis)
primordial follicle (oocyte) --> primary follicle --> secondary follicle --> Graafian follicle (has corona radiata) --> rupture follicle releases oocyte --> corpus luteum (secretes progesterone)
46
if oocyte is fertilized vs not
fertilized: corpus luteum --> pregnancy and doesnt degenerate
if not: becomes corpus albicans and then bleed
47
what does the corpus luteum secrete
progesterone
48
where does corona radiata develop
in graffian follicle
---------------------
In a Graafian follicle, the corona radiata is the innermost layer of cumulus cells that is directly attached to the zona pellucida surrounding the oocyte.
It forms part of the cumulus oophorus, which is a mound of granulosa cells that suspends the oocyte within the follicular fluid.
These corona radiata cells are tightly connected to the oocyte via gap junctions, providing nutrients and signaling molecules.
After ovulation, the corona radiata remains attached to the ovulated oocyte and plays a key role in supporting fertilization.
So within the Graafian follicle:
Oocyte → Zona Pellucida → Corona Radiata → Cumulus Oophorus → Antrum (fluid)
49
theca cells vs granulosa cells
stimulated by? secrete?
theca (outside the follicle): stimulated by LH to make androgens (androstenedione)
granulosa cells (inside the follicle): stimulated by FSH to convert the androgens from the theca cells into estradiol via aromatase enzyme
50
where are cilia concentrated at in the ovarian tubes to move the oocyte
infundibulum
51
ovary anatomy
infundibulum: initial opening to receive oocyte; lined with fimbriae
ampulla: length of tube
isthmus: opening near uterus
52
three layers of utuerus
endometrium: mucosa (changes during menstrual cycle; thicken until fertilized, if unfertilized will shed)
myometrium: muscularis (smooth muscle)
perimetrium: serosa
53
during last stages of pregnancy what substance helps soften and thin the cervix so fetus can pass through uterus fungus
relaxin from corpus luteum
54
hymen
covers vaginal introitus
three layers: mucosa in transverse rugae or folds. muscularis, and adventitia
55
clitoris
paired erectile corpora cavernosa
56
labia minora vs majora
minora: stratified squamous epithelium, rich vasculature, many sebaceous glands, no hair follicles
majora: cornfield epidermis, sebaceous and sweat glands and hair follicles
57
breast
15-20 lobes each with lactiferous ducts leading to the nipple
stratified squamous epithelium
areola: pigmented; nipple and sebaceous glands, dense collagenous CT with elastic fibers and stratified squamous
58
ovary produces
estrogen, progesterone and ova
59
where are theca and granulosa cells
the ovary
60
artery, vein, lymph and nerve for ovary
ovarian arteries (from ab aorta)
pampiniform plexus to ovarian vein
lumbar lymph nodes
ovarian plexus to uterine plexus, PNS from vagus
61
where does fertilization occur
ampulla of the fallopian tube
62
artery, vein, lymphs and innervation of fallopian tube
branches of uterine and ovarian arteries
tubal veins drain to ovarian veins and uterine venous plexus
lumbar lymph nodes
nerves: ovarian plexus and uterovaginal plexus
63
where does the embryo and fetus develop
uterus
64
artery, vein, lymph and nerves for uterus and cervis
uterine and ovarian arteries
uterine venous plexus
internal and external iliac, lumbar, sacral and superficial inguinal lymph nodes
nerve; uterovaginal plexus
65
broad ligament; 3 parts
Mesosalpinx
Surrounds and supports the fallopian tube.
Located superior to the mesovarium.
Mesovarium
Connects the anterior surface of the ovary to the rest of the broad ligament.
Contains vessels, lymphatics, and nerves entering the ovary via the ovarian hilum.
Mesometrium
The largest portion, extends from the pelvic wall to the uterus.
Supports the uterus and contains the uterine vessels.
66
ligament of ovary
connects ovary to uterus
It lies within the broad ligament, specifically in the mesovarium region.
67
round ligament
helps to maintain what position of what organ
from uterus (uterine horns) and travels through inguinal canal and inserts into labia majora
to help uterus maintain anteverted position; pull forward
68
suspensory ligament
connects ovary to lateral pelvic wall
69
vestibular/ bartholins glands
erectile tissue; secrete mucus during arousal to moisten labia and vestibule
on sides of vaginal orfice under bulbospongiosus muscle (within labia majora)
70
vestibule
cleft between left and right labia minor
71
vaginal artery, vein and lymph, and nerves
uterine and vaginal arteries
vaginal venous plexi
internal and external iliac, sacral, common iliac and superficial inguinal lymph nodes
nerves: uterovaginal plexus, SNS via lumbar splanchnic nerves, PNS via pelvic splanchnic nerves
72
vaginal fornix
recessed space formed between cervix and vaginal wall
73
SNS vs PNS nerves of vagina
SNS via lumbar splanchnic nerves, PNS via pelvic splanchnic nerves
74
mons pubis
fatty sub tissue covered with pubic hair
75
laby minor vs majora
minor: hairless and absent of fat. have sebaceous glands and sensory nerve endings
majora: has sebaceous glands and pubic hair
76
composition of clitoris
two crura, two corpora cavernosa, one glans clitoris covered by the prepuce
77
perineal body
supports vagina posteriorly; between vagina and anal canal
78
artery, vein, lymphs and innervation of labia minor and majora
internal and external pudendal arteries
internal pudendal veins
superficial inguinal lymphs
ilioinguinal, genitofemoral, pudendal, perineal and cutaneous thigh nerves
79
suspensory ligaments of cooper
attach mammany glands to overlying dermis
80
mammary gland
secretes milk
81
lactiferous sinus and lactiferous duct
sinus: dilated portion of each lactiferous duct,, where small drop of milk remains
duct: in each lobule; drains the lobule and opens individually on the nipple
82
lymphatics of breast
axillary lymph 75% (lateral)
parasternal nodes (medial)
subaerolar lymphatic plexus (areola --> nipple --> lobules)
83
sebaceous gland on breast
secretes oily substance to protect nipple from chaffing during nursing
84
axillary tail
part of mammary gland that extends to inferolateral edge of pec major toward axilla, may enlarge during menstrual cycle
85
when is progesterone highest in menses
luteal phase
86
when is LH highest in menses
ovulation
87
when is estradiol highest in menses
ovulation
88
when is FSH highest in menses
follicular phase
89
FSH role
in follicular phase day 1-14; stimulates granulosa cell to make estrogen
follicle enlarges and forms an antrum
90
LH role
high estrogen in late follicular phase act on pituitary to release LH surge to induce ovulation
in luteal phase the LH stimulates remaining granulosa and theca cells of follicle to become the corpus luteum, which secretes progesterone and estrogen
91
main source of estreogen
developing follicles and corpus luteum of the ovaries
92
where is estrogen and other hormones metabolized
liver ; to excrete in urine
93
estrogen impacts
ovary and follicle growth, increase contractions, create clear cervical mucus, helps FSH effects on follicular growth, increase vaginal epithelial cells, female pattern pubic hair and body fat, bone growth and calcium deposition, increase HDL and lower LDL
94
progesterone functions
stimulate endometrial glands to secrete substance rich in protein and glycogen which is needed for survival, nutrition and adherence of implanted embryo
antagonizes estrogen action and decreases contractions of uterine tubes and myometrium
stimulates breast growth
inhibits milk inducing effects of prolactin
acts on hypothalamic centers; and causes rise of basal body temperature at ovulation
95
what weeks in developing ovaries do primordial germ cells product oogonia by mitotic divisions
gestational wks 20-24
**at gestational wks8-9 some of these oogonia enter prophase of meiosis and become primary oocytes
96
when do all oogonia become oocytes? what state are they suspended in? when will they continue?
6 months after birth; and they will remain in a state of suspended prophase; the first meiotic division will not be complete until ovulation
97
in follicular phase what causes primordial follicles to develop ?
17-beta estradiol (which also causes proliferation of endometrial lining and inhibits FSH and LH in anterior pituitary via negative feedback)
98
when is dominant follicle selected? and what does it cause?
proliferative phase; day 6-14
this causes plasma estrogen levels to rise --> thinner cervical mucus for passage of sperm
follicle will secrete digestive enzymes and prostaglandins to mediate ovulation
99
when does oocyte complete its first meiotic division
just before ovulation
Timeline:
The primary oocyte is arrested in prophase I from fetal life until puberty.
LH surge triggers the completion of meiosis I shortly before ovulation.
This produces:
A secondary oocyte (haploid, larger cell),
And a first polar body (small, non-functional cell).
🟡 The secondary oocyte then enters meiosis II and arrests at metaphase II until fertilization.
100
impact of progesterone in secretory phase (day 15-28)
progesterone cause spiral arteries to coil more tightly
making it secretory mucosa to secrete nutritious glycoporteins to sustain an implanted embryo
FSH and LH are inhibited so no new follicles can develop
hormone dependent spiral arteries will slough off and die if not fertilized
101
when to get pregnant
5 days before or 24 hours after ovulation
sperm can fertilize oocyte for up to seven days (viable after ejactulation)
ovulated oocyte remains fertile for 12-24 hours
102
uterine/ fallopian tubes are lined with
cilia-lined fimbria
103
passage of sperm through cervical mucus is dependent on
estrogen induced changes in the mucus conssitency
104
sperm reaching oocyte
sperms own propulsion, smooth muscle contraction, prostaglandins
low pH of vagina inhibits
105
what needs to happen for sperm to penetrate oocyte
for sperm to penetrate oocyte they need to be capacitated: glycoprotein coat on head of sperm is removed to bind
106
what happens when sperm and oocyte fuse
reaction in which secretory vesicles in oocytes periphery release their contents to inactivate sperm binding sites and harden zona pellucida; so only 1 sperm can bind
107
what happens when sperm enters oocyte
secondary oocyte completes meiosis II and ejects second polar body; forming female pronucleus
sperms tail degenerates, nucleus enlarges and forms male pronucleus
pronuclei migrate toward each other as mitotic spindles form between them' --> maternal and paternal chromosomes combine to for diploid zygote
108
uterine implantation ; receptivity of endometrium to fertilized ovum is dependent on
low estrogen/progesterone ratio
corresponds to period of highest progesterone output by corpus luteum
109
hCG
what is it secreted by
LH like homrone; secreted by embryonic trophoblast cells of the placenta to maintain viability of corpus leuteum and therefore plasma levels of estrogen and progesterone
(during pregnancy)
110
estrogen
stimulate growth of uterine muscle mass; contractile force for baby delivery
111
progesterone
inhibit uterine motility so fetus not expelled prematurely
112
oxytocin
via posterior pituitary myometrial contractions at term, milk release during lactation, induction of labour
113
prolactin
estrogen stimulates prolactin secretion by anterior pituitary ; increase over course of pregnancy (but estrogen and progesterone block its action until after pregnancy) so that lactation can happen
lactation via suckling; stimulates oxytocin and prolactin
as long as lactation continues; ovulation is suppressed because prolactin inhibits GnRH secretion by the hypothalamus and FSH and LH secretion by anterior pituitary
114
placental lactogen
act on fetus to promote and regulate growth and metbaolism
115
menopause- what is happening
ovaries lose ability to response to gonadotropins; ovarian follicles and oocytes have degenerated, so estrogen is no longer produced
FSH and LH rise because hypothalamus and anterior pituitary are functioning normally and are not being inhibited by estrogen
small amount of estrogen persists because of conversion of androgens to estrogens in adrenal glands and storage in adipocytes
breast and genital atrophy, decrease bone mass, cholesterol accumulates
116
tunica albuginea and tunica vaginalis of the testes
albuginea: more internal; fibrous coat covering the testes
vaginalis: periotneal sac forming visceral and parietal layers
117
somniferous tubules
site where sperm are formed
Sperm get stored in epididymis
118
spermatogonia
two types
type A serves as stem cells (make more type A and B spermatogonia)
type B divides to form primary spermatocytes, stimulated by FSH
119
primary spermatocytes vs secondary spermatocytes
primary: prophase of first phase of meiosis for 22 days then become secondary
secondary: passs through second phase of meiosis and divide to form spermatids
120
spermatogenesis
Spermatogonia (2n, stem cells)
↓ mitosis
Primary Spermatocyte (2n)
↓ meiosis I
Secondary Spermatocyte (1n)
↓ meiosis II
Spermatids (1n)
↓ spermiogenesis (no division)
Spermatozoa (1n, mature sperm)
121
spermatozoa
fully mature male gamete, takes 48-64 days to form
nucleus head covered by acrosome (contain enzymes to penetrate oocyte)
neck with dense sheath of mitochondria to power movement of tail
122
sertoli vs leydig cells
secrete? stimulated by?
sertoli: secrete inhibin, AMH, androgen binding protein, provide developing germ cells with nutrients. inhibited by causes negative feedback on anterior pituitary release of FSH and LH
--> stimulated by FSH
leydig: secrete testosterone
--> stimulated by LH
123
journey of spermatozoa
straight tubules --> rete testis --> efferent ductules --> epididymis --> storage in terminal epididymis --> at ejaculation, epididymis and vas deferens smooth muscle contract to propel sperm out into urethra
124
seminal vesicles
develop as outgrowth of vas deference
produce fructose-rich fluid which makes up 70% of semen, and provide main energy source for sperm
also contribute prostaglandins, falcons and proteins and enzymes to coagulate sperm after ejaculation
125
bublourethral glands (of Cowper)
in distal urethra; produce a fluid that lubricates the urethral lumen preceding ejactulation
126
prostate
cuboidal/columnar epithelium secretes fluid rich in lipids, proteolytic enzymes, acid phosphatase, fibrinolysis (liquefies semen), prostatic acid phosphatase, prostate-specific antigen, critic acid
fibromuscular CT stroma; help move seminal fluid out and prevent retrograde ejactulation
127
penis erectile tissue
two corpora cavernosa length wise
at head is corpus spongiosum
128
testes form what?
form spermatozoa, also synthesize, store and release testosterone
129
hormones of the testes
Sertoli cells secrete androgen binding protein, AMH and inhibin
leydig (in between seminiferous tubules) secrete testosterone to promote secondary sex characteristics
130
site of spermatic maturation
epididymis
131
artery, vein, lymphs and nerves for testis
testicular arteries from abdominal aorta
testeicular veins form pampiniform plexus (left is longer and drains to left renal vein, making varicoceles more likely on left) (right drains right into IVC)
lumbar and preaortic lymph
testicular plexus of nerves
SNS and PNS from T7
132
scrotum is a fibromuscular sac containing
testes, epididymis, initial portion of ductus deferent
133
scrotal raphe
midline; indicate bilateral embryonic origin
134
scrotum artery, vein, lymph, nerve
artery: external pudendal (from femoral artery) and internal pudendal (from internal iliac artery)
vein: external pudendal vein (drain to great saphenous vein and then femoral vein)
superficial inguinal lymph
iliolinguinal, genitofemoral, posterior scrotal, posterior femoral cutaneous nerves
135
ductus deferens (vas deferens)
at tail of epididymis; transport sperm to ejaculatory duct
136
prostate location
between male urinary bladder and urogenital diaphragm
secretes nutritive component of semen and enzymes for coagulation
137
artery, vein, lymph, nerve of prostate
LOL I DONT WANT TO (pg 464)
138
what lobe of the prostate is palpable on digital examination
posterior lobe
139
seminal vesicles
artery vein lymph innervation (pg 464)
secrete alkaline fluid to mix with sperm
LOL NO
140
ejaculatory ducts
artery vein lymph innervation (pg 465)
NOPE
141
glans penis
i.e head of penis, distal expansion of corpus spongiosum
142
FSH and LH role in male
FSH stimulates spermatogenesis via Sertoli cells to release androgen binding proteins (ABP). ABP promotes spermatogenicc cells to bind and concentrate testosterone, which in turn stimulates spermatogenesis
LH binds leydig cells to secrete testosterone
143
testosterone
testes secrete testosterone at constnnt rate
hypothalamus; GnRH pulses are episodic
Anterior pituiaty: FSH and LH
functions: protein anabolism, bone growth, etc
144
composition of semen
fructose (fuel for sperm)
prostaglandins (decrease cervical mucus viscosity)
relaxin (for sperm motility)
alkaline fluids (neutralize acidic vaginal enviroenemt)
seminal plasmin (antibacterial)
fibrinogen (coagulate semen after ejaculation)
fibrinolysis, PSA (liquefy coagulated semen to enable sperm to swim)
145
amenorrhea
total absence of menstural flow
possibly from; idiopathic anovulation, ovarian failure (menopasue, ED, athletes), PCOS, pregnancy
146
anovulation
lack of prodcution of egg and thus corpus luteum in the menstural cycle
no mid cycle LH surge, progesterone levels never rise
there is frequently physiologic (normal) anvolution in first 1-2yrs after menarche
from: hormonal imbalances, ED, athlete, PCOS, thryoid or adrenal insufficiency
sx: oligomenorrhea, variable cycle length, PMS, lack of temperature spike mid cycle
147
dysfunctional uterine bleeding
what is the underlying problem
seen in; estrogen drugs, PCOS, chronic anovulatory cycles
problem: excessive unopposed estrogen
148
menopause
loss of ovarian sensitivity to gonadotropin stimulation
osteoporosis, vaginal atrophy, arteriosclerosis
hot falshes, night sweats, diaphoresis, vaginal dryness, amenorrhea, fatigue, depression, anxiety, myalgia, arthralgia
149
ovarian insufficiency
women under 40yoa
primary ovarian insuffieicney: from ovarian disorder (ovaries themselves)
--> i.e. autoimmune, genetic, radiation
secondary: inadequate ovarian stimulation due to hypothalamic or pituitary issues
--> i.e. stress, anorexia, pituitary tumor
causes menopause sx
150
balanitis
inflammation of glans penis (head)
from: STI, allergy, candidiasis etc
sx: pain, discharge, inguinal lymphadenopathy, dysuria
151
cervicitis
inflamed cervix, usually from STI
vaginal discharge, pelvic pain, cervical motion tenderness, fever, myalgia, fatigue
152
endometriosis
presence of endometrial tissue outside the uterus
risks: excess estrogen exposure
complications: infertility, chocolate ovary cysts
sx: worsening dysmenorrhea, pelvic pain, dyspareunia
153
endometritis (not endometriosis); cause
dangerous infection of uterus; staph aureus or strep spp.
usually from instrumentation or retention of placental fragments
chronic endometriosis can occur in the setting of PID, tuberculosis, chlamydia, cerivical cancer
risk: prgnacny, immunosuppression
sx: fever, anorexia, dyspareunia, uterine tenderness, vaginal discharge, malaise
154
orchitis
inflamed testes
from mumps, viral infection, UTI complication, gonorrhea, catheter
can lead to infertility
sx: unilateral, enlarged testes, tender
155
pelvic inflammatory disease (PID)
causes?
infected and inflamed endometrium, fallopian tubes, or pelvic peritoneum
STIs: neisseria gonorrhea, chlamydia trachomatis, mycoplasma spp., staph and strep
risk: unopretoected sex, multiple parteners
complications; infertility
sx: ab pain, slow gait, fever, tachycardia, rebound tenderness, guarding, leukocytosis
156
salpingitis
infalmmation of infection of fallopian tubes; often used interchangeably with PID
157
vaginitis
most common causes
inflamed vaginal epithelium
Candida albicans, haemophilus vaginalis, trichomonas vaginalis and menopasue (atrophic vaginitis)
risks: sexually active or menopuase
158
give the typical characteristics of the following forms of vaginitis
candidal vaginitis
bacterial vaginosis
atrophic vagintis (menopause)
trichomoniasis
candidal vaginitis: creamy white discharge, yeasty odor, pH <4.5, yeast, pseudohyphae or hyphae seen on KOH wet mount
bacterial vaginosis: fishy vaginal order and discharge, pH > 4.5, clue cells on wet mount
atrophic vagintis (menopause): no vaginal discharge, pale tissue without rogation, pH 5-5.7, petechiae
trichomoniasis: yellow or green foul discharge, lymphadenopathy, pH 5-7, strawberry cervix
159
BV vs candida vs trichomoas for vaginitis key findings
BV = Bacteria + clue cells + fishy odor (basic pH)
Candida = Cottage cheese, itchy, low pH
Trichomonas = Tricky protozoa, frothy green, motile, strawberry cervix
160
pH < 4.5 vs > 4.5 for vagina infections
<4.5: candida
> 4.5: BV and trichomonisis
161
clue cells in what vaginitis (seen on wet mount)
BV
162
strawberry cervix in what vaginitis
trichomoniasis
163
yellow green foul discharge
trichomoniasis
164
fish vaginal odor
BV
165
KOH wet mount of candida
yeast, pseudohyphae or hyphae
166
cryptorchidism
failure of testes to descend into scrotum (congenital)
risks: premature infants, xenoestrogens
complication: sterility, testicular atrophy
sx: palpable testicles in inguinal canal
167
epispadias vs hypospadias
which is more common
epispadias: urethral opening on dorsal (top) of penis
hypospadias: urethral opening on ventral (underside) of penis
--> more common
168
fragile X syndrome
what is the genetic mutation?
CGG trinucleotide repeat expansion in the FMR1 gene on X chromosome
X linked dominant; seen in males; impaired brain development
CGG repeats on X chromosome --> block FMR1 gene expression --> FMR protein is for neural development
macroorchidism (large testes), elongated face, prominent ears, low muscle tone, autism, mental retardation
169
imperforate hymen
tampon use, sx, medical paps etc
170
Klinefelter's syndrome
what is the genetic mutation
47 XXY, (multiple x syndrome)
males with small genitals and lack of sexual maturation
tall, infertile, gynecomastia, mental retardation, lack male secondary sex characteristics
171
Klinefelter's syndrome/ multiple X syndrome
vs
fragile X syndrome
klinefelter: 477 XXY causing small genitals and mental problems in males
fragile: CGG repeats on X chromosomes; FMR1 gene; impacts neural development, low muscle tone, macroorchidism (big testes), long face
172
paraphimosis
Retracted foreskin cannot return to cover glans
173
paraphimosis vs phimosis
para: Retracted foreskin cannot return to cover glans (cant pull it forward; constrict glans/ vasculature --> emergency)
phimosis: Foreskin cannot be retracted over glans (cant pull it back; may cause infection or block pee)
174
phimosis
Foreskin cannot be retracted over glans
175
pseudohermaphroditism
someone both with secondary sex characteristics that dont match their gonads or chromosome
i..e look male but have ovaries and 46,XX genotype
176
septate vagina and uterus
septate or double vagina or uterus
Both are Müllerian duct anomalies due to incomplete resorption of the medial septum after fusion of the paramesonephric (Müllerian) ducts. this causes a division??
sx: dysfunctional uterine bleeding or amenorrhea
----
"Septate = Single on the outside, Split on the inside"
Uterus: Think pregnancy problems
Vagina: Think dyspareunia or tampon issues
177
turners syndrome
45, X genome
lead to hypogonadism and features (short stature, aortic coarctation, broad chest, web neck)
DX:
Hormonal profile: High FSH/LH, low estrogen
Ultrasound: Streak ovaries, structural anomalies
------------------------
"Turner = Tiny (short), webbed neck, no ovaries"
"XO = no estrogen → infertility"
178
benign scrotal conditions
-hydrocele
-hematocele
-spermatocele
-varicocele
Hydrocele: Painless fluid buildup in the tunica vaginalis that transilluminates; often congenital or post-infectious.
Hematocele: Painful blood accumulation in the tunica vaginalis, usually due to trauma; does not transilluminate.
Spermatocele: Painless, cystic swelling from the epididymis containing sperm, often found incidentally; may transilluminate.
Varicocele: Dilated veins of the pampiniform plexus, feels like a “bag of worms,” most common on the left; may cause infertility.
179
fibrocystic breat
from excess estrogen exposure or idiopathic
sx: cyclic mastalgia, changing bra size, improvement after menses
4 types
fibrosis form: fibrous overgrowth
cystic form: serous fluid, blood or thick secretions
sclerosis adenosis: small ducts or acini with increased stroma but no cysts
ductal epithelial hyperplasia: extensive multi-layered epithelium in ducts but with no cysts ;; pre malignant
180
galactocele
dilation of duct leading to cyst formation during lactation
181
maxillary duct ectasia
granulomatous infalmmation with lots of plasma cells around lactiferous duct
post-menopausal
leads to dilation and influx of lymphocytes; fill with solidified secretions and have thick and ropey feeling
182
mastitis - cause?
painful inflammation of breast, usually in lactation and get cracks in nipples, one sided from strep or staph
183
traumatic fat necrosis
degenerate fatty tissue in boob; palpable mass and pain and inflammed
184
fibroadenoma
most common benign tumor of breast; before 30yoa
fibrous and glandular= responses to estrogen; changes with menses
firm, rubbery, painless
185
breast cancer
most common cancer in women
peak incidence after menopause
186
pagets disease of bone
Paget’s disease causes enlarged, weakened, and deformed bones due to uncoordinated activity of overactive osteoclasts followed by chaotic osteoblast repair. Common sites include the skull, spine, pelvis, and long bones.
187
pagets disease of breast
A rare form of ductal carcinoma in situ (DCIS) or invasive breast cancer that extends to the epidermis of the nipple and areola, causing eczematous changes.
🔑
Paget’s disease of the breast presents as a scaly, red, itchy nipple with possible discharge or erosion and is strongly associated with underlying ductal carcinoma. Diagnosis requires biopsy showing Paget cells — large, clear cells in the epidermis.
--> looks like eczema of the nipple
risk: long term estrogen exposure
188
breast carcinomas:
intraductal carcinoma in situ
lobular CIS
ductal carcinoma
Intraductal Carcinoma In Situ (DCIS):
A non-invasive breast cancer where malignant cells fill ductal spaces but do not invade the basement membrane. Typically found as microcalcifications on mammogram; may progress to invasive ductal carcinoma if untreated.
Lobular Carcinoma In Situ (LCIS):
A non-invasive proliferation of atypical lobular cells, usually found incidentally on biopsy. It’s not cancer itself but a marker for increased bilateral breast cancer risk, especially if estrogen receptor–positive.
Ductal Carcinoma (Invasive):
The most common type of invasive breast cancer, arising from ductal epithelium and invading surrounding stroma. Presents as a firm, irregular mass, may cause skin dimpling or nipple retraction; often spreads to lymph nodes.
189
benign prostatic hyperplasia (BPH)
which zone?
increased division of normal prostate cells in zone surrounding the urethra (transitional sone)
can mechanically compress the urethra and cause obstruction
obesity, insulin resistnace, rising estrogen and delving testosterone
BRCA1/2 genes, type 2 DM
sx: freuqnecy, nicturia, incomplete bladder emptying, total PSA mildly elevated with normal free PSA, smooth large prostate (sulcus not palpable)
190
chronic prostatitis
inflamed prostate or lower urinary tract (i.e. bacterial, non bacterial etc)
prostate stones can form
leaky urothelial syndrome: due to breakdown in urine-prostate barrier from dysbiosis and inflammation in gut causes bacteria and urinary compounds in urinary tract to cause inflammation and pain
sx:tender prostate, WBC high if bacterial, pain or burning on ejactulation or urination
191
which bacteria causes bacterial chronic prostatitis
Enterobacteriaceae
--------
Enterobacteriaceae are a large family of Gram-negative bacteria that includes a number of pathogens such as Klebsiella, Enterobacter, Citrobacter, Salmonella, Escherichia coli, Shigella, Proteus, Serratia and other species.
192
acute vs chronic prostatitis and the type of WBC seen
acute: neutrophils
chronic: macrophages and lymphocytes
193
most common cause of acute prostatis
e coli
usually spread sexually
sx: fever, dysuria, hematuria, pyruria, bacteriuria
194
ovarian cysts
hyperplasia of one or more ovarian follicles, which become fluid filled
most are physiological or functional and part of normal cycle of oocyte formation
195
types of ovarian cysts
hemorrhagic cyst: blood vessel rupture
--> adnexal pain at ovulation and mense
endometriosis (chocolate) cyst: endometrial tissue grows on ovary as part of endometriosis
dermoid cyst (teratoma): benign tumor
196
PCOS
bilateral cystic ovaries; insulin resistnace, hyperandrogenism, obesity
cysts are enlarged immature follicles (not true cysts)
excess adiposity --> insulin resistance --> aromatization --> worsen estrogen/androgen imbalances
sx: amenorrhea, oligomenorrhea, anovulatory cycles, acanthuses nigricans, hirsutism, acne
197
choriocarcinoma (discesa of the plant)
malignant neoplasm of trophoblast invalding surrounding tissue and vascular space
metastatic hydatiform mole
risks: high beta-hCG
---------------------
A highly malignant, invasive trophoblastic tumor composed of cytotrophoblasts and syncytiotrophoblasts without villi.
Usually arises after a molar pregnancy, but can follow any gestation or occur as a testicular tumor.
Produces very high levels of beta-hCG, leading to symptoms like abnormal uterine bleeding and sometimes hyperthyroidism.
Characterized by early hematogenous spread, especially to the lungs and brain.
Treatment is highly responsive to chemotherapy (e.g., methotrexate or EMA-CO regimen).
198
moles: hydatidiform mole, invasive mole, metastatic mole, partial mole
A molar pregnancy is an abnormal form of pregnancy where the placenta develops into a mass of cysts (grape-like swollen villi) instead of a normal fetus. It results from abnormal fertilization leading to overgrowth of trophoblastic tissue, causing high levels of hCG, uterine enlargement, and bleeding.
----------
abnormal placental formation with no fetal component; type of gestational trophoblastic disease. all pregnancy sx but exacerbated, high beta hCG and uterine bleeding
---------
Complete mole = no fetus, 100% paternal DNA, high risk of malignancy
Partial mole = some fetal tissue, triploid, lower risk
Invasive mole = local myometrial invasion, post-mole complication
Metastatic mole (choriocarcinoma) = malignant spread, aggressive
199
pre eclampsia vs eclampsia
Pre-eclampsia is hypertension + proteinuria in pregnancy; eclampsia is when seizures develop on top of pre-eclampsia.
after 20 weeks gestation
200
pre eclampsia
New-onset hypertension (≥140/90 mmHg) and proteinuria (≥300 mg/24h) after 20 weeks gestation in a previously normotensive woman.
May include symptoms like edema, headache, visual disturbances, and elevated liver enzymes.
Due to abnormal placental blood vessel development causing endothelial dysfunction and vasospasm.
201
eclampsia
Pre-eclampsia + seizures (tonic-clonic convulsions) not explained by other causes.
[[pre eclampsia= hypertesnion and proteinuria after 20wks gestation]]
It’s a life-threatening progression with risk of maternal and fetal complications.
Requires urgent management with magnesium sulfate to prevent/treat seizures.
202
bartholins cysts
bartholin glands secrete mucus to lubricate vaginal Introits during sex
blocked glands
usually infection in deeper tissue
dyspareunia, pain on sitting
203
cystocele/rectocele/urethrocele (vaginal hernia)
herniation of urinary bladder, rectum or uretha into the vaina
i.e. pregnancy, trauma, surgery, lack of perineal muscle tone
incontience, pain, dysuria
204
cervical intraepithelial neoplasia
from what disease
HPV induced dysplasia of the cervix
premalignant; can lead to cervial cancer
risk; multiple sex partners,
205
endometrial hyperplasia
excess estrogen stimulation which may be causes by anovulatory cycles
sx: abnormal vaginal bleeding, polyps
206
leiomyoma (uterine fibroids)
most common female tumor
benign neoplasms that are estrogen sensitive; increase in pregnancy and decrease in menopause
asymptomatic or cause excess bleeding
207
invasive carcinoma of the cervix
which cell type and from what
squamous cell carcinoma via HPV
208
leomyosarcoma
rare malignant tumor from benign leiomyoma
209
prostate cancer
which zone
adenocarcinoma of the prostate; most common cancer in men; in peripheral zone of prostate
western life, low vitmain D, HPV, high estrogen
palpable nodule, high total PSA and low free PSA
210
which zone of prostate for prostate cancer vs BPH?
Peripheral zone = cancer
Transition zone = BPH
211
total PSA and free PSA in prostate cancer vs BPH
cancer: high total PSA, low free PSA
BPH: slightly high total PSA, high free PSA
212
ovarian cancer
3 types: serous, mutinous, endometriod
risks: nulliparous, excess estrogen exposure, BRCA1/2 gene
no sx until late; metastatic, high mortlality
213
penile cancer
rare but most common is scquamous cell carcinoma
214
testicular cancer
95% are germ cell origins
germ cell
--> seminoma (germ cells mixed with lymphocytes
--> non-seminoma
non-germ cell tumors
--> Sertoli cell tumor: an secrete androgens or estrogen and cause feminization or masculinization
--> leydig cell tumor: can secrete androgens or estrogen and cause gynecomastia
215
vulvar cancer
from which type of HPV
HPV 16 and 18
216
chancroid
from what bacteria
penile lesion; painful non-indurated ulcer with lymphadenitis
haemophilus ducreyi (gram negative rod)
217
haemophilus ducreyi
what type of bacteria
gram negative rod
218
bacterial vaginosis from which bacterial
gardnerella vaginalis
could be from feminine hygiene products, intercourse, IUD
219
chlamydia
c. trachomatis,
replication cycle- form elementary bodies inside inclusion vesicles
can cause PID and infertility
220
chlamydia serovars A-C
chlamydia serovars D-K
chlamydia serovars L1-L3
A-C: trachoma
-infecting neonatal eye--> corona scar and blindness
D-K: urethritis and cervicitis
L1-L3: lymphogrnauloma venereum; painful ulcer --> inguinal lymphadenopathy, associated with HIV
221
lymphogrnauloma venereum
from chlamydia serovars L1-L3
stage 1: painless genital ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: chronic inflammation --> fibrosis
222
gonorrhea
most women asymptomatic or mucopurlent discharge. can cause PID and infertility. in infants can cause ophthalmia neonatorum (blindness)
men: symptomatic with yellow green mucopurulent penile discharge and dysuria and red swollen meatus
223
virulence factors of gonorrhea
pili, IgA protease, lipooligosaccharide
224
type of bacteria that gonorrhea is
gram negative diplococci
225
herpes simplex virus
HSV 1- saliva, latent in trigminal ganglia, reactivate is stress, illnesss, hormonal fluctuations --> cold sore of fever blister
HSV-2- sexual, latent in lumbar or sacral ganglia --> fever and inguinal lymph, genital lesions (but can also be in mouth)
226
human papilloma virus (HPV)
type of bacteria?
transmission?
sx
non enveloped DNA papovavirus
skin to skin contract
common and plantar warts
condyloma acuminata (genital wart)
-->anal, genital or oral warts from HPV6 or HPV11
--> carcinoma of cervix, penis or anus: HPV16, HPV18, HPV31
227
condyloma acuminata are what and caused by what
genital warts via HPV (6 and 11)
16&18 are cancer
228
which HPV causes warts vs cancer
-->anal, genital or oral warts from HPV6 or HPV11
--> carcinoma of cervix, penis or anus: HPV16, HPV18, HPV31
229
nongonococcal urethritis
Urethral inflammation not caused by Neisseria gonorrhoeae.
It’s the most common cause of urethritis in men.
---------------------
via chlamydia (most common)
inflamed and clear discharge in male
asymptomatic or cervicitis in female
other causes: ureaplasma urealyticum, mycoplasma genitalium, haemophilus vaginalis, adenovirus
230
syphillis
cause?
treponema pallidum
-sphirocete, thin wall
from initiate contact with mucus membranes with the lesion or vertical transmission to fetus
s
231
primary vs secondary vs latent vs tertiary syphilis
primary: painless chancre (ulcer)
secondary: rash (palms/soles), condyloma lata (lesions on genitals)
latent: none
tertiary: gummas, aortitis, neurosyphilis; granulomas in skin or bones or CNS insolvent and cardiovascular lesion; can cause death
232
toxic shock syndrome
what bacteria and product
acute, febrile, exotoxin producing strains of phage group 1 staphylococcus aureus, from tampon
high fever, sore throat, diarrhea, vomit, lethargy, confusion -->can cause shock or death
233
trichomoiaiss
cause
trichomonas vaginalis
from multiple sex parters, IV drugs etc
vaginitis, increased risk of CIN and PID
asymptomatic or abnormal vaginal discharge, vaginal door, dyspareniunia and dysuria
234
NPLEX
flashcards
Decks in class (48)
# Cards
-
BOARDVITALS questions423
-
BOARDVITALS part 2249
-
BOARDVITALS #3166
-
book- cardiovascular system351
-
book- endocrine system153
-
book- gastrointestinal system325
-
book- hematopoietic system92
-
book- immunological system115
-
book- integumentary system150
-
book- musculoskeletal system223
-
book- neurological system228
-
book- respiratory system103
-
book- reproductive system234
-
book- urinary system79
-
book- general pathology68
-
ETP- biochemistry quiz14
-
book- appendix59
-
ETP- microbiology quiz4
-
ETP- hematology quiz5
-
ETP- cardiology quiz4
-
ETP- spinal MSK quiz33
-
ETP- dermatology quiz5
-
ETP- upper limb MSK quiz0
-
ETP- upper limb #2 MSK quiz0
-
embryology8
-
ETP- pulmonology quiz5
-
ETP- gastroenterology quiz15
-
ETP- nephrology quiz20
-
ETP- reproductive quiz124
-
ETP- endocrine/bone16
-
Othet Good Shit373
-
moreeee good shit127
-
weeee24
-
ETP immunology and rheumatology quiz10
-
ETP neuroanatomy50
-
muscles210
-
NPLEX mock exam from CHATGPT111
-
BOOK MC QUESTIONS296
-
BOOK MC Qs part 2137
-
BOOK MC Qs part 3131
-
just a bit more75
-
anemia?!125
-
fancy AI test104
-
more things just for funzies!197
-
ETP NPLEX mock exam105
-
ETP NPLEX mock exam part 2100
-
have I lost my mind?330
-
this is not fun. I do not like.156
