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1

what vessels does the rectovessical septum contain

seminal vessicals

2

what is an associated pathology of the transitional zone of the prostate?

Parenchymal cells of this zone can show hyperplasia in elderly [benign prostatic hyperplasia], compressing the urethra

3

where do most prostatic carcinomas arise?

in the peripheral zone

4

Prostatic Utricle Diverticulum / Cyst path

The prostatic utricle is a remnant of the Müllerrian ducts. Normally it is very small, but can be up to 1cm in depth if there is abnormal fusion of the genital folds during development. If urine or bacteria become trapped, inflammation and infection can result.

5

what openings are in the prostatic urethra?

seminal colliculus
-openings for ejaculatory ducts
-orifice of the prostatic utricle
-openings for prostatic ducts
into prostatic sinuses
-prostatic sinuses

6

where are the openings for the bulbourethral ducts?

Penile/Spongy Urethra

7

where do the prostate and seminal vessicals get there blood supply from?

inferior vessical

8

The testicular ligament is a remnant of what? and connects what?

remnant of the gubernaculum. It connects the testis to the tunica vaginalis

9

what muscle wrinkles the scrotum and innervation

dartos ,muscle Nerve: genitofemoral nerve L1 L2

10

the internal abdomial obliuque is continuous with what muscle in the scrotum that does what innervated by what?

cremastor muscle raising and lowering the testes and epidydimus n: genital branch of the gentifemerol nerve

11

does the transversalis muscle contribute to the scrotum?

No it is not continous

12

hydrocycle pathology

serous fluid accumulation in the tunica vaginalis/ can also accumalte in spermatic cord

13

hematocycle path

blood accumulating in layers of tunica vaginlalis

14

where is sperm produced and stored?

seminiferous tubules stored in epididymis

15

route of sperm after production

Seminiferous tubules >
Straight tubule >
Rete testis >
Efferent ductile >
Epididymis

16

sprematocycle path

build up of fluid that contains sperm

17

epididymial cyst

just serous fluid build up on epididymis

18

blood supply to the scrotum?

testicular aretery and vein pass through deep and superficial ring... left testicular vein goes into left renal while right goes into ivc veins form the panpiniform plexus which cools down blood coming to the testes

19

phimosis path

foreskin cannot be retracted over penis

20

paraphimosis

glans penis stuck past foreskin/ stuck retracted

21

fundiform ligament of the penis is made of what fascia?

scarpas

22

suspensory ligament of the penis is continuous with what?

external abdominal oblique

23

the intercavernous septum is made up of what fascia layer?

deep penile fascia (Buck's fascia)

24

deep artery of the penis is located in where?

inside the corpus cavernosum

25

venous drainage of the penis

superficial dorsal drains into the external pudendal which drains into femoral
-deep dorsal v drains into preprostatic plexus
internal pudendal v drains into internal iliac

26

what artery and nerves are responsible for erection?

deep dorsal artery dilates under control of the PNS which dilates and fills the helicine arteries which blocks venous return

27

ejaculation and cessation of erection is caused by

mediated by Sympathetic, Parasympathetic & somatic NS
GVE-S fibers cause vasoconstriction of helicine aa.

28

what fibers cuase vasoconstriciton of the helice arteries?

GVE-S

29

how does blood drain during cessation of erection?

through emissary vein then circumflex vein then into deep dorsal vein

30

lymph drainage of testes and epididymis/uterine tube fundus of uterus?

Lumbar nodes

31

lymph drainage of superior bladder and superior uterus

extrernal iliac nodes

32

Inferior bladder, prostate, cervix, superior vagina
seminal vesicles Inf. rectum lymph drainage

Internal iliac nodes

33

inferior rectum/ inferior vagina lymph drainage

sacral nodes

34

skin and external genitalia lymph drainage

superficial inguinal nodes

35

glans penis/glans clitoris lymph drainage

deep inguinal nodes

36

where would you perform culdocentesis on female and male

most inferior space where fluid accumlates in males recoveicle pouch in females rectouterine pouch

37

the wall of the uterus is primarily made up of what

myometrium M.

38

membranous pelvic fascia forms what?

tendinous arch of pelvic fascia anteriorly forms pubovessicle ligament, posteriorly forms, uterosacral liagament and periculpium

39

endopelvic facsia forms what ligament also embeded inside the mesometrium of the broad ligament

cardinal ligament of the cervix CONTAINS THE UTERINE ARTERY AND VEIN

40

deep to superficial layers of the uteris

endometrium, myometrium, and perimetrium
(mucosa, smooth muscle, serrrous layer)

41

FSH function females

promotes follicular development

42

LH function females

promotes ovulation & development of corpus luteum

43

divisions of the broad ligament

mesometrium is largest portion overlies the uterus, mesosalphinx overlies the uterine tube, mesoavium connects the ovary to the rest of the broad ligament

44

how can endometrosis end up in the perineal cavity

goes up through uterine tube and because fibrae are not preitonelized it can escape into the piteineal cavity

45

mittleschmirtz pathology

ovulation pain

46

what vessels does the suspensory ligament of the ovary contain?

ovarian vessels

47

what ligament attaches the ovary to the uterus?

ovarian ligament

48

what portion of the vagina receives autonomic innervation?

superior 2/3rds

49

what portion of the vagina receives somatic innervation?

inferior 1/3

50

what are two causes of a rectovaginal tear?

childbirth/episiotomy

51

the uterine artery anastomoses with what artery?

ovarian artery

52

what is the relationship between the ureter and the ovarian artery?

the ureter passes inferior to the ovarian artery water under the bridge

53

once the vagina passes through the perineal membrane where does it get its blood supply? above the perineal membrane?

internal pudendal artery below vaginal and uterine above

54

what arteries supply the stratum functionals of the endometrium?

Spiral a from the radial a

55

what artery supplies the stratum basalis of the endometrium

straight a from radial a

56

what artery supplies the myometrium?

radial a from the arcuate a

57

what artery supplies perimetrium

arcuate a from the uterine a

58

pelvic congestion syndrome involves which venous structures

ovarian veins become distended during pregnancy can back up into uterine veins and cause blood to pool

59

bartholens gland cyst location

posterolateral to vaginal canal

60

skenes gland cyst

lateral to urethral orifice

61

what passes through the urogenital hiatus

deep dorsal vein of the clitoris forms vesical plexus

62

mons pubis and labia majora recieve sensory innervation from what nerve?

Ilioinguinal & genitofemoral nn and lateral femeroral cutaneous

63

what makes up the tunica albuguinea

a dense layer of connective tissue around the corpus cavernosum of the penis and forms a septa around testicular lobes

64

where is the site of sperm production

seminiferous tubules in the testicles

65

spermatogenisis overview

-Spermatogonia undergo mitosis to form primary spermatocytes
-Spermatocytes undergo meiosis (x2)
to form haploid Spermatids
-Spermatids mature into Spermatozoa

66

what allows sperm to mature as a syncicium?

Cytoplasmic connections between cells within seminiferous tubules

67

what do principle cells of the epididymis secrete?

glycerophosphocholine, which inhibits capacitation of sperm.

Principal cells also function to phagocytize residual bodies

68

what kind of epithelium lines the lumen of the ductus defrons?

pseudostratified

69

seminal vessicles is surrounded by smooth muscle that contracts during ejaculation due to what kind of innervation?

sypmathetic innervation

70

where is DHT secreted and what does it do?

(Dihydrotestosterone) – stimulates growth of prostatic epithelium

71

Where is PSA secreted and what does it do?

(Prostate-specific antigen) – normally incorporated into semen; prostate cancer marker

72

Where is PAP secreted and what does it do?

(Prostatic acid phosphatase) - regulates growth of prostatic epithelium; also used as a prostate cancer marker

73

where are proteolytic enzymes secreted and what do they do?

de-coagulates semen after deposition in female reproductive tract

74

smooth muscle of the helicine arteries and sinuses are relaxed under what kind of control and contracted under what kind of control?

Smooth m. of the Sinuses & Helicine aa. are relaxed under parasympathetic control (erection) & contracted under sympathetic control (remission)

75

what kinds of epithelium lines the prostatic urethra?

transitional epithelium

76

what kind of epithelium lines the penile urethra (spongy urethra)

pseudostratified columnar epithelium

77

what time frame does the sry gene have to push gonads to testes

before 9 weeks sry activates sox 9 which goes to testes

78

What causes the paremesphric ducts to regress in males?

sertoli cells of the testes secrete MIF

79

what promotes mesonephric duct or wolfian ducts to persist

testosterone from leydig cells

80

what regulates early levels of testosterone in fetal development?

regulated by maternal hCG or fetal LH

81

go back and study embro defects

do it

82

what releases inhibin and where does it act?

sertoli cells release inhibin which acts on the anterior pituitary to stop secreting FSH

83

what produces androgen binding protein and what is its function?

produced by sertoli cells helps testosterone get into the lumen

84

what causes testosterone to be converted to estradiol and what cells produce it?

aromatase produced by sertoli cells

85

male-pattern sexual differentiation depends on the presence of three hormones what are they

testosterone, DHT, AMH

86

What histological sections make up the endometrium of the uterus?

Simple columnar epithelium and lamina propria

87

where do the majority of ovarina cancers arise?

in the simple cuboidal epithelium

88

what is the purpose of the corpus leutium secreting progesterone and estrogen and inhibin?

prevents development of more ovarian follicles

89

Why is there high levels of progesterone after ovulation?

after ovulation theca and granulosa cells have LH recepetor which allows both cells to produce progesterone

90

function of LH?

promotes ovulation & corpus luteum development

91

At what stage is a follicle most sensitive to LH and FSH?

when it becomes a large secondary follicle

92

what increases the growth of the stratum functionalis during the proliferative phase?

estrogen

93

when does an oocyte become haploid?

Graafian Follicle: Undergoes Meiosis I 1-2 days prior to ovulation.

94

effect of low levels of estrogen secretion by granulosa cells on GnRH/LH/FSH release?

low levels inhibit release of GnRH from hypothalumus and inhibits FSH and LH from the anterior pituitry

95

Effects of high levels of estrogen secretion from granulosa cells on GnRH/ LH/ FSH release?

initiates positive feedback near ovulation

96

high levels of progesterone effect on feedback?

high levels= negative feedbalc

97

low levels of progesterone effect on feedback?

low levels =positive feedback

98

What are the effects of high levels of stress on ovulation?

glucocorticoids can also inhibit GnRH, Lh FSH, and maturation of follicules delating ovulation

99

effects of estrogen and porgesterone on the endometrium?

estrogen: Increase in size of glands through cellular proliferation
Progesterone: maintenance of thick endometrial glands; increases adhesivity of endometrium

100

effects of estrogen and progesterone on the cervix?

E:Promotes production of thin, alkaline, lubricative fluid; softening of cervix and slight dilation of cervical canal
P:Promotes production of viscous & acidic mucus; hardening of the cervix & closing of cervical canal

101

effects of estrogen and progesterone on the vagina

E:Promotes proliferation of vaginal epithelium; increases glycogen content
P:Increases desquamation of vaginal epithelial cells

102

effects of estrogen and progesterone on Bone.

E: Promotes closure of epiphyseal plates
P: Stimulate osteoblast activity

103

effects of estrogen on cardiovascular

E: promotes vasodilation

104

the umbilcal vein carry deoxygenated or oxygenated blood

oxygenated

105

At what point does the blastocyct move from the fallopian tubes into the uterus and at what day does it implant

progesterone causes the smooth muscle of the uterous to relax at day 3 post fertilization allowing the blastocyst to move into the uterus, implants on PO day 7 adn secretes HCG PO day 8

106

At what point does the palcenta secrete all necessary levels of hormones to maintain preganancy

week 8 progesterone and other hormone levels suffeciet week 9 corpus luteum starts degrading

107

at what point does HcG produciton peak?

10 weeks

108

What is the function of hPL also called ?

Antagonizes insulin action increases the diabetogenicity of pregnancy to increase glucose availability for the fetus
- Inhibits maternal glucose uptake
- Lypolytic action  mother uses FFAs instead
2. Simulates mammary gland development and milk production

109

what three enzymes does the placenta have that the fetus doesnt that allows it to make estrogen?

aromatase, sulfatase, and 3β-hydroxysteroid dehydrogenase

110

progesterone actions during pregnancy?

produced by CL/ P does not indicate fetal death/ Levels remain high throughout pregnancy, uterus downregulates P receptors just before parturition = functional P withdrawal /required to maintain a pregnant uterus
Down-regulates uterine E receptor expression = Quiescent myometrium/↑secretory activity necessary for nourishment, growth and implantation of the embryo
↑ fat deposition early in pregnancy
Stimulates appetite, diverts energy stores from sugar to fat


111

Estrogen functions during pregnancy?

require the maternal placental-fetal unit for production
\E levels are lower than P until the end of the 3rd trimester
Estrogens are required for successful parturition
↑ Uteroplacental blood flow
↑ Uterine smooth muscle hypertrophy
↑ Prostaglandins (uterine contraction) just before and during labor
↑ Oxytocin receptors on myometrium just before and during labor
↑ Mammary gland growth
↑ Prolactin secretion (maternal pituitary)

112

what receptor can HcG stimulate in the first trimester to raise basal metabolic rate?

HcG binds TSH receptor stimulating production of more thyroid hormone t4 increases in amount but free T4 remains same

113

What are the effects of estrogen and progesterone on MAP during pregenancy?

MAP doesnt increase even though HR increases becasue added system in parralel and Estrogen and progesterone proposed antagonists to vasopressive action (ANGII)
P may promote vasodilation as a smooth m. relaxant via NO production

114

What are the changes to co2 levels and respiration during pregancy?

E and P cause new set point for co2 in medulla. 40->32 =mild respiratory ankylosis with renal compensation (dumping bicarb keeping H+)

115

what causes increased gastric reflux during pregnancy?

decreased gastric emptying rate and decreased lower esophageal sphincter tone

116

upregulation of estrogen receptors towards the end of pregnancy results in?

Gap junctions on uterine smooth muscle cells
Uterine oxytocin (OT) and prostaglandin (PG) receptors
Collagenase expression in fetal membranes and cervix = effacement and dilation

117

what sort of feedback loop does cervical stretch have on oxytocin release? fergenson reflex

positive more stretch equals more oxytocin = more contractions/ high levels of estrogen lead to greater Oxytocin receptor expression and prostaglandins which increase contraction

118

proteins sugars and salts use what pathway for secretion

secretory pathway RER to GOLGI packaged and exocytosed to lumen (casein/lactose)

119

how are antibodies moved from the mother into the breast milk

through transcellular endocytosis/exocytosis (IGA)

120

How are white blood cells moved into the breast milk?

WBC salts and water move paracellulary

121

neurologic reflex from breast feeding

infant sucks->signal from breast to spinal cord to hypothalumus---> spinal cord neurons inhibit arcuate neurons of hypothalumus blocking DPA release leading to increased PRL--->spinal neurons also stimulate release and production of oxytocin via paraventricular and supraoptic nuclei---> spinal neurons also inhibit nuclei in the proptic area blocking release of GnRH

122

where do most tumors arise in breast tissue

TDLU terminal ductal lobular unit

123

besides dopamine what can inhibit prolactin secretion before birth?

progesterone levels

124

what transducer is the most commonly used for abdominal imaging?

curvilinear

125

What are the effects of parasypatheitcs and sympatheitcs on defecation and micturition?

sympathetics decrease micturation and defecation ahile parsympatheitcs increase it

126

parasympathetic vs sympathetic action on the uterus?

asympathetics contract uterus parasympatheitcs relax

127

route of lumbar splanchnic nerves? sympathetic innervation

presynaptic cell body in lateral horn of T11-L2 enter sympathetic chain then extic without synapes travel. synapse on postsynaptic cell bodies in various intermesenteric plexus then through superior hypogastric plexus then inferior hypogastric plexus then synampse on organ

128

route of sacral splanchnic nerves? sympathetic innervation

presynaptic sympathetic cell bodies arise from lateral horn of t12-L2 axons travel into sympathetic chain all the way to sacral level then hit postsynaptic cell bodies on paravertebral ganglia of sacral region at this point "sacral splanchnic nerves" postaganglionic axons then travel ONLY THROUGH THE INFERIOR HYPOGASTRIC plexus then to target organ
OPTION 2: exits sympathetic chain as preganglionic fiber then synapes in inferior hypogastric plexus then through subsidiary plexus to target organ where synapes

129

pelvic splanchnic nerve route and type of innervation provided

PARASYMPATHETIC presynaptic cell bodies from lateral horn of S2-S4 exits spinal cord via VENTRAL RAMI, NEVER ENTERS SYMPATHETIC CHAIN, passes through inferior hypogastric plexus on its way to target tissue, postsynaptic cell body found close to or on target organ

130

the superior hypogastric plexus contains what kind of neurons

sympathetic only

131

sympathetic innervation of the bladder is through?

lumbar and sacral splanchnics

132

where do presynaptic lumbar splancic nerves synapse

intermesenteric plexus

133

where do presynaptic sacral splanchnic nerves synapse?

paravertebral ganglia or inferior hypogastric plexus

134

what autonomic nerves are responsible for parasympatheic innervation to the bladder?

pelvic splanchnic nerves, s2-s4

135

what controls emmission?

emmision is movement of the sperm from ductus defrons to prostate, sympatheitic lumbar and sacral slpanchnic nerves, contraction of smooth muscle of ductus defrons

136

parasympathetic and sympathetic contributions to ejaculation, somatic

sympathetic contracts smooth muscle of prostate, ejaculatory duct and seminal vessicles, parasympatheitc results in increased secretion by prostate and siminal glands, somatic contracts bulbospongiosus muscle vie prudendal nerve

137

remission is under what control

sympathetic cause vasoconstriction of helicine arteries to cause remission

138

what provides autonomic innervation to the ovaries and testes

lesser and least splanchnic nerves as well as first lumbar splanchnic these primarily synapse at the aorticorenal ganglion then postganglionic axons travel to gonads

139

Organs above the pelvic pain line?

Those in contact with peritoneum
GVA information travels back to the spinal cord with sympathetics (Lumbar & Sacral splanchnics)
Include:
Ureter
Superior part of bladder
Testis, Epididymis, Inguinal part of Ductus deferens (M)
Ovary & Uterine Tube (F)
Uterus (body & fundus) (F)

140

Organs below the pelvic pain line?

Subperitoneal structures
GVA information travels back to the spinal cord with parasympathetics (Pelvic splanchnics)
Include:
Inferior bladder
Proximal urethra
Prostate (M)
Seminal vesicles & ejaculatory duct (M)
Rectum
Anal canal above pectinate line
Cervix & upper 2/3 of vagina (F)

141

somatic innervation to the structures of the perineum is provided by what nerves

prudendal N, ilioinguinal N, and genital branch of genito femoral.

142

the anterior scrotal nerve is a branch of what nerve?

ilioinguinal nerve

143

what hormone prevents

luteolysis during early pregnancy HcG

144

where is HcG first produced and then where is it produced after what time?

first by blostocyst then around week 8 placenta takes over

145

hCG action to prevent luteolysis is mediated through which receptors?

LH receptors

146

This patient’s corpus luteum ruptured and was surgically removed around the 7th week of pregnancy. What must be supplemented at this time in order for the pregnancy to be maintained?

Primary role of the corpus luteum during the first trimester: Progesterone secretion

147

Which progesterone actions are essential during the first week following fertilization?

Stimulates glands in oviduct and uterus to secrete nutrients for the embryo, adhesion proteins for implantation, endometrial development and angiogenesis
Inhibits uterine SM contraction  myometrial quiescence
Tubal SM relaxation on PF day 3 to open tube

148

Where is progesterone synthesized by around 8 weeks of pregnancy?

placenta

149

what causes a pregnant women to feel lightheaded in the supine position?

compression of the IVC

150

what happens to TPR during pregnancy and what causes this change?

TPR is decreased due to addition of fetal circuit and high levels of estrogen and progesterone causing vasofilation

151

what happens to the threshold level for ADH/AVP during pregnancy?

decreased meaning more ADH and water retention
Net: ↓ osmolality despite ↑ Na+ retention)

152

What leads to water retention during pregnancy?

decreased threshold for ADH, increase aldosterone ang II and renin, Change in set-point for ADH/AVP and osmoreceptor sensitivity

153

what are serum bicarb levels in pregenancy compared to pre pregnancy?

serum bicarb levels are lower due to compensation by the kidneys in response to respitory alkalosis

154

estriol provides an assessment of the function of what?

placenta and fetal adrenal glands

155

what are the main effects of estrogen in parturition?

Estrogen levels rise when nearing full-term and increase:
OT receptors
Prostaglandins and Pg receptors
SM gap junctions in the uterus
Cervical collagenase production

156

Factors that Contribute to Insulin Resistance during Pregnancy

Human placental growth hormone (hPGH or hGH-V)
Similar to pituitary GH and PRL
More prominent than pituitary GH in maternal circulation and not regulated by GHRH
85% of GH activity due to hPGH, 12% to hPL, 3% pituitary GH
hPL- also may stimulate insulin production
Progesterone
Placental TNF-α

157

arterial blood supply of the rectum above the pectinate line?

superior rectal artery

158

arterial blood supply below the pectinate line

middle and inferior rectal artery

159

venous drainage above the pectinate line

superior rectal vein drains into Inferior mesenteric vein which drains into spenic which drains into hepatic portal

160

venous drainage below the pectinate line

middle and inferior rectal veins caval system

161

lymphatic drainage of the upper part of the anal canal?

internal iliac nodes

162

lymphatic drainage of the inferior part of the anal canal

superficial iliac nodes

163

What are the peritoneal coverings for the rectum?

upper third has peritoneal anteriorly and laterally, middle is anterior only, lower third none- subperitoneal

164

lymphatic drainage of the superior middle upper portion of rectum

para-rectal/sacral to inferior mesenteric to lumbar nodes

165

lymphatic drainage lower rectum

Lower; sacral to internal iliac nodes