endo test two Flashcards
(165 cards)
1
Q
what vessels does the rectovessical septum contain
A
seminal vessicals
2
Q
what is an associated pathology of the transitional zone of the prostate?
A
Parenchymal cells of this zone can show hyperplasia in elderly [benign prostatic hyperplasia], compressing the urethra
3
Q
where do most prostatic carcinomas arise?
A
in the peripheral zone
4
Q
Prostatic Utricle Diverticulum / Cyst path
A
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
Q
what openings are in the prostatic urethra?
A
seminal colliculus -openings for ejaculatory ducts -orifice of the prostatic utricle -openings for prostatic ducts into prostatic sinuses -prostatic sinuses
6
Q
where are the openings for the bulbourethral ducts?
A
Penile/Spongy Urethra
7
Q
where do the prostate and seminal vessicals get there blood supply from?
A
inferior vessical
8
Q
The testicular ligament is a remnant of what? and connects what?
A
remnant of the gubernaculum. It connects the testis to the tunica vaginalis
9
Q
what muscle wrinkles the scrotum and innervation
A
dartos ,muscle Nerve: genitofemoral nerve L1 L2
10
Q
the internal abdomial obliuque is continuous with what muscle in the scrotum that does what innervated by what?
A
cremastor muscle raising and lowering the testes and epidydimus n: genital branch of the gentifemerol nerve
11
Q
does the transversalis muscle contribute to the scrotum?
A
No it is not continous
12
Q
hydrocycle pathology
A
serous fluid accumulation in the tunica vaginalis/ can also accumalte in spermatic cord
13
Q
hematocycle path
A
blood accumulating in layers of tunica vaginlalis
14
Q
where is sperm produced and stored?
A
seminiferous tubules stored in epididymis
15
Q
route of sperm after production
A
Seminiferous tubules > Straight tubule > Rete testis > Efferent ductile > Epididymis
16
Q
sprematocycle path
A
build up of fluid that contains sperm
17
Q
epididymial cyst
A
just serous fluid build up on epididymis
18
Q
blood supply to the scrotum?
A
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
Q
phimosis path
A
foreskin cannot be retracted over penis
20
Q
paraphimosis
A
glans penis stuck past foreskin/ stuck retracted
21
Q
fundiform ligament of the penis is made of what fascia?
A
scarpas
22
Q
suspensory ligament of the penis is continuous with what?
A
external abdominal oblique
23
Q
the intercavernous septum is made up of what fascia layer?
A
deep penile fascia (Buck’s fascia)
24
Q
deep artery of the penis is located in where?
A
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
