Anatomy/Phys

Question 1

Gonadal venous drainage

Answer 1

Left ovary/testis –> L gonadal vein –> L renal vein –> IVC

RIght ovary/testis –> R gonadal vein –> IVC —– so more varicoceles on the left side!

Question 2

Gonadal lymphatic drainage

Answer 2

Ovaries/testes (para-aortic lymph nodes) — distal vagina/vulva/scrotum (superficial inguinal nodes) — proximal vagina/uterus (obturator, external iliac, hypogastric nodes)

Question 3

Infundibulopelvic ligament (suspensory ligament of the ovary)

Answer 3

Ovaries to lateral pelvic wall – contains ovarian vessles – ureter courses retroperitoneally and is at risk during ligation of ovarian vessels

Question 4

Cardinal ligament (transverse cervical ligament)

Answer 4

Cervix to side wall of pelvis – contains uterine vessels

Question 5

Round ligament of uterus

Answer 5

Uterine fundus to labia majora – travels through inguinal canal above artery of Sampson

Question 6

Broad ligament

Answer 6

Uterus, fallopian tubes, and ovaries to pelvic side wall — made of mesosalpinx, mesometrium, and mesovarium

Question 7

Ovarian ligament

Answer 7

Medial pole of ovary to lateral uterus

Question 8

Female reproductive histology

Answer 8

Vagina and ectocervix (stratified squamous nonkeratinized) — transformation zone (squamocolumnar junction) — endocervix, uterus, fallopian tubes (simple columnar epithelium - glands in uterus, cilia in fallopain tube) — ovaries (simple cuboidal epithelium)

Question 9

Pathway of sperm during ejaculation

Answer 9

SEVEn UP – Seminiferous tubules, Epididymis, Vas deferens, Ejaculatory duct, Urethra, Penis

Question 10

Urethral injury

Answer 10

Blood seen at urethral meatus — posterior (membranous urethra damaged by pelvic fracture - urine leaks into retropubic space) — anterior (penile and bulbar urethra damaged by perineal straddle injury - urine leak beneath deep fascia)

Question 11

Male sexual response

Answer 11

Erection (Parasympathetic - pelvic nerve - NO –> cGMP –> smooth muscle relaxation and vasodilation) – Emission (Sympathetic - hypogastric nerve) – Ejaculation (viseral and somatic nerves - pudendal nerve)

Question 12

Spermatogonia

Answer 12

Germ cells - produce primary spermatocytes - line seminiferous tubules

Question 13

Sertoli cells

Answer 13

FSH stimulates them —- Secrete inhibin (inhibit FSH) – androgen binding protein (local testosterone) – form blood testis barrier – support and nourish sperm – regulate spermatogenesis – produce MIF – temperature sensitive (seen in varicocele and cryptorchidism)

Question 14

Leydig cells

Answer 14

Endocrine cells – secrete testosterone in presence of LH – INTERSTITIUM!

Question 15

Estrogen

Answer 15

Ovary (17B-estradiol), placenta (estriol), adipose (estrone) — develop genitalia and breast, female fat distribution, endometrial proliferation, upregulate estrogen/LH/progesterone receptors, inhibit FSH and LH, then LH surge — increase HDL (increase hepatic HMG-CoA reductase), decrease LDL

Question 16

Progesterone

Answer 16

Corpus luteum (for 10 days), placenta (after 10 days), adrenal cortex, testes — stimulate endometrial gland secretions, maintain pregnancy, induce gallbladder hypomobility (gallstones in pregnancy), thick cervical mucus, inhibit LH/FSH, prevent uterine contractions, prevent endometrial hyperplasia, inhibits prolactin —- increased progesterone indicates ovulation

Question 17

Tanner stages

Answer 17

II (pubic hair, breast buds) – III (dark/curly hair, single contour breasts, increase penis length) – IV (increase penis width, darker scrotum, double contour breasts) – V (pubic hair on inner thigh)

Question 18

Menstrual cycle follicular/proliferative phase

Answer 18

Variable length - ESTROGEN stimulates endometrial prolifeartion –> LH surge –> ovulation

Question 19

Menstrual cycle luteal/secretory phase

Answer 19

ALWAYS 14 DAYS – PROGESTERONE (corpus luteum) maintains endometrium for implantation – progesterone falls and then menstruation occurs

Question 20

Oogenesis

Answer 20

Primary oocytes (diploid 2N 4C) begin meiosis I in fetal life (stopped in prophase I until ovulation) — seconday oocytes (haploid 1N 2C) stopped in metaphse II until fertilization – ovum (haploid 1N 1C)

Question 21

Pregnancy fertilization

Answer 21

MC occurs in ampulla of fallopian tube within 1 day of ovulation – implantation within uterine wall by day 6 – syncytiotrophoblasts secrete hCG (blood at 1 week, urine at 2 weeks)

Question 22

Lactation

Answer 22

Decreased progesterone after labor increases prolactin (induces and maintains milk and decreases reproductive function), oxytocin (milk letdown and uterine contractions) – nerve stimulation (suckling) increase prolactin and oxytocin

Question 23

Breast milk

Answer 23

IgA (passive immunity) – reduces infections and asthma/allergies/DM/obesity – reduces moms risk of breast and ovarian cancer – require vitamin D and K supplementation

Question 24

hCG

Answer 24

From syncytiotrophoblasts] – maintains corpus luteum for first 8-10 weeks by acting like LH – identical a unit as LH/FSH/TSH but B unit is unique (B for baby) —- increased in hydaditiform moles, choriocarcinomas, Down syndrome — decreased in ectopic, Edward, and Patau

Question 25

Menopause

Answer 25

Decreased estrogen d/t decreased ovarian follicles -- average age 51 (earlier in smokers) --- HUGELY increased FSH, also increase LH and GnRH -- HAVOCS (Hot flashes, Atrophy of Vagina, Osteoporosis, Coronary artery disease, Sleep disturbances) --- before age 40 is Premature Ovarian Failure

Question 26

Spermatogenesis

Answer 26

Begins at puberty, occurs in seminiferous tubules -- spermatids undergo spermiogenesis (gain acrosomal cap) to form mature spermatozoon (haploid 1N 1C)

Question 27

Androgens

Answer 27

DHT is most potent -- Testosterone (differentiate genitalia, growth spurt, deep voice, close epiphyseal plates, libido) --- DHT (early does differentiation of penis/scrotum/prostate, late does prostate growth/balding/sebaceous glands) --- Testosterone to DHT by 5a-reductase --- Androgens to estrogen by aromatase