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ESA 4 > Repro 4 > Flashcards

Repro 4 Flashcards

1
Q

4 component parts of male reproductive system?

A

paired testes- site of spermatozoa production, and sex hormone secretion
duct system- transports spermatozoa to urethra
accessory sex glands- supply fluid components to semen: prostate, seminal vesicles, bulbourethral glands
penis

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2
Q

type of gland the testis is?

A

compound tubular gland

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3
Q

What does the tunica albuginea form posteriorly that contains many interconnected channels which provide passageways for sperm to enter duct system?

A

mediastinum testis

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4
Q

muscle contained within superficial fascia of the scrotum?

A

dartos muscle

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5
Q

what are the testes contained within?

A

the scrotal sac

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6
Q

the 2 types of cells found within the seminiferous epithelium?

A 
sertoli cells (supporting cells)
spermatogenic cells (germ cells)
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7
Q

most primitive spermatogenic cells?

A

spermatogonia-rest on BM

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8
Q

distinguishing between spermatids and spermatozoa on microscopy?

A

spermatids- lightly stained round nucleus
spermatozoa- deeply staining heads, which appear to be embedded in sertoli cells, their tails hanging into lumen of seminiferous tubule

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9
Q

approximate length of spermatogenesis?

A

70 days

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10
Q

what is oligozoospermia?

A

clinical condition where abnormally low number of spermatozoa in semen.

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11
Q

what is azoospermia?

A

no sperms appear in ejaculate

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12
Q

what is cryptorchid (maldescended) testis, and what problems can it create?

A

spermatogenesis impaired as elevated temperature. Germs cells absent, while Sertoli and Leydig cells secrete male sex hormones.
Associated with increased incidence of malignant testicular tumours

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13
Q

what is orchitis?

A

inflammation of testes- occurs in some people who suffer mumps after puberty, causing impaired spermatogenesis, occasionally leading to seminiferous tubule degeneration, or at times, infertility.

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14
Q

what happens to sperm in the epididymis?

A

transport, mature, stored

stored in tail segment until ejaculation

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15
Q

name of terminal portion of vas deferens?

A

ampulla

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16
Q

how is the ejaculatory duct formed?

A

ampulla of vas deferens joins with duct of seminal vesicle

ejaculatory duct then opens into prostatic urethra

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17
Q

epithelial lining of ductus epididymis- duct of the epididymis?

A

pseudostratified columnar with stereocilia

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18
Q

discontinuous layer of longitudinally-oriented strands of striated muscle enclosing spermatic cord?

A

cremaster muscle

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19
Q

collection of small veins surrounding vas deferens, and forming most bulk part of spermatic cord?

A

pampiniform plexus

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20
Q

which bacteria may cause epididymitis?

A

N gonorroheae, E coli, Chlamydia trachomatis

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21
Q

sequence of secretions that forms ejaculate?

A

bulbourethral glands
prostate
spermatozoa
seminal vesicles

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22
Q

where do the seminal vesicles lie?

A

posterior to prostate

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23
Q

where are the bulbourethral glands located?

A

within the urogenital diaphragm

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24
Q

3 cylindrical bodies of erectile tissue forming the penis?

A

2 corpora cavernosa penis

single corpus cavernosum urethrae (corpus spongiosum)

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25
Q

importance for testes to be contained within scrotum?

A

keeps them at the low temperature necessary for spermatogenesis by allowing the testis to sit outside of the body

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26
Q

what remnant of peritoneum forms a fluid filled structure around testes?*

A

tunica vaginalis

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27
Q

why is the spermatic cord important to the testes?

A

it contains the testicular blood vessels- testicular artery and pampiniform venous plexus, and the ductus deferens

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28
Q

function of the small amount of fluid in the cavity of the tunica vaginalis?

A

to allow testes to move freely in scrotum

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29
Q

origin of testicular arteries?

A

abdominal aorta, just inferior to renal arteries- IV disc between L1 and L2 vertebrae

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30
Q

origin of testicular veins?

A

pampiniform venous plexus, which lies anterior to the vas deferens and surrounds the testicular artery in the spermatic cord

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31
Q

drainage of testicular veins?

A

R: IVC
L: left renal vein

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32
Q

drainage of testicular veins?

A

R: IVC
L: left renal vein

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33
Q

how may the cremasteric reflex be evoked and what does it demonstrate?

A

by lightly stroking medial aspect of superior part of the thigh, which causes the cremaster muscle to contract and result in rapid elevation of the testis on the same side. Area of skin supplied by ilioinguinal nerve which synapses in the SC and activates the motor fibres of the genital branch of the genitofemoral nerve causing cremaster muscle contraction

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34
Q

problem of hyperactive cremasteric reflex in children?

A

may be mis-diagnosed as cryptorchidism
hyperactive reflex can be aboloished by getting children to sit cross-legged in a squatting position as if the testes are descended, they can then be palpated in the scrotum

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35
Q

problem of hyperactive cremasteric reflex in children?

A

may be mis-diagnosed as cryptorchidism
hyperactive reflex can be aboloished by getting children to sit cross-legged in a squatting position as if the testes are descended, they can then be palpated in the scrotum

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36
Q

where is the internal spermatic fascia derived from?

A

transversalis fascia

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37
Q

where is the cremasteric spermatic fascia derived from?

A

fascia of both superficial and deep surfaces of internal oblique muscle, and transversalis fascia

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38
Q

where is the external spermatic fascia derived from?

A

external oblique aponeurosis and its investing fascia

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39
Q

describe the course of the spermatic cord

A

begins at deep inguinal ring, lateral to the inferior epigastric vessels, passes through inguinal canal, exits at superficial inguinal ring, and ends in the scrotum at the posterior border of the testis

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40
Q

why is a L sided varciocele more common than a R sided one?

A

because the acute angle of entry of the R testicular vein into the IVC is more favourable to flow than the nearly 90 degree angle at which the L testicular vein enters the L renal vein, making it more susceptible to obstruction or flow reversal

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41
Q

contents of the scrotum?

A

testis
first part of spermatic cord
epididymis

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42
Q

optimum temp for enzymes responsible for spermatogenesis?

A

2 degrees below normal body temp

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43
Q

what is the septum of the scrotum?

A

continuation of dartos fascia separating scrotum into R and L compartments internally, 1 for each testis

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44
Q

how is septum of scrotum marked externally?

A

by scrotal raphe- cutaneous ridge marking line of fusion of labioscrotal swellings

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45
Q

what is the internal spermatic fascia lined by internally?

A

the parietal layer of the tunica vaginalis

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46
Q

what is the sinus of the epididymis?

A

slit-like recess of tunica vaginalis, between body of the epididymis and PL surface of testis

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47
Q

where does an undescended testis commonly lie?

A

in the inguinal canal

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48
Q

why is increased risk of testicular malignancy in undescended testis in cryptorchidism part. problematic?

A

not palpable and not usually detected until cancer has progressed

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49
Q

what structures enable an adequate temp in testes for spermatogenesis to occur?

A

dartos muscle
cremaster muscle
pampiniform venous plexus

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50
Q

location of scrotum in relation to penis and pubic symphysis?

A

PI to penis, and inferior to PS

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51
Q

where is the surface of the testis not covered by the visceral layer of the tunica vaginalis?

A

where testis attaches to epididymis and spermatic cord

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52
Q

what is the processus vaginalis and how is it formed formed?

A

peritoneal invagination which made pathway for descent of testes into scrotum
musculo-fascial layer evaginates into scrotum as it develops, together with peritoneal membrane

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53
Q

describe course of testicular arteries?

A

pass retroperitoneally in oblique direction, crossing over ureters and inferior parts of external iliac arteries to reach deep inguinal rings where enter inguinal canal, exit through superficial inguinal rings, enter spermatic cords to supply testes
artery or 1 of its branches anastomoses with artery of vas deferens

54
Q

how is pampiniform venous plexus formed?

A

by veins emerging from testis and epididymis

55
Q

importance of configuration of pampiniform venous plexus?

A

veins wrapped around testicular artery in a meshwork that enables cooler venous blood to pass next to warmer arterial blood, that can then be cooled via a heat-exchange mechanism to ensure testes are kept in cool environ. necessary for spermatogenesis

56
Q

components of spermatic cord?

A 
testicular artery
cremasteric artery
artery to vas deferens
vas deferens
pampiniform venous plexus
genital branch of genitofemoral nerve
vestige of processus vaginalis
lymphatic vessels
57
Q

why is testicular torsion a surgical emergency?

A

necrosis of testis may occur: twisting of spermatic cord obstructs venous drainage, with resultant oedema and haemorrhage, and subsequent obstruction of the testicular artery. Twisting just above upper pole of testis.

58
Q

how can recurrence/occurrence of torsion of spermatic cord on contralateral side be prevented?

A

both testes surgically fixed to scrotal septum- continuation of dartos fascia

59
Q

lymphatic drainage of testes?

A

paraaortic lymph nodes- not palpable, would only be seen by imaging

60
Q

lymphatic drainage of scrotum?

A

superficial inguinal lymph nodes- palpable

61
Q

innervation of testes and scrotum?

A

lumbar plexus- anterior surface

sacral plexus- posterior and inferior surfaces

62
Q

what is a hydrocele of testis?

A

serous fluid in tunica vaginalis so layers opened up. Confined to scrotum, tunica vaginalis distended.

63
Q

why might haematocoele of testis occur?

A

collection of blood in tunica vaginalis may result from rupture of branches of testicular artery by trauma to testis

64
Q

how could a hydrocele of testis be differentiated from a haematocele?

A

transillumination- blood does not transilluminate as denser so doesn’t let light pass through

65
Q

what is a varicocele?

A

varicosities of pampiniform venous plexus

66
Q

why is a varicocele typically not visible when patient supine?

A

veins able to drain, especially if scrotum elevated as gravity allowed to empty the veins

67
Q

how may varicoceles be caused?

A

defective valves in testicular vein, or kidney or renal vein problems e.g. traction on SMA causing compression of L renal veins

68
Q

what is a spermatocele?

A

epididymal cyst containing spermatogonia

69
Q

developmental basis of indirect inguinal hernia?

A

reopening of processus vaginalis

potential continuity between peritoneal cavity and tunica vaginalis- so between abdomen and scrotum

70
Q

what does seminal vesicle develop from?

A

diverticulum of vas deferens

71
Q

what is a hydrocele of the spermatic cord?

A

presence of excess fluid in a persistent processus vaginalis as result of secretion of abnormal amount of serous fluid from visceral layer of tunica vaginalis

72
Q

where do the seminal vesicle lie anatomically?

A

between the bladder and the rectum

73
Q

where does duct of seminal vesicle join vas deferens?

A

within body of prostate gland

74
Q

describe the composition of the seminal vesicle secretion

A

thick, alkaline fluid with fructose- energy source for sperms, PGs, aa and proteins, so male gamete receives nutrition and is buffered

75
Q

how are superior ends of seminal vesicles separated from rectum?

A

by peritoneum of rectovesical pouch

inferior ends separated by rectovesical septum

76
Q

important anatomical relationships of prostate?

A

base- neck of bladder
apex- urethral sphincter and deep perineal muscles
muscular anterior surface- urethral sphincter
posterior- ampulla of rectum
infero-lateral- levator ani

77
Q

why do prostatic malignancies tend to present late?

A

affect peripheral zone of prostate, so don’t produce urinary symptoms e.g. nocturia and urgency, until later on

78
Q

how can prostatic malignancies spread via lymphatics?

A

via internal iliac and sacral LNs

79
Q

why does the prostate give rise to bony metastases, commonly in the back?

A

as venous drainage via internal vertebral plexus to vertebrae and brain

80
Q

why can a DRE be used to look for prostatic malignancy?

A

as prostate lies anterior to the rectum

81
Q

3 parts to penis?

A

root, body and glans

82
Q

internal structure of penis?

A

pair of corpora cavernosa dorsally

single corpus spongiosum ventrally which is continuous with glans distally

83
Q

blood supply of penis?

A

branches of internal pudendal arteries- branches of anterior division of internal iliac artery

84
Q

penis innervation?

A

pelvic splanchnic and pudendal nerves

85
Q

importance of corpus spongiosum remaining soft during erection?

A

contains spongy penile urethra so ensures that urethra isn’t obstructed which would prevent release of ejaculate

86
Q

what covers each cavernous body of penis?

A

the tunica albuginea

87
Q

how are the corpora cavernosa and corpus spongiosum bound together?

A

the deep fascia of the penis- superficial to tunica albuginea and is a continuation of deep perineal fascia

88
Q

what is the venous drainage of the penis?

A

blood from cavernous spaces drained by venous plexus of penis, that joins deep dorsal vein of penis, then prostatic venous plexus, internal iliac vein, and IVC

89
Q

function of bulbospongiosus?

A

a superficial muscle of perineum, responsible for helping to expel last drops of urine as forms a constrictor that compresses bulb of penis and corpus spongiosum, also assist in keeping an erection by increasing pressure on erectile tissue in root of penis

90
Q

function of ischiocavernosus?

A

superficial perineal muscle, surrounds crura in root of penis, compresses veins, restricting venous outflow and so help maintain erection

91
Q

least distensible part of male urethra?

A

membranous part

92
Q

when can suprapubic catheterisation be used?*

A

bladder very enlarged and risen above pubic bone

93
Q

how is the posterior rim of the pelvic outlet defined?

A

by ligaments- sacrotuberous ligament

94
Q

boundaries of pelvic outlet (inferior pelvic aperture)?

A

pubic arch anteriorly
ischial tuberosities laterally
inferior margin of sacrotuberous ligament posterolaterally
tip of coccyx posteriorly

95
Q

features of gynecoid pelvis making it suitable for childbirth?

A

wide, oval and rounded pelvic inlet
pelvic outlet comparatively large
sacral promontory only makes small indentation into pelvic cavity
wide subpubic angle (>80o)
straight side walls of mid-pelvis
greater sciatic notch almost 90o, well-rounded
ischial spines not too prominent

thin and light
shallow false pelvis
wide and shallow, cylindrical true pelvis
oval obturator foramen
small acetabulum
96
Q

features of male (android) pelvis?

A 
thick and heavy
prominent ischial spines
prominent projecting promontory of sacrum
heart-shaped, narrow pelvic inlet
narrow subpubic angle <70o
comparatively small pelvic outlet
funnel shaped pelvic cavity
round obturator foramen
large acetabulum
deep false pelvis
narrow and deep, tapering true pelvis
97
Q

what is the pelvic inlet (entrance into lesser pelvis)- superior pelvic aperture, formed by?

A

promontory and ala of sacrum posteriorly

right and left linea terminalis anteriorly: arcuate line, pectineal line and pubic crest

98
Q

what is the pelvic inlet defined by?

A

the pelvic brim

* ureter crosses pelvic brim at bifurcation of common iliac artery, and this is a point of ureteric constriction

99
Q

how is the pelvic inlet assessed clinically?

A

AP diameter:

  • anatomic conjugate: Measured from the sacral promontory to the superior border of the pubic symphysis
  • obstetric conjugate: from sacral promontory to midpoint of pubic symphysis, midpoint of PS can’t be palpated, but this is minimum diameter of pelvic canal as is where pubic bone is thickest
  • diagonal conjugate: from sacral promontory to inferior border of pubic symphysis, gives reasonable approx of min AP diameter
100
Q

how can size of pelvic outlet be increased during pregnancy?

A

progesterone makes ligaments- sacrotuberous, softer and more capable of stretch, so more give in pelvic outlet

101
Q

what is the greater pelvis?

A

(false pelvis) part of pelvis:
superior to pelvic inlet
bounded by iliac alae posterolaterally and antero-superior aspect of S1 vertebra post
occupied by abdom viscera e.g. ileum and sigmoid colon
no obstetric relevance, lies above linea terminalis

102
Q

what is the lesser pelvis?

A

(true pelvis) part of pelvis:
between pelvic inlet and outlet
bounded by pelvic surfaces of hip bones, sacrum and coccyx
includes true pelvic cavity and deep parts of perineum, specif ischioanal fossae

bony canal- solid and immobile, so limiting, obstetric relevance

103
Q

importance of testosterone in spermatogenesis?

A

necessary for proliferation and differentiation of spermatogenic cells

104
Q

how is testosterone maintained at a relatively high conc in testes?

A

due to high concentration of androgen binding protein

105
Q

how are efferent ductules specialised for sperm transport?

A

ciliary action- pseudostratified cililiated columnar cells, and myoid contraction- cells beneath BM

106
Q

which zone of prostate does BPH commonly affect?

A

transition zone

107
Q

which zone of prostate does prostatic carcinoma commonly affect?

A

peripheral zone

108
Q

most common type of prostatic cancer?

A

adenocarcinoma

109
Q

which cells are involved in most ovarian cancers?

A

epithelial- simple cuboidal

as continuous rupture and repair of epithelium with ova release

110
Q

name given to site of transition between vaginal and cervical epithelium, which is most common site of neoplasms?

A

transformation zone

111
Q

describe the course of the vas deferens

A

begins in tail of epididymis, at inferior pole of testis
ascends posterior to testis, medial to epididymis
forms main component of spermatic cord
penetrates A abdom wall via inguinal canal
crosses over external iliac vessels and enters pelvis
passes along lateral wall of pelvis, where it lies external to parietal peritoneum
ends by joining duct of seminal vesicle to form ejaculatory duct in body of prostate

112
Q

nerve roots of ilioinguinal and genital branch of genitofemoral nerves, and hence what is demonstrated by the cremasteric reflex?

A

ilioinguinal- L1
genitofemoral- L1, L2

spinal reflex arc

113
Q

which smooth muscle layer causes scrotal skin to wrinkle on cold exposure?

A

dartos muscle

114
Q

where are the paraaortic LNs located anatomically?

A

transpyloric plane*, L1

115
Q

why can a malignancy in the testis spread to cervical LNs?

A

testes originate on post abdom wall, relocate to scrotum, taking their lymphatic drainage with them, so drain into para-aortic LNs were metastasis can spread, and these LNs anastomose with intra-thoracic and in turn, cervical LNs

116
Q

where can bladder, prostate and urethral infections spread to vas deferens?

A

where it joins the duct of the seminal vesicle to form the ejaculatory duct within the body of the prostate gland, which joins prostatic urethra, inferior to bladder

117
Q

describe layers surrounding testes, from superficial to deep

A 
scrotal skin
superficial fascia (dartos fascia)
spermatic fascia: external spermatic
cremasteric
internal spermatic
tunica vaginalis
tunica albuginea
118
Q

at what fetal mnth do testes reach iliac fossa?

A

3

119
Q

at what fetal mnth do testes travel through inguinal canal?

A

7

120
Q

at what fetal mnth do testes reach external ring?

A

8

121
Q

at what fetal mnth do testes enter scrotum?

A

9

122
Q

how are peristaltic waves during emission controlled?

A

Sympathetic nervous system- hypogastric nerve (L1, L2)

123
Q

function of PGs in secretion by seminal vesicles?

A

facilitate sperm motility and may promote smooth muscle contraction in female tract

124
Q

characteristics and components of prostate secretion

A

thin, milky, slightly acidic
proteolytic enzymes e.g. PSA, pepsinogen
citric acid
acid phosphotase

125
Q

function of proteolytic enzymes in prostate secretion?

A

bdown clotting proteins from SV secretion so semen re-liquefied 10-20 mins after ejaculation

126
Q

function of citric acid in prostate secretion?

A

used by sperm in TCA cycle for ATP production

127
Q

why is the membranous part of the urethra the least distensible part?

A

surrounded by sphincter urethrae muscle and perineal membrane

128
Q

describe arterial supply of penis

A

branches of internal pudendal artery which form deep arteries, dorsal arteries and arteries of the bulb

deep arteries and dorsal supply crura and corpora cavernosa
dorsal arteries and arteries of bulb supply bulb and corpus spongiosum

129
Q

how is corpus spongiosum stopped from becoming rigid in male?

A

tunica albuginea that surrounds it is not as fibrous or restrictive as that surround the corpora cavernosa

130
Q

problem of undescended testes?

A

infertility

increased risk of testicular malignancy

ESA 4 (24 decks)

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