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Rachael Phase 1 > Reproduction (Male and Female Anatomy) > Flashcards

Reproduction (Male and Female Anatomy) Flashcards

1
Q

How long is the inguinal canal?

A

5cm

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2
Q

Which nerve passes through the inguinal canal?

A

Ilioinguinal

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3
Q

What are the borders of the inguinal canal?

A 
Ant = External oblique aponeurosis
Post = Transversalis fascia
Roof = Inguinal ligament
Floor = arched fibres of internal and transversalis muscle
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4
Q

Which artery lies immediately medial to the deep inguinal ring?

A

inferior epigastric artery

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5
Q

How are direct hernias related to the inferior epigastric artery?

A

medial to epigastric artery

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6
Q

How are indirect hernias related to the inferior epigastric artery?

A

lateral to epigastric artery

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7
Q

What happens in a direct inguinal hernia?

A

peritoneal sac emerges from an area medial to epigastric vessels and bulges in via the posterior wall (X through deep ring)

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8
Q

What happens in an indirect inguinal hernia?

A

Peritoneal sac emerges from an area lateral to epigastric vessels and passes through deep inguinal ring

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9
Q

Where does the inguinal ligament extend from and to?

A

ASIS to pubic symphysis

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10
Q

What is the deep inguinal ring created by?

A

The transversalis fascia

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11
Q

Where is the superficial ring located?

A

Just superior to pubic tubercle

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12
Q

Where do femoral hernias occur?

A

Below and lateral to the pubic tubercle in the wall of the inguinal ligament

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13
Q

What marks the end of the inguinal canal?

A

The superficial inguinal ring

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14
Q

What is the inguinal canal in males?

A

A pathway that the testes can leave the abdominal cavity and enter scrotum

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15
Q

At the embryological stage the inguinal canal is flanked by an out-ouching of what?

A

The peritoneum and abdominal musculature

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16
Q

What happens to the processus vaginalis in male embryology?

A

It usually degenerates

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17
Q

Failure of the processus vaginalis to degenerate in males is called what?

A

An indirect inguinal hernia

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18
Q

In male embryology where do the testes begin and end?

A

the testes establish in the posterior abdominal wall and descend into the scrotum

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19
Q

What guides the testes during their descent?

A

the gubernaculum attaches inferior portion of gonad to future scrotum and guides them

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20
Q

What is the role of the gubernaculum in female embryology?

A

attaches the ovaries to the uterus and future labia majora

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21
Q

How are the ovaries prevented from descending as far as the testes?

A

The gubernaculum attaches the ovaries to the uterus

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22
Q

In females what does the gubernaculum become?

A

ovarian ligament and round ligament of the uterus

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23
Q

What happens in the 8th week of male reproductive embryology?

A

The Wolffian duct develops into VEES

  • vas deferens
  • epididymis
  • ejaculatory
  • Seminal vesicles
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24
Q

What happens to the Mullerian duct in males?

A

regresses under the influence of AMH (anti-mullerian hormone)

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25
Q

What happens in the 9th week of male reproductive embryology?

A

leydig cells form which secrete testosterone

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26
Q

What happens to the testes during the last 3 months of gestation?

A

The testes descend into scrotum from the abdomen under the influence of testosterong

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27
Q

What is the epididymis?

A

single coiled tube male up of a head, body and tail

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28
Q

What is the function of the epididymis?

A
  • to store sperm

- sperm maturation

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29
Q

How is the epididymis separated from the testes?

A

The tunica vasculosa and tunica alberginia

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30
Q

What is the pathway of sperm from the testes?

A

Seminiferous tubules&raquo_space; straight tubules&raquo_space; rate testis&raquo_space; efferent ducts&raquo_space; ductus epididymis&raquo_space; vas deferens

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31
Q

Which testes is normally lower?

A

left = lower

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32
Q

Which muscles do the scrotum contain?

A 
dartos = wrinkled appearance
cremaster = pulls testes up towards body (in cold temperatures)
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33
Q

What is semen made up of?

A

60%- seminal fluid
10%- sperm
30%- prostate fluid

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34
Q

What is seminal fluid made up of?

A

A fructose rich, alkaline fluid

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35
Q

What is prostate fluid made up of?

A

secretes fluid in ejaculationrich in bicarbonate buffers

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36
Q

What do seminal vesicles do?

A

secrete prostaglandins

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37
Q

What is the prostate gland split up into?

A

2 x lobes

lateral and median

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38
Q

What is the clinical significance of the lateral and median lobes of the prostate gland?

A 
lateral = malignant tumours
median = benign tumours
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39
Q

What glands lie inferior to the prostate gland?

A

Bulbourethral

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40
Q

What do the bulbourethral glands secrete?

A

A lubricating fluid prior to ejaculation which helps neutralise the acidity of the urethra to make it a more hospitable environment for sperm

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41
Q

What is the corpus cavernosa?

A

a spongy tube which fills with blood to become erect?

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42
Q

What is the blood-testes barrier?

A

a barrier formed between sertoli cells of the seminiferous tubules and the blood vessels

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43
Q

What is the blood-testes barrier formed by?

A
  • tight junctions
  • adherent junctions
  • gap junctions
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44
Q

What do the junctions of the blood-testes barrier divide the seminiferous tubules into?

A
  • basal compartment = outer side of tubule IN CONTACT with the blood and lymph
  • adluminal compartment = inner side of tubule ISOLATED from blood and lymph
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45
Q

What is the function of the blood-testes barrier?

A

To prevent an autoimmune reaction as sperm are anti genetically different from self tissue

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46
Q

What can enlargement of the scrotum be caused by?

A
  1. inguinal hernia
  2. hydrocoele
  3. haematocoele
  4. varicocoele
  5. epididymitis
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47
Q

What is a hydrocoele?

A

collection of serous fluid int he tunica vaginalis

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48
Q

What is a varicocoele?

A

dilation of veins draining the testes

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49
Q

Which vein is more likely to be affect by a varicocoele?

A

The left gonadal vein as it drains into smaller vessels at a perpendicular angle

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50
Q

What is epididymitis?

A

Inflammation due to bacteria or a viral infection

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51
Q

What is the venous drainage of the testes?

A

right gonadal&raquo_space; IVC
left gonadal&raquo_space; left renal vein&raquo_space; IVC
(left = longer)

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52
Q

Which type of spermatogonia do not mature?

A

Type A spermatogonia

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53
Q

What is the innervation of the testes?

A

testicular plexus

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54
Q

What is the lymph drainage of the testes?

A

para-aortic lymph nodes and the lumbar nodes

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55
Q

How many efferent ducts are there and what do they do?

A

8-10 and transport the sperm from the rate testis into the ductus epididymis

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56
Q

What capsule surrounds the testes?

A

The tunica alberginea

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57
Q

What is the tunica vaginalis?

A

a pouch of serous membrane that covers the testes

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58
Q

What is the origin of the vas deferens?

A

tail of the epididymis

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59
Q

What 4 muscles are in the root of the penis?

A

2x bulbospongiosus

2x ischiocavernosus

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60
Q

What is the blood supply to the penis?

A
  • dorsal artery
  • deep cavernous artery
  • bulbourethral artery
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61
Q

What is the nerve supply to the penis?

A

deep nerve (a branch of the pudendal)

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62
Q

What is the nerve supply to the scrotum?

A

posterior scrotal nerve (a branch of the pudendal)

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63
Q

What is the nerve supply to the anus?

A

Inferior anal nerve

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64
Q

What are the three layers of fascia surrounding the spermatic cord?

A
  1. external
  2. cremasteric
  3. internal
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65
Q

What structures are contained within the spermatic cord?

A 
3x arteries (TAC) = testicular, artery of vas, cremasteric
3x veins = testicular, vein of vas, cremasteric
3x nerves (SIG) = sympathetic, ilioinguinal, genito-femoral
3x other structures = vas deferens, tunica vaginalis, lymphatics
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66
Q

What ligaments support the root of the penis?

A

suspensory ligament- connects erectile bodies > pubic symphysis
fundiform ligament- runs from line alba, surround penis like a sling and attaches to pubic symphysis

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67
Q

How would you assess testicular cancer lymph node spread?

A

check the upper abdominal aorta in the epigastrium

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68
Q

Where may testicular referred pain be felt?

A

in the loin (groin to loin)

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69
Q

What may impede the progress of a catheter?

A

The navicular fossa

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70
Q

What is different about the skin of the penis?

A

more heavily pigmented that the rest of the body

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71
Q

What is the prepuce, how is it formed and where is it located?

A

foreskin = double layer of fascia (@ neck of glans)

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72
Q

how is the prepuce connected to the skin of the glans?

A

By the frenulum (fold of skin on the ventral surface of the penis)

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73
Q

What is the preputial sac?

A

A potential space between the glans and prepuce

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74
Q

What is the HPG axis?

A

a negative feedback loop system regulating levels of LH and FSH

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75
Q

What do hypothalamic hormones travel down to reach the anterior pituitary?

A

hypophyseal portal vessels

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76
Q

In males what does LH act on and what does it cause?

A

Leydig cells in the interstitial space&raquo_space; secrete testosterone

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77
Q

In males what does FSH act on and what does it cause?

A

Sertoli cells in the seminiferous tubules &raquo_space; stimulates release of ABH (androgen binding hormone)&raquo_space; promotes synthesis of sperm

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78
Q

What are LH and FSH inhibited by?

A

Prolactin

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79
Q

What are the 5 actions of testosterone?

A
  1. sertoli cells > spermatogenesis
  2. induces differentiation of male 2nd sex characteristics
  3. stimulates bone growth and sex drive
  4. stimulates EPO by kidney
  5. responsible for internal male genitalia
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80
Q

High testosterone leads to what?

A

A reduction in the secretion of LH

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81
Q

What hormone produces the external male genetalia?

A

Dihydrotestosterone

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82
Q

In females what does FSH promote?

A

enters ovariers and stimulates primary maturation of the follicles

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83
Q

In females what does LH do?

A

triggers ovulation

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84
Q

What are 5 actions of oestrogen?

A
  1. stimulates bone/muscle and endometrial growth
  2. at low concentrations inhibits LH release
  3. at high concentrations it stimulates LH secretion (LH surge)
  4. at low concentrations triggers release of FSH
  5. increases the number of oestrogen and progesterone receptors in the uterus
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85
Q

What are 3 actions of progesterone in the female?

A
  1. converts endometrium into secretory endometrium to prepare for implantation
  2. decreases contractility of smooth muscle
  3. prevents breakdown of uterus wall (menstruation)
86
Q

What is the pathway that sperm travels?

A

epididymis&raquo_space; vas deferens&raquo_space; ejaculatory duct&raquo_space; prostatic urethra&raquo_space; membranous urethra&raquo_space; penile urethra

87
Q

Where is sperm made?

A

In the seminiferous tubules

88
Q

What is sermiogenesis?

A

Spermatids develop to become immature spermatozoa in the lumen of the seminiferous tubules

89
Q

Where does oogenesis start?

A

starts in the foetus

90
Q

What is a primary follicle made up of?

A

a layer of follicular cells around the primary oocyte

91
Q

How many primordial follicles are produced before birth?

A

~ 2 million

92
Q

When does the process of oogenesis resume?

A

at puberty

93
Q

How many of the primordial follicles will develop into ova?

A

400-500

94
Q

As the primordial follicle cells develop what are they surrounded by?

A

granulose cells that secrete a jelly like layer around the oocyte called the zona pellucida

95
Q

What is the layer of smooth muscle around a primordial follicle cell called and what is its function?

A

theca- supplies the oocyte with blood AND cells secrete oestrogen which helps the formation of secondary follicles which contain primary oocytes

96
Q

When does a Graafian follicle develop?

A

A month after puberty

97
Q

What is a Graafian follicle?

A

A mature secondary follicle which ruptures during ovulation and enables the empty follicle to fill up with secretory cells and become the corpus luteum (produces progesterone)

98
Q

When is a primary oocyte arrested?

A

In prophase I (of meiosis I)

99
Q

Name 4 things that sertoli cells do?

A
  • produce AMH
  • produce androgen binding protein
  • phagocytosis
  • produce blood-testes barrier
100
Q

How is the normal position of the uterus maintained?

A

tone and 4x sets of ligaments

  • tone in the elevator and muscles
  • transvers cervical ligaments
  • pubocervical ligaments
  • sacrocervical ligaments
  • broad ligaments
101
Q

What is the action of prostaglandin F2 alpha?

A
  • stimulates contraction of the uterus and bronchial SM
  • vasoconstriction of some blood vessels
  • luteolysis of the CL&raquo_space; tunica albicans
102
Q

How can abortion be induced?

A

The use of prostaglandin F2 alpha

103
Q

What is the normal position of the uterus?

A

Anteverted- lies tilted forwards over the bladder

104
Q

What is retroversion of the uterus?

A

when the uterus lies backwards impinging on the anterior wall of the rectum

105
Q

Which nerve passes through the superficial ring but not the deep ring of the inguinal canal?

A

ilioinguinal

106
Q

What does the round ligament attach

A

originates at the uterine horns and passes to the labia majora where its fibres attach the the mons pubis

107
Q

How long is the uterus?

A

8cm

108
Q

How long is the vagina?

A

10cm

109
Q

How long are the uterine tubes?

A

10cm

110
Q

What is the internal os?

A

cervix communicating with the uterine cavity

111
Q

What is the external os?

A

cervix communicating with the vagina

112
Q

What are the fornices and name them?

A

spaces around the cervix in the vagina:

  1. anterior
  2. posterior
  3. right lateral
  4. left lateral
113
Q

Where do the ovaries lie and what forms this?

A

Lie in the ovarian fossa formed by the angle between the internal and external iliac arteries

114
Q

What are the labia majora?

A

prominent hair bearing folds of skin which cover the vestibule

115
Q

What is the vestibule?

A

The area of skin that contains the urethral opening and vaginal opening

116
Q

How many bundles of connective tissue does the clitoris comprise of?

A

3 bundles

117
Q

Where is ovarian pain felt and why?

A

In the medial thigh- the ovary is sitting alongside the lateral pelvic wall where the obturator nerve runs

118
Q

Where is vaginal/uterine pain felt?

A

in the lower back

119
Q

Which lymph nodes can cervical cancer spread to?

A

internal iliac lymph nodes

120
Q

What is the epithelium of the following…

  1. fallopian tubes
  2. vagina
  3. uterus
A
  1. ciliated epithelium
  2. stratified squamous
  3. columnar cells
121
Q

What is the arterial supply to the vagina?

A

vaginal artery a branch of the internal iliac

122
Q

What is the venous drainage of the vagina?

A

vaginal veins form a plexiform and drain into internal iliac vein

123
Q

What is the lymph drainage of the vagina?

A

upper 1/3 = ext and int iliac nodes
middle 1/3 = internal iliac nodes
lower 1/3 = superficial inguinal nodes

124
Q

What are the anterior relations to the vagina?

A

bladder and urethra

125
Q

What are the 3 posterior relations of the vagina?

A
  1. pouch of douglas
  2. ampulla of rectum
  3. perineal body
126
Q

What are the 3 lateral relations of the vagina?

A
  1. ureter
  2. ant. fibres of levator ani
  3. urogenital diaphragm
127
Q

What are the 3 phases of menstruation and when do they occur?

A
  1. proliferation (day 7-14)
  2. secretory (day 14-28)
  3. menses (say 0-7)
128
Q

What happens in proliferation?

A
  1. mitosis of stromal and endometrial cells&raquo_space; thickening of uterus lining and uterine glands&raquo_space; 3.5-5mm thick
  2. causes up regulation of O and P receptors in the endometrium
  3. under the influence of oestrogen
129
Q

What happens in the secretory phase?

A
  1. glands become convoluted and dilated with secretions
  2. spiral arteries become more prominent (more corkscrew in appearance)
  3. under the influence of progesterone
130
Q

What happens in menses and why?

A

shedding of the endometrium due to no oestrogen production

131
Q

What is the importance of up regulation of O and P receptors during the proliferative stage?

A

prime the endometrium and enable it to respond to progesterone in the luteal phase

132
Q

What changes occur during the secretory phase?

A
  • tortuous glands
  • spiral arteries
  • secretions in lumen of glands
  • increased stromal bulk
133
Q

How does contraception containing progesterone work?

A

increased progesterone = decreased FSH and no follicle maturation

134
Q

Where does fertilisation take place?

A

ampulla of the fallopian tube

135
Q

How long can sperm remain viable in the fallopian tube for?

A

A few days

136
Q

What percentage of sperm deposited in the vagina enter the cervix?

A

1%

137
Q

How does movement of sperm from the cervix to the uterine tube occur?

A

muscular contractions of the uterus and uterine tube (and very little by their own propulsion)

138
Q

How long does the trip take for sperm from the cervix to the oviduct?

A

30minutes to 6 days

139
Q

Where do sperm cease their migration and why?

A

At the isthmus because they become less motile

140
Q

When do the sperm become motile again and why?

A

at ovulation due to chemoattractants produced by cumulus cells surrounding the egg

141
Q

Can spermatozoa fertilise the oocyte immediately upon arrival in the female genital tract?

A

NO

They must undergo 1. capacitation and 2. the acrosomal reaction

142
Q

What is capacitation?

A

removal of the glycoprotein coat and seminal plasma proteins from the plasma membrane overlying the acrosomal region of the spermatozoa

143
Q

How long does capacitation last?

A

7 hours

144
Q

What are capacitated sperm then allowed to pass through?

A

The corona radiata

145
Q

When do the sperm undergo the acrosomal reaction?

A

when they have passed through the coronal cells

146
Q

How is the acrosomal reaction induced?

A

by zona proteins

147
Q

What is the acrosomal reaction?

A

acrosin and trypsin like substances are released to penetrate the zona pellucida

148
Q

What do the phases of fertilization include?

A
  1. penetration of corona radiata
  2. penetration of the zona pellucida
  3. fusion of the oocyte and sperm cell membranes
149
Q

Both binding of sperm and the acrosomal reaction are mediated by what?

A

the ligand ZP3 (a zona protein)

150
Q

What happens to the zona pellucida when the head of the sperm comes into contact with the oocyte surface?

A

release of lysosomal enzymes from cortical granules lining the plasma membrane of the oocyte&raquo_space; alter properties of zona pellucida (zone reaction)&raquo_space; prevents sperm penetration and inactivate species-specific receptors for spermatozoa on the zona surface

151
Q

In the human what parts of the spermatozoon enter the cytoplasm of the oocyte?

A

the head and tail BUT plasma membrane is left behind on the oocyte surface

152
Q

As soon as the spermatocyte has entered the oocyte what happens?

A
  1. oocyte finished 2nd meiotic division and forms the female pronucleus
  2. zona pellucida becomes impenetrable to other spermatozoa
  3. the head of the sperm separates from the tail, swells and forms the male pronucleus
153
Q

What part of the sperm forms the pronucleus?

A

the head

154
Q

What are the results of fertilization?

A
  1. restoration of diploid no. of chromosomes
  2. determination of chromosomal sex
  3. initiation of cleavage
155
Q

What is cleavage?

A

a series of mitotic divisions that result in an increase in cells, blastomeres which become smaller with each division

156
Q

After 3 divisions what do blastomeres undergo?

A

compaction to become a tightly grouped ball of cells with inner and outer layers

157
Q

What happens to compacted blastomeres?

A

they divide to form a 16-cell morula

158
Q

When does the morula enter the uterus?

A

on the third or fourth day after fertilization

159
Q

The morula changes into a …..

A

blastocyst

160
Q

What will the inner cell mass develop into?

A

the embryo proper

161
Q

What will the outer cell mass develop into?

A

trophoblast

162
Q

Where does the blastocyst implant in the endometrium?

A

along the anterior or posterior wall

163
Q

What happens if fertilisation does not occur?

A

the menstrual phase begins and the spongy and compact endometrial layers are shed

164
Q

Which layer of the endometrium remains?

A

the basal layer to regenerate the other layers during the next cycle

165
Q

What enzyme is released from the acrosomal rupturing and what does it breakdown?

A

hyaluronidases which break down the hyaluronic acid surrounding the oocyte and zona pellucida

166
Q

Which layer of the blastocyst is the foetal basis for the placenta?

A

the outer cell layer the trophoblast

167
Q

What type of stem cells does the zygote have?

A

totipotent - can differentiate into ANY type of cells

168
Q

What type of stem cells of the inner (embryoblast cells) have?

A

pluripotent stem cells - have ability to generate MOST but NOT ALL types of cells

169
Q

What are multi-potent stem cells?

A

can only generate a specific type of tissue

170
Q

What are the 3 layers of the endometrium?

A

endometrium, myometrium and perimetrium

171
Q

What does the chorion develop to allow absorption from the endometrium and placenta?

A

chorionic villi

172
Q

Which hormone does the chorion produce and what does it do?

A

Human chorionic gonadotropin - prevents the CL from degenerating

173
Q

What is the amniotic sac?

A

surrounds the foetus

174
Q

What is the function of the amniotic sac?

A
  1. shock absorber
  2. protection
  3. allows movement
  4. heat buffering for the foetus
175
Q

What type of gland is the placenta?

A

endocrine gland- secretes P and O

176
Q

What does the placenta allow to be transferred to the foetus?

A
  • antibodies and nutrients
177
Q

When the baby becomes stressed (birth) what hormone is released and from where?

A

corticotrophin hormone (ACTH) from anterior pituitary gland&raquo_space; stimulates the babies adrenal glands to release cortisol

178
Q

What is the effect of cortisol during labour?

A

decreases P and O in the placenta

increases prostaglandin release&raquo_space; uterine contractions

179
Q

What causes the release of oxytocin from the posterior pituitary gland?

A

the stretch of the uterus

180
Q

What does oxytocin stimulate?

A

the rhythmic contractions of the uterine wall and further production of prostaglandins

181
Q

What do prostaglandins cause in labour?

A

dilation of the cervix (10cm) and the rupture of the amniotic membrane (waters to break)

182
Q

What position should the baby be born in?

A

head first, facing the mothers spine (anterior presentation)

183
Q

What is the positive feedback loop for oxytocin?

A

the head pressing down on cervix&raquo_space; sends nervous impulses to PPG to release more oxytocin

184
Q

What hormone stimulates lactation?

A

pro-lactin

185
Q

Where is prolactin released from?

A

the anterior pituitary gland

186
Q

What is prolactin release controlled by?

A

prolactin releasing factor from the hypothalamus

187
Q

When is PRF high?

A

during pregnancy but MILK NOT PRODUCED due to the presence of prolactin inhibiting factor

188
Q

Why is prolactin inhibiting factor released?

A

due to high levels of P and E during pregnancy

189
Q

When does lactation occur and why?

A

After pregnancy the decrease in O and P, decreases prolactin inhibiting factor&raquo_space; prolactin action

190
Q

What does suckling stimulate?

A

more milk to be produced and nervous impulses to the hypothalamus&raquo_space; PRH&raquo_space; anterior pituitary&raquo_space; prolactin&raquo_space; milk

191
Q

What is the SRY gene?

A

a region on the Y chromosome

192
Q

What does the SRY gene produce and when?

A

6 weeks gestation produces a protein called SRY

193
Q

What does the SRY protein cause?

A

bipotential gonads to become testes which secrete AMH which dissolves the mullerian duct

194
Q

What happens if no SRY protein is produced?

A

the biopotential gonads become ovaries and the Wolffian duct dissolves (as it needs testosterone)

195
Q

In females what does the mullerian duct turn into?

A

the mesonephric ducts

196
Q

What types of maternal changes occur during pregnancy?

A
  1. cardiovascular
  2. respiratory
  3. GI
  4. skin
  5. spinal
  6. biochemical
197
Q

What CV maternal changes occur?

A
  • increased CO, uterine blood flow, plasma and RBC mass

- decreased peripheral resistance and BP

198
Q

What respiratory maternal changes occur?

A

increased alveolar ventilation

199
Q

What GI maternal changes occur?

A

acid reflux and delayed gastric emptying

200
Q

What skin maternal changes occur?

A
  • linea nigra: dark central line on abdomen
  • striae gravidarum: stretch marks in lumbar/lower abdominal regions
  • darkened areolar of breast
201
Q

What spinal maternal changes occur?

A

increased lumbar lordosis

202
Q

What biochemical maternal changes occur?

A

weight gain
insulin resistance
increased protein and lipid synthesis

203
Q

What are the short term signs of the menopause?

A

vasomotor = hot flushes, sweats, palpitations, headaches
psychological = irritability, panic attacks, depression
menstrual changes = shorter cycle, altered blood loss
skin dryness

204
Q

What are the long-term signs of the menopause?

A

sexual = vaginal dryness, decreased libido
hair and nails = hair loss/thinning, brittle nails and hair
urogenital = diminished urethral seal
general aches and pains

205
Q

What is the average age of the menopause?

A

51

206
Q

When can the menopause be diagnosed?

A

no period for 12 months

207
Q

when does depletion of primordial follicles occur?

A

at approx 40 years of age

208
Q

Why does the menopause occur?

A

decreased oestradiol and lack of ova

209
Q

what does decreased estradiol lead to an increase in?

A

FSH and LH due to lack of negative feedback

210
Q

What further contributes to the increase in FSH?

A

decline of inhibit B

Rachael Phase 1 (11 decks)

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