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REPRODUCTIVE Flashcards

0
Q

Principal advances in the first 10 weeks of fetal development??(6)

A 
Week 1 implantation 
Week 2 2 layers Bilaminar disc
Week 3  3 layers trilaminar disk  GASTRULATION 
Week 4. Heart beating 4 limbs
Week 6 ✅ fetal cardiac activity
Week 10 genitalia characteristics
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1
Q

What are mesodermal defects VACTEREL?

A

Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal defects
Limb defects (bone and muscle)

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2
Q

Seven most easy teratogenic agents

A

Amino glycosides CN VIII toxicity
Lithium Ebstein Anomaly
Methimazole Aplasia cutis congenital
Phenytoin Fetal hydantoin syndrome—cleft palate, cardiac defects, phalanx/fingernail hypoplasia
Thalidomide Limb defects 🐬
Valproate neural tube defects
Warfarin Bone , ophthalmologic defects

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3
Q

What’s the effect of maternal diabetes in the fetal development? (3)

A

Caudal regression syndrome (anal atresia to sirenomelia)
congenital heart defects
neural tube defects

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4
Q

Explain the type of monozygotic twins

A

13 days embryonic disc MONOCHORIONIC MONOAMNIOTIC SIAMESES

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5
Q

What are the defects of urachus? (3)

A

Patent urachus

Urachal cyst
Vesicourachal diverticulum

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6
Q

What are the defects of Viteline duct? (2)

A

Vitelline fistula
Meckel diverticulum

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7
Q

What are aortic arch derivatives (5)?

A

1st arch is maximal art.
2nd Second = Stapedial and hyoid artery
3rd Common Carotid , internal Carotid
4th ➡️ aortic have arch ⬅️ right subclavian art.
6th pulmonary art. Ductus arteriosus

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8
Q

Explain the first and second arch derivatives

A

1st Meckel cartilage: Mandible, Malleus, incus, spheno- Mandibular ligament,
Muscles of Mastication and anterior belly of digastric, rtensors
V2. V3 nerves
TREACHER COLLINS SD.

2st Reichert cartilage: Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament
Muscles of fascial expression Stapedius, Stylohyoid, platySma, posterior belly of digastric
VII nerve Smile
PHARIGOCUTANEUS FISTULA

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9
Q

Explain the third arch

A

3rd stylopharyngeus Msc–glossopharyngeal nerve

IX swallow

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10
Q

Explain fourth and sixth arches

A

4th CN X simply swallow superior laryngeal nerve
pharyngeal constrictors; cricothyroid, levator veli palatini

6th CN X speak recurrent laryngeal nerve
Intrinsic laryngeal muscles

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11
Q

Explain the four pouch derivatives

A

1 (ear)
2 (tonsils)
3 dorsal (bottom for inferior parathyroids)
3 ventral (to = thymus)
4 (top = superior parathyroids)

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12
Q

Defects in MEN 2A

A

Adrenal medulla
Parathyroids
Para follicular cells

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13
Q

What hormones are important for male embryologic development?

A

SRY gene —produces testis- determining factor Ž testes development.
Sertoli cells secretes (MIF) ❎paramesonephric ducts.
Leydig cells secrete androgens ✅mesonephric ducts.

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14
Q

What is the principal embryologic derivative for female internal organs?

A

Paramesonephric (Müllerian) duct

fallopian tubes, uterus, upper portion of vagina
Müllerian agenesis 1° amenorrhea

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15
Q

What is the principal derivative embryologic male internal male organs?

A

Mesonephric (Wolffian) duct

Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens

In females, remnant Gartner duct.

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16
Q

What are the three uterine anomalies?

A

Septate uterus
Bicornuate uterus

Uterus didelphys

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17
Q

Explain what last two products make urogenital folds and labioscrotal sweeping in male and female ?

A

Urogenital folds MALE penile urethra FEMELE Labia minora

Labosicrotal swelling MALE scrotum FEMELE Labia Majora

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18
Q

Associations of hypospadias and epispadias

A

Hypospadias cryptorchidism inguinal hernia

Epispadia exstrophy of the bladder

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19
Q

Where drains the left tonal vein?

A

Left renal vein ➡️ IVC

varicocele more common on the left

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20
Q

What ligament is important to ligate in oophorectomy?

A 
Infundibulopelvic ligament (suspensory ligament of the ovary)
Contain ovarian ligaments
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21
Q

What is the epithelium in outer surface of ovary?

A

Simple cuboidal epithelium

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22
Q

Functions of Sertoli cells (6)

A

Secrete inhibin Ž ❎FSH.
Secrete androgen-binding protein

Produce MIF
Tight junctions
Support and nourish developing spermatozoa
Temperature sensitive

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23
Q

What estrogens are most potent?

A

Estradiol>estrone>estriol

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24
Q

Explain principal features of tanner stages (5)

A

I. Childhood (prepubertal)
II. Pubic hair appears (pubarche); breast buds form (thelarche)
III. Pubic hair darkens and becomes curly; penis size/length ; breasts enlarge
IV. Penis width , darker scrotal skin, development of glans; raised areolae
V. Adult; areolae are no longer raised

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25
Q

Definitions about menstruation (6)

A

Dysmenorrhea PAIN
Oligomenorrhea >35 days
Polymenorrhea 80mL >7days
Menometrorrhagia heavy irregular

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26
Q

Oocyte’s Cycles (3)

A

Meiosis I is arrested in PROHASE I for years until Ovulation (1° oocytes).

Meiosis II is arrested in METAPHASE II until fertilization (2° oocytes)

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27
Q

Explain the Oocyte development phases (4)

A

Oogonium Diploid (2N, 2C)
⬇️
1° oocyte Diploid (2N, 4C)
⬇️
2° oocyte Haploid (1N, 2C)
⬇️
Ovum Haploid (1N, 1C)

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28
Q

Time to production of Beta hCG

A

First 10 weeks

Acting like LH

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29
Q

Eat hCG is augmented and diminished ?(4.4)

A

hCG is ⬆️in multiple gestations, hydatidiform moles, choriocarcinomas, and Down syndrome

hCG is ⬇️ in ectopic/failing pregnancy, Edward syndrome, and Patau syndrome.

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30
Q

When is premature ovarian failure?

A

Menopause before age 40

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31
Q

How is the spermatogenesis?(5)

A 
Spermatogonium Diploid(2N, 2C)
⬇️
1° spermatocyte Diploid (2N, 4C)
⬇️
2° spermatocyte Haploid (1N, 2C)
⬇️
Spermatid Haploid (1N, 1C)
⬇️
Mature spermatozoon Haploid(1N, 1C)
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32
Q

Potency of the three androgens

A

DHT>testosterone> androstenedione

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33
Q

How are FSH and LH in klinefelter and Turner syndrome?

A

⬆️ FSH

⬆️ LH

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34
Q

What’s Female pseudo- hermaphrodite (XX) and Male pseudo- hermaphrodite (XY)

A

Female pseudo- hermaphrodite (XX) too much androgens
Male pseudo- hermaphrodite (XY) androgen insensitivity syndrome

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35
Q

What’s Kallman syndrome ?

A

Defective migration of GnRH cells and formation of olfactory bulb;  anosmia; 
⬇️GnRH, FSH, LH, testosterone.

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36
Q

What signs are related whit hydatidiform mola? (3)

A

Hyperemesis gravidica
Hyperthyroidism
Preeclampsia

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37
Q

Kariotype and fetal parts in hydatidiform mole

A

Complete 46 XX , 46 XY
Empty egg+sperm
No parts
SNOWSTORM IN USG

Partial 69 XXX, 69 XXY, 69 XYY
Egg+ 2 sperms
✅Fetal PARTS

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38
Q

What HELLP means?(3)

A

Hemolysis,

Elevated Liver enzymes
Low Platelets.

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39
Q

Defects in placental implantation deep (3) site (2)

A

ACRETA attaches myometrium whit out penetrating
INCRETA penetrates into myometrium
PERCRETA penetrates until serosa

PLACENTA PREVIA
Partial
Complete

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40
Q

What’s the incidence of gynecologic tumors?

A

Endometrial>ovarian>cervical

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41
Q

Histologic features of sarcoma botryoides

A

Spindle-shaped cells

Desmine ✅

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42
Q

What are the malignant VPH virus and its malignant products?

A

HPV16
HPV18

E6 (inhibit p53 suppressor gene)
E7( inhibit RB suppressor gene)

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43
Q

What are the sequence of polycystic ovarian syndrome?

A

Hyperinsulinemia and/or insulin resistance
alter hypothalamic hormonal feedback
⬆️LH:FSH,
⬆️androgens
⬇️rate of follicular maturation
⬆️Ž unruptured follicles (cysts) + anovulation.

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44
Q

Treatment for polycystic ovarian syndrome (5)

A 
weight reduction
OCPs
clomiphene citrate
ketoconazole
spironolactone.
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45
Q

Principal feature of the seven benign ovarian tumors

A

Serous cystadenoma most common BILATERAL
Mucinous cystadenoma multiloculade large
Endometrioma chocolate cyst complex in USG
Mature cystic teratoma (dermoid cyst)thyroid tissue
Brenner tumor solid like BLADDER
Fibromas MEIGS SYNDROME ovarian fibroma, ascites, hydrothorax. “Pulling” sensation in groin.
Thecoma like Granulosum produce estrogen bleeding post menopause

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46
Q

Principal features of the eight malignant ovarian tumors

A

Immature teratoma THYROID TISSUE
Granulosa cell tumor abnormal uterine bleeding coffee bean nuclei
Serous cystadenocarcinoma MOST COMMON BILATERAL PSAMMOMA BODIES
Mucinous cystadenocarcinoma. Pseudomixoma peritoneal like apendice
Dysgerminoma adolescents fried egg cells hCG LDH
Choriocarcinoma. ⬆️frequency of bilateral/multiple theca-lutein cysts. ⬆️β-hCG,hemoptysis
Yolk sac (endodermal sinus) most common tumor male infants like gromerulo body ⬆️AFP
Krukenberg tumor primary GI tumor

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47
Q

What are the benign breast tumors ?

A

Fibroadenoma: 40yrs

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48
Q

What are the different proliferative breast diseases (4)?

A

Fibrosis
Cystic painful
Sclerosing adenosis
Epithelial hyperplasia

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49
Q

What drugs causes gynecomastia?(5)

A 
Spironolactone
Digoxin
Cimetidine
Alcohol
Ketoconazole
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50
Q

What are the general characteristics of malignant breast tumors?(4)

A

Postmenopausal
Terminal duct lobular unit.
Overexpression of estrogen/progesterone receptors or c-erbB2 (HER-2, an EGF receptor)
Axillary lymph node = metastasis

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51
Q

What’s the the single most important prognostic factor in breast malignant tumor?

A

Axilary lymph involvement

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52
Q

What makers give poor prognosis in breast tumors ?

A

triple negative (ER ⊝, PR ⊝, and Her2/Neu ⊝)

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53
Q

Noninvasive breast cancer (3)

A

Ductal carcinoma in situ (DCIS)
Comedocarcinoma: central necrosis
Paget disease: patches on nipple

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54
Q

What are invasive breast tumors?

A

Invasive ductal. Rock hard WORST
Invasive lobular INDIAN FILE ⬇️E-cadherin expression
Medullary. Lymphocytic infiltrate good prognosis
Inflammatory Peau d’orange 50%dead

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55
Q

What aré the precursor in situ lesions for squamous cell carcinoma?

A

Bowen disease
erythroplasia of Queyrat
Bowenoid papulosis

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56
Q

What are the most common extragonadal germ cell tumor?

A

Sacrococcygeal teratoma in young children

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57
Q

What a the principal features of tsticular germ cell tumors ? (5)
ALL ARE MALIGNANT

A

Seminoma:“fried egg” placental radio sensible ✅✅ PLAP
Yolk sac (endodermal sinus) tumor:Schiller duval bodies ⬆️AFP

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58
Q

Testicular non germ tumors (3)

A

Leyding reindeer crystals gynecomastia or rapid puberty GOLDEN
Sertoli
Testicular lymphoma 👴🏼

59
Q

What are the causes of acute and chronic prostatitis?

A

Acute. E.coli

Chronic abacterial

60
Q

Where the prostatic adenocarcinoma ocurrs ?

A

Posterior lobe (peripheral zone)

61
Q

What’s leuprolide?

A

GnRH agonist
Infertility PULSATILE
prostate Ca CONTINUOS

62
Q

What are selective estrogen receptor modulators?(3)

A

Clomiphene antogonist in hypothal amus ✅infertility
Tamoxifen❎ breast ✅ endometrium ✅bone
Raloxifene ❎ breast ❎ endometrium ✅ bone

63
Q

Use of aromatase inhibitors (2)

A

Anastrazole
Exemestane

postmenopausal women with ER ⊕ breast cancer.

64
Q

Use of mesiprestone

A

Inhibitor of pregesterone

ABORTION

65
Q

Contraindications for oral contraceptives (3)

A

smokers > 35 years old
history of thromboembolism and stroke
history of estrogen-dependent tumor.

66
Q

Use of danazol

A

Agonist androgen receptor

Endometrosis
Hereditary angioedema

67
Q

What are the principal features of antiandrogens (4)?

A

Finasteride 🚫5α-reductase
Flutamide. 🚫receptro CA prostate

Ketoconazole 🚫17,20-desmolase.
Spironolactone 🚫17α-hydroxylase, and 17,20-desmolase.
CAUSE GYNECOMASTIA AMENORRHEA

68
Q

Type of alpha receptors found only in smooth muscle in prostate inhibited by tamsulosin?

A

α1A,D receptors

69
Q

What’s the most common cause of nipple pathologic discharge (blood)?

A

Intraductal papilloma whit proliferación of papillary cells

70
Q

In what type of cancer is seen keratin pearls and intercellular bridges in epithelial cells ?

A

squamus cell cancer

71
Q

What are the hallmarks of BENIGN mature cyst teratoma?

A

Sebaceous glands

Keratinaceus debris

72
Q

How can manifest the chronic herpes genitals?

A

Recurrent vesicles, ulcers, crusting

73
Q

What type of cell is indicative of HPV infection?

A

KOILOCYTE!!!!!

74
Q

Hat are the risk factors of epithelial ovarian cancer? (4)

A

Nuliparity
Endometriosis
BRCA-1 BRACA-2 LYNCH mutation
Postmenopausal

75
Q

Hat are the protective factors of epithelial ovarian cancer? (3)

A

Oral contraceptives
Multi-parity breast feeding
Tubal ligation

76
Q

Causes of uterin defects : bicornuate, didelphys, longitudinal uterin septum?

A

bicornuate incomplete lateral fusion
didelphys: complete lack of fusion
longitudinal uterin septum: failed involution

77
Q

What is the function of testosterone in the genital fetal development ?

A

Stimulates mesonephric duct ( epididymis , vas defernets)

DHT male external genitalia

78
Q

What is the product of urogenital sinus in males and females (4,4)

A

👨🏻 bladder, urethra, prostate, bulbourethral glands

👩🏻 bladder , urethra, lower vagina, Bartholdi glands

79
Q

Where lymphatic from glands of penis drains ?

A

Deep inguinal nodes which in turn drain into external iliac nodes

80
Q

How is the innervation of penis to its erectile function?

A

Hypogastric nerve
⬇️
Inferior hypogastric plexus (fascia of prostate)
⬇️
lesser and greater cavernous nerves
⬇️
innervation corpora cavernous a and urethra

81
Q

Consequence of pudendal nerve injury?

A

Fecal incontinence
Decrease penile sensation
External urethral paralysis

82
Q

What are the layers of spermatic cord ? (3)

A

Internal spermatic fascia : form transversal is fascia
Cremasteric fascia: from internal oblique abdominal muscle
External spermatic fascia : from external oblique abdominal Msc

83
Q

Where is the problem in the Peyrone disease?

A

Excess of collagen in TUNICA ALBUGINEA

84
Q

Which muscle force blood into the clitoris when it is stimulated ?

A

Squiocavernosus

85
Q

Which muscle is involved in posterior midline episiotomy?

A

Perineal body

86
Q

Which artery is inside the round ligament ?

A

Sampson

87
Q

Which process leads to menstruation after progesterone withdrawal?

A

APOPTOSIS!!!!

88
Q

What’s the gold standard for prolactinoma diagnosis ?

A

MRI of the brain

89
Q

What the major inhibitor of prolactine secretion?

A

DOPAMINE

90
Q

Muscles that have to be exercised in the keguel exercises?

A

LEVETOR ANI MUSCELS
Iliococcygeus
Pubococcygeus
Puborectalis

91
Q

Which levels nerves are implied in urinary continence?(2)

A

L1-L2 Hypogastric plexus : bladder relaxation, internal sphincter contraction
S2-S4 pudendal nerve: external sphincter contraction

92
Q

What is the tumor marker for nonseminomatous germ cells tumors?
What is the hormonal presentation?

A

hCG!!!!
PARANEOPLASIC HYPERTIROIDISM
because the hCG alpha subunits are very similar with TSH (FSH-LH)

93
Q

Patients with polycyclic ovary syndrome are in risk for which type of cancer?

A

ENDOMETRIAL CARCINOMA !!!!

94
Q

What type of cells are required to combat HPV infection?

A

T cells

95
Q

What Histologic findings are related whit malignancy in fibrocystic disease of the breast? (2)

A

Atypical lobular hyperplasia
Atypical ductal hyperplasia

4-5 X risk

96
Q

What’s the serum marker for yolk sac tumor?

And what is its pathognomonic Histologic finding ?

A

Alpha-fetoprotein

Schiller-Duval bodies

97
Q

What is the drug analog of gonadotropin releasing hormone , used in prostate cancer?

A

LEUPROLIDE!!!!

98
Q

What drug inhibits 5alpha reductase?

A

FINASTERIDE!!!!

99
Q

Which drug blocks the androgen receptor used as anti cancerous ?

A

FLUTAMIDE!!!!!

Cyproterone acetate
Spironolactone

100
Q

Mechanism of action of trastuzumab ?

A

Monoclonal antibody Antagonist at the ERB-B2 receptor

101
Q

what is the mechanism of urge urinary incontinence?

A

increase intra abdominal pressure

102
Q

difference among adenomyosis , leimyosis and endometrial hyperplasia?

A

ADENOMYOSIS uniformely enlarged
LEIOMYOSIS Irregularly enlarged
ENDOMETRIAL HYPERPLASIA No painful

103
Q

important landmarks for pudendal nerve block (2)

A

ischial spines

sacrospinous ligament

104
Q

what arteries can be achived and accidentaly inyected in pudendal nerve block?

A

internal pudendal artery

inferior gluteal artery

105
Q

which nerves can be damaged after pelvic surgery? (3)

A

genitofemoral
iliohypogastric
obturador

106
Q

which nerve can be damaged during log duration of lothotomy position?

A

lateral femoral cutaneuous

107
Q

which ovaric tumor has coffee beans cells ?

A

ganulosa cells tumor

108
Q

what elevated AFP means?

A

fetal neural defect
understimation of gestational age
twin
YOLK SAC TUMORS OVARIES AND TESTES

109
Q

gestational choriocarcinoma is preceded by ….

A

ANY KIND OF PREGNANCY PHYSIOLOGIC OR PATHOLOGYC

110
Q

what are the most common causative agents of orchitis in adolescents and older patients?

A

ADOLESCENTES Chlamidia trachomantis , Neisseria gonhorreae

OLDER E. coli

111
Q

cells which synthesize progesterone , testorone and estradiol ?

A

TECHA INTERNA progesterona and testosterone

GRANULOSA estrogen

112
Q

Which hormones activate and inhibit the prolactin secretion?

A

STIMULATION : TRH

INHIBITION : PROGESTERONE

113
Q

When is the peak of B-hCG secretion?

A

9 week

114
Q

Which artery have to be clamped bilaterally in order to control the bleeding in a uterine atony ?

A

Internal iliac ( hypogastric)

115
Q

What is the most common agents in septic abortion?

A

STAPHYLOCOCCUS AUREUS!!!
gram-negative bacilli
Group B Streptococcus

116
Q

Cause of cervicitis - pelvic inflammatory disease and vaginosis?

A

cervicitis-pelvic inflammatory disease N.GONORRHEAE , CHLAMYDIA

vaginosis. GARDNERELLA

117
Q

Which genetic illnes is related whit ABSCENSE of vas deference bilaterally?

A

CYSTIC FIBROSIS

118
Q

Where the gonadals veins drain?

A

Left gonadal ➡️ left renal vein

Right gonadal ➡️ IVC

119
Q

Association whit Mullerian Aplasia?

A

Renal agenesis

120
Q

How patients whit Mullerian Aplasia are seen phenotipically?

A

Not upper vagina nor uterus
AMENORREA

Looks like women

121
Q

Why patients with Turner syndrome are sterile?

A

ATROPHIC OVARIES !!!!

122
Q

Explain de TWO arrested stages of the Oocyte formation..

A

Childhood until puberty MEIOSIS I ( prophase)

Puberty until fertilization MEIOSIS II (metaphase)

123
Q

Causes of polyhydramnios?(2)

A

Impaired fetal swallowing

Increase fetal urination (⬆️CO= alloinmunization)

124
Q

Why adolescents have irregular menstruations at the menarche?

A

ANOVULATORY CICLES!!!

Hypothalamic-pituitary-ovarian IMMATURE CICLES

125
Q

What are the embryologic derivatives of hyoid bone? (2)

A

Lesser horn 2 ARCH

Greater horn 3 ARCH

126
Q

Big difference between fetal 21-hydroxylase and aromatase deficiencies?

A

🚫21-hydroxylase ➡️ fetus virilization

🚫aromatase ➡️ mother and fetus virilization

127
Q

What is precocious puberty in Caucasian females ?

A

Development of secondary sexual characters at age less than 7 years old.

128
Q

what receptors have to be analized in orther to predict breast tumor prognosis ?(3)

A

HER2
ER
PR

128
Q

In congenital TORCH what are the principal fetal clinical effects ?

A

TOXOPLASMOSIS chorioretinitis, hydrocephalus, calcifications

OTHER
🔹VZV limb hypoplasia, cataracts , chorioretinitis.
🔹PARVOVIRUS ssDNA!!! hydrops fetalis
🔹SYPHILIS snuffles hepatomegaly skeletal anomalies

RUBELLA ssRNA!! Deafness, cataracts, blueberry muffin heart defect hepatosplenomegaly

CMV deafness chorioretinitis jaundice peri ventricular calcifications

HSV cutaneous vesicles lesions

129
Q

Type of virus in TORCH

A

All are dsDNA least :
PARVOVIRUS ssDNA
RUBELLA ssRNA

130
Q

what nerve can be injured in the labor by streching the labor canal

A

PUDENDAL NERVE!!!!!

pass near to schial spine
fecal , urinary incontinence , perineal pain

132
Q

How is LH,FSH, inhibin and testosterone in cryptorchidism?

A

↔️TESTOSTERONE. ↔️LH

⬇️INHIBIN ⬆️FSH. ⬇️sperm

133
Q

Hormone responsible by fusion of labial folds in male fetus?

A

Dihydrotestosterone

134
Q

Where the glands drains?

A

Deep inguinal nodes

135
Q

Why’s hCG is used to ovulation?

A

Because the alpha subunit of hCG is similar to LH

136
Q

Cause of disseminated intravascular coagulation in pregnant patients?

A

Placental damage
⬇️
Release tissue factor

137
Q

Important cardiovascular consequence of amniotic fluid embolism?

A

CARDIOGENIC SHOCK

138
Q

Important liver injury in pregnancy

A

Acute fatty liver of pregnancy

Nausea
Vomiting
Abdominal pain
⬆️ liver enzymes

139
Q

Two principal infectious agents related with ectopic pregnancy?

A

Neisseria Gonorrhoeae

Chlamydia Trachomatis

140
Q

Management of PID?

A

Third generation cephalosporins (gonococcal coverage)
AND
Azithromycin or doxycycline (chlamydia coverage)

141
Q

Principal phenotypic features in neonate with Down syndrome?(4)

A

Protruding tongue
Excessive skin at the nape of the neck
Upslanting palpebral fissures
Epicantal folds

142
Q

What are the clinical features of amniotic fluid embolism?(4)

A

Carcinogenic shock
Hypo mic respiratory failure
Disseminated intravascular coagulation
Seizures or coma

143
Q

What is the only indication of treatment of partner in vaginitis?

A

TRICHOMONIASIS

yellow-green malodorous
Ph>4.5

METRONIDAZOLE

144
Q

Gene related with Hereditary Breast cancer?

A

Tumor suppressor genes

BRCA1 and BRCA2

145
Q

What neoplastic lesion appears classically after mastectomy and Axillary lymph-node resection In breast cancer?

A

ANGIOSARCOMA

Stewart-Treves syndrome

146
Q

How prostate cancer disseminate?

A

Hematogenously !!!!

Prostatic venous plexus
Vertebral venous plexus

Step 1 (1) (16 decks)

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