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Phase 1 Medicine - Riona > Suger 1 > Flashcards

Suger 1 Flashcards

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1
Q

Where does the inguinal canal travel?

A

From deep inguinal ring in transversalis fascia to superficial inguinal ring in external oblique aponeurosis

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2
Q

What does the inguinal canal convey?

A

M - spermatic cord

F - round ligament of uterus

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3
Q

What is the floor of the inguinal canal formed by?

A

Inguinal ligament

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4
Q

What is a hernia?

A

A protrusion of organs/fascia through the wall of the cavity that contains them

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5
Q

What is an indirect hernia?

A

Peritoneal sac enters canal through deep inguinal ring
(gains same 3 coverings as it enters)
(more common)

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6
Q

What is a direct hernia?

A

Sac bulges into canal via posterior inguinal wall
(due to weakening in abdominal musculature)
(sac from area medial to epigastric vessels)

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7
Q

What are the 3 layers covering the spermatic cord?

A

One for each layer of muscle in abdominal wall
Internal
External
Transverse

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8
Q

What is contained within the spermatic cord? (3x5)

A

3 arteries - testicular, cremasteric, to vas deferens
3 veins - as above
3 nerves - ilioinguinal, genitofemoral, sympathetic & afferent fibres
3 others - vas deferens, lymphatics, pampiniform plexus
3 coverings - external spermatic, cremasteric, internal spermatic fascia

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9
Q

What do the testes produce?

A

Spermatozoa

Testosterone

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10
Q

What is the tunica vaginalis?

A

Peritoneal sac that partially covers testes

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11
Q

What are the parts of the epididymis?

A

Head - formed by convergence of efferent tubules
Body
Tail

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12
Q

What is the vas deferens?

A

Muscular tube
Transports sperm from testes to ejaculatory ducts
Continuous from inferior tail of epididymis

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13
Q

What is the tunica albuginea?

A

A fibrous capsule that fully encloses each testes

Penetrates into parenchyma to divide it into lobules

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14
Q

What is the scrotum?

A

Fibromuscular cutaneous sac that the testes sit within

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15
Q

What is the dartos muscle?

A

Lies immediately beneath skin of scrotum & helps in temperature regulation by wrinkling skin

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16
Q

What is the path of the vas deferens?

A

Tail of epididymis > inguinal canal in spermatic cord > deep ring > between bladder & urethra > seminal vesicle duct

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17
Q

What are the 3 muscles of the wall of the vas deferens?

A

Inner longitudinal
Middle circular
Outer longitudinal

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18
Q

What is the ejaculatory duct formed by?

A

Confluence of vas deferens & seminal vesicle duct

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19
Q

What does the ejaculatory duct drain into?

A

Prostatic urethra

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20
Q

What are the secretions of the seminal vesicle composed of? (4)

A

Alkaline fluid
Fructose
Prostaglandins
Clotting factors

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21
Q

What does the prostate gland secrete?

A

Proteolytic enzymes that break down clotting factors in semen to allow it to remain fluid in the female tract

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22
Q

What are the 3 parts of the penis?

A

Root
Body
Glans - continuous with corpus spongiosum

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23
Q

What are the 3 cylinders of erectile tissue?

A

2x corpus cavernous

Corpus spongiosum

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24
Q

What are the 2 main roles of the penis?

A

Sexual intercourse

Miturcation

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25
What are the 3 erectile tissues in the root of the penis?
2x crura | Bulb
26
What are the 2 muscles of the root of the penis?
Bulbospongiosus x2 - contracts to empty spongy urethra of residual Ischiocavernosus x2- contracts to help maintain erection
27
What are the 3 main parts of the male urethra?
Prostatic Membranous Spongy
28
What are the 2 fascial coverings of the penis?
``` Deep fascia of the penis (more superficial) Tunica albuginea (around each cavernous) ```
29
What are the 2 ligaments of the root of the penis?
Suspensory | Fundiform
30
What is the arterial supply to the penis?
Dorsal to penis Deep to penis Bulbouretheral (all branches of internal pudendal artery)
31
What is the innervation to the penis?
S2-4 spinal cord segments Sensory & sympathetic by dorsal nerve of penis (branch of pudendal) Parasympathetic by cavernous nerves (from prostatic nerve plexus)
32
What are the 3 main functions of the pelvic floor?
Support of abdominopelvic viscera Resistance to increases in intra pelvic/abdominal pressure Urinary & faecal continence
33
What are the 2 main holes in the pelvic floor?
Urogenital hiatus | Rectal
34
What are the 4 main muscles of the pelvic floor?
``` Levator ani muscles: puborectalis pubococcygeus iliococcygeus Coccygeus ```
35
What are the borders of the urogenital triangle?
Pupic synthesis | Ischiopubic rami x2
36
What does the urogenital triangle contain? (6)
``` Deep perineal pouch Perineal membrane Superficial perineal pouch Deep perineal fascia Superficial perineal fascia Skin ```
37
What is the glomerular filtration rate?
Amount of fluid filtered from blood by renal corpuscle per unit time
38
What is the GFR determined by? (3)
Glomerular filtration pressures Permeability of glomerular capillary wall Surface area available for filtration
39
What is the pressure of glomerular filtration under control of?
Neural & hormonal inputs
40
What does constriction of afferent/dilation of efferent arterioles do to the GFR?
Decrease Overall decrease in pressure at glomerulus Reduction of blood hydrostatic pressure in capillaries
41
What does neuroendocrine input to the intraglomerular mesangial cells that surround the glomerular capillaries do?
Contract when stimulates Reduce SA for filtration Decrease GFR
42
What is the equation for the amount filtered by the glomerulus?
Amount filtered = GFR x plasma concentration
43
How does reabsorption by diffusion occur?
Water reabsorption from tubule Relative concentrations of various substances in filtrate increase Substances diffuse across tight junctions between epithelial cells & into interstitial fluid Diffuse from interstitial to peritubular capillaries
44
How does reabsorption by mediated transport occur?
Linked to reabsorption of Na+ ions Cotransported substance moves against concentration gradient by secondary active transport by cotransporter protein on luminal membrane Also transports Na+ down its concentration gradient into cell
45
What are the transporters in each part of the nephron? (4)
PCT - NKC (sodium-potassium co-transporter) Loop of Henle - NKCC2 (sodium-potassium-chlorine co-transporter 2), loses K keeps Cl & Na DCT - NCC (sodium-calcium co-transporter), loses K, keeps Na & Ca CD - EnaC (epithelial sodium channel), keep or secrete K
46
Why is there a transport maximum for mediated transport mechanisms?
Binding sites of membrane proteins become saturated y the substances they are helping to transport
47
Define osmolarity
Number of moles of a solute in a solution per L of solvent
48
Define osmolality
Number of moles of a solute in a solution per kg of solvent
49
What is osmolarity affected by that osmolality isn't?
Changes in water temperature & pressure as these change the volume of the solution
50
Where is ADH synthesised & released from?
Synthesised in hypothalamus | Released from posterior pituitary gland
51
How does ADH influence the permeability of the luminal membranes of the collecting ducts?
Enters interstitial fluid Binds with receptors on basolateral membrane of epithelial cells Helps produce secondary messenger cAMP cAMP activates protein kinase A (PKA) Results in fusion of vesicles containing AQP2 aquaporin channels with luminal membrane More water can now enter cell by osmosis through channels
52
What are the 3 inputs to the juxtaglomerular cells that stimulate the release of renin?
Renal sympathetic nerves - stimulated by CV baroreceptors that detect drop in BP Infrarenal baroreceptors - cells less stretched when drop in BP Macula densa - between thick ascending & distal tubules, sense low Na+ concentration
53
What does atrial natriuretic peptide act to do?
(decreases BP by vasodilation) Secreted from heart atria Increase Na+ excretion by: Inhibiting reabsorption Increasing GFR by causing vasoconstriction of efferent arteriole Inhibiting secretion of aldosterone This reduces BP/plasma volume as water follows Na+ by osmosis
54
What is the pressure natriuresis mechanism?
An increase in urinary sodium loss | By increase in renal perfusion pressure due to increase in arterial BP
55
Where is angiotensinogen secreted from?
Liver
56
Where is ACE secreted from?
Lungs
57
Where is renin secreted from?
Kidneys
58
Where is aldosterone secreted from?
Adrenal gland | Cortex
59
What is renin's role in the RAA system?
Converts angiotensinogen to angiotensin I
60
What is ACE's role in the RAA system?
Converts angiotensin I to angiotensin II
61
What are the roles of angiotensin II in the RAA system? (5)
Sympathetic activity increases Tubular Na+ & Cl- reassertion, K+ excretion, H2O retention Aldosterone secretion (also causes ^) Arteriolar vasoconstriction, increase in BP ADH secretion from posterior pituitary gland
62
What is ADH's role in the RAA system?
Increases H2O reabsorption from the collecting duct
63
What is the overall role of the RAA system? (3)
To retain water & salt To increase circulating volume To overall increase BP
64
What causes renin to be released? (3)
Drop in BP/fluid volume Decrease in renal perfusion Juxtaglomerular apparatus & macula densa activated
65
What are the 3 mechanisms for the controls of Na+ reabsorption?
RAA system ANP Pressure natriuresis
66
What does parathyroid hormone do in the kidney?
Blocks reabsorption of phosphate in PT | Promotes calcium reabsorption in Henle, DT, CT
67
What are the 2 functions of urinary buffers?
To excrete daily acid load | To regenerate bicarbonate lost during EC buffering
68
How do urinary buffers work?
Free H+ combines with weak acids/ammonia to be excreted
69
What are the 2 main urinary buffers?
Phosphate | Ammonium
70
Which of the 2 main urinary buffers is the major adaption to an increased acid load?
Ammonium
71
What does the Henderson equation give?
Law of mass action | Approximation of H+ or HCO3- concentration
72
What is cortisol an example of & where is it produced?
Glucocorticoid steroid hormone | Zona fasiculata of adrenal cortex
73
What is cortisol responsible for?
Control of glucose metabolism | Increases blood glucose through gluconeogenesis
74
Where is adrenaline an example of & where is it produced?
Catecholamine | Medulla of adrenal gland
75
What is the role of adrenaline? (6)
``` Fight or flight response Increased HR & BP Blood vessel constriction Smooth muscle dilation Dilation of bronchioles & lung capillaries Increased metabolism ```
76
What is erythropoietin (EPO) an example of & where is it produced?
Glycoprotein | Kidney
77
What is the role of EPO?
Stimulation of production of erythrocytes from their precursor cells (reticulocytes) in bone marrow
78
What are the 3 main types of adrenergic receptors?
Alpha Beta 1 Beta 2
79
Where is the alpha adrenergic receptor found & what is it's role?
Arteries Causes arteries to constrict (apart from in skeletal muscles as they need to stay open to utilise the increased blood load) Increase BP & blood flow to heart
80
Where is the beta 1 adrenergic receptor found & what is it's role?
Heart | Increase HR & contractility
81
Where is the beta 2 adrenergic receptor found & what is it's role?
Bronchioles & arteries of skeletal muscle | Dilate bronchioles & vessels of skeletal muscle
82
What are the 3 layers of the skin from superficial to deep?
Epidermis Dermis Subcutaneous layer (hypodermis)
83
What are the 7 main functions of the skin?
``` Mechanical barrier Regulation of temperature & electrolytes Waterproofing Immunity Protection from UV Production of vitamin D Sensation ```
84
What are the 5 layers of the epidermis?
Stratum corneum = horny cell layer, dead cells Stratum lucidum = dead cells Stratum granulosum = flat cells, granules of keratohyaline Stratum spinosum = prickle cells Stratum basale = hemidesmosomely attached to basement membrane, mitotically active Come, Let Gays Suck Balls
85
What are the majority of the cells in the epidermis?
Keratinocytes which move up through the layers as they undergo keratinisation
86
What are the 3 other types of cells in the epidermis?
Melanocytes Langerhan cells Merkel cells
87
What do melanocytes produce?
Melanin from tyrosine using enzyme tyrosinase
88
How do melanocytes transport their product to keratinocytes?
Via dendritic processes | Melanin into vesicles - melanosomes
89
What is the role of langerhans cells & what are they derived from?
Antigen presenting cells | Haemopoietic bone marrow cells
90
Where are Birbeck granules (tennis racket shaped) found?
Langerhans cells
91
What is the role of merkel cells?
Neuroendocrine cells Act as mechanoreceptors & mediate tactile sensation Make contact with nerve endings
92
Where are the merkel cells found?
Along the stratum basale
93
What are the main things the dermis is made up of?
``` Irregular loose connective tissue Fibroblasts Collagen Glycosaminoglycan metric Blood vessels Lymphatics Nerves Sensory cells Scattered inflammatory cells ```
94
What are the 2 layers of the dermis?
Papillary dermis | Reticular dermis
95
What are the adhesion molecules between the cells in the stratum corneosum called?
Corneodesmosomes
96
What is the breakdown of corneodesmosomes called?
Desquamation
97
What does a change in the number of adhesion molecules in the skin cause?
Increase - psoriasis | Decrease - eczema
98
What does a change in the pH of the skin cause?
High pH - skin dryness & decreased defence | Low pH - dry skin, irritation, sensitivity, hyperpigmentation
99
Why does acne develop?
Blockages in hair follicles
100
What are the steps of the itch-scratch cycle? (8)
1) stress causes an itchy feeling 2) urge to scratch 3) scratch 4) relief/pleasure 5) damaged skin barrier 6) allergens/irritants/bacteria penetration 7) inflammation/irritation 8) itchy feeling
101
At what level are the kidneys found?
T12-L3
102
What are the 4 layers surrounding the kidney from superficial to deep?
Pararenal fat (mainly on posterolateral aspect) Renal fascia Perirenal fat Renal capsule
103
What are the 2 main areas of the kidney parenchyma?
Cortex (outer) | Medulla (inner)
104
What does the cortex divide the medulla into?
Medullary pyramids
105
What is the flow of urine from the medullary pyramid?
Pyramid > renal papilla > minor calyx > major calyx > renal pelvis > ureter
106
What is the arterial supply to the kidneys?
``` L & renal arteries Segmental branches Interlobular arteries Arcuate arteries Interlobular arteries Afferent arterioles Glomerulus Efferent arterioles ```
107
What forms the peritubular network?
Efferent arterioles Supply nephron tubules Outer 2/3rds of cortex
108
What are the inner 1/3rd of cortex & medulla supplied by?
Vasa recta
109
What are the 2 main areas of the adrenal gland parenchyma?
Cortex (from mesoderm) | Medulla (from ectodermal neural crest cells)
110
What do the adrenal glands produce?
Steroid & catecholamine hormones
111
What are the 3 sub-zones of the adrenal cortex?
Zona glomerulosa Zona fasiculata Zona reticularis
112
Give an example of the type of hormone each of the 3 sub-zones of the adrenal cortex secretes
G = Mineralocorticoid - aldosterone F = Glucocorticoids - cortisol R = Sex hormones - testosterone (salt, sugar, sex)
113
What does the medulla of the adrenal gland secrete & give an example
Catecholamine | Adrenaline & noradrenaline
114
What is the adrenal gland supplied by? (arterial)
Superior Middle Inferior adrenal arteries
115
What is the purpose of the ureter?
To transport urine from the kidney to the bladder
116
What is the pathway of the abdominal ureter?
Renal pelvis > ureteropelvic junction > anterior surface os posts major > bifurcation of common iliac artery at pelvic brim
117
What is the pathway of the pelvic ureter?
Lateral pelvic walls > turn anteromedially at level of ischial spines > towards bladder > lateral bladder wall in oblique manner
118
What is the significance of the ureter piercing the bladder in an oblique manner?
Makes a one way valve | When the bladder contracts, the valve is shut
119
What is the trigone in the bladder?
Triangular area that marks orifices of ureters and urethra Smooth muscle walls Different embryological development (from mesonephric ducts)
120
What are the sections of the bladder?
Apex Body Fundus Neck
121
Which of the two sphincters in the bladder is under voluntary control?
External | Skeletal muscle
122
What is the difference in the internal urethral sphincter in the sexes?
M - circular smooth muscle, autonomic control | F - functional sphincter, no muscle
123
What is the smooth muscle of the bladder?
Detrusor | Contracts during micturition
124
What is the vascular supply of the bladder?
Internal iliac vessels Superior vesicle branch of artery Vesical venous plexus
125
How is the sympathetic nervous system involved in control of the bladder?
Hypogastric nerve T12-L2 | Relaxation
126
How is the parasympathetic nervous system involved in control of the bladder?
Pelvic nerve S2-4 | Contraction
127
How is the somatic nervous system involved in control of the bladder?
Pudendal nerve S2-4 Voluntary control External urethral sphincter Relax/contract
128
What is the bladder stretch reflex?
Micturition is stimulated in response to stretch Overridden in toilet training Usually voluntary Spinal injuries?
129
What is the structure of the renal corpuscle?
Glomerulus (network of capillaries) sits inside Bowman's capsule Afferent & efferent arterioles
130
What are the layers that the filtrate passes through in a nephron?
Endothelium of capillary Basement membrane Slit diaphragms between podocytes
131
What is the structure of the renal tubule?
``` PCT Loop of Henle (ascending & descending limbs) DCT CT CD ```
132
Which parts of the Loop of Henle are permeable to water?
Descending highly permeable to water, impermeable to ions | Ascending impermeable to water, highly permeable to ions
133
Which part of the nephron is not in the renal cortex?
Loop of Henle descends into medulla
134
What hormones are secreted by the anterior pituitary gland?
``` FSH LH ACTH TSH Prolactin I(gnore) GH Flat pig ```
135
Define acute kidney injury
Abrupt loss of kidney function within 7 days
136
What are the 3 types of acute kidney injury?
Pre-renal Renal/intrinsic Post-renal
137
What is pre-renal AKI & what are some of the causes?
``` Decreases effective blood flow to the kidney, decrease in GFR Causes: low blood volume (dehydration) low BP heart failure liver cirrhosis renal artery stenosis renal vein thrombosis ```
138
What is renal AKI & what are some of the causes?
``` Disease processes which directly damage kidney itself Causes: glomerulonephritis acute tubular necrosis acure intersticial nephritits ```
139
What is post-renal AKI & what are some of the causes?
``` Disease starts downstream of kidney Causes: UT obstruction benign prostatic hyperplasia kidney stones obstructed catheter bladder stones cancer of bladder, ureters, prostate ```
140
What do NSAIDs do to the afferent arteriole?
Vasoconstrict
141
What are the 3 most common causes of chronic renal failure?
Diabetes High BP Glomerulonephritis
142
What are the 3 main places where the ureter narrows
Uretropelvic junction Pelvic brim Where ureter enters bladder (common sites of obstruction)
143
What is the referred pain for the kidney?
Loin to groin
144
What are the 4 main posterior abdominal muscles?
Quadratus lumborum - extension & lateral flexion of vertebral column Psoas major - flexion of thigh at hip & lateral flexion of vertebral column Psoas minor - flexion of vertebral column Illiacus - flexion of thigh at hip
145
Define sex differentiation
Processes involved in development of reproductive system in foetus
146
Define sex determination
46XX or 46XY
147
What is the process of sex differentiation in a male?
* SRY gene in Y chromosome * testes develop * Leydig cells produce testosterone * Sertoli cells produce Mullerian-inhibiting factor * degeneration of Mullerian duct * testosterone causes Wolffian duct to develop into male genitalia * testosterone converted into dihydrotestosterone * causes development of penis & scrotum
148
Where do the gonads develop from?
Urogenital ridge
149
What are the 3 sections of the uterus?
Fundus Body Cervix
150
What are the 3 layers of the uterus wall from superficial to deep?
Perimetrium Myometrium Endometrium
151
What are the vaginal fornices created by?
Cervical canal projecting slightly into vagina
152
What is the position of the uterus maintained by?
(anteflexed) | Round ligament of uterus
153
What are the 4 sections of the fallopian tube from proximal to the uterus to distal?
Isthmus Ampulla (where fertilisation usually takes place) Infundibulum Fimbria
154
What are the ovaries attached to the lateral wall of the uterus by?
Fibrous ovarian ligament
155
What are the 2 epithelia of the Bowmann's capsule?
Parietal layer - simple squamous | Visceral layer - podocytes
156
What is the epithelia of the PT?
Simple cuboidal
157
What is the epithelia of the thick loop limbs?
Simple cuboidal
158
What is the epithelia of the thin loop limbs?
Simple squamous
159
What is the epithelia of the DT?
Simple cuboidal
160
What is the epithelia of the CD?
Simple cuboidal
161
What is urothelium?
Transitional epithelium
162
What parts of the urinary tract have urothelium? (4)
Renal pelvis Ureter Urinary bladder Prostatic urethra
163
What is the epithelia of the female urethra?
Pseudostratified columnar
164
What is the epithelia of the external urethral meatus?
Stratified squamous
165
What is the epithelia of the skin?
Stratified keratinised squamous
166
What is the epithelia of the sweat glands
Stratified cuboidal
167
What 2 hormones regulate melanin secretion?
ACTH | Melanin secreting hormone

Phase 1 Medicine - Riona (13 decks)

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