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Phase 1 Medicine - Riona > Suger 1 > Flashcards

Suger 1 Flashcards

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
Q

What are the 3 erectile tissues in the root of the penis?

A

2x crura

Bulb

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26
Q

What are the 2 muscles of the root of the penis?

A

Bulbospongiosus x2 - contracts to empty spongy urethra of residual
Ischiocavernosus x2- contracts to help maintain erection

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27
Q

What are the 3 main parts of the male urethra?

A

Prostatic
Membranous
Spongy

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28
Q

What are the 2 fascial coverings of the penis?

A 
Deep fascia of the penis (more superficial)
Tunica albuginea (around each cavernous)
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29
Q

What are the 2 ligaments of the root of the penis?

A

Suspensory

Fundiform

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30
Q

What is the arterial supply to the penis?

A

Dorsal to penis
Deep to penis
Bulbouretheral
(all branches of internal pudendal artery)

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31
Q

What is the innervation to the penis?

A

S2-4 spinal cord segments
Sensory & sympathetic by dorsal nerve of penis (branch of pudendal)
Parasympathetic by cavernous nerves (from prostatic nerve plexus)

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32
Q

What are the 3 main functions of the pelvic floor?

A

Support of abdominopelvic viscera
Resistance to increases in intra pelvic/abdominal pressure
Urinary & faecal continence

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33
Q

What are the 2 main holes in the pelvic floor?

A

Urogenital hiatus

Rectal

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34
Q

What are the 4 main muscles of the pelvic floor?

A 
Levator ani muscles:
puborectalis
pubococcygeus
iliococcygeus
Coccygeus
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35
Q

What are the borders of the urogenital triangle?

A

Pupic synthesis

Ischiopubic rami x2

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36
Q

What does the urogenital triangle contain? (6)

A 
Deep perineal pouch
Perineal membrane
Superficial perineal pouch
Deep perineal fascia
Superficial perineal fascia
Skin
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37
Q

What is the glomerular filtration rate?

A

Amount of fluid filtered from blood by renal corpuscle per unit time

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38
Q

What is the GFR determined by? (3)

A

Glomerular filtration pressures
Permeability of glomerular capillary wall
Surface area available for filtration

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39
Q

What is the pressure of glomerular filtration under control of?

A

Neural & hormonal inputs

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40
Q

What does constriction of afferent/dilation of efferent arterioles do to the GFR?

A

Decrease
Overall decrease in pressure at glomerulus
Reduction of blood hydrostatic pressure in capillaries

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41
Q

What does neuroendocrine input to the intraglomerular mesangial cells that surround the glomerular capillaries do?

A

Contract when stimulates
Reduce SA for filtration
Decrease GFR

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42
Q

What is the equation for the amount filtered by the glomerulus?

A

Amount filtered = GFR x plasma concentration

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43
Q

How does reabsorption by diffusion occur?

A

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

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44
Q

How does reabsorption by mediated transport occur?

A

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

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45
Q

What are the transporters in each part of the nephron? (4)

A

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

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46
Q

Why is there a transport maximum for mediated transport mechanisms?

A

Binding sites of membrane proteins become saturated y the substances they are helping to transport

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47
Q

Define osmolarity

A

Number of moles of a solute in a solution per L of solvent

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48
Q

Define osmolality

A

Number of moles of a solute in a solution per kg of solvent

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49
Q

What is osmolarity affected by that osmolality isn’t?

A

Changes in water temperature & pressure as these change the volume of the solution

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50
Q

Where is ADH synthesised & released from?

A

Synthesised in hypothalamus

Released from posterior pituitary gland

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51
Q

How does ADH influence the permeability of the luminal membranes of the collecting ducts?

A

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

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52
Q

What are the 3 inputs to the juxtaglomerular cells that stimulate the release of renin?

A

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

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53
Q

What does atrial natriuretic peptide act to do?

A

(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

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54
Q

What is the pressure natriuresis mechanism?

A

An increase in urinary sodium loss

By increase in renal perfusion pressure due to increase in arterial BP

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55
Q

Where is angiotensinogen secreted from?

A

Liver

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56
Q

Where is ACE secreted from?

A

Lungs

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57
Q

Where is renin secreted from?

A

Kidneys

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58
Q

Where is aldosterone secreted from?

A

Adrenal gland

Cortex

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59
Q

What is renin’s role in the RAA system?

A

Converts angiotensinogen to angiotensin I

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60
Q

What is ACE’s role in the RAA system?

A

Converts angiotensin I to angiotensin II

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61
Q

What are the roles of angiotensin II in the RAA system? (5)

A

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

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62
Q

What is ADH’s role in the RAA system?

A

Increases H2O reabsorption from the collecting duct

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63
Q

What is the overall role of the RAA system? (3)

A

To retain water & salt
To increase circulating volume
To overall increase BP

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64
Q

What causes renin to be released? (3)

A

Drop in BP/fluid volume
Decrease in renal perfusion
Juxtaglomerular apparatus & macula densa activated

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65
Q

What are the 3 mechanisms for the controls of Na+ reabsorption?

A

RAA system
ANP
Pressure natriuresis

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66
Q

What does parathyroid hormone do in the kidney?

A

Blocks reabsorption of phosphate in PT

Promotes calcium reabsorption in Henle, DT, CT

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67
Q

What are the 2 functions of urinary buffers?

A

To excrete daily acid load

To regenerate bicarbonate lost during EC buffering

68
Q

How do urinary buffers work?

A

Free H+ combines with weak acids/ammonia to be excreted

69
Q

What are the 2 main urinary buffers?

A

Phosphate

Ammonium

70
Q

Which of the 2 main urinary buffers is the major adaption to an increased acid load?

71
Q

What does the Henderson equation give?

A

Law of mass action

Approximation of H+ or HCO3- concentration

72
Q

What is cortisol an example of & where is it produced?

A

Glucocorticoid steroid hormone

Zona fasiculata of adrenal cortex

73
Q

What is cortisol responsible for?

A

Control of glucose metabolism

Increases blood glucose through gluconeogenesis

74
Q

Where is adrenaline an example of & where is it produced?

A

Catecholamine

Medulla of adrenal gland

75
Q

What is the role of adrenaline? (6)

A 
Fight or flight response
Increased HR & BP
Blood vessel constriction
Smooth muscle dilation
Dilation of bronchioles & lung capillaries
Increased metabolism
76
Q

What is erythropoietin (EPO) an example of & where is it produced?

A

Glycoprotein

Kidney

77
Q

What is the role of EPO?

A

Stimulation of production of erythrocytes from their precursor cells (reticulocytes) in bone marrow

78
Q

What are the 3 main types of adrenergic receptors?

A

Alpha
Beta 1
Beta 2

79
Q

Where is the alpha adrenergic receptor found & what is it’s role?

A

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
Q

Where is the beta 1 adrenergic receptor found & what is it’s role?

A

Heart

Increase HR & contractility

81
Q

Where is the beta 2 adrenergic receptor found & what is it’s role?

A

Bronchioles & arteries of skeletal muscle

Dilate bronchioles & vessels of skeletal muscle

82
Q

What are the 3 layers of the skin from superficial to deep?

A

Epidermis
Dermis
Subcutaneous layer (hypodermis)

83
Q

What are the 7 main functions of the skin?

A 
Mechanical barrier
Regulation of temperature & electrolytes
Waterproofing
Immunity
Protection from UV
Production of vitamin D
Sensation
84
Q

What are the 5 layers of the epidermis?

A

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
Q

What are the majority of the cells in the epidermis?

A

Keratinocytes which move up through the layers as they undergo keratinisation

86
Q

What are the 3 other types of cells in the epidermis?

A

Melanocytes
Langerhan cells
Merkel cells

87
Q

What do melanocytes produce?

A

Melanin from tyrosine using enzyme tyrosinase

88
Q

How do melanocytes transport their product to keratinocytes?

A

Via dendritic processes

Melanin into vesicles - melanosomes

89
Q

What is the role of langerhans cells & what are they derived from?

A

Antigen presenting cells

Haemopoietic bone marrow cells

90
Q

Where are Birbeck granules (tennis racket shaped) found?

A

Langerhans cells

91
Q

What is the role of merkel cells?

A

Neuroendocrine cells
Act as mechanoreceptors & mediate tactile sensation
Make contact with nerve endings

92
Q

Where are the merkel cells found?

A

Along the stratum basale

93
Q

What are the main things the dermis is made up of?

A 
Irregular loose connective tissue
Fibroblasts
Collagen
Glycosaminoglycan metric
Blood vessels
Lymphatics 
Nerves
Sensory cells
Scattered inflammatory cells
94
Q

What are the 2 layers of the dermis?

A

Papillary dermis

Reticular dermis

95
Q

What are the adhesion molecules between the cells in the stratum corneosum called?

A

Corneodesmosomes

96
Q

What is the breakdown of corneodesmosomes called?

A

Desquamation

97
Q

What does a change in the number of adhesion molecules in the skin cause?

A

Increase - psoriasis

Decrease - eczema

98
Q

What does a change in the pH of the skin cause?

A

High pH - skin dryness & decreased defence

Low pH - dry skin, irritation, sensitivity, hyperpigmentation

99
Q

Why does acne develop?

A

Blockages in hair follicles

100
Q

What are the steps of the itch-scratch cycle? (8)

A

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
Q

At what level are the kidneys found?

102
Q

What are the 4 layers surrounding the kidney from superficial to deep?

A

Pararenal fat (mainly on posterolateral aspect)
Renal fascia
Perirenal fat
Renal capsule

103
Q

What are the 2 main areas of the kidney parenchyma?

A

Cortex (outer)

Medulla (inner)

104
Q

What does the cortex divide the medulla into?

A

Medullary pyramids

105
Q

What is the flow of urine from the medullary pyramid?

A

Pyramid > renal papilla > minor calyx > major calyx > renal pelvis > ureter

106
Q

What is the arterial supply to the kidneys?

A 
L & renal arteries
Segmental branches
Interlobular arteries
Arcuate arteries
Interlobular arteries
Afferent arterioles
Glomerulus
Efferent arterioles
107
Q

What forms the peritubular network?

A

Efferent arterioles
Supply nephron tubules
Outer 2/3rds of cortex

108
Q

What are the inner 1/3rd of cortex & medulla supplied by?

A

Vasa recta

109
Q

What are the 2 main areas of the adrenal gland parenchyma?

A

Cortex (from mesoderm)

Medulla (from ectodermal neural crest cells)

110
Q

What do the adrenal glands produce?

A

Steroid & catecholamine hormones

111
Q

What are the 3 sub-zones of the adrenal cortex?

A

Zona glomerulosa
Zona fasiculata
Zona reticularis

112
Q

Give an example of the type of hormone each of the 3 sub-zones of the adrenal cortex secretes

A

G = Mineralocorticoid - aldosterone
F = Glucocorticoids - cortisol
R = Sex hormones - testosterone
(salt, sugar, sex)

113
Q

What does the medulla of the adrenal gland secrete & give an example

A

Catecholamine

Adrenaline & noradrenaline

114
Q

What is the adrenal gland supplied by? (arterial)

A

Superior
Middle
Inferior adrenal arteries

115
Q

What is the purpose of the ureter?

A

To transport urine from the kidney to the bladder

116
Q

What is the pathway of the abdominal ureter?

A

Renal pelvis > ureteropelvic junction > anterior surface os posts major > bifurcation of common iliac artery at pelvic brim

117
Q

What is the pathway of the pelvic ureter?

A

Lateral pelvic walls > turn anteromedially at level of ischial spines > towards bladder > lateral bladder wall in oblique manner

118
Q

What is the significance of the ureter piercing the bladder in an oblique manner?

A

Makes a one way valve

When the bladder contracts, the valve is shut

119
Q

What is the trigone in the bladder?

A

Triangular area that marks orifices of ureters and urethra
Smooth muscle walls
Different embryological development (from mesonephric ducts)

120
Q

What are the sections of the bladder?

A

Apex
Body
Fundus
Neck

121
Q

Which of the two sphincters in the bladder is under voluntary control?

A

External

Skeletal muscle

122
Q

What is the difference in the internal urethral sphincter in the sexes?

A

M - circular smooth muscle, autonomic control

F - functional sphincter, no muscle

123
Q

What is the smooth muscle of the bladder?

A

Detrusor

Contracts during micturition

124
Q

What is the vascular supply of the bladder?

A

Internal iliac vessels
Superior vesicle branch of artery
Vesical venous plexus

125
Q

How is the sympathetic nervous system involved in control of the bladder?

A

Hypogastric nerve T12-L2

Relaxation

126
Q

How is the parasympathetic nervous system involved in control of the bladder?

A

Pelvic nerve S2-4

Contraction

127
Q

How is the somatic nervous system involved in control of the bladder?

A

Pudendal nerve S2-4
Voluntary control
External urethral sphincter
Relax/contract

128
Q

What is the bladder stretch reflex?

A

Micturition is stimulated in response to stretch
Overridden in toilet training
Usually voluntary
Spinal injuries?

129
Q

What is the structure of the renal corpuscle?

A

Glomerulus (network of capillaries) sits inside Bowman’s capsule
Afferent & efferent arterioles

130
Q

What are the layers that the filtrate passes through in a nephron?

A

Endothelium of capillary
Basement membrane
Slit diaphragms between podocytes

131
Q

What is the structure of the renal tubule?

A 
PCT
Loop of Henle (ascending & descending limbs)
DCT
CT
CD
132
Q

Which parts of the Loop of Henle are permeable to water?

A

Descending highly permeable to water, impermeable to ions

Ascending impermeable to water, highly permeable to ions

133
Q

Which part of the nephron is not in the renal cortex?

A

Loop of Henle descends into medulla

134
Q

What hormones are secreted by the anterior pituitary gland?

A 
FSH
LH
ACTH
TSH
Prolactin
I(gnore)
GH
Flat pig
135
Q

Define acute kidney injury

A

Abrupt loss of kidney function within 7 days

136
Q

What are the 3 types of acute kidney injury?

A

Pre-renal
Renal/intrinsic
Post-renal

137
Q

What is pre-renal AKI & what are some of the causes?

A 
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
Q

What is renal AKI & what are some of the causes?

A 
Disease processes which directly damage kidney itself
Causes:
glomerulonephritis
acute tubular necrosis
acure intersticial nephritits
139
Q

What is post-renal AKI & what are some of the causes?

A 
Disease starts downstream of kidney
Causes:
UT obstruction
benign prostatic hyperplasia
kidney stones
obstructed catheter
bladder stones
cancer of bladder, ureters, prostate
140
Q

What do NSAIDs do to the afferent arteriole?

A

Vasoconstrict

141
Q

What are the 3 most common causes of chronic renal failure?

A

Diabetes
High BP
Glomerulonephritis

142
Q

What are the 3 main places where the ureter narrows

A

Uretropelvic junction
Pelvic brim
Where ureter enters bladder
(common sites of obstruction)

143
Q

What is the referred pain for the kidney?

A

Loin to groin

144
Q

What are the 4 main posterior abdominal muscles?

A

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
Q

Define sex differentiation

A

Processes involved in development of reproductive system in foetus

146
Q

Define sex determination

A

46XX or 46XY

147
Q

What is the process of sex differentiation in a male?

A
  • 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
Q

Where do the gonads develop from?

A

Urogenital ridge

149
Q

What are the 3 sections of the uterus?

A

Fundus
Body
Cervix

150
Q

What are the 3 layers of the uterus wall from superficial to deep?

A

Perimetrium
Myometrium
Endometrium

151
Q

What are the vaginal fornices created by?

A

Cervical canal projecting slightly into vagina

152
Q

What is the position of the uterus maintained by?

A

(anteflexed)

Round ligament of uterus

153
Q

What are the 4 sections of the fallopian tube from proximal to the uterus to distal?

A

Isthmus
Ampulla (where fertilisation usually takes place)
Infundibulum
Fimbria

154
Q

What are the ovaries attached to the lateral wall of the uterus by?

A

Fibrous ovarian ligament

155
Q

What are the 2 epithelia of the Bowmann’s capsule?

A

Parietal layer - simple squamous

Visceral layer - podocytes

156
Q

What is the epithelia of the PT?

A

Simple cuboidal

157
Q

What is the epithelia of the thick loop limbs?

A

Simple cuboidal

158
Q

What is the epithelia of the thin loop limbs?

A

Simple squamous

159
Q

What is the epithelia of the DT?

A

Simple cuboidal

160
Q

What is the epithelia of the CD?

A

Simple cuboidal

161
Q

What is urothelium?

A

Transitional epithelium

162
Q

What parts of the urinary tract have urothelium? (4)

A

Renal pelvis
Ureter
Urinary bladder
Prostatic urethra

163
Q

What is the epithelia of the female urethra?

A

Pseudostratified columnar

164
Q

What is the epithelia of the external urethral meatus?

A

Stratified squamous

165
Q

What is the epithelia of the skin?

A

Stratified keratinised squamous

166
Q

What is the epithelia of the sweat glands

A

Stratified cuboidal

167
Q

What 2 hormones regulate melanin secretion?

A

ACTH

Melanin secreting hormone

Phase 1 Medicine - Riona (13 decks)

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