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Phase 1 Simplified > SUGER > Flashcards

SUGER Flashcards

1
Q

What is the opening and exit of the inguinal canal?

A

Opening = deep inguinal ring, exit = superficial inguinal ring

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2
Q

What are the boundaries of the inguinal canal?

A

 anterior – aponeurosis of superior oblique
 posterior – transversalis fascia
 roof – transversalis fascia, internal oblique, transversus abdominis
 floor – inguinal ligament (pubic tubercle -> anterior superior iliac crest)

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3
Q

What are the contents of the inguinal canal?

A

 Spermatic cord or round ligament
 Genital branch of genitofemoral artery
 Ilioinguinal nerve

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4
Q

What is the difference between a indirect and direct herniation at the inguinal canal?

A

 Indirect – congenital, through deep inguinal ring

 Direct – abdominal weakness, through posterior inguinal canal wall

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5
Q

Why do hernias often occur at the inguinal canal?

A

No abdominal muscles present (I think, double check)

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6
Q

Go through the 2 coverings of the testicles

A 
	Tunica vaginalis:
•	External layer derived from peritoneum
•	Covers anterior surface and sides of testes
	Tunica albuginea:
•	Fibrous capsule enclosing testes
•	Penetrates parenchyma -> lobes
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7
Q

Go through the route spermatozoa takes starting at the semniferous tubules

A

o Spermatozoa production in seminiferous tubules -> rete testes -> efferent tubules -> epididymis

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8
Q

Function and anatomy of the epididymis

A

 Stores sperm for 50 days

 Head -> coiled body -> tail connects to vas deferens

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9
Q

What innervates the testicles?

A

Testicular plexus

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10
Q

What is the arterial supply to the testicles?

A

Paired testicular arteries via the inguinal canal

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11
Q

What is the venous drainage in the testicles?

A

 Left testicular vein -> left renal vein

 Right testicular vein -> inferior vena cava

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12
Q

Describe the anatomical position of the kidneys

A

o Retroperitoneal, T12-L3, R kidney lower than L kidney

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13
Q

What are the layers around the kidney?

A

 Kidney capsule
 Perirenal fat
 Renal fascia (kidney and suprarenal glands covered)
 Pararenal fat

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14
Q

Go through the deeper layers of the kidney and include the function and a basic description of each

A 
o	Cortex:
	Space for renal arterioles and venules
	Production of EPO
	Divides medulla into renal pyramid
o	Medulla:
	Functional units of kidney – nephrons
	Form renal pyramids
	Apex of pyramid – minor calyx
	Minor calyx -> major calyx = urine collection
o	Pelvis:
	Collects urine from major calices
	Drains urine into ureter
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15
Q

What is the arterial supply to the kidneys?

A

 Renal arteries arise directly from abdominal aorta – L1-L2
 Renal arteries -> hilum -> segmental branches -> interlobar -> arcuate -> interlobular -> afferent arterioles -> glomerulus

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16
Q

What is the venous drainage of the kidneys?

A

o Venous drainage – renal veins -> inferior vena cava

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17
Q

Describe the shape of the supra-renal glands

A

o R adrenal gland = pyramidal, L adrenal gland = semi-lunar

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18
Q

What are the layers of the adrenal cortex?

A

 Zona glomerulosa
 Zona fasciculate
 Zona reticulate

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19
Q

What does the adrenal cortex secrete?

A

Corticosteroids and androgens

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20
Q

What does the adrenal medulla secrete?

A

Catecholamines from chromaffin cells

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21
Q

What are the layers of the adrenal glands?

A

Cortex and medulla

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22
Q

What is the arterial supply to the adrenal glands?

A

 Superior adrenal artery – inferior phrenic
 Middle adrenal – abdominal aorta
 Inferior adrenal – renal arteries

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23
Q

What is the venous drainage of the adrenal glands?

A

 Right adrenal vein -> inferior vena cava

 Left adrenal vein -> left renal vein

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24
Q

What are the 3 parts of the ureter?

A

Abdominal, pelvic, intramural (in bladder)

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25
Q

Where are the narrowing of the ureter?

A

 Ureteropelvic junction – renal pelvis -> ureter
 Bifurcation of common iliac artery
 Oblique entrance of ureter into bladder wall

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26
Q

Go through the branches of the abdominal aorta

A

o Inferior phrenic arteries – T12– diaphragm
o Coeliac trunk – L1 – stomach, liver, duodenum
o Superior mesenteric artery – lower L1 – jejenum, ileum, ascending and transverse colon
o Middle suprarenal arteries – L1 – adrenal glands
o Renal arteries – L1 and L2 – kidneys
o Gonadal arteries – L2 – testicles and ovaries
o Inferior mesenteric artery – L3 – transverse, descending and sigmoid colon, rectum

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27
Q

Name the muscles in the posterior abdominal wall

A

 Quadratus lumborum – lateral
 Psoas major – medial
 Iliacus – fan shaped below quadratus lumborum
o Iliacus and psoas major combine to form iliopsoas – hip flexion

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28
Q

What innervates the muscles of the posterior abdominal wall?

A

o Posterior wall muscles innervated by lumbar plexus – T12-L4

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29
Q

What is the function of the bladder?

A

Store and expel urine

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30
Q

What is the structure of the bladder?

A

 Apex – connection to umbilicus by medial umbilical ligament
 Body
 Fundus – contains trigone, smooth walled orifice = entrance of ureters
 Neck – joins bladder to urethra

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31
Q

What are the muscles in the bladder?

A

 Detrusor – contracts during micturition
 Internal urethral sphincter – smooth muscle fibres in male, female functional sphincter
 External urethral sphincter – voluntary skeletal muscle relaxes during micturition

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32
Q

What’s the arterial supply to the bladder?

A

Internal iliac artery

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33
Q

What is the sympathetic supply to the bladder?

A

detrusor relaxation, parasympathetic supply = detrusor contraction

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34
Q

Describe the parts of the vulva in the female genitalia

A

 Mons pubis – superior pad of fat
 Labia majora – hair bearing folds
 Labia minora – non-hair bearing folds
 Clitoris – erectile corpus cavernosa tissue (genital tubercle)

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35
Q

What is the function, histological layering and arterial supply of the vagina?

A

 Function – transport to and from uterus for baby, menstrual fluid, semen
 Histological – stratified squamous epithelium, elastic lamina propria, fibromuscular layer, adventitia
 Arterial supply – uterine and vaginal arteries from internal iliac

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36
Q

Go through the anatomy of the cervix

A

 Ectocervix -> external os -> endocervical canal -> internal os

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37
Q

What is the function of the cervix?

A

 Connects vagina and uterus, maintains uterine sterility

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38
Q

What are the 3 layers, the 3 parts and arterial supply (for cervix too) of the uterus?

A

 3 parts – fundus, body (blastocyst implantation), cervix
 3 layers – endometrium -> myometrium (muscular) -> perimetrium
 Arterial supply of cervix and uterus – uterine arteries

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39
Q

Go through the fallopian tubes

A

 Fimbriae -> infundibulum -> ampulla (fertilisation) -> isthmus

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40
Q

Which layers cause peristaltic contractions in the fallopian tubes?

A

 Inner ciliated mucosa and muscular layer

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41
Q

What are the basic layers of ovaries?

A

 Surface, cortex (primordial germ cells), medulla (neurovascular)

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42
Q

What is the arterial supply to the ovaries and fallopian tubes

A

ovarian arteries from abdominal aorta

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43
Q

What are the ligaments in the abdominal female genitalia?

A

 Broad ligament – sheet of peritoneum covering uterus and ovaries
 Ovaries:
• Ovarian – connects ovary to uterus
• Suspensory – connects ovary to lateral abdominal wall
 Uterus:
• Round ligament – passes through inguinal canal, connects uterus and labia majora

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44
Q

What are the parts of female genatalia?

A

Vulva, vagina, cervix, uterus, fallopian tubes, ovaries, ligaments

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45
Q

What are the parts of the male genitalia?

A

Penis, scrotum, spermatic cord, prostate gland, seminal vesicle and ejaculatory duct

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46
Q

What is the general route semen takes in the penis?

A

 Root -> body -> glans

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47
Q

General anatomy of the soft tissues

A

 L and R crus and bulb in root -> L and R corpus cavernosa and corpus spongiosum (contains urethra and glans)

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48
Q

Muscles in the penis

A
  • Bulbospongiosus – bulb of penis – expulsion in micturition

* Ischiocavernosus – L and R crus of penis – squeezing blood into penis

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49
Q

Describe the fascia in the penis?

A
  • Deep fascia = superficial layer = continuation of perineal fascia
  • Tunica albuginea – capsule covering individual parts of penis
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50
Q

Describe the ligaments in the penis

A
  • Suspensory – connects erectile tissue to pubic symphysis

* Fundiform – continuation of linea alba, attaches to pubic symphysis

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51
Q

What is the arterial supply and venous drainage of the penis?

A

Arterial supply

  • Dorsal and deep penile arteries, bulbourethral arteries
  • Branches of internal pudendal -> internal iliac

Venous drainage
- superficial and dorsal veins of the penis

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52
Q

Parasympathetic or sympathetic stimulation for ejaculation?

A

Sympathetic

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53
Q

What does the scrotum contain?

A

testes, epididymis and spermatic cord

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54
Q

What is the dartos muscle?

A

Layer of smooth muscle which contracts the scrotum for heat loss

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55
Q

What is the arterial supply of the scrotum?

A

Superior and inferior scrotal tissue supplied by the external and internal pudendal artery

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56
Q

Go through the spermatic cord

A

 Deep inguinal ring -> superficial inguinal ring -> scrotum

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57
Q

What are the structures in the spermatic cord?

A
  • Testicular artery and vein (pampliform plexus)
  • Genital branch of genitofemoral nerve
  • Vas deferens
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58
Q

What are the 3 zones of the prostate gland and what is its arterial supply?

A

 3 zones – central, peripheral, transitional

 Arterial supply – prostatic arteries -> internal pudendal arteries

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59
Q

What produces semen and how much of this fluid makes up ejaculate?

A

o Seminal vesicle produces semen – fluid makes up 70% of ejaculate

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60
Q

What is the ejaculatory duct?

A

confluence of seminal vesicle and prostatic duct and vas deferens

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61
Q

What are the 2 hiatus in the pelvic floor?

A

Urogenital and rectal

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62
Q

What are the muscles in the pelvic floor?

A

 Levator ani – puborectalis (continence), pubococcygeus, ileococcygeus
 Coccygeus

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63
Q

What makes up the pelvic floor?

A

Muscles and fascia

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64
Q

What are the contents and boundaries of the urogenital triangle?

A

o Boundaries – pubic symphysis and pelvic ischial tuberosities
o Contains most of the important UG stuff – male/female genitalia

65
Q

What is the GFR?

A

o Filtration volume per unit time – 125ml/min
o Measured GFR = conc of M in urine x urine flow rate/conc of M in plasma - creatinin
o Renal clearance – volume of plasma from which a substance is completely removed by the kidney
 <125ml/min – freely filtered and partially reabsorbed
 >125ml/min – freely filtered and excreted
 0ml/min – freely filtered and completely reabsorbed (glucose)

66
Q

What is hydrostatic pressure?

A

P -> out of vessel

67
Q

What is oncotic pressure?

A

O -> into vessel

68
Q

Equation for GFR

A

o GFR = (PGC – PBS) – (OGC – OBS) x KF

69
Q

Factors affecting GFR

A

 Afferent dilation/efferent constriction -> increased PGC -> increased GFR
 Afferent constriction/efferent dilation -> decreased PGC -> decreased GFR

70
Q

What is autoregulation

A

 Increase blood flow in afferent arteriole -> stretch of wall -> smooth muscle contracts -> arteriolar constriction
 Systemic circulation BP change doesn’t affect renal circulation

71
Q

What is tubuloglomerular feedback?

A

 Macula densa detect NaCl -> release prostaglandins -> granular cells release renin

72
Q

What is the filtration barrier?

A

o Podocytic foot processes, basement membrane and capillary endothelium
o Small and +ve charged molecules can cross filtration barrier
o Glomerular basement membrane has -ve charge -> proteins can’t cross barrier

73
Q

Discern between osmolarity and osmolality

A

• Osmolarity – concentration of solute in litres vs osmolality – concentration of solute in kg

74
Q

What is the structure of the nephron?

A

o Glomerulus – basic filtration unit
o Proximal convoluted tubule – bulk reabsorption
o Loop of Henle – urinary dilution
o Distal convoluted tubule – selective reabsorption
o Collecting duct – like distal tubule

75
Q

Go through the proximal convoluted tubule and symporters, antiporters as well as bicarbonate reabsorption

A

o Basolateral Na/K pump establishes conditions for mass reabsorption
o Glucose and phosphate absorbed with sodium – symporter
o Sodium absorbed as H+ excreted – antiporter
o Bicarb reabsorption:
1. H+ combines with bicarb to form carbonic acid
2. Converted to carbon dioxide and water by carbonic anhydrase
3. Carbon dioxide diffuses into cell -> carbonic acid reformed
4. Bicarb pumped into capillary through basolateral membrane

76
Q

Go through the Loop of Henle

A

o Descending limb = water absorption, ascending limb = solute absorption
o Vasa recta reabsorbs water in descending limb -> higher osmolarity down descending limb
o Vasa recta reabsorbs solutes in ascending limb -> decreasing osmolarity up ascending limb
o Top of loop of Henle = low osmolarity, bottom of loop = high osmolarity
o Creates conditions for selective reabsorption in collecting duct
o NKCC2 transporter – reabsorption of Na, K and Cl (ROMK = K excretion)

77
Q

Go through the distal convoluted tubule

A

o Continues urine dilution – reabsorption of Na, impermeable to water
o NCC transporter – Na and Cl

78
Q

Go through the collecting duct

A

o Surrounded by hypertonic medullary interstitium – set up by loop of Henle
o Water impermeable, selective Na absorption, selective K and acid secretion

79
Q

Go through a principle cell

A

 Contains ENaC – epithelial sodium channel
 K excretion
 Aldosterone = more ENaC channels = inc Na reabsorption and K excretion
 ADH -> V2 receptors -> aquaporins in apical membrane -> increased water permeability

80
Q

Go through a intercalated cell

A

 Acid secretion
 ATPase pumps out H ions – by-product of bicarb production in renal cell
 K/H antiporter
 Ammonia diffuses into tubular fluid -> combines with H to form ammonia

81
Q

What are the hormonal effects on the renal system?

A

o Parathyroid hormone:
 Blocks phosphate reabsorption in proximal convoluted tubule
 Increases calcium reabsorption every else
o Atrial natriuretic peptide:
 Glomerular arteriole dilation -> increased GFR
 Increased vasa recta blood flow
 Affects NCC transporter– decreased sodium reabsorption in distal convoluted tubule
 Inhibits renin secretion – RAAS system
o Angiotensin 2, aldosterone and vasopressin all increase blood volume levels by increasing water reabsorption at the kidneys

82
Q

What are the 3 urinary buffers?

A

H ion secretion, phosphate buffer and ammonia buffer

83
Q

Go through the phosphate buffer

A

 Most common, impermeable to apical membrane

 HPO42- + H+ -> H2PO4-

84
Q

Go through the H ion secretion buffer

A

 Allows reabsorption of bicarb in proximal tubule (H + HCO3- -> H2CO3 -> CO2 + H2O)
 Daily acid load secretion – buffers required

85
Q

Go through the ammonia buffer

A

 Adaptive response to acid load -> synthesised from glutamine
 NH3 diffuses into tubular fluid -> NH4+ impermeable to apical membrane
 Proximal convoluted tubule -> reabsorbed in loop of Henle -> intercalated disc in collecting duct
 Law of mass action = principle that the rate of a chemical reaction is proportional to the concentrations of the reacting substances

86
Q

What happens during respiratory acidosis?

A 
o	Hypoventilation = hypercapnia = equilibrium shifts to right = more H+
o	Renal compensation:
	Increased H+ secretion
	Increased bicarb production
	Increased ammonia secretion
87
Q

What happens during respiratory alkalosis?

A

o Hyperventilation = hypocapnia = equilibrium shifts to left = less H+
o Renal compensation:
 Decreased H+ secretion
 Increased bicarb secretion

88
Q

What happens during metabolic acidosis?

A

o Excess acid production or decreased bicarb concentration
o Respiratory compensation:
 Low pH stimulates chemoreceptors
 Increased ventilation -> decreased Pco2

89
Q

What happens during metabolic alkalosis?

A

o Vomiting = acid loss
o Respiratory compensation:
 High pH stimulates chemoreceptors
 Decreased ventilation -> increased Pco2

90
Q

Go through the RAAS system

A

• RAAS system:

  1. Body sodium levels decrease -> blood pressure decrease
  2. Macula densa cells detect low sodium and low arteriolar BP -> renin release from juxtaglomerular apparatus
  3. Renin cleaves angiotensinogen from liver into angiotensin 1
  4. Angiotensin converting enzyme from lungs converts angiotensin 1 -> angiotensin 2
91
Q

Where are macula densa cells found?

A

JGA (I think double check)

92
Q

What are angiontensin 2 functions?

A

 aldosterone release from adrenal cortex – zona glomerulosa
 Vasoconstriction of efferent arteriole
 ADH release from posterior pituitary
 Increased proximal tubular sodium reabsorption - cotransport

93
Q

What is aldosterone’s function?

A

 Increased K secretion in collecting duct

 Increased eNaC channels in principal cells

94
Q

Go through the ADH system

A

o Vasopressin synthesised in supraoptic nuclei of hypothalamus -> stored in posterior pituitary
o Hypothalamic osmoreceptors detect increased osmolarity -> ADH release
o ADH functions:
 Increase in water permeability in distal convoluted tubule and collecting duct – aquaporin 2 channels
 Increase in urea permeability in collecting duct
 Increased sodium absorption in ascending loop of Henle -> increased osmolaric counter-current exchange

95
Q

What is the general shape of each adrenal gland?

A

o R adrenal gland = pyramidal, L adrenal gland = semilunar

96
Q

What’s the layered structure of adrenal glands?

A

 Zona glomerulosa – mineralocorticoids – aldosterone
 Zona fasciculata – glucocorticoids – cortisol
 Zona reticularis – androgens – DHEA -> testosterone
 Medulla – catecholamines - adrenaline

97
Q

What is derived from cholosterol?

A

o Steroid hormones produced in adrenal glands

98
Q

What are the receptors in the adrenal glands?

A

 Mineralocorticoids only act on mineralocorticoid receptors
 Glucocorticoids act on mineralocorticoid and glucocorticoid receptors
 Androgen only act on androgen receptors

99
Q

What is the action of cortisol?

A

 Released in response to stress and low blood glucose levels
 Increases gluconeogenesis and fat/protein metabolism

100
Q

What is the action of adrenaline?

A

 Catecholamines released from adrenal medulla – peptide hormones
 Functions – gluconeogenesis, lipolysis, increased heart rate
 Alpha receptors in smooth muscle – vasoconstriction/dilation
 Beta receptors:
• Beta 1 – amylase secretion
• Beta 2 – bronchodilation
• Beta 3 – lipolysis in adipocytes

101
Q

What are the functions of skin?

A

o Mechanical barrier and waterproofing
o Regulates temperature and electrolytes
o Sunlight – UV protection and vit D production
o Sensory and immune organ

102
Q

What are the epidermal layers of skin?

A

o Corneum – dead keratinised cells
o Lucidum – dead cells containing keratohyalin
o Granulosum – keratohyalin + protein envelope, cells begin dying
o Spinosum – keratin fibres and lamellar bodies
o Basale – mitotic cells migrate up to spinosum

103
Q

What are keratinocytes?

A

o Skin cells – 95% of epidermis

o Nucleated epithelial cells containing keratin – fibres move through desmosomes

104
Q

What is the dermis layer of the skin?

A

o Papillary dermis – rete ridges, type 3 collagen, ground substance + fibroblast
o Reticular dermis – type 1 collagen, well organised and elastic fibres

105
Q

What does subcutaneous tissue have an abundance of?

A

Adipocytes

106
Q

Why does healthy skin have a pH of 5.5?

A

this allows the proteases to remain on the skin thereby enabling balance of new cells from the basal layers of the epidermis (desquamation)

107
Q

What causes skin flare ups?

A

• Skin flare ups are caused by allergens which penetrate the skin where they’re met by lymphocytes which release chemicals to induce inflammation:
o Red skin: dilation of blood vessels
o Itchy skin: stimulation of nerves
o Dry skin: skin cells leaking

108
Q

What is the cause of increasing pH?

A

• Less water retention in the corneocytes will mean pH will increase which results in damage to the skin barrier since corneodesmosomes become damaged by the increased pH

109
Q

In acne, how is skin irritation and inflammation induced?

A

• In acne, hypercornification of the stratum corneum results in adherent cells blocking the entrance to hair follicles -> increased production of greasy sebum -> sebum trapped in narrowed hair follicle -> sebum stagnates in anaerobic conditions in the pit of the hair follicle -> allows propionic bacteria acnes to multiply there -> irritation and inflammation

110
Q

What is the skin barrier essentially?

A

o Lipid lamellae above cells - corneocytes connected by corneodesmosomes

111
Q

Examples of positive and negative feedback loops in the body

A

• Positive feedback loop = oxytocin, negative feedback = pretty much all the other hormones

112
Q

Function of the hypothalamus

A

o Homeostasis – thirst, sleep, temp regulation

o Controls endocrine function via pituitary

113
Q

Functions of the hormones produced by the hypothalamus

A

 Thyrotropin releasing hormone – stimulates TSH release
 Corticotropin releasing hormone – stimulates ACTH release
 Gonadotrophin releasing hormone – stimulates LH and FSH release
 Growth hormone releasing hormone – stimulates GH release
 Dopamine – inhibits prolactin release

114
Q

What is the blood supply to the anterior pituitary?

A

o No arterial supply -> portal venous supply from hypothalamus (superior hyphoseal)

115
Q

What are the hormones released from the anterior pituitary and their function?

A

 Thyroid stimulating hormone (TSH) – stimulates thyroid to release thyroxine
 Follicle stimulating hormone (FSH) – stimulates ovarian follicle growth
 Luteinising hormone (LH) – stimulates ovulation
 Adrenocorticotrophic hormone (ACTH) – glucocorticoid and androgen production
 Growth hormone (GH) – growth, metabolism, bone mass
 Prolactin – stimulates lactation

116
Q

Go through a hypothalamus-pituitary feedback example

A

o Hypothalamic input – stress, diurnal rhythm, cytokine release
o Hypothalamus releases CRH -> anterior pituitary
o Anterior pituitary releases ACTH -> zona fasciculus of adrenal cortex
o Cortisol released from adrenal glands
o Cortisol inhibits release of ACTH and CRH – negative feedback

117
Q

Function the posterior pituitary

A

o No production of hormones -> storage of hypothalamic hormones

118
Q

Divisions of the posterior pituitary and their functions

A

o Supraoptic nucleus:
 Produces vasopressin
 Vasopressin function – increase renal fluid reabsorption (aquaporins)
o Paraventricular nucleus:
 Produces oxytocin
 Oxytocin function – positive feedback system during labour

119
Q

Which cells are involved in the exocrine activity in the pancreas?

A

• Exocrine activity – acinar cells, make up 98% pancreatic cells

120
Q

Go through the Islets of Langerhans in relation to cell types

A 
•	Islets of Langerhans:
o	Alpha cells: 
	Glucagon synthesis
	Glucagon function – utilises glucose stores
o	Beta cells:
	insulin secretion
	Insulin function - decreased hepatic gluconeogenesis, increase glucose storage
o	Delta cells – somatostatin secretion
121
Q

Go through insulin secretion

A
  1. Glucose enters beta cells via GLUT2 transporter
  2. Glucokinase metabolises glucose -> glycolysis and Kreb produces ATP
  3. ATP closes K channel -> no efflux of K -> depolarisation of cell
  4. Depolarisation causes influx of Ca -> exocytosis of insulin
  5. Endogenous insulin has C peptide attached – exogenous is free insulin
122
Q

Go through insulin action

A
  1. Insulin binds to insulin receptor on target cell
  2. Increased exocytosis of GLUT4 vesicles to cell membrane -> more GLUT4 vesicles in cell membrane
  3. Increased glucose uptake through GLUT4 receptors
123
Q

What is the fasting state in terms of glucose regulation?

A

o Glucose comes from liver:
 Gluconeogenesis – pyruvate from glucose-alanine cycle
 Hepatic glycogen stores utilised - glucagon
o Low insulin levels – glucose supplied to brain and RBC

124
Q

What is the feeding state in terms of glucose regulation

A

o Rising glucose levels increases insulin synthesis, decreases glucagon synthesis
o Glucose travels to liver and muscles – converted to glycogen storage
o Excess glucose converted to fat in adipocyte

125
Q

What is hyperglycaemia?

A

• Hyperglycaemia -> inhibition of glucagon release

126
Q

What is hypoglycaemia?

A

• Hypoglycaemia -> inhibition of insulin release

127
Q

What’s the location, structure, blood supply and venous draniange of teh thyroid gland?

A

• Anatomy:
o Location:
 C5-T1
 Inferior to thyroid cartilage
 Wraps around cricoid cartilage and superior tracheal rings
o Structure – 2 lobes separated by isthmus
o Blood supply (paired arteries):
 Superior thyroid artery – external carotid artery
 Inferior thyroid artery – subclavian
o Venous drainage -> jugular vein

128
Q

What are the cell types found in the thyroid gland?

A 
o	Follicular cells:
	Surround colloid to form follicles
	Produce T3 and T4
o	C cells:
	Parafollicular cells
	Secrete calcitonin
129
Q

e synthesis

A
  1. Thyroid stimulating hormone released from anterior pituitary
  2. Na/I symporter increase iodine uptake
  3. Thyroglobulin iodinised – catalysed by thyroperoxidase
  4. Thyroglobulin + tyrosine -> thyroxine (T3 and T4)
130
Q

Name the thyroid hormones

A 
o	Triiodothyronine (T3) – biologically active hormone
o	Thyroxine (T4) – de-iodinised in peripheral tissues to form T3, most abundant
131
Q

How are the thyroid hormones carried in the blood?

A

o T3 and T4 carried in bloodstream bound to albumin and thyroxine binding protein

132
Q

What is the function of the thyroid? What is the function of thyroxine?

A
  • Thyroid function – absorption of iodine

* Thyroxine function – conversion to T3, metabolic regulation

133
Q

What hormonal changes occur during pregnancy?

A 
o	Human chorionic gonadotrophin:
	stimulates ovarian oestrogen and progesterone production
o	Oestrogen:
	regulates progesterone levels
	prepares uterus + lactating breasts
o	Progesterone:
	builds up endometrium
	inhibits uterine contraction
o	Prolactin: 
	increases milk-producing cells
o	Relaxin:
	Limits uterine activity
	Involved in cervical ripening
o	Oxytocin:
	Caring reproductive behaviour
	Cause uterine contractions during labour
o	Prostaglandins:
	Tissue hormones that initiate labour
134
Q

Name 4 maternal adaptions

A

CV, respiratory, veins and skin

135
Q

Go through the respiratory maternal adaptions

A

 Increased inspiratory volume

 Increased breathing rate

136
Q

Go through the CV maternal adaptions

A

 Increased cardiac output
 Decreased peripheral resistance -> decreased BP
 Increased uterine blood flow
 Increase plasma and RBC volume

137
Q

Go through the venous maternal adaptions

A

 Growing uterus -> presses on IVC

 Increased lower limb venous pressure -> varicose veins

138
Q

Go through the skin maternal adaptions

A

 Linea nigra – dark line between umbilicus and pubic symphysis
 Stretch marks at site of maximal growth

139
Q

What induces the initiation of labour?

A

o Stress -> CRH release -> ACTH release -> cortisol release -> oestrogen release
o Oestrogen release -> inhibits uterine progesterone release -> uterine contractions
o Prostaglandins (PGF2a) and relaxin (from ovaries) relax walls of cervix -> dilation
o Baby pushing onto cervix -> oxytocin release -> uterine contractions (positive FB)

140
Q

What happens during cervial ripening at labour?

A 
o	Growth and remodelling of cervix prior to labour
o	Hormones involved – placental:
	Prostaglandins
	Relaxin
	Oxytocin
141
Q

Go through the phases that occur in the endometrium during menstruation and pregnancy

A 
	Proliferative phase:
•	Stimulated by oestrogen
•	Glands proliferate and show mitotic activity
	Secretory phase:
•	Stimulated by progesterone
•	Glands secrete into lumen of uterus
•	Reduces smooth muscle capabilities of uterus
•	Spiral arteries increase blood flow
	Menstrual phase:
•	Progesterone stimulation removed
•	Stromal haemorrhage and fragmentation
142
Q

What is the general structure of the myometrium?

A

 Inner longitudinal
 Middle circular
 Outer longitudinal

143
Q

What is the structure and function of the placenta?

A

 Umbilical cord:
• 2 umbilical arteries
• 1 umbilical vein
 Maternal side – villous tree structures = blood/nutrient supply
o Functions:
 Metabolism – synthesises glycogen and fatty acids for energy
 Transport – gas and nutrients, water, glucose, hormones, most molecules

144
Q

What are the hormones and their functions released from the placenta?

A

 Human chorionic gonadotrophin -> luteinising hormone
 Human chorionic somatomammotrophin – mammary development
 Human chorionic thyrotrophin and corticotrophin – thyroxine and cortisol
 Oestrogen and progesterone – proliferative and secretory endometrium
 Relaxin – cervical ripening and dilation

145
Q

What happens during follicular development at birth and puberty?

A

o Birth:
 40,000 primary oocytes in primordial follicles
 Arrested in prophase of meiosis 1 until puberty
o Puberty:
 FSH and LH released by anterior pituitary
 Primordial follicle -> meiosis 1 -> secondary follicle -> meiosis 2
 Graafian follicle contains secondary oocyte – haploid nucleus
 Polar body produces during meiosis 1 and meiosis 2

146
Q

Go through the 4 stages in the menstrual cycle in detail

A

o Follicular phase:
1. Gonadotrophin releasing hormone released from hypothalamus
2. FSH released from ant pituitary – proliferation of granulosa follicular cells
3. LH released from ant pituitary – proliferation of granulosa cells in follicles
4. Oestrogen released from granulosa cells – stimulates endometrium growth
5. At low levels oestrogen inhibits release of FSH and LH from ant pituitary
6. Inhibin released from granulosa cells – inhibits ant pituitary
o Ovulation:
1. Oestrogen production reaches threshold – no longer negative feedback
2. LH surge causes weakening in follicle wall -> mature ovum released
o Luteal phase:
1. FSH and LH cause follicle to degrade into corpus luteum
2. Corpus luteum produces high amounts of progesterone and some oestrogen
3. Progesterone stimulates endometrium growth – ready for blastocyst
4. Corpus luteum suppresses FSH and LH production from ant pituitary
o Post luteal:
1. Implantation – embryo produces human chorionic gonadotrophin hormone which preserves corpus luteum and endometrium
2. No implantation – low FSH and LH levels cause corpus luteum atrophy which stops progesterone production and menstruation occurs

147
Q

Go through fertilization

A
  1. Capacitation – sperm prepares for fertilisation by destabilising membrane
  2. Sperm binds to corona radiata -> reaches zona pellucida
  3. Acrosome bursts -> digests through glycoprotein matrix
  4. Cortical granules release -> hardening of zona pellucida -> no sperm entry
  5. Sperm enters oocyte cytoplasm and fuses with ovum nucleus
148
Q

Go through the 6 step process of implantation

A 
1.	Syngamy:
•	Day 1
•	Chromosomes align in preparation for mitosis 1
2.	Cleavage:
•	Day 2-3
•	Mitotic division occurs
•	Totipotent stem cells
3.	Compaction:
•	Day 4
•	Cells flatten
•	Tight gap junctions between cells
4.	Cavitation + expansion:
•	Day 5
•	Blastocyst formation
5.	Hatching:
•	Day 6-8
•	Blastocyst hatches from zona pellucida
6.	Implantation
149
Q

Other names for the Wolffian and Mullerian ducts

A

Mesonephric and paramesonephric ducts

150
Q

What is the Wolffian duct?

A
  • Wolffian duct (mesonephric duct) is a paired organ found in humans during embryogenesis. They are male structures that include the epididymis, vas deferens and seminal vesical that differentiate from this structure
  • Wolffian duct degenerates in females and develops in males
151
Q

What are the Mullerian ducts?

A

• Mullerian ducts (or paramesonephric ducts) are paired ducts in the embryo that develop to form the cervix, the uterine tubes, the uterus and the upper one-third of the vagina. In the male they are lost.

152
Q

Go through foetal sex determination

A

o Sex determining region on Y chromosome – SRY gene hence male dictates sex
o Presence of SRY gene causes Mullerian inhibitory factor (MIF) to be released by Sertoli cells in testes
o Mullerian ducts regress -> no uterus or fallopian tubes
o Dihydrotestosterone also produced – development of external male genitalia
o Female – no SRY gene -> no MIF -> Mullerian ducts form -> uterus and ovaries form

153
Q

What happens at meiosis during reproduction?

A

o Interphase – cell contents replicate (2n ->4n)
o Meiosis 1 – mitosis, but crossing over and independent assortment occurs (4n -> 2n)
o Meiosis 2 – daughter cells divide to form haploid cells (2n -> n)

154
Q

Go through oogensis

A

o Primordial germ cells = oogonia -> gametes = primary oocytes
o First meiotic division = puberty due to LH surge
o Primary oocytes -> secondary oocyte and polar body (most cytoplasm in secondary)
o Second meiotic division = post ovulation
o Secondary oocyte -> tertiary oocyte/ovum and polar body

155
Q

What happens during spermatogenesis?

A

o Two daughter cells produced in mitosis:
 Type A stay outside blood testes barrier and continue producing daughter cells
 Type B -> primary spermatocytes that move through BTB
o Meiosis 1 = primary spermatocyte -> secondary spermatocyte
o Meiosis 2 = secondary spermatocyte -> spermatid
o Sertoli cells form BTB – tight junctions and basement membrane

156
Q

What happens during spermiogenesis?

A

o Occurs in seminiferous tubules bordering Sertoli cells
o Spermatid -> spermatozoa
o Discards excess cytoplasm and grows flagellum

157
Q

Go through the hypothalmic-pituitary-gonadal axis in males and females

A

o Male:
 GnRH in hypothalamus -> FSH and LH in ant pituitary
 FSH -> Sertoli cells -> inhibin release -> inhibits anterior pituitary
 LH -> Leydig cells -> testosterone release -> inhibits hypothalamus and pit
o Female:
 GnRH in hypothalamus -> FSH and LH in ant pituitary
 FSH and LH -> oestrogen and progesterone release -> both have positive/negative feedback with hypothalamus and anterior pituitary

158
Q

What is menopause and what are its symptoms?

A

o Cessation of menstruation – average age = 50 – degradation of follicles
o Decrease in oestrogen causes increase in FSH and LH – negative feedback
o Symptoms:
 Vasomotor – flushes, sweats, palpitations
 Psychological – irritability, lethargy, loss of libido
 UG and skin – vaginal and skin dryness, brittle hair and nails
 Osteoporosis – less bone tissue in bone, regulated by oestrogen

159
Q

What is the blood testes barrier?

A

Research

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