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SUGER Flashcards

1
Q

where is the mid-inguinal point and what is significant about it

A

halfway between pubis symphysis and ASIS

can palpate femoral pulse

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2
Q

where is the mid-point of the inguinal ligament

A

halfway between pubic tubercle and ASIS

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3
Q

name the contents of the inguinal canal

A
  1. spermatic cord = males
  2. round ligament = females
  3. ilioinguinal nerve
  4. genital branch of genitofemoral nerve
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4
Q

what is a hernia

A

potrusion of organ/fascia through wall of cavity that normally contains it

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5
Q

what is an indirect hernia

A

peritoneal sac enters inguinal canal through deep inguinal ring

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6
Q

what is a direct hernia

A

peritoneal sac enters inguinal canal through posterior wall of inguinal canal

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7
Q

name the 3 fascial layers of the spermatic cord

A
  1. external spermatic fascia
  2. cremaster muscle and fascia
  3. internal spermatic fascia
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8
Q

name the contents of the spermatic cord

A

vas deferens
testicular artery
pampiniform plexus of veins/nerves/lymphatics

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9
Q

name the sac which surrounds the testes

A

tunica vaginalis

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10
Q

name the 3 arteries of the spermatic cord

A
  1. testicular artery
  2. artery of vas deferens
  3. cremastic artery
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11
Q

name the 3 veins of the spermatic cord

A
  1. testicular vein
  2. vein of vas deferens
  3. cremasteric vein
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12
Q

name the 3 nerves of the spermatic cord and what do they supply

A
  1. ilioinguinal = 1/3rd genital skin sensation
  2. genitofemoral = cremaster
  3. sympathetic = vas deferens/testicular pain
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13
Q

what vertebral level are the kindeys

A

T12 - L3

right slightly lower

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14
Q

describe the path of blood supply to the kidney

A 
abdominal aorta to renal arteries
= divide into interlobar arteries
= divide into arcuate arteries
= divide into interlobular arteries
= divide into afferent arterioles
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15
Q

name the blood supply of the outer 2/3rd of the renal cortex

A

peritubular network supply nephrons and tubules

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16
Q

name the blood supply to the inner 1/3rd of renal cortex

A

vasa recta = long straight arteries

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17
Q

describe the venous drainage of the kidneys

A

renal veins leave hilum anterior to renal arteries

= directly to IVC

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18
Q

describe the ureter

A

25cm runs from kidneys to bladder

abdominal part/pelvic part

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19
Q

name the blood supply to the ureter

A

abdominal = renal artery and testicular/ovarian artery

pelvic part = sup/inf vesical arteries

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20
Q

where do sensory fibres from the ureter enter the spinal cord and what is the significance of this

A

T11 to L2 = referred pain

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21
Q

describe the inner wall of the bladder

A

has ruggae = can expand

trigone = smooth

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22
Q

name the specialised smooth muscle of the bladder

A

detrusor muscle

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23
Q

describe the internal sphincter of the bladder in males

A

circular smooth muscle fibres

autonomic control

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24
Q

describe the internal sphincter of the bladder in females

A

functional so no muscle present

formed by bladder neck and proximal urethra

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25
describe the blood supply to the bladder
superior vesical branch of internal iliac vessels males = inferior vesical artery as well females = vaginal arteries as well
26
describe the venous drainage of the bladder
vesical venous plexus = empty into internal iliac veins
27
what nerve supplies sympathetic nerves to the bladder and what is its role
hypogastric T12-L2 = relaxation of detrusor muscles
28
what nerve supplies parasympathetic nerves to the bladder and what is its role
pelvic nerve S2-S4 = contraction of detrusor muscles
29
what nerve supplies somatic nerves to the bladder and what is its role
pudendal nerve S2-S4 = innervates external urethral sphincter = voluntary control over micturition
30
describe the parts of the male urethra
``` 15-20cm long pre-prostatic prostatic = widest membranous = narrowest spongy ```
31
name the blood supply to each part of the male urethra
``` prostatic = inferior vesical artery membranous = bulbourethral artery spongy = branches of internal pudental artery ```
32
name the nerve supply of the male urethra
prostatic plexus = sympathetic/parasympathetic/visceral fibres
33
describe the female urethra
approx 4cm long open directly onto perineum = vestibule skenes glands = 2 mucous glands either side
34
name the blood supply and nerve supply to the female urethra
internal pudendal arteries | pudendal nerve
35
name the 5 muscles of the posterior abdominal wall
1. iliacus 2. psoas major 3. psoas minor 4. quadratus lumborum 5. diaphragm
36
name the attachments, action and innervation of the quadratus lumborum
iliac crest to L1-L4 transverse processes extension/lateral flexion of vertebral column anterior rami of T12-L4
37
name the attachments, action and innervation of psoas major
transverse processes of T12-L5 to femur flexion of thigh/ lateral flexion vertebral column anterior rami of L1-L3
38
name the attachments, action and innervation of psoas minor
vertebral bodies T12-L1 to superior ramis of pubic bone flexion of vertebral column anterior rami of L1 spinal nerve
39
name the attachments, action and innervation of the iliacus
iliac fossa/AIIS to femur flexion of thigh femoral nerve L2-L4
40
what is the lumbar plexus and what is it formed by
network of nerve fibres that supplies the lower limb | formed by anterior rami of lumbar spinal nerves L1-L4, some of T12
41
what is the order of the nerves of the lumbar plexus from t12 to l4
``` iliohypogastric ilioinguinal lateral cutaneous femoral oburator ```
42
what does the iliohypogastric nerve innervate
posterolateral gluteal skin in pubic region
43
what does the ilioinguinal nerve innervate
skin on upper middle thigh male = root of penis/scrotum female = mons pubis/labia majora
44
what does the genitofemoral nerve innervate
cremaster muscle
45
what does the lateral cutaneous nerve innervate
anterior/lateral thigh down to knee
46
what does the obturator nerve innervate
skin over medial thigh
47
what does the femoral nerve innervate
skin of anterior thigh/medial leg
48
what epithelium is the ectocervix
stratified squamos non-keratinising epithelium
49
what epithelium is the endocervix
mucus secreting stratified simple columnar
50
describe an anteverted uterus
rotated forward towards anterior surface of body with respect to the vagina
51
describe an anteflexed uterus
flexed toward anterior surface of body with respect to the cervix
52
name the 3 layers of the uterus
peritoneum myometrium endometrium = deep stratum basalis and superficial stratum basalis
53
which layer undergoes hypertrophy and hyperplasua during pregnancy in order to expel the foetus at birth
myometrium
54
which layer proliferates in response to oestrogen and becomes secretory in response to progesterone and is shed in menstruation
superficial stratum functionalis
55
what is the role of the broad ligament
attaches sides of uterus to pelvis
56
what is the role of the round ligament
extend from uterine horns to labia majora via inguinal canal = maintains anteverted position
57
what is the role of the ovarian ligament
attaches ovaries to uterus
58
what is the role of the cardinal ligament
= base of broad ligament attaches cervix to lateral pelvic walls contains uterine artery and vein
59
what is the role of the uterosacral ligament
attaches cervix to sacrum
60
what supplies blood to the uterus
uterine artery from the internal iliac artery
61
what provides venous drainage from the uterus
plexus in broad ligament = drain into uterine veins
62
what provides sympathetic innervation to the uterus
uterovaginal plexus
63
what provides parasympathetic fibres of the uterus
pelvic splanchnic nerves S2-S4
64
what is the fornix
recess formed between margin of cervix and vagginal wall | anterior/posterior/2 x lateral
65
where is the uterine artery found
base of broad ligament in close relation to ureter
66
where is the vagina
upper 2/3rd in pelvic cavity | lower 1/3rd in perineum
67
how long is the vagina
9cm
68
name the 4 layers of the vagina
1. stratified squamous epithelium 2. elastic lamina propria 3. fibromuscular layer 4. adventitia
69
what is the role of the stratified squamous epithelium in the vagina
protection/lubrication by cervical mucus
70
what is the blood supply to the vagina
uterine/vaginal arteries
71
what is the venous drainage of the vagina
vaginal venous plexus to internal iliac veins
72
what is the nerve supply of the vagina
superior part = inferior fibres of uteroveginal plexus | inferior part = deep perineal nerve
73
name the layer that surrounds each cavernous body in the penis
tunica albuginea
74
what is the role of the suspensory ligament in the penis
connects erectile bodies to pubic symphysis
75
what is the role of the fundiform ligament in the penis
runs down from linea alba = surrounds penis and attaches it to pubic symphysis
76
describe the blood supply to the penis
internel iliac to internal pudendal artery to 1. dorsal arteries of penis 2. deep arteries of penis 3. bulbourethral artery
77
what is the nerve supply to the penis
S2-S4 spinal cord segments/spinal ganglia
78
name the 3 zones of the prostate
central zone transitional zone peripheral zone
79
what is the role of the seminal vesicle
secrete thick alkaline fluid = forms bulk of seminal fluid
80
what innervates the prostate gland
inferior hypogastric plexus
81
how is the ejaculatory duct created
seminal vesical duct merges with vas deferens
82
what is benign prostatic hyperplasia
benign enlargement of the prostate
83
what is the pelvic floor formed from
levator ani and coccygeus
84
what innervates the levator ani muscles
branches of pudendal nerve S2-S4
85
what are the 3 roles of the pelvic floor muscles
1. support of abdominopelvic viscera 2. resistance to increases in intra-pelvic abdominal pressure 3. urinary/faecal continence
86
what produces human chorionic gonadotrophin and what is its role
produced by trophoblasts stimulate oestrogen and progesterone secretion decreases as placenta grows
87
what produces prolactin and what is its role
produced by anteiror pituitary increases cells that produce milk prevents ovulation = not reliable
88
what produces relaxin and what is its role
produced by ovary and placenta high in early pregnancy limits uterine activity, softens cervix
89
what is the role of oestrogen in pregnancy
produced throughout pregnancy regulates progesterone prepares uterus for baby, breasts for lactation
90
what is the role of progesterone in pregnancy
prevents miscarriage builds up endometrium for placental support prevents contractions
91
what produces oxytocin and what is its role
produced by posterior pituitary gland stimulates uterine contractions triggers caring reproductive behaviours synthetic drug used to induce labour
92
what produces prostoglandins and what is their role
produced by uterine tissue | initiates labour
93
what is parturition
birth process = successful transition form intra-uterine to extra-uterine life
94
what is cervical ripening
growth and remodelling of the cervix prior to labour
95
describe the events of prelabour 4 steps
1. Stress = CRH release = ACTH release = cortisol release -= oestrogen release 2. Oestrogen release = inhibits uterine progesterone release = uterine contractions 3. Prostaglandins (PGF2a) and relaxin (from ovaries) relax walls of cervix = dilation 4. Baby pushing onto cervix = oxytocin release = uterine contractions (positive FB)
96
what are the chemicals released from the foetus to signal labour
oxytocin vasopressin cytokines
97
what chemical is the maternal signal of labour
oxytocin
98
describe the 3 events of the active phase of labour
1. stronger, higher frequency contractions 2. full dilation resulting in foetal expulsion 3. placental expulsion
99
when does the placenta begin developing and when has it implanted
at blastocyst implantation | 11th day post ovulation
100
what does the placenta provide for the developing foetus
nutrition gas exchange waste removal endocrine/immune support
101
what are the 3 main functions of the placenta
metabolism transport endocrine
102
what is synthesised in placental metabolism and what does it provide
glycogen cholesterol fatty acids = provides nutrient and energy
103
what does the placenta transport
``` gases/nutrition water/glucose/vitamins hormones (steroid) electrolytes maternal antibodies waste products drugs and metabolites infectious agents ```
104
name 4 placental hormones
1. hCG 2. progesterone 3. oestrogen 4. relaxin
105
what is placenta accreta
doesnt adhere properly to wall of uterus | absence of decidua basalis
106
what is placenta praevia
placenta overlies internal os = abnormal bleeding = C section
107
describe the hormone changes at puberty
increase GnRH | increase FSH, LH, GH and sex steroids
108
what is the effect of FSH on the ovary
causes ovarian follicles to mature leads to 1 dominant follicle developing acts on granulosa cells = follicle secrete oestrogen
109
what is the effect of LH on the ovary
release of secondary oocyte from dominant follicle = fusion of follicular and ovarian membrane acts on thecal cells = allow secrete oestrogen
110
what is the effect of oestrogen on the endometrium
proliferate increase production of glands synthesis of progesterone receptors on surface
111
what is the effect of progesterone on the endometrium
proliferate and change to secretory | bind to progesterone receptors
112
what is the effect of oestrogen on the cervix
secrete abundant and watery mucus before/during ovulation for best possible sperm entry
113
what is the effect of progesterone on the cervix
produce thick mucus secretions = act as plug prevent bacteria entry
114
when is inhibin secreted and what is its role
= inhibit FSH increases during late follicular phase remains high in luteal phase decrease as corpus luteum regenerates
115
when must sperm enter the uterus for fertilisation to occur
5 days before/1 day after ovulation
116
how long can sperm survive
4-6 days
117
what is a renal corpuscle
whole unit of glomerular tuft and bowmans capsule
118
name the layers that fluid is filtered across in the kidney
1. endothelial cells 2. basement membrane/basal lamina = negatively charged 3. between foot processes of podocytes
119
what are the 2 types of nephron and what are their proportions
``` 15% = juxtamedullary = renal corpuscle in part of cortex closest to medulla 85% = cortical = renal corpuscle in outer cortex ```
120
what is the glomerular filtration rate
volume of fluid filtered from glomeruli into bowman's space per unit time
121
what is the oncotic pressure in the bowman's capsule
0
122
what is the calculation for GFR
filtration coefficient x glomerular capillary hydrostatic pressure - bowmans hydrostation pressure - osmotic/oncotic pressure of glomerular capillary
123
what is the average GFR for a 70kg person
125mil/min
124
what determines GFR
net filtration pressure permeability of corpuscular membranes surface area
125
what is osmolality
osmoles of solute per kg of solvent
126
what is osmolarity
osmoles of solute per litre of solution
127
what 2 things stimulate the release of renin
1. reduced NaCl to DCT detected by macula densa cells | 2. reduced perfusion pressure in kidney detected by baroreceptors in afferent arteriole
128
what cells release renin
granular cells of the juxtaglomerular apparatus
129
describe the RAAS system in 4 steps
1. renin secreted 2. cleaves angiotensinogen to angiotensin 1 3. angiotensin 1 to angiotensin 2 by ACE 4. angiotensin 2 stimulates release of aldosterone from adrenal medulla
130
where is angiotensin converting enzyme found (ACE)
epithelium of kidney/lungs
131
what are 5 effects of angiotensin 2
1. aldosterone release 2. vasoconstriction 3. Na+ reabsorption in PCT 4. thirst 5. ADH release
132
what is the effect of aldosterone and where does it act
CD increase ENaC channels = increase Na+ absorption increase K+ excretion DCT increase Na+ absorption
133
where is aldosterone secreted from
zona glomerulosa of adrenal gland
134
where is ADH made
hypothalamus
135
where is ADH secreted from
posterior pituitary
136
what regulates ADH secretion and why is it secreted
osmoreceptors in hypothalamus detect osmotic pressure of plasma = high osmolality = ADH released
137
what acts faster ADH or aldosterone and why
ADH is steroid so is faster than peptide hormone aldosterone
138
what is the effect on the kidneys of parathyroid hormone
increases Ca2+ reabsorption = decrease urinary Ca2+ levels | blocks phosphate reabsorption in PCT
139
where and why is parathyroid hormone released
released by parathyroid glands in response to decreased Ca2+
140
where is atrial natriuretic peptide synthesised and secreted
cardiac atria
141
what is the effect of atrial natriuretic peptide (3)
1. inhibit Na+ reabsorption by blocking ENaCs in collecting duct + decrease Na+ reabsorption in DCT 2. acts as renal vasodilator = increases GFR = increase Na+ excretion 3. inhibits renin secretion = inhibit RAAS
142
where is erythropoietin (EPO) produced and what does it do
peritubular cells in interstitial space of renal cortex = stimulate bone marrow maturation of RBCs
143
when does EPO increase and decrease
``` increase = anaemia, altitude decrease = polythaemia, renal failure ```
144
name the 3 main hormones secreted by the adrenal cortex
1. aldosterone 2. cortisol 3. corticosteroid
145
what layer of the adrenal cortex produces mineralcocorticoids
zona glomerulosa
146
what layer of the adrenal cortex produces glucorcorticoids e.g. cortisol (+ small amount androgens)
zona fasiculata
147
what layer of the adrenal cortex produces androgens (+ small amount cortisol)
zona reticularis
148
what is stress
a real/perceived threat to homeostasis
149
what is the normal function of cortisol
maintenance of homeostasis in absence of external stress
150
name 3 results of chronic stress
severe decrease: 1. bone density 2. immune function 3. reproductive fertility
151
what is the main site for adrenaline synthsesis
adrenal medulla
152
describe the proportions of catecholamines released during fight or flight and their roles
``` adrenaline = 80% = vasoconstriction noradrenaline = 20% = vasodiltation ```
153
what do alpha receptors have a higher affinity for
noradrenaline
154
what do beta receptors have a higher affinity for
adrenaline
155
name 4 things that occur in a flight or fight response
1. gluconeogenesis in liver/muscle 2. lipolysis in adipose tissue 3. tachycardia and cardiac contractility 4. redistribution of circulating volume
156
whats the commonest urinary buffer
alkaline phosphate
157
what is titratable acidity
quantity of base needed to bring base to pH 7.4 | = does not increase in response to acidosis
158
what is the equation for net acid excretion
titratable acidity + ammonium - HCO3-
159
name the physical changes of a male at puberty
1. testicular enlargement 2. body hair growth 3. growth spurt 4. spermatogenesis begins 5. acne/body odour/mood changes
160
name the physical changes of a female at puberty
1. breast development 2. body hair 3. growth spurt 4. menarche 5. acne/body odour/mood changes
161
what age for puberty in males
9-14
162
what age for puberty in females
8-14
163
what age for menopause
48-52
164
what are the short term signs of menopause (5)
1. hot flushes/sweats/headaches 2. irritability/lethargy/panic attack/depression 3. shorter menstrual cycle 4. altered blood loss 5. dry skin
165
what are the long term signs of menopause (5)
1. vaginal dryness 2. decrease libido 3. hair loss/thinning 4. loss in compliance 5. general aches and pains
166
what is responsible for people having darker skin
melanocytes producing more melanin
167
what is the normal skin pH
5.5
168
what is desquamation
mature corneocytes are shed from the surface of epithelium to make room for new cells in basal layer + degradation of extracellular corneo-desmosomes by proteases
169
what is the role of Vitamin D in the skin
essential in producing anti-microbial peptides = defend skin from bacteria/viruses
170
mneumonic for layers of epidermis
come lets get sun burned
171
where is vitamin D synthesised in the skin
stratum spinosum
172
what is the role of the lipid lamellae
keeps water inside skin cells
173
what causes red skin
dilation of blood vessels due to lymphocyte activity
174
what causes itchy skin
stimulation of nerves
175
what causes dry skin
skin cells leaking due to lymphocyte activity
176
what do irritants do to the skin
break down healthy skin
177
what do allergens do to the skin
trigger flare ups by penetrating into skin and causing reaction
178
how do allergens cause inflammation
penetrate into skin met by lymphocytes lymphocytes release chemicals which cause inflammation
179
what are the 3 signs of inflammation
red skin dry skin itchy skin
180
what is the function of the dermis
strength and elasticity
181
name the 2 layers of the dermis
papillary dermis | reticular dermis
182
where are sebaceous glands and sweat glands found in the skin
reticular dermis
183
what are the functions of the subcutaneous layer
insulation energy store shock absorbent = LOTS OF ADIPOCYTES
184
what is glucogenesis
glycogen to glucose
185
what is glucogenolysis
glucose to glycogen
186
what is gluconeogenesis
amino acids/lactate to glucose
187
where is incretin secreted
endothelial cells of GI tract
188
what is renal clearance
volume of plasma from which a substance is completely removed
189
what increases GFR
afferent dilation | efferent constriction
190
what decreases GFR
afferent constriction | efferent dilation
191
what is autoregulation in the kidney
when high blood flow in afferent arteriole = walls stretch = smooth muscle contract = arteriolar constriction
192
how do macula densa cells stimualte the release of renin and what is this process called
macula densa detect NaCl = release prostaglandins = stimulate granular cells to releases renin TUBULOGLOMERULAR FEEDBACK
193
what transporter is used in the ascending limb of the loop of henle
NKCC2 transporter
194
kidney response to respiratory acidosis
increase H+ secretion increase bicarb production increase ammonia secretion
195
kidney response to respiratory alkalosis
decrease H+ secretion | increase bicarb secretion
196
3 effects of ADH
1. increase water permeability in DCT and CD = aquaporins 2. increase urea permeability in collecting duct 3. increase Na+ reabsorption in ascending limb
197
when is cortisol released and what is the action of cortisol
released in stress/low blood glucose | stimulate gluconeogenesis and fat/protein metabolism
198
5 layers of skin
1. stratum corneum 2. stratum lucidum 3. stratum granulosum 4. stratum spinsoum 5. stratum basale
199
describe the papillary dermis
rete ridges type 3 collagen fibroblasts
200
describe the reticular dermis
type 1 collagen | well organised elastic fibres
201
describe the skin barrier
lipid lamellae above cells = corneocytes held together by corneodesmasomes
202
what hormones does the hypothalamus secrete (4)
1. gonadotrophin releasing hormone 2. growth hormone releasing hormone 3. thyrotropin releasing hormone 4. corticotropin releasing hormone
203
what hormones does the anterior pituitary secrete (6)
1. follicle stimulating hormone and leutinising hormone 2. growth hormone 3. thyroid stimulating hormone 4. Adrenocorticotrophic hormone 5. prolactin
204
does the posterior pituitary secrete hormones
no just stores hypothalamic hormones
205
what hormones are released from the posterior pituitary
vasopressin | oxytocin
206
what cells are in islets of langerhans and what do they secrete
``` alpha = glucagon beta = insulin delta = somatostatin ```
207
what does insulin do
decrease hepatic gluconeogenesis increase glucose storage decrease lipolysis (= decreased ketogenesis)
208
what does glucagon do
increase gluconeogenesis | stimulate lipolysis = more ketogenesis
209
describe what happens when there is a high level of plasma glucose
high glucose detected by Beta cells insulin released increase glucose uptake in muscles/fat
210
describe the mechanism of insulin release in 5 steps
1. glucose into beta cell via GLUT 2 2. glucokinase metabolise glucose = krebs and glycolysis producing ATP 3. ATP close K+ channels = no efflux = depolarisation 4. depolarisation = opens calcium channels = influx Ca2+ 5. allows exocytosis of insulin
211
what is the difference between endogenous and exogenous insulin
endogenous has C peptide attached
212
describe the mechanism of insulin action
1. insulin binds to receptor on target cell 2. increased exocytosis of GLUT 4 vesicles to cell membrane 3. increase uptake glucose through GLUT 4
213
what is the role of incretins
pre-emptively amplifies the effect of insulin
214
what is the blood and nerve supply to the thyroid
superior and inferior thyroid artery | parasympathetic = vagus
215
what are the different cell types in the thyroid and what do they do
follicular cells = surround colloid, form follicles = produce T3/T4 C cells = parafollicular cells = produce calcitonin
216
describe the mechanism of thyroid hormone synthesis
1. TSH released from anterior pituitary 2. increase iodine uptake Na+/I symporter 3. thyroglobulin iodinised = catalysed by thryoperoxidase 4. thyroglobulin + tyrosine = thyroxine (T4)
217
what is T3
triiodothyronine = active hormone
218
what is T4
thyroxine - deiodinised in peripheral tissues to form T3 | most common
219
how are T3/T4 carried in bloodstream
bound to albumin
220
name some changes in pregnancy
``` greater CO greater blood volume greater alveolar ventilation greater inspiratory volume decrease BP linea nigra striae gravidarum ```
221
name the 8 stages of fertilisation
1. capacitation 2. acrosome reaction 3. syngamy 4. cleavage 5. compaction 6. cavitation/expansion 7. hatching 8. implantation
222
where does spermiogenesis take place
seminiferous tubules by sertoli cells
223
what is the point of the blood testis barrier
1. prevents chemicals from blood affecting seminiferous tubules 2. helps retain luminal fluid 3. proper conditions for cell development/differentiation
224
what is menopause
cessation of menstruation due to degradation of follicles = decrease oestrogen = increase FSH/LH

Phase 1 mine (12 decks)

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