Block 3 Week 6

Front 1

describe distribution of tissues in testes

Back 1

80% seminiferous tubules (sertoli, spermatogonia); 20% leydig (testosterone)

Front 2

describe regulation of sperm production

Back 2

FSH stimulates sertoli cells and sperm production; sertoli cells secrete inhibin > hypothalamus/pituitary inhibit FSH release

Front 3

what is effect of sertoli cell on leydig cell

Back 3

sertoli cell contain aromatase to convert testosterone to estradiol > stimulate leydig cell to make more testosterone

Front 4

describe regulation of leydig cells

Back 4

LH stimulates leydig cells > testosterone release; testosterone has inhibitory effect on hypothalamus/pituitary to inhibit LH release

Front 5

describe effect of LH and FSH on leydig cell

Back 5

LH stimulates testosterone production; FSH stimulates expression of LH receptors

Front 6

what is the paracrine function of testosterone

Back 6

high local concentration of testosterone supports spermatogenesis

Front 7

what are the nerves involved with sexual response

Back 7

pelvic plexus (S2-S4, parasympathetic); pudendal nerve (S2-S4, motor/sensory)

Front 8

what are the four phases of sexual response, describe each phase

Back 8

1. excitment -- parasympathetic ACh/NO dilate helicine arteries > blood filles corpus cavernosa > occlude venous flow, 2. plateau -- preejaculatory secretion from Bulbourethral glands, 3. orgasm -- sympathetics stimulation peristalsis of internal genitalia (vas deferens, prostate, seminal vesicles), urethral sphincter closes, pudendal nerve contraction of ischiocavernosus and bulbospongiosus muscles, 4. resolution

Front 9

describe sexual response for females

Back 9

1. excitement; 2. bartholin gland secretions, vaginal swelling; 3. sympathetics close urethra and cause vaginal contractions, 4. resolution

Front 10

describe effects of low/high estradiol on feedback

Back 10

low estradiol > negative feedback; high estradiol > switches to positive feedback and initiates the LH surge

Front 11

what is most common barrier against egg-sperm contact

Back 11

scarring of reproductive organs by STDs

Front 12

how does the morning after pill work

Back 12

high progesterone dose to prevent LH surge and fertilization

Front 13

what are the androgen-producing cells in ovary, describe pituitary effects and pathway

Back 13

1. theca cells -- LH stimulates desmolase activity > progesterone production; 2. granulosa cells -- FSH stimulates aromatase > convert testosterone to estradiol

Front 14

explain bladder innervation/activity during storage

Back 14

controlled by sympathetics via pelvic plexus; beta3 adrenergic receptors relax detrusor muscle; alpha1 adrenergic receptors contract the internal sphincter

Front 15

explain bladder innervation/storage during urination

Back 15

controlled by parasympathetics; mechanoreceptors in bladder sense fullness > sends to brain micturation center > ACh acts on muscarinic receptors M2/M3 > contract bladder + relax internal sphincter > voluntary relaxation of external sphincter

Front 16

what is the capacity of the bladder

Back 16

urge at 150-300ml; max at 300-600ml

Front 17

describe effects of aging on female regarding urination, and vagina

Back 17

aging > menopause > estrogen deficiency > inflammation of structures, impair closure of internal/external sphincters; estrogen deficiency causes atrophy or loss of rugae of vagina

Front 18

describe pathogenesis of benign prostate hyperplasia and two primary associated problems

Back 18

aging > enlargement of prostate > can 1. irritate bladder (urge incontinence) or 2. compress urethra (overflow incontinence due to obstruction)

Front 19

list some effects of aging on bladder attributes

Back 19

decreased volume/force, increased urge/frequency, decreased pelvic muscle strength, increased residual volume

Front 20

list and explain three types of incontinence

Back 20

1. urge incontinence (hyperactive bladder), 2. overflow incontinence (BPH, hypoactive bladder), 3. stress incontinence

Front 21

what type of sympathetic receptor is on bladder/internal sphincter

Back 21

beta3 and alpha1

Front 22

what type of drug can help with BPH overflow incontinence

Back 22

alpha1 antagonist to relax internal sphincter

Front 23

what is the role of testosterone and DHT in male development (what do they affect)

Back 23

testosterone affects sperm production, wolffian duct development (internal genitalia), gonadotropin regulation; DHT affects external genitalia, puberty

Front 24

what is 5alpha-reductase

Back 24

converts testosterone to DHT (more potent)

Front 25

what happens in 5alpha-reductase mutation

Back 25

female -- no effect b/c no role for DHT; male -- internal genitalia develop, but external genitalia may be ambiguous, or female-like, sperm is viable, at puberty high level of testosterone may cause descending of testicles and virilization

Front 26

compare 5alpha-reductase mutation versus deficiency

Back 26

type 2 reductase is affected, results in male appearing female and being raised as female

Front 27

describe androgen receptor defect

Back 27

cells (eg pituitary) cannot sense testosterone, so causes elevated synthesis of testosterone, which ends up being converted to estradiol > causes phenotype female

Front 28

describe pathogenesis of familial male precocious puberty

Back 28

activating mutation in LH receptor > elevated testosterone synthesis > early puberty

Front 29

what are effects of steroid abuse

Back 29

1. gynecomastia, 2. increase LDL, decrease HDL, 3. increase muscle mass, 4. decreased sperm count

Front 30

describe estrogen synthesis in female (from two cell sources)

Back 30

1. LH > theca cells > synthesize weak androgen, androstenedione; 2. FSH > granulosa cells > synthese prognenolone and aromatase > weak androgen converted to estradiol > feedback to decrease LH/FSH secretion

Front 31

describe location of estrogen synthesis in pre/post-menopause females

Back 31

pre-menopause occurs in ovary; post-menopause precursor (weak androgens) comes from adrenal, aromatase located in periphery adipose/breast tissues > convert to estrogen

Front 32

what two estrogens can be produced by aromatase

Back 32

oesteone (E1) and estradiol (E2)

Front 33

describe role of estrogen in breast cancer

Back 33

breast cancer cells have receptors for estrogen, so treatment with drugs that inhibit production of estrogen slow breast cancer

Front 34

describe two methods to treat breast cancer

Back 34

1. SERMs to block estrogen receptor; 2. aromatase inhibitors to reduce estradiol levels

Front 35

name three primary cell types in testes and function

Back 35

1. germ cells : spermatogonia; 2. sertoli : secrete MIF to degenerate mullerian duct; 3. leydig : secrete testosterone for wolffian duct maturation

Front 36

what genitalia are induced by testosterone and DHT

Back 36

testosterone > seminal vesicles, vas deference, epididymis; DHT > prostate, penis, scrotum, male external apperance

Front 37

what occurs when SRY gene is not present in XX zygote

Back 37

development of ovaries > no DHT/MIF > mullerian ducts differentiate (fallopian tube, cervix/uterus, upper vagina), female external apperance (vagina, skene glands, clitoris, labia)

Front 38

describe pathogenesis of testicular feminization syndrome

Back 38

XY female appearance; mutated androgen receptor cannot bind DHT; testes produce MIF > mullerican duct regression with intermal male genitalia, but external genitalia defaults to female; undescended testes usually removed due to risk of cancer

Front 39

what is most common cause of intersex

Back 39

congenital adrenal hyperplasia

Front 40

describe 46XX female with congenital adrenal hyperplasia

Back 40

sorta penis, but female internal genitalia is fertile

Front 41

what risk factors are associated with CAH (congential adrenal hyperplasia)

Back 41

lack of aldosterone and cortisol affects ability to tolerate stress

Front 42

compare androgenic and anabolic effects of testosterone

Back 42

sex characteristics and muscle growth

Front 43

list some possible causes of undescended testes

Back 43

1. gubernaculum problem, 2. problem with hormone or receptor, 3. lack of intraabdominal pressure

Front 44

list epidemiology of undescended testes

Back 44

30% premature, 3% term, 1% 1 y/o -- some can self-correct on their own

Front 45

what tests can be done to verify gender of ambiguous infant (eg in CAH)

Back 45

palpate for testes or administer hCG test (see testosterone spike)

Front 46

describe function of each part a) epididymis, b) vas deferens, c) prostate, d) seminal vesicles, e) ejaculatory ducts, f) urethra

Back 46

a) sperm maturation/storage, b) transport, c) alkaline secretions for sperm motility, d) fructose, f) sphincters to prevent retrograde ejaculation

Front 47

identify cause/treatment for the following infertility situations : 1. retrograde ejaculation, 2. sertoli cell-only syndrome, 3. ductal obstruction

Back 47

1. administer drug for sphincter; 2. small testicles, no sperm; 3. congenital or surgical procedure

Front 48

list three general pathologies of erectile dysfunction

Back 48

1. neuropathy, 2. vasculogenic (hints CV disease), 3. trauma/scarring

Front 49

list abdominal layers from outside to inside

Back 49

skin > superficial fascia (campers, scarpas) > external ab oblique > internal ab oblique > transversus abdominis > transversalis fascia > extraperitoneal fat > parietal peritoneum

Front 50

describe the four walls of the inguinal canal

Back 50

1. roof: internal abdominal oblique + transversus abdominis, also forms conjoint tendon; 2. posterior wall: transversalis fascia, deep ring; 3. floor: inguinal ligament; 4. anterior wall: external abdominal oblique, superficial ring

Front 51

what is cooper's ligament, and lacunar ligament

Back 51

formed over the pectineal line, also the pectineal ligament; lacunar ligament is between pectineal ligament and inguinal ligament

Front 52

what does superficial ring transmit in male/female

Back 52

male: spermatic cord, vas deferens, testicular vessels, genital branch; female: round ligament

Front 53

gubernaculum in the female forms which two ligaments

Back 53

round ligament (uterus to wall) and ligament of the ovary (ovary to uterus)

Front 54

describe spermatic cord fascia

Back 54

1. internal spermatic fascia (from transversalis fascia), 2. cremaster muscle (from int ab oblique), 3. external spermatic fascia (from ext ab oblique)

Front 55

describe processus vaginalis and associated pathology

Back 55

part of peritoneal cavity dragged down during gonadal descent, will seal up and form the tunica vaginalis; pathology -- failure to seal results in indirect hernia

Front 56

describe the inguinal triangle

Back 56

medial side: rectus abdominis; superior/lateral side: inferior epigastrics; inferior side: inguinal ligament

Front 57

define direct and indirect hernia

Back 57

direct hernia rips through the triangle; indirect being outside and goes through triangle

Front 58

list three types of urachus defects

Back 58

1. urachal fistula, 2. urachal cyst, 3. urachal sinus

Front 59

what does the wolffian duct become

Back 59

the vas deferens

Front 60

how do gonads develop

Back 60

1. mesoderm cells form genital ridge; 2. germ cells migrate and induce gonadal development