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332 Cards in this Set
- Front
- Back
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proprioceptors impacting balance
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golgi tendon
muscle spindles pacinian corpuscles (deep pressure mechanoreceptors) |
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provides passive bony stability to arches in foot
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talus - keystone* keeps boney structures in place
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planter fascia provides
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passive support for longitudinal arches
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plater calcaneonavicular (spring ligament)
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runs from calcaneous to navicular bone, passive support to longitudinal arch
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why do the elderly generally have more
balance issues |
proprioceptors are not as robust
golgi tendon muscle spindles pacinian corpuscles |
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dorsiflexion
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aka extension
lifting foot up away from group |
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planter flexion
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pointing foot toward the ground
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midline of the foot for refrence of abduction/adduction
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2nd digit
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testing planter reflex
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run something up lateral edge of foot from heel to toe
after two-- toes should flex abnormal-- extension of toes with some abduction, Babinski sign |
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babinskin indicates
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possible problem with upper motor neurons
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gout
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arthritic condition in joints (become extremely sensitive)
commonly in 1st digit of foot but can occur anywhere caused by diet - excess uric acid (in purine proteins) uric crystals form within joint, can have bone erosion |
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bones participating in articulation of ankle joint
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lateral malleolus (fibula)
medial malleolus (tibula) trochlea of talus |
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primary movements of ankle joint
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dorsiflexion and plantarflexion
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hammer toe
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joint between 1st and 2nd phalanx is hyperextended
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tarsal tunnel syndrome
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Tibial nerve (will split into medial and later planter) can be entrapped and compressed, can cause inflammation and infection
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ganglion cysts
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form around inferior extensor retinaculum, compress neurovascular bundle
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plantar fasciatis
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microtears in fascia,causing inflammation
common in runners pain radiates from heel up and worse after sitting/lying down |
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muscles involved in forming Achillis tendon
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soleus
plantaris gastronemius plater-flexion and active support of arches |
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Damage to Achillis tendon
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impact gait
cause inability to plantar-flex |
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compartment syndrome
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bleeding/swelling in any one compartment
causes compression infection will travel path of least resistance |
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why are foot infections common in diabetes
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decreased blood flow to foot, loose cutaneous sensation
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create the compartments in the foot
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plantar aponeurosis, the compartments are:
medial central lateral interosseous |
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muscles found in layer 1 of foot
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abductor hallucis
abductor digit minimi (underlying lateral plantar fascia) flexor digitorum brevis |
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muscles found in layer 2 of foot
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quadratus plantae
lumbricals both attach to tendons of flexor digitorum longus |
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muscles found in layer 3 of foot
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adductor hallucis
flexor hallucis brevis flexor digit minimi brevis |
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muscles found in layer 4 of foot
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dorsal interosseous (4 ABDuctors)
plantar interosseous (3 ADDuctors) |
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medial plantar nerve innervates...
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only 4 muscle in foot
flexor digitorum brevis flexor hallucis brevis ABDuctor hallucis 1st (median) lumbrical everything else in the foot is innervated via lateral plantar |
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arterial supply to first digit of foot
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arcuate deep plantar
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where can pulse be found along dorsum of foot
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dorsalis pedis artery - continuation of ant. tibial
pulse felt lateral to tendon of extensor hallucis longus as it emerges from extensor retinaculum |
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where can pulse be found along medial aspect of foot
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posterior tibial pulse - can be felt between medial malleolus and calcaneal tendon
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as it runs down anterior leg and into dorsum of the foot, the anterior tibial artery is accompanied by
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deep fibular nerve
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at ankle, there is a rich anastomosis from what arteries
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malleolar
tarsal arcuate |
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below the knee, posterior tibial artery gives rise to fibular artery, which courses deep to
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flexor hallucis longus
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as it runs down posterior leg and into sole of the foot, the posterior tibial artery is accompanied by
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tibial nerve
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as posterior tibial artery enters sole of the foot...
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divides into medial and lateral plantar arteries
lateral plantar is much bigger -- forms majority of plantar arch |
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plantar arch is formed by
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lateral plantar (majority)
plantar branches dorsalis pedis artery |
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plantar arch gives rise to
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plantar metarsal arteries which give rise to proper plantar digital branches
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in the foot, want to keep vasculature away from
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heel and ball
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corona phlebectatica
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dialated veins in foot
indication of venous insufficiency common in elderly who have weakened venous valves |
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mortons neuroma (intermetatarsal neuroma)
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entrapment and compression of common digital nerve (branch of medial plantar),
commonly between digits 3 and 4 can happen from wearing too-tight shoes, get burning/tingling |
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as you irritate a nerve via compression...
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nerve becomes enlarged and can eventually lead to permanent nerve damage
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arcuate artery
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arch on dorsal surface of foot
anastomoses with lat/ tarsal artery to form arch give rise to 1st metarsal, metarsals, proper digitals, deep plantar artery |
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hallux valus
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bunion
first digit starts going lateral, can even overlap with 2nd digit, flexor hallicus longus becomes misaligned, sesamoid bone goes out of plaec, bursa (bunion) forms impacts walking |
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subtalar joint
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between talus and calcaneous
where eversion and inversion occurs |
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club foot
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genetic - more common in males
involves subtalar joint shorted medial muscles and ligaments , pulling foot into inverted position cant stand on plantar surface of foot |
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Pott's fracture
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due to extreme inversion
one or more malleoli fractured torn ligaments fractured fibula medial malleolus avulsion |
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ankle sprain
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tearing ligaments, most caused by rolling foot inward
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possible fractures of foot eversion
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single - fibula or medial malleolus
bimalleolar - lateral and medial trimalleolar - lateral, medial, posteror all can occur with or without dislocation of trochlea |
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provides stability to medial side of ankle
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deltoid ligament
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provides stability to lateral side of ankle
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lateral ligament of ankle, not as stable
3 parts with the anterior talofibular ligament being the weakest |
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provide stability to plantar portion of foot arch
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plantar aponeurosis
plantar ligament (long) plantar ligament (short) calcaneocubidal |
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provide stability to medial portion of foot arch
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spring ligament (calcaneonavicular)
2 tendons - fibularis longus tendon and tibilias posterior tendon |
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transverse arch
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runs along midsection of foot (transversally)
essentially the midfoot: cuboidal navicular 3 cuneiforms |
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longitudinal arch
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runs anterior to posterior, has lateral and medial parts
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lateral portion of longitudinal arch consists of
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calcaneous
cuboid lateral 2 metatarsals |
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medial portion of longitudinal arch
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calcaneous
talus navicular all 3 cuneiforms metatarsals 1 2 3 |
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the medial side of the foot...
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not touching ground
allows weight to move anterior and posterior consists of 2 arches |
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lateral side of foot
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touching ground
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gait cycle
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stance phase: weight posterior to back of foot --> anterior to 1st and 2nd digits
so weight goes from tibia - ankle joint - calcaneous - metatarsals |
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arches of the foot allow
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weight to shift
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episiotomy
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incision of perineum and inferior-posterior vagina wall
may be used during labor/delivery to enlarge vaginal oriface to decrease tearing of perineum and uncontrolled jagged tears of perineal muscles median vs. mediolateral |
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4 parts of male urethra
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preprostatic -- very short
prostatic membranous penile or spongy |
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seminal colliculus
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dome-shaped region in/along prostatic urethra
on either side is where the prostate glands are draining into the prostatic urethra |
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prostates role in ejaculatory process
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glands secrete (stimulated via sympathetics) into semen
help provide nutrition and proper environment for sperm in ejaculate. |
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prostatic utricle
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invagination sitting on seminal colliculus
remnant of what would have developed into uterus/vagina often place or just adjacent to where ejaculatory duct enters prostatic urethra |
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bulbourethral glands
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in males deep peritoneal pouch
tiny gland that secrete mucus - cleanses and removes urine in urethra, allowing for safer/cleaner passage of semen through urethra |
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penile urethra
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spongy, goes through corpus spongiosum erectile tissue
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equinus gait
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walking only on forefoot
can be caused by: spastic or contracture of tibialis anterior cerebral palsy club foot |
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antalgic gait
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how it looks when things hurt when you walk
keeping steps and movements small to minimize movement tension based -- increased intraarticular pressure |
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ataxia
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loss of ability to coordinate muscular movement
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unconscious preception of movement and spatial orientation arising from stimuli within body itself
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proprioception
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impaired proprioception can cause
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sensory ataxia
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hypotonia
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muscle weakness
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Trendelenburg Gait
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excessive trunk lateral flexion
(ipsilateral) weakness of lateral gluteal muscles |
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hypertonia
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too much muscle contraction -- spasticity
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scissors gait
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spasticity associated with adductors
usually caused by cerebral palsy |
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foot slap gait
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caused by weak dorsiflexor
foot "slaps" at substrate |
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physiological problems associated with genu recurvatum
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quadriceps weakness
achilles tendon contracture plantar-flexor spasticity -- knee is hyperextended |
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pes cavus
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high arch
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pes planus
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flat foot
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valgus forefoot
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plantar aspect of forefoot is everted
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varus forefoot
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plantar aspect of forefoot is inverted
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excessive femoral medial rotation
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caused by:
tight medial hamstring anteverted femoral shaft weakness of opposing muscle group |
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male urethra starts at
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internal urethra orifice
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males - in active urination
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parasympathetics causes bladder to constrict and internal urethral sphincter to relax
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in women, urinary incontinence is maintained by
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external urethral sphincter
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where spermatogenesis is occuring, sperm are being produced
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testis
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efferent ducts
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about dozen very small tubes, funnel sperm into epididymis
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epididymis
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single highly coiled tube (15 cm long)
stretched out it would be about 4m sits on posterior part of testis |
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role of epididymis
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modifies surface proteins of sperm
prepares them to become motile resorbs some testicular fluid sperm stored in inferior pole until emission, released into tail of vas deferens |
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vas deferens
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runs up back of scrotom (easy access for vastectomy)
thick musclular wall runs through spermatic cord, superficial inguinal rung, deep inguinal ring, down toward prostate |
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prostate
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where seminal vesicle and vas deferens come together to form ejaculatory duct,
has several individual glands that drain independtly into prostatic urethra |
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seminal vesicle
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sits superior lateral to prostate,
highly coiled tubular gland with one duct provides sperm with fructose as energy source so tail can be motile |
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2nd leading cause of death in males behind lung cancer
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prostate cancer
250,00 deaths/year |
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where fluid may accumulate in male pelvic region
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rectovesical pouch
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% of men that will experience some type of prostate cancer
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75%, risk increases with age
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transition zone of prostate
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site of benign prostatic hyperplasia
*the one most men tend to get proliferation of cells can put pressure on prostatic urethra, creating blockage/difficulty urinating |
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peripheral zone of prostate
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main glands, site of prostate carcinoma
*more serious only benefit here is that is can be palpated during prostate exam normal prostate should not be palpable during rectal exam |
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where oocytes are being produced
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ovaries
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uterus is found
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posterior to bladder, superior to cervical region
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infundibulum of uterine tube
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where oocytes are received, have fimbrae or diner-like projections
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cervix
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connection between uterus and vagina
internal os on urerine side external os on vagina side |
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vagina
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walls extend superior above cervical os, creating pockets on either side of cervix
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most common reproductive cancer in woman
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ovarian (20,000 dealth/year)
8th most common cancer among woman 5th leading cause of death |
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in female pelvic cavity, there are two angles to the axes and repro organs...
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between vagina and cervix- anterior bend creating the angle of anteversion
between cervix and uterus - angle of anteflexion (in pregnancy, uterus can become retroflexed, causing back pain) |
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vesicouterine pouch
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in females
created by reflections of peritoneum off fundus of uterus |
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rectouterine pouch
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in females
created by reflections of peritoneum off recum and uterus |
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broad ligament
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peritoneum
3 parts: mesometrium - main lateral extensions mesovarium - part attaching to ovaries mesosalpinx - part attaching to uterine tubes |
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round ligament of uterus
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extends from lateral aspect of uterus to lateral body wall, enters deep inguinal ring
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suspensory ligament of ovary
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runs from ovary to lateral body wall
contains the ovarian vessels look for on left side -- find L.ovarian vein draining into L.renal vein, trace down to find suspen. ligaments |
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from hindgut on, have preganglionic parasympathetic fibers coming from
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S2 3 4
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from hindgut on, have postganglionic parasympathetic fibers coming from
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Auerbach's plexus within wall of the GI tract -- only organized structure with post gang. nerve cell bodies in lower area
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coccygeal plexus
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S4-C0
mostly sensory nerves |
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sympathetic innervation of pelvis is via
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superior hypogastric plexus (L5)
hypogastric nerves inferior hypogastric plexus (S2-4 join) |
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general functions of sympathetic in pelvis
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contraction of smooth muscle in internal urethra and anal sphincters
contraction of smooth muscle associated with repo tract and accessory glands ejaculation (shoot) |
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ganglion impar
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right on coccyx, where left and right sympathetic chains come together
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at superior hypogastric plexus, we have....
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sympathetic fibers descending into pelvis to innervate pelvic viscera
parasym fibers ascending up through hypogastric nerves and sympathetic plexus to hindgut |
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general function of parasympathetics in pelvis
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vasodilation
bladder contraction erection (point) modulate activity of enteric nervous system of colon distal to left colic fixture |
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important in moving secretions from epididymis and associated glands into urethra to form semen during ejaculation
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sympathetics
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umbilical artery
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anterior most branch off anterior internal iliac
runs up body wall and becomes ligament - medial umbilical fold before becoming ligament - gives of superior vesicular artery |
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uterine and vaginal arteries
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both off anterior internal iliac
uterine runs above ureter toward uterine wall vaginal runs below ureter |
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obturator artery
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off anterior internal iliac
follows obturator artery exits via obturator canal |
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internal pudendal artery
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off anterior internal iliac
exits through |
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erection -- the "point"
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parasymp. relaxes helical arteries - they straighten causing cavernous sinuses to fill quickly
puts pressure on efferent veins that normally drain the tissue more blood in-less blood out causes corpora cavernosa tissues to become engorged - penis is erect |
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erection -- the "shoot"
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during climax, sympathetics contract helical arteries, making them spherical again and decreasing blood flow into cavernous sinuses,
less pressure now on efferent veins, begin to drain in pulsating manner |
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during erection, it is important to keep what tissue pliable
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corpora spongiosum to allow urethra to remain patent so ejaculation is possible
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labia majora is homologous to
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scrotum
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labia majora (begins & ends)
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anteriorly- mons pubis, where fatty tissue is
terminates posteriorly as the posterior commissure which is most prominent before labor and delivery |
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labia minora terminates at
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frenulum
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infection can migrate from lower abdomen down to scrotum via
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membranous fascia but NOT past thigh due to fascia lata
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anal columns are formed by
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superior rectal artery and vein
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acts as sling on anal canal to put bend in it when we are not defecating
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pelvic diaphragm
will relax during defecation so anal canal striaghtens |
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connection between endoderm and ectoderm in anal canal
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pectinate line
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how are targets of endocrine glands defined?
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endocrine glands use vasculature to deliver message so target is defined by who senses the signal (who has receptors)
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effect of hormone needs to be sensed by target...
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at extremely low levels
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autocrine
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secretes factors which then bind to a receptor on that very same cell
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juxtacrine
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cell to cell signaling - cells are adjacent
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paracrine
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release in localized area but NOT into vasculature
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endocrine gland that controls most other glands
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pituitary gland
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pituitary gland
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sits in sella turcica, a cavity within sphenoid bone
surrounded by membrane that is actually part of brain |
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posterior pituitary
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pars nervosa (neurohypophysis)
develops from floor of brain (diencephalon) attaches to brain via infundibulum |
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anterior pituitary
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adenohypophysis
forms from roof of mouth, Rathke's ouch provides the endocrine portion of the pituitary |
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cells of parathyroid gland
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chief cell (most abundent) - pale, acidophilic, irregular granules
oxyphil cells - larger, much less of them |
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function of chief cells in the parathyroid gland
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secretion of parathyroid hormone
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major hormone by which we regulate Ca
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parathyroid hormone
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parathyroid hormone function
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increase serum [Ca+2]
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parathyroid hormone targets
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bone (interacts with osteoblasts)
kidneys tubule cells GI tract |
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parathyroid hormone stimulates kidney tubule cells to...
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increase: Ca reabsorption from PCT, phosphate excretion, activation of vitamin D
decrease: phosphate reabsorption |
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bone is formed when Ca and phosphate come together, thus when concentration are both high..
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will form bone
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bone is formed when Ca and phosphate come together, thus when you limit phosphate
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Ca levels stay high, cant be used to form bone
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increasing activity of vitamin D has what effect
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increase Ca absorption in the gut
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in males, bulbospongiosis meets at
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midline of penis at the tendinous raphe
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barium enema is used to look for
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colon carcinomas and abnormalities
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free air in abdomen can indicate
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diverticula, duodenal ulcer, appendicitis
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GOO - gastric outlet obstruction
(radiology) |
characteristics: stomach significantly dilated, paucity (small amount) of bowel gas in large and small bowel
-can be caused by tumor |
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SBO - small bowel obstruction
(radiology) |
indications: centrally located small bowel loops and visible air fluid levels
(fluid cannot go from small to large bowel) can be caused by scar tissue post-surgery or peritonitis (infection) |
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LBO - large bowel obstruction
(radiology) |
significant dilation of large bowel
most common cause - colon carcinoma |
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Ileus
(radiology) |
temporary loss of motility of bowel
significant dilation of large and small bowel most often seen post-op where there was manipulation of bowl during surgery also high doses of pain meds |
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pneumoperitoneum
(radiology) |
presents with free air within abdominal cavity
will see radiolucency beneath right and left hemidiaphragms, representing pockets of free air under diaphragm normally seen post-op |
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with splenomegaly, you may see
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stomach shifted midline
(organomegaly can effect neighboring organs) |
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cholelithiasis would present as
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gallstones in right upper quadrant
also can be stone in kidney, termed renal calculi |
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calcifications in aorta would indicate
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atherosclerotic diseease
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dobhoff tube
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feeding tube
smaller and more flexible than other NG tubes no suction |
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best way to evaluate gall bladder
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ultrasound and doppler
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imaging technique with better organ and vascular definition
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CT
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imaging technique used to stage cancers of the colon
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CT
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biopsies and drainages can be performed with use of
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CT
(biopsies can also be done using ultrasound) |
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imaging technique that helps differentiate cystic/solid masses
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ultrasound/doppler
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good way to rule out aortic aneurysm
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ultrasound
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imaging technique giving definition of structures in multiple planes and clarity between soft tissue and vasculature
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MRI
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in order to see air fluid levels, need to take..
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decubitis or upright films
(prob will not see these levels in supine film) |
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abduct the toe digits
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four dorsal interosseous muscles
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adduct the toe digits
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three plantar interosseous muscles
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see air fluid level along with curved line along right heart border .. this is a presentation of
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hiatal hernia
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while barium study of esophagus may see "birds beak" which is
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narrowing of distal esophagus
if you can see contrast in stomach you know there is not a complete obstruction |
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sometimes described as having a "feathery"appearance on films
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small bowel
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see small radiolucent area in intestines, may be
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polyp
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"apple core" lesion
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circumferential mass within colon
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calcaneal tendon
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thickest and strongest in body
gastrocnemius and soleus use to insert on dorsum of calceneus -- these are the major plantarfelxors of posterior compartment - tearing is very painful, can't plantarflex foot |
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plantaris
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very small
posterior compartment - flexes leg and plantar flexes foot injury here would not cause severe symptoms |
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popliteus
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muscle on posterior knee
allows knee to rotate medially and unlock to initiate flexion of knee innervated via tibial nerve |
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popliteal fossa contains
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popliteal artery (deepest)
popliteal vein common fibular nerve tibial nerve |
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ischial tuberosity is the origin of
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hamstrings
important for flexing leg and extending thigh |
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damage to lateral condyle of tibia may impair
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dorsiflexion
tibialis anterior originates from lateral condyle and is responsible for dorsiflexion |
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sartorius originates on
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ASIS
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rectus femoris takes origin from
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AIIS
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normal ejaculate
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3-5 mL
30-50 million sperm/mL |
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minimum sperm number
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15 million/mL
anything below this iis consdiered infertile |
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connective tissue capsule of testis
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tunica albuginea,
white shiny very dense |
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mediastinum testis
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thickening where tunica albuginea invaginates and creates the connective tissue septa that subdivide testes into ~250 lobules
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teste lobule
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1-4 seminiferous tubules and interstitium
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shape of seminiferous tubules
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U-shaped
both ends open into rete testis |
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ducts of the testis
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seminiferous tubules
rete testis straight tubules (tubuli recti) - connecters of latter and former |
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form outer lining of seminiferous tubules
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pertibular myoid cells
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line lumen of seminiferous tubules
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sertoli cells
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cells in connective tissue surrounding seminiferous tubules
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leydig
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herniation of abdominal contents into thorax would most likely occur through what region
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lumbocostal triangle
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how does retus abdominis assist in respiration
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depresses rib cage on expiration
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have inflamed smaller intestine - where would the nerve cell bodies of the pain afferents from this be located?
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T10 dorsal root ganglion
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structure most likely to refer pain to epigastric region of anterior abdominal wall
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head of pancreas
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does NOT drain directly into IVC
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left suprarenal
left gonadal |
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peritoneum lining lower anterior abdominal wall is called
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parietal
|
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damage to superior gluteal nerve would present as
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hip drop on affected side
superior gluteal innervates gluteus minimus & medius important abductors of the hip, stabilize the pelvis when walking |
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injury to the femoral nerve would
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weaken the quadriceps--the patient would not be able to extend his leg
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injury to the obturator nerve would
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impair adduction of the hip
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Damage to the sciatic nerve would
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paralyze the hamstrings and all the muscles in the leg and foot
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Tensor fasciae latae is a
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medial rotator
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Biceps femoris is a muscle in the
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posterior compartment--it's a hamstring muscle that extends the hip and flexes the knee.
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cruciate anastomosis supply blood to
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area around the head of the femur
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there is a weakness when climbing steps or jumping, you should know that there is a problem with
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powerfully extending the hip--gluteus maximus
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Iliopsoas is a
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hip flexor
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hamstring muscles
innervation origin action |
biceps femoris
semitendinosis semimembranosis originate from ischial tuberostiyy All innervated by tibial nerve EXCEPT short head of biceps formis which is innervated via common fibular nerve action: extension at the hip, flexion at the knee |
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Leydig cells
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interstitial cells in seminiferous tubules
produce primarily testosterone (also estradiol) regulated by LH via pituitary |
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very important in creating the blood-testes barriers
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tight junctions between Sertoli cells
around puberty, spermatogenesis beings and developing spermatocytes will have surface proteins never seen before by immune system - need barrier to prevent lymphocytic attack |
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some men produce anti-sperm antibodies -- this could be an indication of
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infertility
women may also have immune response to sperm in reproductive tract, another explanation of infertility |
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seminiferous epithelium
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unique arrangement of sertoli and spermatogenic cells
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job of sertoli cells is to
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-support development of spermatozoa - nutrition, move and release into lumen, phagocytosis.
-secrete MIS -created blood-testes barrier |
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characteristics of sertoli cells
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columnar - developing sperm cells located in pockets of their cytoplasm
secrete protein - lots of rough ER/extensive golgi complex non-proliferating in adults regulated by FSH |
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in developing male, FSH stimulates
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sertoli cell proliferation
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number of sertoli cells present is roughly proportional to
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number of sperm produced
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animal models have shown their are various factors that can inhibit sertoli cell proliferation, thus leading to
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reduced sperm count in adulthood
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potential to produce sperm is much greater than number
produced -- what is the a monitoring system in seminiferous tubules that detects malformations/mistakes |
sertoli cells - monitor and will phagocytize any mistakes
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MIS (mullerian inhibiting substance)
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produced by sertoli cells to inhibit development of mullerian ducts
if no MIS is present - defult female mullerian ducts develop |
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tight junctions between Sertoli cells divide...
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seminiferous epithelium into basal and adlumenal compartments
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most abundant protein secreted by sertoli cells
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clusterin - found often in areas of pathology (kidney/cardiovas.disease, alzh. disease)
believe Clusterin tries to break down insoluble parts of cells -- Sertoli cells break down cell components they are phagocytizing |
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one of sertoli cell's secretions is inhibin, which will
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decrease levels of FSH
feedback mechanism- responds to FSH levels and tells pituitary to stop secreting it |
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What are the secretions of Sertoli cells
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transferrin (iron transport)
androgen binding p. (testost. transport) collagen IV and laminin (BM components) MIS, inhibin, clusterin |
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in seminiferous tubules, any round cellsitting on basement membrane -- consider it a
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spermatogonia
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primary spermatocytes
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coiled and condensed nuclei - long prophase of 1st meiotic division
immediately go through meiosis I and II to produce spermatids (haploid) (very short time as secondary spermatocyte) |
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spermiogenesis
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maturation of type A spermatogonia into mature spermatozoa
approx. 64 days MUST be 35 deg. C (little color then reg body temp) |
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when spermatozoa are released, excess cytoplasm
is release as structure call the |
residual body -- most of which is phagocytized by Sertoli
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developing male germ cells become adlumenal at what stage?
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primary spermatoyctes
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how is critical 35 deg. C temp achieved during spermatogenesis
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pampiniform plexus of veins
cremaster muscle (relaxes - scrotum sits lower) dartos muscle (insulator around scrotum) |
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spermiogenesis
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form acrosome
condense and elongate nuclei develop flagellum loose most of cytoplasm put mitochondria right as base of flagellsa |
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significance of the estrogen receptor male knockout mouse
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it was infertile
indicated that estrogen does have a role in male development have also found that men with mutation in estrogen receptors have infertility issues |
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pituitary-testicular axis
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axis between pituitary and gonad - feedback mechanisms (i.e. inhibit) help to regulate FSH and LH levels
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released from anterior pituitary, stimulates synthesis of androgen in testes
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LH
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provides the negative feedback of androgen on hypothalamus from testes
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leydig cells
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straight tubules of the testis
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lined by simple cuboidal epithelium of sertoli-like cells
looks very mush like a seminiferous tubule except no sperm |
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rete testis
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anastomosing channels in mediastinum testis
lined by simple cuboidal epithelium |
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function of efferent ducts
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absorb testicular fluid
transport sperm from testis to epididymis (H2o pressure system moves sperm to rete testis and epididymis - efferent ducts remove some of this fluid) |
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characteristics of efferent ducts
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about 12 of these are connecting rete testis to epididymis
epithelium of principal cells w/sterocilia and low cuboidal cells -- creating this alternating epithelium thin layer of smooth muscle to help move sperm |
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function of epididymis
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absorb testicular fluid (drawing sperm toward it)
phag. degenerate spermatozoa and resid. bodies change plasma membrane of sperm STORE SPERM in tail |
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where do sperm become motile
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epididymis
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sperm analysis-- what are some criteria for wither or not sperm is fertile
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can it move?
can is move in straight line? -- malformed flagella can cause sperm to go in circles |
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characteristics of epididymis
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single tube (uncoiled-4 to 6M)
pseudo. columnar with sterocilia (NOT cilia but long microvilia - not motile but increase surface area) circular smooth muscle |
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vas deferens function
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gets sperm from epididymis at ejaculation
moves it to prostatic urethra ampulla at distal end leads to prostate gland |
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vas deferens struture
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psudostratified columnar
3 layers of smooth muscle (looks like flower) |
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ejaculatory ducts
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formed by seminal vesicle and vas deferens
open onto posterior wall of prostatic urethra simple columnar epithelium |
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function of seminal vesicles
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produces alkaline viscous fluid w/ fructose -- gives energy to sperm and prostoglandins
this fluid constitutes 70% of ejaculate (10% of ejaculate is from testes, 20% from prostate) |
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produce the fructose that sperm use as energy source for moving through female repo tract
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seminal vesicles
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seminal vesicles structure
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2 highly tortuous tubes
folded muscosa, simple cuboidal/pseudo. columnar thin layer of smooth muscle outer coat of fibrous connective tisse |
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function of prostate
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decrease viscosity as it adds its secretions to semen
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structure of prostate
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capsule
30-50 branched tubuloalveolar glands squamous to pseudo columnar fibromuscular stroma surrounds glands |
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found in luman of glands in prostate
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prostatic concretions -- corpora amylacea
function: help students identify prostate on practical |
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bulbourethral gland
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secretes mucous with lots of sugar and sialic acid
lubricates/prepares urethra for sperm passage found in urogenital diaphragm opens into penile urethra |
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to distinguish large/small bowl on abdominal CT
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small bowel has markers (haustra) closer together and smaller luminal diameter
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CT - how to distinguish vessel from ducts
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vessels increase with contrast
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"brown glass" appearance of CT
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hazy, difficult to ID margins of organs such as liver and spleen
common causes of this are ascites (fluid buildup) |
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identifying abscess vs. cyst
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cyst is seen as area of decreases density with crisp, defined borders
abscess will not have such defined borders, may also see air bubble which suggests infective process |
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tail of pancreas should be in close proximity to
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hilum of spleen
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when looking for head of pancreas on CT...
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look for contrast filled bowel, which is the 2nd portion of duodenum
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gallstones that are "faceted" stones
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have sharp angulated margins due to rubbing against each other for a while
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how to ID gallstones using ultrasound
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bright areas are stones - stones have acoustic shadowing
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deviations of ureters on CT could indicates
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tumorous mass
wont always see the mass so you look for the mass's effects |
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using ultra sound to look at kidneys, see dilated calices and darker areas -- could indicate
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blockage preventing urine from leaving kidney
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using ultra sound to look at kidneys, see splayed calyx may suggest
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mass effect
could have cyst causing deviation of calices |
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How will a cyst appear with contrast?
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will not be enhances by contrast, fluid is stagnant thus not in contact with vasculature
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histerosalpingogram
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used to check women's repro structures (esp if having trouble getting pregnant)
contrast is added into vagina and through cervix *want to make sure patient is not actually pregnant before performing |
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male: see impression on inferior border of urinary border...
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enlarged prostate
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retrograde urethragram
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contrast added retrograde into penile urethra, looking for congenital problem/trauma to urethra
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a portal system is..
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two capillary plexuses connected by veins
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female primordial germ cell -->
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oogonia - primary oocyte - ovarien follicle - primordial follcile - primary follicle (unilaminar then multilaminar) - secondary (antral) follicle - mature graffian follicle
after ovulation -> corpus luteum - corpus albicans |
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ovarian cortex
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business end of ovary
germinal epithelium tunica albuginea (just beneath the epithelium) primordial follicles |
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primordial follicle contains..
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primary oocyte - stuck in prophase I
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around primary follicles
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single layer follicular cells - continuous basal lamina basically wrapping around the primary follicles
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unilaminar primary follicle
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FSH has stimulates rapid oocyte growth
have mitosis of follicular cells creating a single layer of granulosa cells |
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multilaminar primary follicle
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follicular cells continue to divide, making serveral layers of granulosa cells
have thin rim forming between oocyte and granulosa layer -- this is zona pellucida |
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zona pellucida
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made of glycoproteins
rim between oocyte and granulosa layer NECESSARY for proper acrosomal activation *thus critical in fertilization |
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granulosa filipodia
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membrane extensions of granulosa going through zona pellucida, communicating with microvilli on surface of oocyte via through gap junctions -- allow epithelium to respond in unison
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Antral follicle, granulosa cells....
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start secrete follicular fluid
fluid pushes granulosa to periphery and create cumulus oophorus fluid-filled spaces become antrum corona radiata forms |
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follicular fluid (liquor folliculi)
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lots of steroids: progesterone, androstenedion, estrogen
also hyalutonate, growth factors, fibrinogen (anticoagulant), HS proteoglycan |
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corona radiata
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right up against zona pellucida ?
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during antral follicle stage, stromal cells ...
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arrange in to follicular theca (coat)
theca interna (endocrine) and theca externa (fibrous) |
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theca interna during antral follicular phase
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endocrine
produces androstenedione - precursor of steroid hormones |
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anatomic snuff box is bound by
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"brevis sandwich"
abductor pollicis longus extensor pollicis brevis extensor pollicis longus |
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bone lying in the floor of anatomic snuff box
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scaphoid
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fall on outstretched hand will present has
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swelling in snuff box
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most commonly fractured carpal bone
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scaphoid
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artery that can be found within anatomic snuff box
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radial - can palpate pulse here
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innervation of lumbricals (in the hand)
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1 and 2 - median
3 and 4 - deep branch of ulnar |
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dorsal interosseous muscles
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4 bipennate muscle
innervated deep palmer branch of ulnar ABduct fingers from middle finger |
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palmer interosseous muscles
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3 unipennate muscles
innervated deep branch of ulnar ADDuct finers to middle finger |
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fracture to surgical neck of humerus is common.
what may be injured here? |
axillary nerve
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mid-shaft fracture of humerus - risk injuring
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radial nerve
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maturation from primordial to graffian follicle takes
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90 days
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mature or pre-ovulatory follicle
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granulosa layer thins
thecal layers thicken follicle is actually prtruding from surface of ovary |
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menstral cycle begins with
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pituitary releasing FSH
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corpus luteum
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whats left in ovary
formed by theca interna and granulosa cells controlled via LH - change their function/morphology become granulosa lutein and theca lutein cells |
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when the egg is pushed into oviduct after the LH surge, it will be at what stage?
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secondary oocyte (haploid) (arrested in metaphase II) with first polar body
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most of the corpus luteum is composed of what cells?
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granulosa lutein
responsible for aromatase conversion of androstenedione to estradiol |
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corpus lutem cells arranged in 'strands' or lines, less numerous
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theca lutein
produce progesterone and androstenedione (keep uterus happy and ready for pregnancy) |
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hormone responsible for maintaining integrity of uterine wall so it is ready for implantation
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progesterone
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when corpus luteum ceases steroid production, undergoes apoptosis, phagocytosis - a dense scar tissue forms called...
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corpus albican
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what will induce actual menstration (sloughing off of functional layer of endometrium of uterus?)
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decreased progesterone
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as corpus luteum is dying, estrogen levels are reduced, this allows for...
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FSH to stimulate a new group of follicles to begin the cycle again
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hormone responsible for maintaining corpus luteum
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LH
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if pregnancy occurs, the corpus luteum ...
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maintains uterine mucosa
halted in progesterone production by HCG (?) becomes very large over 4-5 months until placenta takes over progesterone and estrogen production becomes corpus albicans |
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progesterone role in pregnancy
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thickening of endometrium(main)
stimulate breast tissue growth strengthen cervical mucus plug prevents uterus from contracting 38-42 weeks - levels will drop, stimulating contractions of uterus |
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levels a doctor will look at to make sure proper environment is being prepared for fetus development during pregnancy
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progesterone
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normally there is a spike in FSH at beginning of mentral cycle, very high levels of FSH could indicate
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follicles not responding properly to FSH,
pituitary keeps throwing out more FSH b/c oocytes are not growing properly -- 15-20% chance of pregnancy |
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placenta
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fetuses contribution
forms early in pregnancy connects fetus to moms uterine wall |
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main components of placenta
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villous parenchyma (can help distinguish preg. stage)
maternal decidual tissue |
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placental membrane
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2 layers
amnion - innermost lining of amniotic cavity, single layer flat epithelial cells chorion - connective tissue - carries fetal vasculature |
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decidua
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maternal contribution
large, pink cells derived from uterine stromal cells essential for implantation and establishing fetal-maternal communication |
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first trimester villi
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two layers trophoblast cells
stroma loose connective tissue small fetal blood vessels |
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second trimester villi
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smaller/thinner trophoblast layers
compact stroma - collagenous larger fetal capillaries - towards the edge |
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third trimester villi
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smaller, tight knot-like
stroma thin strands btw dilated fetal capillaries whic fuse with thinned trophoblast layer site of exchange btw fetal and maternal circulation |
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oviduct has 4 sections;
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infundibulum (closest to ovary - where egg is released into)
ampulla isthmus intramural (uterine) |
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oviduct function
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thick muscularis of interwoven spiral and longitudinal sm moves embryo
mucosa provides protective/nutritive environment for oocyte/sperm/embryo |
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wall of oviduct characteristics
|
folded branching mucosa
thick muscularis of interwoven spiral and longitudinal sm thin serosa (can touch) |
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oviduct epithelium
|
simple columnar
ciliated and non cells secretory peg cells estrogens of follicular phase promote cili elongation and secretion late luteal phase - loose cili/atrophy |
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capacitation
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process that creates fully mature sperm capable of fertilizing ovum
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Peg Cells
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secrete glycoprotein in oviduct
provides nutritive/protective environment as sperm travel facilitate sperm capacitation support ovum until/when fertilized and embryo during initial stages of development (as it tumbles down to uterus) |
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fertilization usually occurs...
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ampulla of oviduct
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what triggers oocyte to complete 2nd meiotic division
|
fertilization
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time it takes for zygote to travel to uterus
|
~ 5 days
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ectopic or tubal pregnancy can be caused by
|
scar tissue blocking uterine tube
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3 layers of uterus
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perimetrium - connective tissue, outermost
myometrium - vascularized smooth muscle endometrium - simple columnar epithelium (business end of uterus, simple columnar will be in various stages of growth) |
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endometrium - basal layer
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basal ends of uterine glands and highly cellular lamina propria
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on day 1 of menstrual cycle, endometrium of uterus
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sloughing off functional layer -- blood from ruptured vessels
menstrual period lasts 3-4 days followed by proliferative phase (8-10) and then secretory phase (14+) which begins at ovulation |
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allow for inversion and eversion at foot
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subtalar joint ( talus + calcaneus)
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