Module 4

END OF THE EMBRYONIC PERIOD (WEEKS 1-8) What happens to: -Bones -Skeletal muscles -Kidneys -Gonads -Lungs -Blood -Heart/liver -How much does the embryo weigh?

-Bones begin to ossify -Skeletal muscles form and can contract -Kidneys are developing -Gonads have differentiated and formed -Lungs and digestive organs are attaining final shape and body position -Blood delivery to/from placenta is constant and efficient -Heart and liver bulge on ventral surface -All this happening in a embryo that is less than 1 inch from crown to rump and weighs 2 g (0.06 ounces)

DIURETICS: -What are they? -ADH inhibitors: -Na+ resorption inhibitors: -Loop diuretics inhibit: -Osmotic diuretics: >what is not reabsorbed? >example in diabetic patient:

-Chemicals that enhance urine output and reduce BP -ADH inhibitors: alcohol -Na+ reabsorption inhibitors: caffeine, drugs for hypertension or edema -Loop diuretics inhibit medullary gradient formation -Osmotic diuretics: >Solutes not reabsorbed, so water remains in urine >Example, in diabetic patient: High blood glucose exceeds transport maximum and causes glucose to spill into urine. Then Glucose concentration in urine pulls water from body into urine. Thus, frequent urination is sign of high BG in diabetics

ACCESSORY GLAND: PROSTATE -Encircles: -Size of: -What type of tissue? -Secretes what fluid? >contains: >plays a role in: >makes up what % of semen? >significantly reduced after:

-Gland which encircles urethra inferior to bladder -Size of walnut -Has smooth muscle that contracts during ejaculation -Secretes milky, slightly acidic fluid >Contains citrate, enzymes, and prostate-specific antigen (PSA) >Plays a role in sperm activation >Makes up 1/3 volume of semen >Volume of ejaculate is significantly reduced after prostatectomy

EXTRAUTERINE LIFE -Birth is a shock to a baby, so physical status is assessed within 1-5 minutes after birth by Apgar Score; 0-2 points for: -What is is a healthy score? -What is the neonatal period?

-Heart rate, muscle tone, respiration, reflexes, color -Score of 8-10 means healthy baby -Neonatal period: 4 week period immediately after birth

PSEUDOHERMAPHRODITISM -What is this? -Caused by: >What happens if testes do not produce testosterone? >What happens if genetic female is exposed to testosterone? -What do many seek? -When does hermaphroditism occurs?

-Individuals with primary sex characteristics of one sex but secondary sex characteristics different from what is expected on the basis of the gonadal tissue -Caused by interferences of embryotic sex hormones >If embryonic testes do not produce testosterone, a genetic male develops female accessory structures and external genitalia >If genetic female is exposed to testosterone, embryo has ovaries but develops male ducts, glands, as well as a penis and an empty scrotum -Many seek sex-change operations -Hermaphroditism occurs when an individual has functioning sets of both male and female reproductive structures

MEMBRANE TRANSPORT Passive (no ATP; high to low) -Diffusion (facilitated) -Osmosis -Obligatory water movement: -Facultative water movement: Active (ATP; low to high) -Na/K Pump

-Obligatory water movement: water follows salt -Facultative water movement: hormone dependent on water channels called aquaporins

FORMATION OF DILUTE OR CONCENTRATED URINE -Osmotic gradient is formed by: -Without the concentration gradient, -Overhydration: >produces: >what decreases? >what happens if aldosterone is present? -Dehyrdation: >What happens when BP drops? >with maximum ADH secretion... >produces... >urine can reach:

-Osmotic gradient formed by CCM, CCE and urea recycling is used to form dilute OR concentrated urine -Without the concentration gradient, urine could not be concentrated more than 300 mOsm and water could not be conserved during dehydration -Overhydration: >Produces large volume of dilute urine >ADH production decreases; urine ~100 mOsm >If aldosterone present, more sodium is removed and urine is diluted more to ~50 mOsm -Dehydration: >When BP drops, posterior pituitary releases ADH >With maximum ADH secretion, more urea is recycled and up to 99% of water in urine is reabsorbed and returned to blood >Produces small volume of concentrated urine >Urine can reach ~1200 mOsm

MAMMARY GLANDS -Present in: -Function: -Glands: -Areola: -Suspensory ligaments: -How do we get breast size?

-Present in both male and female; Normally function only in female; Develops during mid 1st pregnancy -Function is milk production to nourish newborn -Modified sweat glands consisting of 15-25 lobes -Areola: pigmented skin surrounding nipple -Suspensory ligaments: attach breast to underlying muscle -Breast size is due to amount of fat deposits; Determined by genetics and weight component

THE ORDER IN WHICH URINE PASSES TO THE EXTERNAL ENVIRONMENT

1. Calyx 2. Renal Pelvis 3. Ureter 4. Bladder 5. Urethra

SOURCES OF ACID (H+) 1. 2. 3. 4.

1. Carbon dioxide/ carbonic acid waste product resulting from cellular respiration/ carbohydrate metabolism 2. Phosphoric acid from protein breakdown 3. Fatty acids and ketone bodies from fat metabolism 4. Lactic acid from anaerobic exercise

Urine results from: 1. 2. 3. 4. 5. 6.

1. Chemically cleaning the blood 2. Removing waste, especially urea (nitrogen from protein) 3. Regulating body water volume and blood pressure 4. Regulating ion concentration in extracellular fluid 5. Acid-base balance of the blood (PH) 6. Waste excretion

FEMALE SEXUAL RESPONSE 1. Desire 2. Arousal 3. Plateau 4. Orgasm 5. Resolution -Women do not experience a: -Initiated by: -What secretes lubrication? -Orgasm is accompanied by: -Orgasm is not essential for: -What is female libido prompted by:

1. Desire: Psychological and sensory; Generally non-visual and more tactile 2. Arousal: Increased heart rate and blood flow; increased muscle tension; engorged labia and clitoris; vaginal lubrication; Nipple erections (women can experience vaginal dryness if they don't have good bloodflow) 3. Plateau: Vasocongestion and myotonia intensify 4. Orgasm: Involuntary muscle contractions; Forceful release of muscle tension 5. Resolution: return to unaroused state -Women do not experience a refractory period but can experience multiple orgasms in single sexual experience -Initiated by touch and psychological stimuli -Vestibular gland secretions lubricate vestibule -Orgasm is accompanied by muscle tension, increase in pulse rate and blood pressure,and rhythmic contractions of uterus; Ejaculation can sometimes accompany orgasm -Orgasm is not essential for conception -Female libido is prompted by DHEA (dehydroepiandrosterone) and androgen produced by adrenal cortex

Secretion of progesterone stimulates ________

Preparation of the mammary glands for lactation

A sudden release of luteinizing hormone by the anterior pituitary triggers ovulation.

True

CHROMOSOMAL NONDISJUNCTION: Abnormal distribution of sex chromosomes Turner's syndrome (XO): Triple X syndrome (XXX): Klinefelter's syndrome (XXY):

Turner's syndrome (XO): Females with only a single X chromosome never develop ovaries; Occurs in 1/2500 females Triple X Syndrome (XXX): Females can have 3 or more X chromosomes; intellectually disabled; varying degrees of fertility; Occurs in 1/1000 females Klinefelter's syndrome (XXY): Anatomic males with single Y and 2X chromosomes; Often sterile and are normal or only slightly below normal intellectually; 1/600 men

What structure is the target for gonadotropin stimulation occurring during the events that lead to ovulation?

Vesicular follicles; Gonadotropins (FSH and LH) released by the anterior pituitary stimulate vesicular follicles to grow, mature, and secrete sex hormones.

What is the correct pathway of the egg after leaving the ovary and entering the uterine tube?

infundibulum, ampulla, isthmus, uterus

2 COUNTERCURRENT MECHANISMS THAT REGULATE URINE CONCENTRATION AND VOLUME IN LONG LOOPS OF JM NEPHRONS -Countercurrent = 1. 2. -Countercurrent mechanisms work together to:

-"Countercurrent" refers to the opposing flow of fluid 1. Countercurrent multiplier (Nephron loop) 2. Countercurrent exchanger (in vasa recta) -The CCM and the CCE work together to create a concentration gradient in the interstitium of the renal medulla; The concentration gradient will be used by ADH to create concentrated urine if needed to raise BP

IMPLANTABLE CONTRACEPTION -What is it? -What does it release? -Effectiveness to prevent pregnancy? -Advantages: -Disadvantages:

-1 or 2 rod implantable capsules that are inserted under the skin on the inner arm -Releases a low, steady dose of progestin for up to 3 years -Effectiveness to prevent pregnancy: 99.95% effective perfect use -Advantages: >Lightening or cessation of menstrual periods >No estrogen-related side effects >Safe for use by breast-feeding women -Disadvantages: More expensive than pill/patch/ring because a clinician must insert it

MASTERS AND JOHNSON: -1st to study: -Desire/Excitement: -Arousal/Plateau: -Orgasm:

-1st to study the science of sex (1957) -Desire/ Excitement: >The sensory sexual stimuli >Mental/ emotional -Arousal/Plateau: >Physical changes >Increase in heart and respiratory rate >Vasodilation, vasocongestion and myotonia lead to engorgement, lubrication and erection -Orgasm

MENSTRUAL CYCLE: Regular natural changes in the uterus and ovaries that make pregnancy possible -2 separate cycles called: -Regulated by what axis? -Required for: -What happens in the cycle? -What happens if pregnancy does not occur?

-2 separate cycles: Ovarian and Uterine -Regulated by the Hypothalamic-Pituitary-Gonadal Axis -Required for the production of oocytes, and to thicken the lining of the uterus to prepare for pregnancy -The egg (oocyte) is released from an ovary around day fourteen in the cycle; the thickened lining of the uterus provides nutrients to an embryo after implantation -If pregnancy does not occur, the lining is shed in the process known as menstruation

What does it cost to raise a child? -2013 data = -How much for the first 17 years?

-2013 Data= $1800/month or $21,600 per year -$367,200 for the first 17 years

REGULATION OF CALCIUM BALANCE -99% of calcium is found in: -Regulated by: -Ca2+ in ECF is important for: -Hypocalcemia can lead to: -Hypercalcemia may cause:

-99% of body's calcium is found in bones -Regulated by parathyroid hormone (PTH); Ca2+ stays constant in blood -Ca2+ in ECF is important for: blood clotting and neuromuscular excitability (most important) -Hypocalcemia: can lead to muscle tetany -Hypercalcemia: may cause heart arrhythmias

NUVA RING -What is it? -How long does it work? -What does it release? -Effectiveness to prevent pregnancy? -Advantages: -Disadvantages:

-A soft and flexible plastic hormonal contraceptive ring -Offers protection for 4 weeks -Releases a steady flow of estrogen and progestin -Effectiveness to prevent pregnancy: 99% effective perfect use -Advantages: >Fewer estrogen-related side effects >Easier to remember than a daily pill -Disadvantages: Possible side effects include increased vaginal discharge and vaginal irritation or infection

ANURIA: -What is it? -May indicate that: -Can result from: -Monitor:

-Abnormally low urinary output (less than 50 ml/day) -May indicate that glomerular BP is too low to cause filtration -Renal failure and anuria can also result from situations in which nephrons stop functioning; ie: Acute nephritis, transfusion reactions and crush injuries -Monitor ins and outs (intake and output) to evaluate fluid and electrolyte balance

GROSS ANATOMY OF KIDNEYS -Size -Location -Surface -What protects the kidney from trauma? -Adrenal gland

-About the size of a bar of soap -Retroperitoneal, located between T12 and L5; the right kidney is lower than left due to position of liver -Convex lateral surface; Concave medial surface with vertical renal hilum (Entry/exit of ureters, nerves, blood and lymph vessels) -Perirenal fat capsule which protects kidney from trauma and attaches kidney to body wall -Adrenal gland (suprarenal); Endocrine gland sits atop each kidney; Has unrelated functions

PLACENTAL COMPLICATION -Abruptio placentae/Placental abruption: >Risk factors: -Placenta previa: >Risk factors:

-Abruptio placentae/ Placental abruption: Placenta separates from the wall of the uterus before birth >Risk factors: smoking and abdominal trauma -Placenta previa: When the placenta partially or totally covers the mother's cervix >Risk factors: smoking, cocaine, twins, previous uterine surgery

ORTHO EVRA PATCH -What is it? -How long do you wear it? -Effectiveness to prevent pregnancy? -Advantages: -Disadvantages:

-Adhesive patch that delivers continuous levels of estrogen and progestin through the skin and into the bloodstream -Worn for 1 week, replaced, for 3 consecutive weeks -Effectiveness to prevent pregnancy: >92% effective/typical use >99% effective perfect use -Advantages: >Same benefits /side effects as combination pills, although easier to remember to use than taking a daily pill. -Disadvantages: >Not recommend for women > 180 # >FDA mandated a warning label explaining that patch use exposes women to about 60 % more estrogen than the pill

CERVICAL CANCER -Statistics: -Caused by: -Risks: -Gardasil: -Papanicolaou smear:

-Affects 450,000 women annually, killing half; Most common between ages 30 and 50 -Caused by human papilloma virus (HPV) -Risks: Frequent cervical inflammation, STIs, multiple partners/ pregnancies, diet low in fruits and vegetables (Vit A&C) -Gardasil: 2-dose vaccine; protects against HPV; Recommended for adolescent girls and boys age 11-12 -Papanicolaou (Pap) smear for detection: Recommended every 3 years for ages 21-30; Every 5 years for ages 30-65, but include HPV testing

BEFORE FERTILIZATION -How long does it take for oocyte to travel to fallopian tubes? -When must sperm reach oocyte? -What can allow fertilization?

-After ovulation, it takes ~4 days for secondary oocyte to travel down fallopian tubes -Sperm must reach secondary oocyte while both are viable >Oocyte viable for 12 to 24 hours >Sperm most viable 24 to 48 hours after ejaculation; can survive up to 5-7 days -Coitus (sex) 5 days before OR up to 24 hours after ovulation can allow fertilization

EMERGENCY CONTRACEPTION -Aka -When is it used? -Does not work if? -Most effective when? -What is purchase age limit? -It is NOT: -Advantages: -Disadvantages: -Effectiveness:

-Aka Plan B or morning after pill -Used after unprotected intercourse, before her period; Not to be used for regular contraception -Does NOT work if she is already pregnant -Most effective within 24 hours, but there is a window of effectiveness up to 72 hours (3 Days) after unprotected sex -In June 2013, approved for purchase for all age limits removed -EC is not Mifeprex / mifepristone (formerly known as RU-486) and it is NOT the early abortion pill -Advantages: >Available OTC without prescription >Men and women can purchase it >EC can prevent 1.7 million pregnancies and 800,000 abortions yearly -Disadvantages: Possible side effects of nausea, vomiting, irregular bleeding at next cycle -Effectiveness: >If 100 women use EC pills after having unprotected sex, only 2 of them will get pregnant. >Emergency insertion of a copper-T IUD reduces the risk of pregnancy by more than 99%.

REGULATION OF SODIUM BALANCE (Picture) -What is the key hormone of sodium? >secreted by: >triggered by: >how much Na+ is reabsorbed? >what is aldosterone effect? -Atrial Natriuretic Peptide (ANP): >released by: >decreases ___ by: >only hormone that: -Female Sex Hormones: >Estrogen: chemically similar to: •Increases •Leads to: •Responsible for: >Progesterone: decreases: •Diuretic effect: -Glucocorticoids (cortisol/steroids): increases:

-Aldosterone is the key hormone of sodium (Na+) >Secreted by the adrenal cortex to trigger Na+ reabsorption in the kidneys >Triggered by Renin-Angiotensin-Aldosterone mechanism triggered by granular cells of JGC >90% of Na+ is reabsorbed >Aldosterone effect: K+ is excreted in exchange for Na+ reabsorption -Atrial Natriuretic Peptide (ANP): >Released by atrial cells in response to increased BP >Decreases blood pressure and blood volume to protect heart from damage •Inhibits ADH, renin, and aldosterone production •Increases excretion of Na+ and water •Promotes vasodilation directly and by decreasing production of angiotensin II •ANP is the only hormone with the action to lower BP -Female sex hormones: >Estrogens: chemically similar to aldosterone •Increases NaCl reabsorption •Leads to H2O retention •Responsible for bloating before menses >Progesterone: decreases Na+ reabsorption (inhibits aldosterone) •Diuretic effect: Promotes Na+ and H2O loss -Glucocorticoids (cortisol/steroids): Increases Na+ reabsorption and promotes edema

STEP 2: TUBULAR REABSORPTION -How long does it take? -Without reabsorption, plasma drains out in how long? -How does solutes move? -How is reabsorption in PCT affected? -How is reabsoprtion in DCT?

-All blood plasma is filtered in tubules every 22 min -Without reabsorption, all plasma drains out in 30 min -Solutes move OUT of tube through interstitial (interstitium) into peritubular capillaries or vasa recta -Reabsorption in PCT is affected by NFP only; it DOES NOT vary with body's need -Reabsorption in DCT and collecting duct is specific and DEPENDS ON the body's NEEDS; Controlled by hormones: >Aldosterone- made by adrenal cortex; increases sodium reabsorption and potassium secretion to raise BP >ADH- adds aquaporins in duct so that water can leave which increases blood volume and raises blood volume >ANP- causes sodium secretion and decreases blood volume/pressure >PTH- increases calcium reabsorption)

SPECIALIZATION OF MESODERM -What appears? -3 aggregates appear laterally of notochord: 1. Somites 2. Intermediate mesoderm 3. Lateral plate mesoderm

-Appearance of notochord (vertebral column) -Three aggregates appear laterally of notochord: 1. Somites: 40 segmented pairs with 3 functional parts -Sclerotome (vertebra and rib) -Dermatome (dermis of skin) -Myotome (skeletal muscles of neck, trunk, limbs) 2. Intermediate mesoderm -Forms gonads and kidneys 3. Lateral plate mesoderm -Somatic mesoderm forms dermis of skin, parietal serosa -Splanchnic mesoderm forms heart and blood vessels, most connective tissues of body, walls of GI and lungs

NEPHRON PART 2: RENAL TUBULES -How long is it? -What cells is it made of? 3 major parts: 1. Proximal Convoluted Tubule (PCT) -Located -What type of cells? -Functions in: 2. Nephron loop -Aka -Located 3. Distal convoluted tubule (DCT) -located -what type of cells? -Functions in: -Where does it drain?

-Around 3 cm (1.2 in.) long -Made of single layer of epithelial cells Three major parts: 1. Proximal convoluted tubule (PCT) -In cortex -Cuboidal cells with many microvilli that increase surface area -Functions in reabsorption and secretion 2. Nephron loop -Aka loop of Henle -In medulla 3. Distal convoluted tubule (DCT) -In cortex -Cuboidal cells with few microvilli -Function is mostly secretion -DCT drains into collecting duct

CHANGES IN THE SIZE OF THE UTERUS -Before conception how is the uterus? -Where is uterus during 4 months of pregnancy? -Where is uterus at 7 months of pregnancy? -How is the uterus at 9 months?

-Before conception, uterus is the size of a fist and resides in the pelvis -4 months into pregnancy, fundus of the uterus is halfway between the pubic symphysis and the umbilicus -7 months into pregnancy, the fundus is well above the umbilicus -At 9 months of pregnancy, the fundus reaches the xiphoid process making it difficult to breath

IMPLANTATION -How long does blastocyst float? -When does implantation begin? When is it complete? -What happens if implantation fails to occur? >what happens to uterus? >how many zygotes fail to form? >how many embryos miscarry? >how many eggs make it to 2nd trimester?

-Blastocyst floats for about 2-3 days -Implantation begins ~6 days after ovulation; Complete 10-12 days after; This is around when menses would occur. May cause PMS-like cramping -If implantation fails to occur then: >Uterus becomes non-receptive again >About 2/3 of all zygotes formed fail to implant by end of first week or spontaneously abort >Up to 30% of implanted embryos later miscarry because of genetic defects of embryo, uterine malformation, or unknown problems >Only ~20% of fertilized eggs survive to 2nd trimester

EFFECTS OF ACIDOSIS AND ALKALOSIS -Blood PH below 6.8 causes -Blood PH above 7.8 causes -Respiratory system tries to compensate for: -Kidneys try to compensate for:

-Blood pH below 6.8 cfactauses depression of CNS, which can lead to coma and death -Blood pH above 7.8 causes overexcitation of nervous system, leading to muscle tetany, extreme nervousness, convulsions, and death, often from respiratory arrest -Respiratory system tries to compensate for renal acid- base imbalances -Kidneys try to compensate for respiratory acid-base imbalances

AMENORRHEA -What is it? -Associated with? -Who has little body fat? -Adipose cells are needed to: -What role does leptin play? -Can also lead to:

-Cessation of menses -Associated with low body fat and low leptin levels or extreme strenuous physical activity -Female athletes have little body fat -Adipose cells are needed to convert adrenal androgens to estrogens and secrete leptin -Leptin plays a role in puberty and informs hypothalamus if energy stores are sufficient to support reproduction; If there is not adequate adipose reserves, reproductive cycles are shut down -Can also lead to osteoporosis (because estrogen is protective for bones)

SPERMICIDES -What is it? -How does it work? -Effectiveness to prevent pregnancy? -Not effective for: -How do you get it? -Advantages: -Disadvantages:

-Chemical barriers in the form of jelly, cream, foam Insert deep into vagina, 20-59 minutes before sex to kill sperm before they can reach the egg -Effectiveness to prevent pregnancy: >71% effective/typical use >82% effective perfect use -NOT Effective for safer sex -How do you get it: OTC -Advantages: >Minimal side effects -Disadvantages >Most effective when used with a condom >Messy >Not effective against STIs, N-9 may increased risk of HIV

RENAL DISEASE -Chronic renal disease = -What happens in chronic renal disease? -Seen in what conditions? -Renal failure = -Causes: -Syndrome of: -Symptoms: -Treatment:

-Chronic renal disease = GFR < 60 ml/min for 3 months -Filtrate formation decreases, nitrogenous wastes accumulate in blood, pH becomes acidic -Seen in diabetes mellitus and hypertension -Renal failure = GFR < 15 ml/min -Causes uremia "Urine in the blood" -Syndrome of ionic and hormonal imbalances, metabolic abnormalities, toxic molecule accumulation -Sx: fatigue, anorexia, nausea, mental changes, cramps -Tx: hemodialysis or transplant

BASSON'S SEXUAL RESPONSE CYCLE (newer) -What's the difference? -Acknowledges: >Desire can be: >Orgasm may contribute to: >Relationship factors affect: -What is a unique aspect of Basson's circular model?

-Circular and more complex -Acknowledges that: >Desire can be responsive or spontaneous and may come either before or after arousal >Orgasm may contribute to, but is not necessary for, satisfaction >Relationship factors affect one's willingness and ability to participate in sex -Unique aspect of Basson's circular model is that a person can enter the cycle at several different points.

CIRRHOSIS AND THE KIDNEY -Cirrhosis causes the liver to: -Which pressures are affected? -What happens to net filtration pressure? -Is more or less filtrate formed?

-Cirrhosis causes the liver to produce fewer plasma proteins -Colloid osmotic pressure pressure would be affected -Net filtration would go up -More filtrate would be formed (produce more dilute urine)

PHYSIOLOGY OF THE KIDNEY -What is the function? -How much O2 does it consume? -How much fluid does it process? -How much plasma does it filter? -What is filtrate?

-Cleans and chemical balances blood -Consumes 20-25% of O2 used by body at rest (metabolically active) -180 L of fluid processed daily but only 1.5 L of urine is formed -Kidneys filter body's entire plasma volume 60 times each day -Filtrate: Urine precursor (plasma) resulting from Glomerular Filtration; Contains everything in blood plasma except proteins

ENDOMETRIOSIS -What is it? -Symptoms: -Treatment:

-Condition when endometrial tissue grows outside of the uterus most often in the uterine tubes and abdominopelvic cavity affecting > 10% of women; tissue may block uterine tubes and cause infertility -Symptoms: Painful menstrual cramps, spotting between periods, chronic low back pain, pain during or after sex -Treatment: IUD or continuous cycle birth control which prevents menses

PROGESTIN ONLY PILLS -What hormones does it contain? -Effectiveness to prevent pregnancy? -Advantages: -Disadvantages:

-Contains small doses of synthetic progesterone and NO estrogen; Taken continuously (no placebo pills) -Effectiveness to prevent pregnancy: >92% effective/typical use >99% effective perfect use -Advantages: >Ok for women over 35 or with chronic conditions >Ok for women who are breastfeeding -Disadvantages: >Must be taken at the EXACT same time everyday >Irregular bleeding or spotting >Mood changes >May cause headache or decreased sex drive

UTERINE CYCLE -What is it? -Responds to: 3 phases: 1. Menstrual Phase -How are hormone levels? -What happens to uterine wall? -What happens by day 5? -How is cervical mucus? 2. Proliferative/preovulatory phase -What do rising estrogen levels prompt? -How is the cervical mucus? -How is the cervical mucus before ovulation? -When does ovulation occur? 3. Secretory/postovulatory phase -How is this phase? -What is prepared? -Rising progesterone levels from corpus luteum prompt? >functional layer to: >what enlarges? >what happens to mucus? -If fertilization does not occur then: >what degenerates? >what hormone levels fall? >what spasms? >what cells die? >what do the spiral arteries do? >what happens to the functional layer? -When does the uterine cycle start all over?

-Cyclic series of changes in endometrium -Responds to fluctuating ovarian hormone levels (LH, FSH, Estradiol and Progesterone) 3 phases: 1. Days 1 (first day of menstrual flow)-5: menstrual phase -Ovarian hormones (estrogen and progesterone) are at lowest levels; Gonadotropin levels are beginning to rise -Stratum functionalis detaches from uterine wall and is shed -Menstrual flow of blood and tissue lasts 3-5 days -By day 5, growing ovarian follicles start to produce more estrogen -Cervical mucus is white and thick after menses 2. Days 6-14: proliferative (preovulatory) phase -Rising estrogen levels prompt generation of new stratum functionalis; As the layer thickens, glands enlarge, and spiral arteries increase in number; Estrogen also increases synthesis of progesterone receptors in endometrium -Cervical mucus changes from thick white to thin white to facilitate sperm passage -24-48 hours before ovulation, cervical mucus become clear and stretchy, like egg whites. This is known as "fertile mucus." -Ovulation occurs at end of proliferative phase about day 14 3. Days 15-28: secretory (postovulatory) phase -Phase that is most consistent in duration at 14 days -Endometrium prepares for embryo to implant -Rising progesterone levels from corpus luteum prompt: >Functional layer to become a secretory mucosa >Endometrial glands enlarge and secrete nutrients into uterus >Thickened mucus to form cervical mucus plug that blocks entry of more sperm, pathogens, or debris -If fertilization does NOT occur then: >Corpus luteum degenerates toward end of secretory phase >Progesterone levels fall >Causes spiral arteries to kink and spasm >Endometrial cells die, and glands regress >Spiral arteries constrict again, then relax andopen wide, causing a rush of blood into weakened capillary beds >Blood vessels fragment, and functional layer sloughs off -Uterine cycle starts all over again on first day of menstruation

PREECLAMPSIA -Dangerous complication of pregnancy that can result in: -What happens? -May be due to: -How many women does it affect?

-Dangerous complication of pregnancy that can result in deterioration of placenta and insufficient placental blood supply -Woman becomes edematous and hypertensive, and proteinuria occurs >Can lead to fetus being starved of oxygen -May be due to immunological abnormalities -Affects 1 in 10 pregnant women

BEHAVIORAL METHODS -What is it? -Not effective against: -Can be made safer with: -What is the only method 100% effective against pregnancy? Cervical Mucus Method -What do you check? -When do you avoid sexual activity? Body Temperature Method -When does a woman's temp rise? -When do you avoid sexual activity? Calendar Method -What does it assume? Withdrawal (coitus interruptus) -What is it? -How effective is it?

-Deliberately avoiding intercourse and comingling of body fluids which could lead to pregnancy -Not effective against STIs because of possible oral/genital contact -Can be made safer through use of male and female condoms -Only method that is 100 percent effective against pregnancy is abstinence which does not allow any body fluid comingling Cervical Mucus Method -Check color and consistency to determine fertile times -Avoid sexual activity for 5 days before AND after fertile mucus is present Body Temperature Method -A woman's basal body temperature rises between 0.4 and 0.8 degrees after ovulation -Abstain from sexual activity for 5 days before AND after temperature rise Calendar Method -Assumes that ovulation occurs during the midpoint of the cycle Withdrawal (coitus interruptus) -Removing the penis from the vagina just prior to ejaculation -Highly unreliable, offers no protection against STIs; Only about 78% effective

INITIATION OF LABOR -What does the placenta produce? -Cervical distention activates:

-Fetal oxytocin causes placenta to produce prostaglandins which thins and softens cervix and initiates contractions; Oxytocin makes them more frequent/ vigorous -Increasing cervical distension activates the hypothalamus, causing oxytocin release from posterior pituitary; More oxytocin release causes greater contractile force, leading to greater distension of cervix, causing release of more oxytocin (positive feedback loop)

REGULATION OF URINE CONCENTRATION AND VOLUME Kidneys maintain constant BODY FLUID osmotic concentration ~300 mOsm to prevent brain and other cell from shrinking or swelling by varying the volume and concentration of urine -Dilute urine and concentrated urine = -Where is concentrated urine produced? It is dependent on: and accomplished with:

-Dilute urine if overhydrated or BP is high; Concentrated urine if dehydrated or BP is low -Concentrated urine is produced in JM nephrons; Concentrated urine is dependent on hormones ADH and Aldosterone; Accomplished with countercurrent mechanisms in nephron loop

REFLEXIVE MICTURITION IN INFANTS -What triggers the micturition reflex? -What are the steps? -Does it occur voluntarily or involuntarily?

-Distension of bladder activates stretch receptors which triggers the micturition reflex -Steps: 1. Distension stimulates parasympathetic neurons in reflex center in sacral region of spinal cord 2. This inhibits sympathetic neurons 3. Next is the contraction of detrusor muscle which surrounds the bladder 4. Then the internal sphincter relaxes causing urine to exit the bladder into urethra 5. Inhibition of somatic pathways causes relaxation and opening of external sphincter -In infants, voiding occurs involuntarily (as a reflex)

OOGENESIS AFTER PUBERTY -How many ooctyes are activated each month? -What do the selected oocytes become? -After meiosis I is completed, what is produced? -What happens to secondary ooctye in metaphase II?

-Each month, a few primary oocytes are activated -One oocyte is "selected" to become dominant follicle that resumes meiosis I -After meiosis I is completed, two haploid cells of different sizes are produced: 1. Secondary oocyte: Large cell with almost all of mother cell cytoplasm and organelles-becomes the ovulated ovum 2. 1st polar body- may or may not divide, then degenerates; Other maturing cells undergo apoptosis -Secondary oocyte arrests in Metaphase II then is ovulated; If not penetrated by sperm, it deteriorates and triggers menses; If it is penetrated by sperm, second oocyte completes meiosis II, yielding: Ovum (Large functional gamete) and Second polar body

ANATOMICAL CHANGES IN THE PREGNANT MOTHER -What happens to reproductive organs in early pregnancy? -What is Chadwick's sign? -What happens to breasts? -What happens to skin? -What happens to uterus? -Why does lordosis occur? -What does relaxin cause? -What weight gain is seen? -What do multivitamins do?

-Early in pregnancy, reproductive organs become engorged with blood because of increased blood flow -Chadwick's sign: vagina develops purplish hue -Breasts enlarge, and areolae darken -Pigmentation of facial skin may increase (chloasma) -Uterus expands and fills abdominal cavity, causing ribs to flare, and to thorax widen -Lordosis occurs with change in center of gravity -Hormone relaxin causes pelvic ligaments and pubic symphysis to relax to ease birth passage -Weight gain of ~13 kg (28 lb) is usually seen >25-35 pounds recommended >300 additional daily calories are required -Multivitamins with folic acid reduce maternal anemia and fetal risk of neurological problems, such as spina bifida, anencephaly, and spontaneous preterm birth

ELECTROLYTE BALANCE -Electrolytes include: -Mineral salts are needed for: -How do salts enter/leave body? -What is most abundant/powerful cation in ECF? -What is the most abundant cation in ICF?

-Electrolytes include: minerals, acids, bases, and proteins -Mineral salts are needed for muscle contraction and nerve conduction -Salts enter body by ingestion and metabolism and are lost via perspiration, feces, urine, vomit -Sodium is most abundant and powerful cation in ECF >it exerts significant osmotic pressure because water follows salt >Changes in Na+ affects plasma volume and BP -Potassium is the most abundant cation in the ICF

GASTRULATION: GERM LAYER FORMATION (WEEK 3) -Embryonic disc transforms into: 3 Layers: 1. Endoderm 2. Mesoderm 3. Ectoderm

-Embryonic disc transforms into 3-layered embryo with three primary germ layers present: 1. Endoderm: epithelial linings of digestive, respiratory, and urogenital systems and associated glands 2. Mesoderm: >Notochord becomes vertebral column >Heart, blood vessels, bones, muscles, kidneys, gonads, connective tissue 3. Ectoderm: Nervous system and epidermis

ERECTION -What is it? -How are arterioles? -What enhances blood flow? -What triggers the PNS? -Induced or inhibited by? -How are the muscles in a penis? -What prevents kinking of erect penis? -Erection is a rare example of:

-Erection: penile engorgement and stiffening of penis -Penile arterioles are normally constricted -Sexual excitement/stimuli enhances blood flow -Touch, mechanical stimulation of penis, erotic sights, sounds, and smells triggers the Parasympathetic Nervous System to: >Stimulate Bulbourethral glands to secrete lubricating fluid >Release Nitric oxide (NO): this relaxes local vascular smooth muscles, penile arterioles dilate, corpora cavernosa expands and compresses drainage veins, therefore erectile tissues engorge with blood and enlargement and stiffen the penis -Induced or inhibited by emotions or higher mental activity -There are no muscles in a penis -Longitudinal and circular collagen fibers around penis prevent kinking of erect penis -Erection is a rare example of PNS control of arteries (pudendal, branch of internal iliac) and vagus nerve (CN X)

FAT SOLUBLE SOLUTES Fat soluble substances are processed differently than electrolytes, amino acids and glucose -Examples: -How are lipid-soluble drugs and environmental pollutants processed? -What about fat soluble vitamins and toxins?

-Ex: Fat soluble vitamins (A, D, E and K), heavy metals, pesticides, PCBs, preservatives, food additives, prescriptions, pollutants, anti-anxiety and anti-depressants -Lipid-soluble drugs and environmental pollutants are passively reabsorbed -Makes fat soluble vitamins and toxins difficult to excrete

PREGNANCY VOCABULARY -Define fertilization -Define pregnancy -Define conceptus -Define gestation period -Define zygote -Define morula -Define blastocyst -Define tropoblast -Define embryo -Define fetus -Define infant

-Fertilization: sperm's chromosomes combine with those of secondary oocyte (two haploid) to form fertilized egg -Pregnancy: events from fertilization until parturition (birth) -Conceptus: Developing offspring -Gestation period: Time from last menstrual period (not ovulation) until parturition (~40 weeks / 280 days) -Zygote: fertilized egg -Morula: Solid cluster of 16 cells; 72 hours (3 days) after fertilization -Blastocyst: Hollow cluster of 100 cells; 4-5 days after fertilization until implantation into uterus; implants into endometrium -Tropoblast: Cells start to differentiate into tissues -Embryo: Conceptus from fertilization through week 8 -Fetus: Conceptus from week 9 through parturition -Infant: Baby, after birth through 1st birthday

CONCEPTION TO DELIVERY -Period of fetal growth is a time of rapid and dramatic growth. How big does fetus grow?

-Fetus grows to 360 mm (14 inches) and 3.2 kg (7 lbs+)

GLOMERULAR FILTRATE VS URINE -Filtrate contains: -Urine contains: -What chances the amounts of solute to create urine?

-Filtrate contains high amounts of glucose/proteins and low concentrations of urea and uric acid -Urine contains no glucose/proteins and has a high concentration of urea -Tubular reabsorption via pertibular capillaries or vasa recta changes the amounts of solute to create urine

DEVELOPMENT OF FETAL HEART CIRCULATION -Where do first blood cells arise? -What happens by end of week 3? -How many arteries/veins? >function -3 fetal vascular shunts occluded at birth: 1. 2. 3.

-First blood cells arise in yolk sac -By end of week 3, embryo has system of paired vessels, 2 vessels forming heart have fused and bent into "S" shape and heart beats by 3½ weeks -2 Umbilical arteries (deoxygenated) and 1 umbilical vein (oxygenated) >umbilical arteries drain to placenta for gas exchange then to umbilican vein to liver -3 Fetal vascular shunts; occluded at birth include: 1. Ductus venosus: Umbilical vein bypasses liver via ductus venosus which empties into IVC 2. Foramen ovale: opening in interatrial septum bypasses fetal lungs (pulmonary circulation); Allows oxygenated blood to go to fetal brain 1st 3. Ductus arteriosus: bypasses fetal lungs; pulmonary trunk drains into ductus arteriosus, which drains into aorta and eventually to umbilical arteries

4 EXTRAEMBRYONIC MEMBRANES -When do they form? 1. Amnion: -What is it? -Aka: -Functions: -Where does amniotic fluid come from? 2. Yolk sac: -What is it? -Forms part of: -Source of: 3. Allantois: -What is it? -Structural base for: -Becomes part of: 4. Chorion: -Helps form: -Encloses what?

-Form during first 2-3 weeks. Include: 1. Amnion: -Transparent sac filled with amniotic fluid that envelopes embryo -Also called "bag of waters" -Provides protective buoyant environment, helps maintain homeostatic temperature, allows freedom of movement and prevents parts from fusing together -Initially, amniotic fluid comes from maternal blood; later, fetal urine contributes to volume 2. Yolk sac: -Sac that hangs from ventral surface of embryo -Forms part of digestive tube -Source of earliest blood cells and blood vessels 3. Allantois: -Small pocket at caudal end of yolk sac -Structural base for umbilical cord -Becomes part of urinary bladder 4. Chorion: -Helps form placenta -Encloses embryonic body and all other membranes (outermost membrane)

GLOMERULAR FILTRATION RATE (GFR) -GFR = -Adequate filtration of waste as long as GFR > ____; kidney disease =; kidney failure = -High when: -Low when: -GFR functions in: >increased GFR: >Decreased GFR: -What happens to kidney function as we age?

-GFR = measure of kidney function; rate of filtrate (volume) formed per minute by both kidneys (normal = 90-125 ml/min) -Adequate filtration of waste as long as GFR > 60; kidney disease is less than 60; can function up to 15; kidney failure is less than 15 -High when glomerular filtration pressure is high -Low when glomerular filtration is low -GFR functions in negative feedback loop with systemic BP >Increased GFR: Increases volume of filtrate produced; Increases urine output, but blood volume decreases and BP decreases >Decreased GFR: Lower filtrate volume produced; Low urine volume but higher volume of blood and BP increases -Kidneys shrink and nephrons decrease in number; by age 80, function is reduced 50%; kidney function gradually decreases with age

GENETICS VOCABULARY -Define gamete: >contains: -Define allele: >forms: -Define homologous chromosomes: -Define diploid: >how many chromosomes do somatic cells have? -Define haploid: >how many chromosomes do sex cells have? >how is the chromosomes of the baby? >when 2 haploid gametes join, what do you get? -Define sister chromatid: -Define synapsis: -Define crossing over:

-Gamete: Sex or germ cell (Egg or sperm) >Contains one member of each homologous chromosome (One from each parent) -Allele: Alternate forms of a gene, responsible for genetic variation. >Dominant and recessive forms -Homologous chromosomes: Similar but not identical; Same genes in the same order, but the alleles for each trait may not be the same; maternal and paternal chromosome pair up -Diploid (2n): Having 2 sets of chromosomes (1 homologous chromosome from each parent) >All human somatic cells = 46 chromosomes -Haploid (n): Having 1 set of chromosomes, from only 1 parent >All human sex cells = 23 chromosomes >1 23 chromosome egg + 1 23 chromosome sperm= 1 46 chromosome baby >when 2 haploid gametes join, you get a diploid zygote baby -Sister Chromatid: One half of the duplicated identical chromosomes joined at the centromere -Synapsis: Homologous chromatids seek out the other pair from the other parent and snap together into TETRADS -Crossing Over: During SYNAPSIS, legs of chromosomes wrap around each other creating a chiasma where DNA is swapped

EMBRYONIC ENDODERMAL DEVELOPMENT Organogenesis -What sets the stage for organogenesis? -How long is embryo at week 8? -Specialization of the endoderm:

-Gastrulation sets stage for organogenesis, formation of body organs and systems -At week 8, embryo is ~22 m (1 inch) long from crown to rump and all organ systems are recognizable -Specialization of the endoderm: >Primitive gut forms epithelial lining of GI tract >Organs of GI tract become apparent, and oral and anal openings perforate >Mucosal lining of respiratory tract forms from pharyngeal endoderm (foregut) >Glands arise further along tract

UTERUS -What type of organ is it? -Regions: 1. 2. 3. -Function: -How much can it expand: -Position of uterus: -Has 3 layers 1. Perimetrium: 2. Myometrium 3. Endometrium

-Hollow, thick-walled, muscular organ -Regions of uterus: 1. Body: major portion 2. Fundus: rounded superior region 3. Cervix: narrow neck, or outlet; projects into vagina >Cervical glands: secrete mucus that blocks sperm entry except mid-cycle -Receives, retains, and nourishes fertilized ovum -Can expand 500x its non-pregnant size -Position of uterus: >Anteverted: inclined forward (normal position) >Retroverted: inclined backward -Has 3 layers: 1. Perimetrium: outermost serous layer; visceral peritoneum over uterus 2. Myometrium: -Middle layer of smooth muscle -Contracts rhythmically during childbirth 3. Endometrium: mucosal lining -Simple columnar epithelium -Fertilized egg burrows in and resides here -Stratum functionalis (functional layer) >Changes in response to ovarian hormone cycles >Shed during menstruation -Stratum basalis (basal layer) >Forms new stratum functionalis after menstruation >Unresponsive to ovarian hormones

WHEN CHOOSING A METHOD OF CONTRACEPTION, ASK...

-How comfortable would I be using a particular method? -Will this method be convenient for me and my partner? -Am I at risk for the transmission of STIs? -Do I want to have a biological child in the future? -How would an unplanned pregnancy affect my life? -What are my religious and moral values? -How much will the birth control method cost? -Do I have any health factors that could limit my choice? -Are there any additional benefits I'd like to get from my contraceptive?

DEPO-PROVERA -What is it? -Effectiveness to prevent pregnancy? -Advantages: -Disadvantages:

-IM Shot of long-acting synthetic progesterone that lasts 3 months -Effectiveness to prevent pregnancy: 99.7% effective perfect use -Advantages: >Menstrual periods become lighter and after 1 year, 50% of women stop bleeding >No estrogen-related health risks >Same potential health benefits as progestin-only pills -Disadvantages: Common side effects include dizziness, nervousness, headache, and some loss of bone density

REGULATION OF POTASSIUM BALANCE -Important for: >Hypokalemia leads to: >Hyperkalemia leads to: -What stimulates K+ secretion? -K+ is also part of: -ECF K+ levels rise with ___ and fall with _____ -What are good sources of potassium?

-Important for electrical conduction in neurons and muscle cells. Can lead to sudden death >Hypokalemia leads to heart arrhythmia, muscle cramps and fatigue >Hyperkalemia leads to slow heart rate and weak pulse -Aldosterone stimulates K+ secretion in exchange for Na+ reabsorption >Kidneys have limited ability to retain K+; may lead to deficiency if not replaced in diet -K+ is also part of body's buffer system -ECF K+ levels rise with acidosis/fall with alkalosis -Most fruits and vegetables are good sources of calcium

URINARY INCONTINENCE -In adults, usually caused by: -Stress incontinence: -Overflow incontinence:

-In adults, usually caused by weakened pelvic muscles -Stress incontinence: Increased intra-abdominal pressure forces urine through external sphincter; caused by laughing, coughing, or sneezing -Overflow incontinence: urine dribbles when bladder overfills

DEVELOPMENTAL ASPECTS OF FLUID, ELECTROLYTE AND ACID-BASE BALANCE? -Who have proportionately more ECF? -Problems with fluid, electrolyte and acid-base balance are most common in infancy reflecting: -In first month of life, what do we risk: -What arises at puberty? -What happens to total body water in old age? -What happens to homeostatic mechanisms in old age? -The elderly may be unresponsive to ____ which puts them at a risk for:

-Infants have proportionately more ECF than adults until about 2 years of age -Problems with fluid, electrolyte, and acid-base balance are most common in infancy, reflecting: >Low residual lung volume >High rate of fluid intake and output >High metabolic rate, yielding more metabolic wastes >High rate of insensible water loss >Inefficiency of kidneys, especially during first month -In first month of life, risk dehydration and acidosis -At puberty, sexual differences in body water content arise as males develop greater muscle mass. Muscle has more water than adipose -In old age, total body water often decreases -Homeostatic mechanisms slow down with age -Elderly may be unresponsive to thirst cues, which puts them at risk for dehydration; congestive heart failure and diabetes mellitus may cause fluid, electrolyte, or acid-base problems

URINARY TRACT INFECTIONS -What is it? -What increases susceptibility in women? -Caused by: -Most UTIs occur in: -What can magnify the problem? -What can also inflame the urinary tract? -What % of women get UTIs? -Symptoms: -Treatment: -Define Urethritis: -Define Cystitis: -Define pyelitis or pyelonephritis: inflammation of kidneys -What may cause long-term renal damage?

-Inflammation of urethra, bladder or kidney -Short urethra of females increases susceptibility; Allows fecal bacteria to easily enter urethra -Caused by: Improper hygiene such as wiping back to front after defecation; E. coli bacteria account for 80% of all UTIs -Most UTIs occur in sexually active women; Intercourse drives bacteria from vagina and external genital region toward bladder -Baths, spermicides, dehydration, type of underwear, etc can magnify problem -STIs can also inflame urinary tract -40% of women get urinary tract infections -Symptoms: Dysuria (painful urination), urinary urgency and frequency, fever, cloudy or blood-tinged urine, back pain when kidneys are involved -Treatment: antibiotics can cure most UTIs -Urethritis: inflammation of urethra -Cystitis: inflammation of bladder -Pyelitis or pyelonephritis: inflammation of kidneys -Untreated childhood streptococcal infections may cause long-term renal damage

Cell Life Cycle -Cell growth = -M Phase =

-Interphase (G1, S - synthesis/duplication, G2) = Cell growth -M Phase = Reproduction (when mitosis and meiosis occur) >Prophase >Metaphase >Anaphase >Telephase

BREAST CANCER -Statistics: -Usually arises from: -Risk factors: -Diagnosis: -Treatment:

-Invasive breast cancer is the most common cancer and 2nd most common cause of cancer death in U.S. women; 13% of women will develop condition -Usually arises from epithelial cells of smallest ducts that eventually metastasize -Risk factors (however, 70% of women with breast cancer have no known risk factors): >Early onset of menstruation and late menopause >No pregnancies or first pregnancy after 30 >No or short periods of breast feeding >Family history of breast cancer >Obesity >10% due to hereditary defects, including mutations to genes BRCA1 and BRCA2 (50% to 80% of women with these genes develop breast cancer; Have a greater risk of ovarian cancer as well) -Diagnosis: Early detection via self-examination and mammography, a type of X-ray examination American Cancer Society recommends screening every year for women age 40 +; Diagnostic MRIs recommended for high-risk women -Treatment: >Until 1970s, standard treatment was radical mastectomy that removes breast, with all underlying muscles, fascia, and associated lymph nodes >Lumpectomy: less invasive and excises only cancerous lump >Simple mastectomy: removes only breast tissue, sometimes some axillary lymph nodes >Some women opt for breast reconstruction >Stage 1 (< size of peanut) survival rate is nearly 100% if caught early

RENAL CALCULI -What is it? -Results in: -Caused by: -Treatment: -Prevention:

-Kidney stones in renal pelvis; Crystals of calcium, magnesium, or uric acid salts -Large stones block ureter, resulting in pressure and pain -Caused by: Chronic bacterial infections, urine retention, increased Ca2+ in blood or increased pH of urine -Treatment: shock wave lithotripsy—noninvasive procedure involving shock waves to shatter calculi -Prevention: Drinking lots of water and eating balanced diet

RENAL COMPENSATION FOR RESPIRATORY PH IMBALANCE -Kidneys compensate for lungs by: -In respiratory acidosis: >Kidneys reabsorb: >respiratory acidosis with renal compensation is indicated by: -In respiratory alkalosis: >Kidneys excrete: >respiratory alkalosis with renal compensation is indicated by:

-Kidneys compensate for lungs by adjusting bicarbonate levels -In respiratory acidosis: >Kidneys reabsorb more HCO3-, create new HCO3-, and secrete more H+ >Respiratory acidosis with renal compensation is indicated by low pH, high PCO2 (cause of acidosis) and HCO3- levels (compensation by kidneys) -In respiratory alkalosis: >Kidneys excrete more HCO3- >Respiratory alkalosis with renal compensation is indicated by high pH, low PCO2, and low HCO3-

RENAL BLOOD AND NERVOUS SUPPLY -How is blood supply to kidneys? -Renal arteries deliver: -Arterial flow: -Venous flow: -What adjusts blood flow? -How is blood flow during flight/fight?

-Kidneys have rich blood supply -Renal arteries deliver about ¼ of cardiac output (1200 /ml/ min) to kidneys -Arterial flow (red): renal -> segmental -> interlobar -> arcuate -> cortical radiate (interlobular) -> nephron -> -Venous flow (blue): cortical radiate -> arcuate -> interlobar -> renal veins >No segmental veins -SNS adjusts diameter of renal arteries to regulate blood flow -Renal blood flow is reduced during fight or flight response

PARTURITION (BIRTH) -Define labor: -Who determines birth date? -How is mother's estrogen during last few weeks of pregnancy? -What hormones stimulates the placenta? -What effects does estrogen have?

-Labor: series of events that expel infant from uterus -Fetus determines own birth date -During last few weeks of pregnancy, estrogens reach their highest level in mother's blood -Fetal secretion of cortisol stimulates placenta to secrete more estrogen; cortisol starts labor -Increased estrogen has 3 effects: 1. Stimulation of oxytocin receptors by myometrium 2. Formation of gap junctions between uterine smooth muscle cells 3. Antagonizes calming effects of progesterone, leading to Braxton Hicks contractions in uterus (aka called false labor)

URINE -What is it? -Expelled by; flows through; stored in: -Contains: -Abnormal components: -Chemical composition: -What may indicate pathology? -Color and transparency: >gets pigment from: >when does the color deepen? >what is an abnormal color? can be caused by? -Odor: >when does it develop ammonia odor? >odor may be altered by? -PH: >when does it have low PH? >when does it have increased PH? -Specific gravity: >ranges from ____ b/c:

-Liquid by product of metabolism -Expelled from the kidneys; Flows through the ureters and stored in the urinary bladder until excretion -Contains water, salt, nitrogen and urea -Abnormal components: Blood, protein/albumin, glucose, WBCs, ketones and bile pigments -Chemical composition: 95% water and 5% solutes; Nitrogenous wastes: Urea (from amino acid breakdown; helps form the medullary gradient) is the largest solute component, Uric acid (from nucleic acid metabolism) and Creatinine (metabolite of creatine phosphate); Other normal solutes found in urine are Na+, K+, Ca2+, Mg2+ and HCO3- -Abnormally high concentrations of any constituent, or abnormal components such as blood proteins, WBCs, and bile pigments may indicate pathology -Color and transparency: Clear, pale to deep yellow from urochrome (pigment from hemoglobin breakdown) >Yellow color deepens with increased concentration >Abnormal colors are pink, brown and smoky; this can be caused by food, bile pigments, blood or drugs -Odor: Slightly aromatic when fresh >Develops ammonia odor upon standing as bacteria metabolize urea >May be altered by some disease, drugs or vegetables -pH: Urine is slightly acidic (~pH 6, with range of 4.5 to 8.0) >Low pH with acidic diet (protein, whole wheat) >Increased pH with: alkaline diet (vegetarian), prolonged vomiting or UTI -Specific gravity: how concentrated your urine is; Ratio of mass of substance to mass of equal volume of water (specific gravity of water = 1) >Ranges from 1.001 to 1.035 because urine is made up of water and solutes

ACCESSORY GLAND: SEMINAL VESICLE -Located on: -What type of tissue? -Produces: >what type of fluids: >what color under UV? >what volume of semen? -Duct of seminal gland joins:

-Located on posterior bladder surface -Smooth muscle that contracts during 2nd phase of ejaculation, after sperm -Produces viscous alkaline seminal fluid >Fructose, citric acid, coagulating enzyme (vesiculase), and prostaglandins, spermicide >Yellow pigment fluoresces under UV >Comprises 70% volume of semen -Duct of seminal gland joins ductus deferens to form ejaculatory duct

RESPIRATORY COMPENSATION FOR METABOLIC PH IMBALANCE -Lungs compensate by: -In metabolic acidosis: >High H+ levels stimulate: >metabolic acidosis with respiratory compensation is indicated by: -In metabolic alkalosis: >what lowers PH? >metabolic alkalosis with respiratory compensation is indicated by:

-Lungs compensate by changing respiratory rate/depth -In metabolic acidosis: >High H+ levels stimulate respiratory centers to increase respiratory rate and depth >Metabolic acidosis with respiratory compensation is indicated by blood pH <7.35, HCO3-<22 mEq/L and PCO2 <35 mm Hg as lungs blow off more CO2 -In metabolic alkalosis: >Slow, shallow breathing allows CO2 to accumulate in blood, lowering pH >Metabolic alkalosis with respiratory compensation is indicated by pH >7.45, elevated HCO3- levels, and a PCO2 >45 mm Hg as lungs try to build up H+ levels

PENIS -What type of organ? -Consists of: 1. 2. 3. 4. -What is a circumcision? >how many males are circumcised? >reduces what risk? -Internally, 3 cylindrical bodies of: >made of what tissue? -Corpus Spongiosum: >surrounds: >expands to: -Corpora cavernosa: >what is a crura? -What is an erection?

-Male copulatory organ -Consists of: 1. Root 2. Shaft 3. GLANS PENIS 4. PREPUCE (foreskin): cuff of loose skin covering glans -CIRCUMCISION: surgical removal of foreskin >60% of males in U.S. circumcised; 15% worldwide >Studies show 60% reduction in HIV risk and significant reduced risk for other reproductive infections -Internally, 3 cylindrical bodies of erectile tissue >CT and smooth muscle with vascular spaces -Corpus spongiosum (1): >surrounds urethra >expands to form glans and bulb -Corpora cavernosa (2): paired dorsal erectile bodies; makes up most of the penis >Crura: anchors penis to pubic arch -Erection: arousal enhances blood flow; erectile tissue fills with blood; penis enlarges; become rigid

SPERMATOGENOSIS VS OOGENESIS (BEFORE PUBERTY) -Male stem cells are called: >how do they divide? >what do daughter cells become? -Female stem cells are called: >how do they divide? >how many are produced? >how long are they stalled? >how many remain at puberty?

-Male stem cells are called Spermatogonia >Divide continuously by mitosis from the fetal period until puberty >All daughter cells become spermatogonia until puberty -Female stem cells are called oogonia >Divide continuously by mitosis during the fetal period >Before birth a female has produced 1 million primary oocytes >Primary oocytes stall in Prophase 1 until puberty >At the beginning of puberty about 300,000 primary oocytes remain

DIFFERENCES IN SEXUAL RESPONSE: MALE VS FEMALE -Who has shorter time to reach orgasm? -Ejaculation often accompanies: -Women are capable of: -Men require a: -How is the erection of phenomenon?

-Men usually have shorten time to reach orgasm -Ejaculation often accompanies orgasm in men but only occasionally in women -Women are capable of multiple orgasms without a refractory period -Men require a refractory period; This may be minutes or days depending on age, health and length of time since last ejaculation -In both men and women, erection is a secondary phenomenon of REM sleep- not sexual in origin

MICTURITION IN ADULTS -What is it? -What allows override of reflexive urination? -What provides conscious awareness of bladder fullness? -What maintains tone of internal urethral sphincter? -In order to urinate, 3 simultaneous events must occur: 1. 2. 3. -What is under somatic control?

-Micturition: Emptying the bladder; Also called urination or voiding -In adults maturation of the pons and descending brain circuits allows override of reflexive urination -When the bladder stretches, the pons and higher brain centers provide conscious awareness of bladder fullness -Sympathetic nervous system maintains tone (contraction) of the internal urethral sphincter -In order to urinate, 3 simultaneous events must occur: 1. Involuntary contraction of detrusor by ANS (Smooth muscle in bladder wall) 2. Involuntary relaxing of internal urethral sphincter (Smooth muscle stimulated by ANS) 3. Voluntary relaxing of external urethral sphincter (skeletal muscle; stimulated by somatic nervous system) -The external urethral sphincter is under somatic control and is consciously relaxed during micturition

ACCESSORY GLAND: BULBO-URETHRAL GLANDS -Located: -Function:

-Pea-sized glands inferior to prostate -Produce thick, clear mucus (pre-ejaculate) during sexual arousal- may contain sperm; This lubricates glans penis and neutralizes traces of acidic urine in urethra

SEMEN -What is it? -How much is in ejaculation? -What is in it? -How is the acidity? -Contains: 1. 2. 3. 4. 5.

-Milky-white mixture of sperm and accessory gland secretions -2-5 ml semen are ejaculated containing 20-150 million sperm/ml -Contains fructose for ATP production, protects and activates sperm, and facilitates sperm movement -Alkaline fluid-neutralizes acidity of male urethra and female vagina -Contains: 1. Prostaglandins: -Decreases viscosity of mucus in cervix -Stimulates reverse peristalsis (sucking in) in uterus -Can suppress female immune response 2. Relaxin (hormone) and other enzymes -Enhance sperm motility 3. Vesiculase -Clotting factors coagulate semen -Create vaginal "plug" and prevent draining out 4. ATP for energy 5. Antibiotic chemicals destroy some bacteria

SPERM TRANSPORT AND CAPACITATION -Millions of sperm are ejaculated but only a few make it to the cervix. Why? -How many sperm make it to the uterine tubes? -When are sperm able to penetrate an egg? -What is capacitation? >define >how long is it? >what happens? >what do sperm have?

-Millions of sperm are ejaculated, but only a few make it to the cervix because many are destroyed by acidic environments, many are phagocytized, many are unable to "swim" against the uterine current and are scattered, unable to reach the uterine tubes and -Only a couple thousand reach the uterine (fallopian) tubes -Fresh sperm are unable to penetrate the egg until they are capacitated -What is capacitation? >Physiological changes sperm must undergo in order to have the ability to penetrate and fertilize an egg >2 to 10 hour process >Vaginal secretions weaken acrosome cell membrane in order to release hydrolytic enzymes and thus motility is also enhanced >Sperm have olfactory receptors; They can find egg via chemotaxis; Sperm "sniff" their way to oocyte

TESTICULAR CANCER -Survival rate -Risk factors -Symptoms: -Treatments:

-Most common cancer of young men 15-35; 90% survival rate -Risk Factors: Upper SES, Caucasian, cigarettes, marijuana, muscle building supplements with androgens -Symptoms: painless, solid mass in testis or dull ache in abdomen or testis -Treatments: Surgery, radiation, chemo

DEVELOPMENTAL ASPECTS OF URINARY SYSTEM: -What happens when you get older?

-Most elderly people have abnormal kidneys histologically >Kidneys shrink >Nephrons decrease in size and number >Tubule cells become less efficient >By age 80, GFR is half that of young adult (possibly from atherosclerosis of renal arteries) >Bladder shrinks, and loss of bladder tone can cause nocturia (frequent trips to urinate at night) and incontinence

REABSOPRTION OF SODIUM AND WATER -What does movement of water create? In PCT -Dependent on: -What is always present? In DCT/CD: -Water reabsoprtion is based on? -What increases aquaporins? -What increases sodium reabsorption?

-Movement of Na+ creates osmotic gradient for water (water follows salt) In PCT -Obligatory water reabsorption is dependent on sodium -Aquaporins are always present DCT / CD -Facultative water reabsorption is fine tuned based on body needs and driven by hormones -ADH increases the number of aquaporins -Aldosterone increases sodium reabsorption

SEXUAL RESPONSE CYCLE -What is it? -Similar in: -Indistinguishable: -Involves: -How many stages?

-Multi-stage model of physiologic responses to sexual stimulation -Similar in men and women -Indistinguishable heter/homosexual and solo/partnered -Involves: >Vasocongestion: vasodilation and local increase in BP in erectile tissues >Myotonia: increasing muscle tension (after it releases, we have an orgasm) -3-5 stage depending on model; All include Desire, Arousal and Orgasm

URINARY BLADDER -What is it? -Where is it located? >males >females -Has openings for: -What is the trigone? What persists in this area? LAYERS OF THE URINARY BLADDER WALL 1. Mucosa: made of 2. Lamina Propria: made of 3. Muscular layer: -made of -layers of 4. Fibrous adventitia: made of ___ except on ____ where it is made of: URINE STORAGE CAPACITY -What happens when it is empty? -What happens during filling? -How is a moderately full bladder

-Muscular sac that stores urine -Retroperiotneal, on pelvic floor posterior to pubic symphysis >males: prostrate inferior to bladder neck >females: anterior to vagina and uterus -Has openings for ureters and urethra -Trigone: smooth triangular area between openings for ureters and urethra; infections tend to persist in this area LAYERS OF THE URINARY BLADDER WALL 1. Mucosa: transitional epithelial cells 2. Lamina propria: areolar CT 3. Muscular layer: -Thick detrusor muscle -3 layers of smooth muscle (Inner and outer longitudinal layers with circular middle layer) 4. Fibrous adventitia: Connective tissue exterior, except on superior surface where it is covered by peritoneum URINE STORAGE CAPACITY -Collapses when empty; rugae appear as it stretches -Expands and rises superiorly during filling without significant rise in internal pressure -A moderately full bladder is ~12 cm long (5 in) and can hold ~500 ML (1 pint) -The bladder can hold ~1 L if necessary but can burst if overdistended; Guinness World Record for longest pee is 8 1/2 minutes

NET FILTRATION PRESSURE (NFP) -What is it? >how should glomerular pressure be? -When NFP increases, so does: -When NFP increases, what decreases?

-NFP= difference of outward pressure of blood and inward pulling pressures >Glomerular pressure must be greater than colloid and capsular pressures combined -When NFP increases, so does: >GFR >Volume of filtrate formed >Solutes and water remaining in urine -When NFP increases filtrate reabsorption decreases -If the osmotic pressure in the glomerular capillaries increased from 28 mmHg to 35 mmHg due to dehydration, net filtration would decrease

LACTATION -What is it? -What are the benefits: -Barriers to breastfeeding:

-Nutrition for infants with many other benefits -Benefits: >Easy to digest; perfect blend of proteins >Protects infant from all diseases mother has been exposed to or vaccinated against >Improves IQ scores >Reduces infections of the ear, respiratory tract, digestive system, as wells as SIDS, allergies and childhood leukemia as well as obesity and diabetes >Helps mom's uterus contract and slows bleeding >Burns more calories than pregnancy >Reduces mom's risk of breast and ovarian cancers >Saves $1200-1500 compared to the cost of average formula -Barriers to breastfeeding: >Lack of knowledge of benefits >In the US, bottle feeding is viewed as the norm >Poor support from fathers, family and society >Confusion of breastfeeding as a sexual act >Public shaming and embarrassment >Employment and short maternity leave

CONCEPTION -Occurs when: -Requires: 1. 2. 3.

-Occurs when a viable ovum is fertilized by a viable sperm -Requires: 1. A viable egg (ovum) 2. A viable sperm 3. Access to the egg by the sperm

ERECTILE DYSFUNCTION -Occurs when: -Caused by: -Treatment:

-Occurs when parasympathetic nerves of penis don't release enough NO; Vessels can't dilate and engorge with blood -Caused by: >Vascular diseases (CVD, diabetes, HTN, peripheral artery disease) >Nervous system problems (stroke, injury or nerve damage due to chronic disease such as diabetes >Side effect of alcohol, drugs >Incompetent venous valves fail to retain blood in penis >Stress (if sympathetic nervous system is in overload, the parasympathetic system cannot work) -Treatment: >Vacuum pumps physically draw blood into penis >Drugs (Viagra, Cialis) potentiate existing NO effects

DEVELOPMENTAL ASPECTS OF REPRODUCTIVE SYSTEM Embryological and Fetal Events -How is genetic sex determined? >How many chromosomes are sex chromosomes? >What are female ovums? Males? >What happens if fertilizing sperm delivers an X chromosome? >What happens if fertilizing sperm delivers a Y chromosome? >What is a SRY gene? >Who determines sex of child? Sexual Differentiation -What is the sexually indifferent stage? -What do paramesonephric (Mullerian ducts) form? -When do gonads begin development? -Where do primoridal germ cells migrate to? -When do testes formation begins? -When do ovaries start to develop? Menopause: -When does it occur? -Declining estrogen levels may cause: -How long do males continue to produce sperm?

-Of 46 chromosomes in fertilized egg, two are sex chromosomes (the other 44 are autosomes); the X chromosome is large; the Y chromosome is quite small) >Females are XX: each ovum always has an X chromosome >Males are XY; so ~50% of sperm contain X chromosome, and ~50% contain Y chromosome >If fertilizing sperm delivers an X chromosome, fertilized egg will contain XX, and embryo will develop ovaries; X egg + X sperm = XX (female offspring) >If fertilizing sperm delivers a Y chromosome, fertilized egg will contain XY, and embryo will develop testes; X egg + Y sperm = XY (male offspring) >SRY gene is a master switch on Y chromosome that initiates testes development and maleness >Father determines sex of child Sexual Differentiation -Sexually indifferent stage: embryo could develop into male or female -Paramesonephric (Müllerian) ducts (future female ducts) form lateral to mesonephric (Wolffian) ducts (future male ducts) -Gonads begin development in week 5 -Primordial germ cells migrate to gonadal ridges to provide germ cells destined to become spermatogonia or oogonia -Testes formation begins in week 7 Ovaries start to develop in week 8 Menopause: -Has occurred when menses have ceased for 12 consecutive months -Declining estrogen levels may cause: Atrophy of reproductive organs and breasts, irritability and depression in some, hot flashes as skin blood vessels undergo intense vasodilation, gradual thinning of skin and bone loss and increased total blood cholesterol levels and falling HDL -Males continue to produce sperm well into eighth decade of life, though numbers and motility decrease

INITIATING RESPIRATION -What happens once CO2 is no longer removed by placenta? >What does this stimulate? >what does it require? >what assists the lung? -How is respiratory rate during first 2 weeks? >what do preemies usually require?

-Once CO2 is no longer removed by placenta, levels rise, causing central acidosis >Stimulates respiratory control centers to trigger first inspiration >Requires tremendous effort, as airways are tiny and lungs are collapsed >Surfactant in alveolar fluid reduces surface tension to assist inflation of alveoli -Respiratory rate is ~45 per minute first 2 weeks,then declines >Surfactant production occurs in last months of prenatal life, so preemies usually require respiratory assistance until lungs mature

OOGENESIS VOCABULARY -Define oogenesis -Define oogonia -What are primary oocytes? -What is a primordial follicle? -What is a secondary ooctye? -What is a corpus luteum?

-Oogenesis: Production of female gametes -Oogonia (2n ovarian stem cells) multiply by mitosis and store nutrients; Becomes Primary Oocyte before birth -Primary oocytes: Diploid, immature ovum/egg cell; Begins meiosis but stalls in Prophase I; Housed in ovarian follicles;contain tetrads -Primordial follicle: Dormant immature cell; turns into Primary follicle -Secondary oocyte: Develop from primary oocyte; Released at ovulation -Corpus luteum: Remains of ovarian follicle that has released a oocyte; Produces lots of progesterone, moderate levels of estrogen and inhibin; A new corpus luteum develops each month >The follicle produces the hormone estrogen, while the corpus luteum produces the hormones progesterone and estrogen >estrogen and progesterone are hormones that control the uterine cycle >the corpus luteum deteriorates into the corpus albicans

COUNTERCURRENT EXCHANGER -Opposes flow of: -Preserves: -Vasa recta capillaries surrounding the nephron loop in long JM nephrons: -Blood in vasa recta has the same concentration of: -Where is blood in vasa recta most concentrated?

-Opposes flow of blood in ascending and descending vasa recta -Preserves concentration gradient in the renal medulla -Vasa recta (capillaries) surrounding the nephron loop in long JM nephrons: >Maintain gradient in the medulla established by CC multiplier >Also have a countercurrent flow >Are highly permeable to water AND solutes >As blood moves inferiorly in vasa recta into medulla, water moves out of vasa by osmosis into concentrated interstitium >At same time salts in fluid diffuse down gradient into vasa recta -Blood in vasa recta has the same concentration of solute at the beginning and end of the loop, 300 mOsm, the same as plasma -Blood in vasa recta is most concentrated at the inferior part, 1200 mOsm

COUNTERCURRENT MULTIPLIER -Opposes flow of: -Have varying: -Why is it called the multiplier? -Filtrate is most concentrated where? -Dependent on 3 events: 1. 2. 3. -The more NaCl pumped out, the... -Ascending limb pumps out: -Difference in osmolality of interstititum is multiplied along: -If needed to concentrate urine, then

-Opposes flow of filtrate in ascending and descending nephron loops in Juxtamedullary nephrons; This positive feedback loop of movement of solutes and water in and out fo the loops creates a concentration gradient in the interstitium of the renal medulla and allows for the concentration of urine in the CD to be used in case of low BP or blood volume -Ascending and descending loops have varying permeabilities >Descending Loop is the "Concentrating Loop" so water moves OUT >Ascending Loop is the "Diluting Loop" so Sodium moves OUT of ascending loop and Urea moves IN -Called the multiplier because filtrate concentration is multipled (becomes more concentrated) as fluid moves down the descending limb -Filtrate is most concentrated at bottom of loop, 1200 mOsm; renal medulla is most concentrated deep in the medulla -Dependent on 3 events: 1. Filtrate flows in opposite directions in adjacent loops 2. Descending loop is freely permeable for H2O to move via osmosis from loop into hyperosmotic interstitium, but NOT permeable to solutes 3. Ascending limb of nephron loop is impermeable to H2O, but able to actively pump sodium out of loop into interstitium -The more NaCl pumped out of the ascending loop the more water diffuses out of the descending limb, and the saltier the descending loop filtrate becomes -Ascending limb pumps out salt to raise osmolality of medullary interstitium -Difference in osmolality of interstitium is "multiplied" along length of loop, from 300 in in cortex to 1200 mOsm in medulla -If needed to concentrate urine, ADH will insert aquaporins into the CD and use the concentration gradient to draw water out of DCT/CD

REABSORPTION IN PCT -PCT is major site of -In healthy state, PCT reabsorbs: -What does active NA+ reabsorption create?

-PCT is the main site of reabsorption -In a healthy state PCT reabsorbs: >99% of valuable nutrients (glucose, amino acids) so no nutrients are peed out >65% of sodium actively reabsorbed >65% of water passively via osmosis >50% Urea passively reabsorbed -Active Na+ reabsorption creates concentration gradient for passively reabsorbing almost every other substance (ie: Glucose and amino acids, electrolytes, calcium and other minerals)

STEP 1: GLOMERULAR FILTRATION -Active or passive? -What are the filters? -How is rate controlled? -GFR=

-Passive (No ATP required) -Glomeruli are mechanical filters -Rate controlled by pressure of blood in glomerulus (not directly by systemic BP) -GFR= glomerular filtration rate

CONTRACEPTIVE EFFECTIVENESS -Perfect use= -Typical use = -No method of birth control =

-Perfect Use= # of pregnancies likely to occur in the 1st year of use, if used without error 100% of time -Typical Use= # of pregnancies likely to occur during the first year of use with the normal number of errors, memory lapses and incorrect or incomplete use -No Method of Birth Control: Results in pregnancy 85% of the time over 1 year

PLACENTATION -Define placenta -Placentation is stimulated by: -When is placenta fully functional? -What does the placenta do? -What happens if placental hormones are inadequate? -What happens to levels of estrogen/progesterone? -What hormone does the placenta secrete?

-Placenta: temporary organ that originates from both embryonic and maternal tissues -Placentation stimulated by human chorionic gonadotropin (hCG) secreted by trophoblast cells and later chorion; HCG levels rise until end of month 2 when placenta begins to secrete progesterone and estrogen >Corpus luteum is maintained by hCG to prevent menstruation -Placenta not fully functional until end of month 3 -Provides nutritive, respiratory, excretory, and endocrine functions and separates maternal/ embryonic blood supply -If placental hormones are inadequate for any reason, pregnancy is aborted -Blood levels of estrogens and progesterone increase; This prepares mammary glands for lactation -Placenta secretes hormone relaxin which relaxes the ligaments in the pelvis and softens and widens the cervix

MATERNAL CHANGES IN METABOLISM -What does lactogen stimulate? -What does it reserve for fetus? -How to PTH levels stay?

-Placental hormone human placental lactogen (hPL) stimulates maturation of breasts, fetal growth, and glucose sparing in mother -Reserves glucose for fetus; may cause gestational diabetes mellitus -Parathyroid hormone and vitamin D levels stay high throughout pregnancy to enhance adequate calcium absorption for fetal bone mineralization; mom has to use her own calcium at her bone's expenses

BLOCKS TO POLYSPERMY -What is it? -How many sperm can enter one egg in humans? What about other species? -Once sperm is inside egg, what does egg release? >what happens after? >what happens if >1 sperm penetrates an egg?

-Polyspermy is the fertilization of an egg by multiple sperm -In humans only 1 sperm can enter the egg; Other species allow multiple sperm to penetrate egg (some birds, amphibians, fish and reptiles) -Once one sperm is in inside egg, egg's ER releases Ca+; This signals egg to proceed to Meiosis II >Afterwards, additional sperm receptors are destroyed (cortical reaction) >If > 1 sperm penetrates egg, excess genetic material usually triggers apoptosis

SPONGE -What is it? -Effectiveness to prevent pregnancy? -Not effective for: -How do you get it? -Advantages: -Disadvantages:

-Polyurethane foam, containing spermicide -Effectiveness to prevent pregnancy: >84% effective/typical use >91% effective perfect use -NOT Effective for safer sex -How do you get it: OTC -Advantages: >Convenient-no Rx, no fitting >Immediate protection and effective for 24 hours >Limited protection against some STIs -Disadvantages: >Less effective for women who have been pregnant >Messy >Risk of TSS when used during menstruation /left in >24hrs

FILTRATION MEMBRANE -What is it? -What does it allow to pass? -Where does the filtered fluid move? -What remains in blood? >maintains: >prevents: -Healthy urine should not contain ___; ____ in filtrate indicates:

-Porous membrane between glomerulus and capsule -Allows most small molecules to pass into PCT (Allows Water, glucose, electrolytes, urea, everything EXCEPT giant plasma proteins, WBC & RBC) -Fluid filtered moves into tubules, this fluid is pre-urine (called filtrate or tube fluid) -Plasma proteins REMAIN in blood >Maintain colloid osmotic pressure (draws water back into capillaries) >Prevents loss of all water to capsular space -Healthy urine should not contain protein/ blood; Protein in filtrate indicate membrane problem

PH -Stands for: -Measure: -Low PH = -High PH = -Why is PH closely rgulated? >what is altered by low PH? >what happens when metabolic processes are halted? >what systems are most affected by shifts in PH? -Normal PH of blood = -Alkalosis or alkalemia: PH = -Acidosis or acidemia: PH = -When does death occur?

-Power of hydrogen -Measures H+ ions in blood -Low pH= lots of H+ = acid -High pH= little H+ / lots of -OH = base -pH affects all proteins and biochemical reactions, so it's closely regulated by body >proteins are denatured and plasma membrane stability is altered by too low PH >enzymes have optimal PH for metabolic processes; when metabolic processes are halted for too long, death occurs >cardiovascular and nervous systems are most affected by shifts in PH -Normal pH of blood 7.35-7.45 -Alkalosis or alkalemia: arterial pH >7.45 -Acidosis or acidemia: arterial pH <7.35 -Death occurs when pH <7 or >8

FEMALE REPRODUCTIVE PHYSIOLOGY -Previously, scientists assumed what about females eggs? But new evidence suggests: -In general, how many eggs does a woman have and releases?

-Previously scientists assumed that females' total supply of eggs was determined at birth; However, new evidence suggests that stem cells can arise from epithelial cells at ovary surface; This may overturn previous assumption but still unsure what stimulates this event -In general a woman has 300,000 eggs at the beginning of puberty and releases about 500 in her lifetime; This 1-2 eggs per month x 40 years

KIDNEY DISEASE -Primary cause = -2ndary cause = -Uncontrolled high BP causes: -Damaged vessels cannot___ which causes:

-Primary cause = diabetes -2ndary cause = hypertension -Uncontrolled high BP over time causes renal arteries to narrow, weaken or harden -Damaged vessels cannot deliver adequate blood to kidneys which causes problems with fluid and acid/base balance and waste products back up into blood

OOGENESIS -Production of: -Oogenesis vs spermatogenesis: >what differs?

-Production of female gametes -Oogenesis vs Spermatogenesis: >Number of functional gametes differ; Oogenesis produces 1 viable ovum and 3 polar bodies; Unequal divisions ensure oocyte has ample nutrients for 6- to 7-day journey to uterus; Polar bodies degenerate and die >Spermatogenesis produces 4 equal viable sperm >Error rates differ; Spermatogenesis has an error rate of 3-4% while oogenesis has an error rate of 20%

BLOOD-TESTIS BARRIER -What forms this? -What does it prevent? -Why do sperm need to be kept separate? -Spermatids are pushed from ____, where they gain:

-Sustenocytes have tight junctions which form the blood-testis barrier -Prevents sperm antigens from escaping into blood or causing activation of immune system -Sperm is not formed until puberty; absent during immune system development; Thus sperm are not recognized as "self"; Therefore, sperm needs to be kept separated from rest of body to avoid being attacked by immune system -Spermatids are pushed from seminiferous tubules in testes into the epididymis, where they gain motility and fertilizing power

LACTATION -Production of: -What hormone is it stimulated by? -What releases this hormone? -What is initially released during lactation? -What type of feedback is it? -Advantages of breast milk for infant: >what is better absorbed? >includes unique beneficial chemicals such as:

-Production of milk by mammary glands -Toward end of pregnancy, hypothalamus is stimulated to release prolactin releasing hormone (PRH) by placental estrogens, progesterone and human placental lactogen -PRH stimulates anterior pituitary to release prolactin -Initially colostrum is released; 2-3 days later, true milk production begins -Positive feedback -Advantages of breast milk for infant: >Fats and iron are better absorbed and breast milk's amino acids are more easily metabolized compared with cow's milk >Unique, unreproducible, beneficial chemicals, including: •IgA, complement, lysozyme, interferon, and lactoperoxidase (protect infant from infections) •Interleukins and prostaglandins (prevent overzealous inflammatory responses) •Glycoprotein, which deters ulcer-causing bacterium (Helicobacter pylori) from attaching to stomach mucosa

EFFECTS OF ESTROGENS -Promotes: -Exerts anabolic effect on: -Supports: -Induces: -Has metabolic effects on:

-Promotes oogenesis and follicle growth in ovary -Exerts anabolic effects on female reproductive tract -Supports rapid short-lived growth spurts at puberty -Induces secondary sex characteristics >Growth of breasts (too much can cause breast cancer) >Increased deposit of subcutaneous fat (hips and breasts) >Widening and lightening of pelvis -Estrogen also has metabolic effects: >Maintains low total blood cholesterol and high HDL levels (protective of heart disease) >Facilitates calcium uptake >Acts like aldosterone and stimulates sodium reabsorption in the kidney which leads to pre-menstrual bloating

OCCLUSION OF FETAL BLOOD VESSELS AND SHUNTS -What persists as superior vesical arteries? -What do distal umbilical arteries become? -What does umbilical vein become? -What is ductus venosus converted to? -What do pressure changes cause? >What does foramen ovale become? >what does ductus arteriosus become?

-Proximal umbilical arteries persist as superior vesical arteries to bladder -Distal umbilical arteries become medial umbilical ligaments -Umbilical vein becomes round ligament of liver (ligamentum teres) -Ductus venosus is converted to ligamentum venosum -Pressure changes from infant breathing cause pulmonary shunts to close >Foramen ovale becomes fossa ovalis >Ductus arteriosus becomes ligamentum arteriosum

CONTRACEPTION -What is it? -Types?

-Purposely creating a barrier to prevent pregnancy through use of a device, substance or method -Types of Contraception/ Safer Sex: >Barrier devices (some barrier methods reduce the risk of STIs also) >Hormonal methods (prevent ovulation) >Intrauterine Devices >Behavioral methods >Surgical procedures

PYELITIS AND PYELONEPHRITIS -Define pyelitis -Define pyelonephritis >in females, usually caused by: >can cause >if left untreated, what may result? >how it is normally treated?

-Pyelitis: Infection of renal pelvis and calyces -Pyelonephritis: Inflammation of entire kidney >In females, usually caused by fecal bacteria entering urinary tract >Can cause swelling of kidney and pus formation >If left untreated, kidney damage may result >Normally is successfully treated with antibiotics

CLEAVAGE -What is it? -When does it occur? -First cleavage: -16+ cells = -When does 100 cell embryo reach uterus? -What is a blastocyst?

-Rapid mitotic divisions of zygote -Occurs while zygote moves toward uterus -First cleavage ~36 hours -After 72 hours, solid cluster of 16+ cells is referred to as a morula -Day 4 or 5, 100 cell embryo (blastocyst) reaches uterus -Blastocyst is hollow with outer rim of cells called trophoblast and an inner cell mass (embryo)

RENAL PTOSIS AND HYDRONEPHROSIS -What is it? -What happens? -Can cause?

-Rapid or extreme weight loss causes loss of protective fat capsule -1 or both kidneys may drop which can cause kink in ureter (ptosis) >Hydronephrosis •Urine backs up and kidney swells •Damages kidney tissue •Leads to tissue necrosis and renal failure

HYDATIDIFORM MOLAR PREGNANCY -Rare complication of pregnancy characterized by: -Caused by:

-Rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta. -Caused by an abnormally fertilized egg; Most often the embryo has 69 chromosomes instead of 46. This most often occurs when two sperm fertilize an egg (polyspermy), resulting in an extra copy of the father's genetic material.

NEPHRON PART 3: COLLECTING DUCT -Receive: -Run through: -Maintains: -What do its ducts do?

-Receive filtrate from many nephrons -Run through medullary pyramids (this gives pyramids their striped appearance) -Maintains body water, Na and acid-base balance -Ducts fuse together to deliver urine through papillae into minor calyces

UTERINE (FALLOPIAN) TUBES -Site of: -How long: -Extends from: -Regions of uterine tube: 1. 2. 3. >contains: -Oocyte is propelled toward uterus by: -What nourishes oocyte and sperm?

-Receive ovulated oocyte and are usual site of fertilization -~10 cm (4 in) long -Extends from ovary to uterus -Regions of uterine tube 1. Isthmus: constricted originating area 2. Ampulla: distal curving section 3. Infundibulum: distal expansion near ovary >Contains ciliated fimbriae that creates current to suck oocyte into uterine tube -Oocyte is propelled toward uterus by smooth muscle via peristalsis and ciliary action -Non-ciliated cells of tube nourish oocyte and sperm

JUXTAGLOMERULAR COMPLEX (JGC) -Region of: -Regulates: 3 types of cells in the JGC: 1. Macula densa -What is it? -If GFR increases then: 2. Granular cells -What are they? -What do they sense? -What do they secrete? 3. Mesangial cells -What do they do? -How do they control diameter? -Intra vs Extra = -Secretes

-Region of special cells surrounding the DCT, efferent and afferent arteries (1 JGC per nephron) -Regulates BP and rate of filtrate formation 3 cell types in JGC: 1. Macula densa: -Chemoreceptors that sense NaCl in filtrate in DCT (preurine) -If GFR increases, filtrate flow rate increases causing decreased reabsorption time and high NaCl levels in filtrate in nephron loop; This causes constriction of afferent arteriole, reduced flow, reduced GFR and more time for NaCl reabsorption; Opposite mechanism occurs for decreased GFR (afferent arteries dilate) -When the macula densa detects an increase in NaCl concentration in the renal filtrate, GFR decreases 2. Granular cells (juxtaglomerular, or JG cells) -Enlarged, smooth muscle cells of arterioles -Mechanoreceptors sense BP in afferent arteriole >if preurine is too salty, it will constrict and slow down flow -Secretes enzyme renin when pressure is too high (regulates GFR through renin-angiotensin mechanism) 3. Mesangial cells -Pass regulatory signals between MD and JG cells (communication cells) -Contract or relax to control capillary diameter -Intraglomerular cells = glomerular capillaries; extraglomerular cells = afferent arteries -Secretes EPO

FLUID MOVEMENT -Regulated by: -How is body fluid osmolality? -Change in solute concentration leads to: -High ECF osmolality = -Low ECF osmolality = -ECF exchanges beween plasma and tissues occur where: -Exchanges between IF and ICF occur where: >dependent on: >what have unidirectional flow?

-Regulated by osmotic and hydrostatic pressures -All body fluid osmolality is almost always equal -Any change in solute concentration leads to net water flow -High ECF osmolality causes water to leave the cell and dehydrates -Low ECF osmolality causes water to enter cell -ECF Exchanges between plasma and tissues (Interstitial fluid IF) occur across capillary walls >Fluid leaks from arteriolar end, reabsorbed at venule end >Lymphatics return excess fluid to IVC -Exchanges between IF and ICF occur across cell membrane >Two-way osmotic flow of water >Dependent on membrane permeability >Nutrients, wastes, gases have unidirectional flow

HORMONAL REGULATION OF MALE SEXUAL FUNCTION Hypothalamic-Pituitary Gonadal (HPG) Axis -Regulates: -Involves the following interacting hormones: Sequence of events: 1. 2. 3. 4. 5. 6. 7. -Amount of testosterone and sperm produced involved 3 interacting sets of hormones: 1. 2. 3. -Balances takes how long to achieve? -What happens without these hormones? -Before birth, male infant has how much testosterone? How much after birth?

-Regulates production of gametes and sex hormones -Involves interacting hormones: 1. Hypothalamus: GnRH 2. Anterior Pituitary: FSH, LH 3. Testes: testosterone 4. Testes, pituitary, placenta: inhibin (when testosterone is high, it suppresses GnRH and FSH) Sequence of events: 1. Hypothalamus releases gonadotropin-releasing hormone (GnRH) 2. GnRH binds to anterior pituitary gonadotropic cells, causing them to secrete: FSH: Follicle-stimulating hormone and LH: Lutenizing hormone 3. FSH stimulates sustentocytes to release androgen-binding protein (ABP); ABP keeps concentration of testosterone high near spermatogenic cells, promoting spermatogenesis 4. LH binds to Leydig cells which stimulates testosterone; Rising testosterone triggers spermatogenesis; LH also promotes bone development 5. Testosterone enters blood stimulating sex organ maturation, development/ maintenance of 20 sex characteristics and libido 6. Rising testosterone levels inhibit GnRH release from hypothalamus and inhibit FSH/LH release from pituitary gland 7. Inhibin is released by sustenocytes when sperm count rises; it inhibits GnRH and FSH release -Amount of testosterone and sperm produced involves 3 interacting sets of hormones 1. GnRH 2. Gonadotropins (LH and FSH) 3. Gonadal hormones (Testosterone and Inhibin) -Balance takes 3 years to achieve then its fairly stable throughout life -Without GnRH and gonadotropins, testes atrophy and sperm and testosterone production ceases -Before birth, male infant has testosterone levels 2/3 of adult (stimulates genitalia development); Soon after birth, levels recede and remain low through childhood until puberty

-Renal clearance = -Renal clearance determines: -Detects: -Monitors progress of: -Each substance has a: -What is used as a quick assessment?

-Renal clearance = volume of plasma kidneys can clear of a particular substance in a given time -Renal clearance determines GFR -Detects glomerular damage -Monitors progress of renal disease -Each substance or drug has a unique renal clearance value -We use creatinine clearance as a quick assessment

SCROTUM -What is it? -What temp does sperm prefer? -Contains: 1. Function 2. -Function 3. -Type of muscle -Function 4. -Type of muscle -Function

-Sac of skin and superficial fascia which hangs outside abdominopelvic cavity to maintain constant 95 F -Sperm prefer temp lower than core -Contains 1. Paired testes -Where sperm is born 2. Pampiniform venous plexus -Cools arterial blood before entering scrotum; absorbs heat from testes; in response to warm, the scrotum increases its surface area 3. Dartos muscle -Smooth muscle (involuntary) -Wrinkles scrotal skin and pulls scrotum close to body 4. Cremaster muscles: -Skeletal muscle (voluntary) -Elevates testes **Both dartos and cremaster muscles regulate the temp of testes

STEP 3: TUBULAR SECRETION (reabsorption in reverse) -What happens? -Important for:

-Selected substances are moved from peritubular capillaries into tubules -Important for: >Disposing of drugs or metabolites bound to plasma proteins that were too big to cross the glomerular filtration membrane into filtrate >Eliminating undesirable substances that were passively reabsorbed (urea/uric acid) >Ridding body of excess K+ (aldosterone effect) >Controlling blood pH by altering amounts of H+ or bicarbonate (HCO3- ) in urine

SEMINIFEROUS TUBULES AND EPIDIDYMIS OF THE TESTES -Septa divides what: >Site of: -Sperm moves from ____ to ____: >production line for: >stored in ____ until:

-Septa divides testes into ~250 lobules containing seminiferous tubules >Site of sperm production "sperm factories" -Sperm moves from seminiferous tubules to epididymis >site of sperm storage until ejaculation

DIAPHRAGM AND CERVICAL CAP -What is it? -Must use what in conjunction? -Diaphragm effectiveness to prevent pregnancy? -Cervical Cap effectiveness to prevent pregnancy? -Not effective for: -How do you get it? -Advantages: -Disadvantages:

-Shallow latex or silicone cup that fits over the cervix -Must use spermicide jelly or cream in conjunction -Diaphragm Effectiveness to prevent pregnancy: >-71% effective/typical use -up to 88% with spermicide >82% effective perfect use- up to 96% with spermicide -Cervical Cap Effectiveness to prevent pregnancy: >68% effective/typical use if woman has been pregnant >82% effective perfect use if woman has never been pregnant -NOT Effective for safer sex -How do you get it: Requires doctor's visit for sizing; it is an uncommon form of contraception -Advantages: >Protects against some STIs-Gonorrhea, possibly Chlamydia and HPV >Can be used for multiple acts >Can insert up to 6 hours prior, must be left in 6 to 8 hours after -Disadvantages: >Must be fitted by trained practitioner >Messy >Risk of TSS when used during menstruation or if left in >24hours

INTRAUTERINE DEVICES -What is it? -How long does it last? -Available since: -How does it prevent fertilization? -Effectiveness to prevent pregnancy? -Advantages: -Disadvantages:

-Small flexible metal or plastic uterine device -Last 5-10 years -Most common reversible contraceptive worldwide -Available in the modern world since 1909 -IUDs affect the way the sperm and the egg move, thereby preventing fertilization -Effectiveness to prevent pregnancy: 99.95% effective perfect use -Advantages: >Nothing to remember to take >Lightening or cessation of menstrual periods >No estrogen-related side effects >Safe for use by breast-feeding women >Menses often ceases after 6 months of use -Disadvantages: >More expensive than pill/patch/ring because a clinician must insert it >Not recommended for women with multiple partners

TUBULAR SECRETION IN PCT -Solutes move from: -Solutes include: > > > > -When body PH is too acidic what is secreted: -When body PH is too acidic, what is secreted?

-Solutes move from blood in peritubular capillaries through interstitium to PCT -Solutes include: >K+: Aldosterone effect causes K+ to enter DCT/CD in exchange for Na+ when BP is low >Ammonia, creatinine, organic acids >Drugs and toxins >Urea -When body pH is too basic, H+ is secreted in exchange for Na+ -When body pH is too acidic, -HCO3- is secreted

REVIEW -What is a solvent? >what is the universal solvent? -What are solutes? -What is a hypertonic solution? -What is an isotonic solutions? -What is a hypotonic solution? -What leads to water flow? Solutes can be classified as: -Nonelectrolytes: >how are the charged particles? >common nonelectrolytes? -Electrolytes: >results when: >how is the osmotic power? >common electrolytes:

-Solvent: the substance solutes are dissolved in (greatest volume) >Water is the universal solvent -Solutes are substances dissolved in water -Hypertonic: a solution which has more dissolved solutes or osmotic pressure than plasma or interstitial fluid (super salty/sugary) -Isotonic: a solution with the same concentration of solutes or osmotic pressure (ie: contact saline) -Hypotonic: a solution with fewer dissolved solutes or osmotic pressure than body fluids (usually water) -A change in solute concentration leads to net water flow Solutes can be classified as: -Nonelectrolytes: Do NOT dissociate in water >No charged particles are created >Most are organic molecules: glucose, lipids, creatinine, and urea -Electrolytes: >Result when salts/minerals dissociate in water into charged ions >Greater osmotic power than nonelectrolytes because salts dissolve into 2+ ions >Common electrolytes: Cations = + charge (Sodium, potassium, calcium, magnesium); Anions = - charge (Chloride, phosphorus)

SPERMATOGENOSIS VS OOGENESIS (BEFORE PUBERTY) -When does spermatogenesis begin? -Where does it occur? -After puberty each mitotic division results in 2 kinds of cells: 1. 2. -How long does it continue? -What % of sperm has chromosomal abnormalities? -When does oogenesis begin? -How many oocytes remain at puberty? -What happens to oocytes at puberty? -Secondary oocyte: >Suspends in: >If fertilization occurs, then: -What % of oocytes have a chromosomal abnormality?

-Spermatogenesis begins during puberty (average age 12) -Occurs in seminiferous tubules of the testes -After puberty each mitotic division results in 2 kinds of cells: 1. Type A remain spermatogonia; remain at basal lamina to continue the pool of diving germ cells 2. Type B become primary spermatocyte destined to produce sperm -Continues through life; Every day, healthy men make 200-400 million sperm -4% of sperm has chromosomal abnormalities -Oogenesis begins in the fetal stage, suspends, restarts and suspends again -At puberty ~ 300,000 primary oocytes exist and remain viable until menopause -At puberty, one primary oocyte is chosen each month to complete Meiosis I resulting in 2 haploid daughter cells >One large secondary oocyte and one tiny polar body Secondary oocyte: >Suspends in Metaphase II and is ovulated >If fertilization occurs, meiosis II completes resulting in a fertilized zygote and another polar body -~20% of oocytes have a chromosomal abnormality

SPERMATOGENESIS BEFORE PUBERTY -What are spermatogonia? -What are daughter cells? -What happens at puberty? -How many sperm do men make a day? -When does spermatogenesis begin?

-Spermatogonia are stem cells which divide by mitosis -All daughter cells are clones that duplicate and divide to make more stem cells -At puberty stems cells differentiate into EITHER spermatogonia or primary spermatocytes -Every day, healthy men make Millions of sperm -Begins around age 14 continues throughout life

BACTERIAL STIs -Spread by: Chlamydia -Most common bacterial STI -Can be contracted by: -Responsible for 25-50% of: -Spread by: -Best protection: -Symptoms: >what % of women have no symptoms >what happens if left untreated? -What can it cause in men? -Newborns picking bacteria up from birth canal can develop: -Treatment: Gonorrhea -Bacterial infection of: -Caused by: -Spread by: -Best protection: -Treatment: -How are the # of cases? -Signs and symptoms: >Males: >Females: •what % of females show no symptoms? •can result in? •what can it cause in infants? Syphilis -Bacterial infection of: -Caused by: -Spread by: >what can happen to infected fetuses? -Best protection: -Symptoms: >primary infection: >secondary signs: >latent period: >tertiary syphilis: >also causes: -Treatment: -How is the prevalence? -How is the prevalence of congenital syphilis? How many babies died of this?

-Spread by comingling of body fluids Chlamydia -Caused by Chlamydia trachomatis -Can be contracted from oral sex, vaginal sex, anal sex and via the birth canal -Responsible for 25-50% of all diagnosed cases of pelvic inflammatory disease -Best protection: Condoms/dental dams -Symptoms: urethritis; penile and vaginal discharges; abdominal, rectal, or testicular pain; painful intercourse; irregular menses >80% of women have no symptoms >If left untreated, leads to sterility -Can also cause arthritis and urinary tract infections in men -Newborns picking bacteria up from birth canal can develop: >Trachoma, a painful eye infection that can lead to corneal scarring >Respiratory tract inflammations, including pneumonia -Treatment: tetracycline Gonorrhea (aka the clap) -Bacterial infection of mucosae of reproductive and urinary tracts -Caused by Neisseria gonorrhoeae -Spread by contact with genital, anal, and pharyngeal mucosa and secretions -Best protection condoms and dental dams -Treatment: Antibiotics, but resistant strains are becoming prevalent -Number of cases in U.S. rising since 2010 -Signs and symptoms: >Males: Urethritis, painful urination, discharge of pus >Females: •Majority (70%) of females display no signs or symptoms •Abdominal discomfort, vaginal discharge, or abnormal uterine bleeding •Can result in pelvic inflammatory disease and sterility •Causes blindness in infants Syphilis -Bacterial infection of the mucosa and skin -Caused by: Treponema pallidum -Spread by: >Vaginal, anal, or oral sex or contact with sores >Bacteria invades mucosa or even broken skin >Infected fetuses can be stillborn or die shortly after birth >Poor hygiene and close living conditions -Best protection: Condoms and dental dams to prevent comingling of body fluids; Barriers to skin to skin and oral transmission -Symptoms: >Primary Infection is asymptomatic for 2-3 weeks and then painless chancre (sores) appear at site of infection then disappears within a few weeks >If untreated, secondary signs appear several weeks later (Pink skin rash, fever, and joint pain can develop; Appear for 3-12 weeks, then disappear) >Disease can enter latent period, which may or may not progress to tertiary syphilis >Tertiary syphilis is characterized by gummas, lesions that develop in CNS, blood vessels, bones, and skin >Also causes symptoms of nose collapse (saddle nose) and psychosis -Treatment: Penicillin in primary and secondary stages but can't undue damage of tertiary syphilis -Prevalence increased 40% from 2010 -Congenital syphilis is preventable with prenatal care but growing at rapid rates; In 2018 over 1000 babies in the US died of congenital syphilis

VIRAL STI -Spread by: Genital Herpes -Caused by: -Spread by: -Best protection: -Symptoms: -Treatment: HPV -Caused by: -Prevalence: -Spread by: -Best protection: -Treatment: >Vaccine available: Hepatitis B -Caused by: -Contracted by: >Hep A: >Hep B >Hep C: -Spread by: -Symptoms: -Treatment: >acute virus: >vaccine available: HIV/AIDS -Caused by: -Spread by: -Prevalance: -Best protection: -Symptoms: -Treatment:

-Spread by skin to skin or mucous membrane contact Genital Herpes -Caused by Herpes simplex virus -Spread by: >Kissing, saliva or sharing glass/utensil >Skin to skin contact >Mucous membrane secretions from oral, vaginal or anal sex >Can survive on moist towels, clothes >Congenital herpes can cause malformations -Best protection: condoms and dental dams but they are not fully protective because many sore are found outside of the area covered by condoms -Symptoms: >Flu like symptoms >Swollen glands >Fever blisters, cold sores or blisters on the genitals >Latent periods altering with flare-ups >Long term symptoms: nerve pain >People are symptomless during latent periods -Treatment: >Acyclovir and other antiviral drugs >Controls outbreaks but does not kill virus >Does not have a cure HPV -Caused by human papillomavirus (HPV) -Most common STI in United States >About 6.2 million new cases each year >80% of sexually active people have HPV >80% of cases of invasive cervical cancer are linked to some strains of HPV >Most HPV strains cause warts, not cancer -Spread by skin to skin or mucous membrane contact between genitals, mouth and throat -Best protection: Condoms and dental dams but they are not completely protective -Treatment: difficult and controversial; some physicians prefer to leave warts alone, and some prefer to remove with cryosurgery, laser, or alpha-interferon treatments >Vaccine available: Gardasil Hepatitis B -Caused by viral Inflammation of liver -Contracted by: >Hep A: usually fecal contaminated food or water; sometimes spread through sex or close contact /caring for someone with Hep A >Hep B: from blood, semen, vaginal fluids and saliva >Hep C: from blood, dirty needs and syringes -Spread by: >Saliva (toothbrushes) >Blood, semen, vaginal secretions, razors >Fecal - oral routes >Childbirth >Not spread by casual contact -Symptoms: >Fatigue and flu like symptoms >Loss of appetite >Jaundice >Dark urine >Latent periods altering with flare-ups -Treatment: >Acute virus runs its course; 10% become chronic >Vaccine available for Hep A and B; This is recommended for healthcare workers and sexually active adults who are not in monogamous relationships HIV/AIDS -Caused by virus which attacks immune system-CD4 cells -Spread by: >Direct contact with blood, semen, vaginal secretions >Childbirth/ Breastfeeding >Not spread by casual contact -Prevalance: >Increasing in women and heterosexual populations >20% of newly diagnosed cases were age 13-24; due to poor use of condoms and multiple sex partners >80% of HIV in women transmitted heterosexually >Only 1 in 5 people infected know they are infected -Best protection: Condoms and dental dams -Symptoms: >Fatigue and flu like symptoms >Swollen lymph nodes in neck or groin >Fever > 10 days >Night sweats >Unexplained weight loss -Treatment: >Anti-retroviral drugs and close monitoring >More of a chronic illness than death sentence (like diabetes)

PARASITIC STI -Spread by: Trichomoniasis -Caused by: -Spread by: -Best protection: -Symptoms: >symptom only show in ___% -Treatment: Scabies -Caused by: -Spread by: -Best protection: -Symptoms: -Treatment: Pubic Lice (Crabs) -Caused by: -Spread by: -Best protection: -Symptoms: -Treatment:

-Spread by skin to skin or mucous membrane contact Trichomoniasis -Caused by protozoan infection -Spread by oral, vaginal and anal sex sometimes via hands/fingers -Best protection: condoms and dental dams but these do not provide full protection -Symptoms: >Symptoms only in 30% of those infected >Yellow-green vaginal discharge with strong odor >Itching or burning in genitals, with urination or ejaculation >Penile discharge -Treatment: >Most easily and inexpensively treatable STI >Given oral antibiotic >All partners need to be treated and abstain from sex for 10 days Scabies -Caused by mite infections; mites burrow under the skin and lay eggs -Spread by: >Contact with infected skin, clothes, towels, bedding >Poor hygiene in crowded living condition -Best protection: avoid close contact with infected people and their clothes, towels or bedding -Symptoms: >Rash and intense itching; Usually in creases of skin -Treatment: Rx lotion or creams. Washing clothes, bedding and towels in hot water and hot dryer Pubic Lice (Crabs) -Caused by Louse infection -Spread by contact with infected skin, hair, clothes, towels or bedding -Best protection: avoid close contact with infected people and their clothes, towels or bedding -Symptoms: Itching in hair (head or pubic; occasionally in eyebrows and lashes) -Treatment: OTC gel and shampoos and washing clothes, bedding and towels in hot water and hot dryer

TESTOSTERONE -What is it? -In prostate, it is converted to? -In brain, bones and fat cells, it is converted to? -What does it prompt? -What effects does it have? -Deficiency leads to? >how are deficiencies treated?

-Steroid hormone synthesized from cholesterol -In prostate, T is converted to dihydrotestosterone (DHT) -In brain neurons, bone and fat cells, T is converted to estradiol -Prompts spermatogenesis and targets all accessory organs -Has multiple anabolic effects throughout body: Muscles, bones, metabolic rate -T Deficiency leads to atrophy of accessory organs, less semen volume, impaired fertility, erection/ejaculation >Treated by supplemental testosterone replacement

CHEMICAL BUFFER SYSTEMS -How do strong acids work? -How do weak acids work? -A buffer will: >convert: >bind: >release >maintain: >neutralizes: >not eliminate: -When does it no longer work?

-Strong acids dissociate and release all of its H+ ions (causes PH to drop) -Weak acids only partially dissociate/ release fewer H+ -A buffer will: >Convert a strong acid to a weak acid >Bind H+ if pH drops >Release H+ if pH rises >Maintain pH in a tight range as long as buffering agents are free >neutralize acids and bases >will not eliminate acids or bases (only lung and kidney can) -If enough acid enters blood and ties up all of the HCO3- ions, the buffer system no longer works and pH changes

EJACULATION -Reflex of: -How is semen propelled? -What constricts? -What contracts? -Ejaculation occurs in:

-Sympathetic spinal reflex (L1&2) -Smooth muscles propel semen from male duct system -Bladder sphincter muscle constricts, preventing expulsion of urine -Ducts and accessory glands contract and empty their contents -Bulbospongiosus muscles undergo rapid series of contractions that cause expulsion of semen at close to 11 mph -Ejaculation occurs in spurts: 1st: sperm and prostatic fluid; Later: seminal vesicles (vesiculase and spermicide)

HORMONAL METHODS -What does synthetic estrogen prevent? -What does synthetic progestin do? -Advantages: -Disadvantages:

-Synthetic estrogen prevents ovulation -Synthetic progestin thickens cervical mucus, inhibits egg traveling though fallopian tubes and affects sperms ability to join with egg -Advantages: >Discreet and convenient, predictable cycle >Lighter menstrual flow, less cramps >Decreased reproductive cancer, osteoporosis, PID and anemia >Very, very effective and easily reversible -Disadvantages: >Requires Rx >Does not protect against STIs >Antibiotics diminish effectiveness >Estrogen associated with blood clots >Some women have nausea

ORAL CONTRACEPTIVE PILLS (OCPS) -Synthetic estrogen prevents? -What does synthetic progestin do? -Effectiveness to prevent pregnancy? -Advantages: -Disadvantages:

-Synthetic estrogen prevents ovulation -Synthetic progestin thickens cervical mucus, inhibits egg traveling though fallopian tubes and affects sperms ability to join with egg -Effectiveness to prevent pregnancy: >92% effective/typical use >99.7% effective perfect use -Advantages: >Can skip periods, 3-4 per year >Less room for user error than barriers -Disadvantages: >Must be taken every day >Not for smokers over 35 >May cause rise in blood pressure >May cause vaginal dryness and decreased sex drive

MECONIUM -What is it? -What can it cause? -What happens if aspirated? -Clearing it helps prevent what?

-Tarry green-black paste containing sloughed-off epithelial cells, bile, and other substances; 1st stool of an infant -Can cause fetal distress if released into the amniotic sac before birth -Ok to be swallowed but if aspirated into lungs, it can make lungs more difficult to inflate and/or risk aspiration pneumonia -Route for eliminating bilirubin from the body, clearing meconium as quickly as possible helps to prevent physiological jaundice

ASSISTED REPRODUCTIVE TECHNOLOGY -What does it help? >Hormones can help increase: >Surgery can open: -Involves: >surgical removal of: -Disadvantages include: Examples: -In vitro fertilization (IVF) -Zygote intrafallopian transfer (ZIFT) -Gamete intrafallopian transfer (GIFT)

-Technologies and processes which help infertile couple's to have offspring >Hormone therapies can increase sperm and egg production >Surgery can open blocked uterine tubes -Assisted reproductive technology (ART) procedures involve: >Surgical removal of oocytes following hormone stimulation, fertilizing oocytes, then returning fertilized oocytes to woman's body -Disadvantages of ART procedures: costly, emotionally draining, and painful for oocyte donor Examples of ART: -In vitro fertilization (IVF): most common ART; Oocytes and sperm are incubated in culture dishes for several days; Embryos at 2-cell to blastocyst stage are then transferred to uterus in hopes of implantation -Zygote intrafallopian transfer (ZIFT): In vitro fertilized oocytes are transferred to uterine tubes, so natural implantation can occur -Gamete intrafallopian transfer (GIFT): Does not use in vitro fertilization; sperm and oocytes are transferred together into uterine tubes so natural fertilization to take place

TERATOGENS -What are they? -What is fetal alcohol syndrome (FAS)? >Typified by: -What teratogen readily crosses the placenta?

-Teratogens: Factors that may cause severe congenital abnormalities or even fetal death if potentially harmful substances cross placental barriers and enter fetal blood (ie: Thalidomide given for morning sickness) -Pregnant women who drink alcohol may result in fetal alcohol syndrome (FAS) >Typified by microcephaly (small head), intellectual disability, and abnormal growth -Nicotine readily crosses the placenta; This hinders oxygen delivery to the fetus, impairing normal growth and development

THE FUNCTIONAL UNIT OF THE KIDNEY: NEPHRON -What are nephrons? -How many are there per kidney? -Two main parts: 1. Renal Corpuscle >located in >what are they? 2. Renal Tubules >what is the pathway? >what are they? 3. Collecting Ducts

-The blood processing unit -More than 1 million per kidney -Two main parts: 1. Renal corpuscle >In renal cortex >Protected capillaries >glomerulus 2. Renal tubules >Begin in cortex, drop into medulla, then return to cortex >Absorption/ Secretion "pipes"

VAGINA -How long? -Function: -Location: -Layers 1. 2. 3. -Hymen: -How are the secretions?

-Thin-walled tube 8-10 cm (3-4 inches) in length -Birth canal, passageway for menstrual flow, and organ of copulation -Between bladder and rectum; cervix to exterior -Layers of wall: 1. Fibroelastic adventitia 2. Smooth muscle muscularis 3. Stratified squamous mucosa with rugae -Mucosa near vaginal orifice forms incomplete partition called hymen -Secretions are acidic in adult females; Alkaline in adolescents, thus adolescents are more prone to STIs

TRANSPORT MAXIMUM -Transport systems are: >have a limited number of: >what happens when carriers for a solute are saturated? >example: -Transport carriers are like:

-Transport systems are specific and limited >Have a limited number of carriers in renal tubules >When carriers for a solute are saturated, excess is excreted in urine, even if the body needs it >Example: In diabetes hyperglycemia (BG>180mg/dl) leads to glucose spilling into urine -Transport carriers are like doors. If all of the doors are being used, even if your body needs the solute (like glucose) there is no way to reabsorb it through the doors and it is lost in the urine

TUBULAR SECRETION IN LOOP -Urea is secreted from: -Urea is used to maintain: -Urea is recycled from: -Urea is main solute contributing to: -Why does the concentration gradient exist? -ADH enhances:

-Urea is secreted from interstitium into ascending loop via diffusion and then reabsorbed from CD into interstitium -Urea is used to maintain the concentration gradient in the medullary interstitium -Urea is recycled from CD to ascending loop -Urea is main solute contributing to high osmolarity in the deep medulla -Concentration gradient exists to draw water out of CD when ADH is secreted -ADH enhances urea recycling to increase medullary osmotic gradient; This allows more concentrated urine to form

UREA RECYCLING: -Urea makes up most of: -How much urea enters filtrate in glomerulus?

-Urea makes up most of the solute in the interstitium of the renal medulla -100% of urea in plasma enters filtrate in glomerulus; Breakdown: -50% is reabsorbed in PCT -55% is reabsorbed and recycled from CD into interstitium >50% is secreted into ascending loop >5% diffuses into vasa recta -30% is reabsorbed in DCT -15% is excreted in urine

URETERS -What are they? -Where do they enter? -What is its function? Ureters are hollow organs; Have 3 layers of ureter wall from inside out 1. Mucosa: made of what tissue? 2. Muscularis: -made of what tissue -contracts in response to? -what does it move? how? -What innervates here? 3. Adventitia: made of what tissue?

-Ureters: tubes that convey urine from kidneys to bladder; Begin at L2; Continuation of renal pelvis; Retroperitoneal -Enter base of bladder through posterior wall -As bladder pressure increases, distal ends of ureters close, preventing backflow of urine Ureters are hollow organs; Have 3 layers of ureter wall from inside out 1. Mucosa: transitional epithelial tissue 2. Muscularis: -smooth muscle -Contracts in response to stretch -Peristalsis of smooth muscle propels urine into bladder; Gravity is not enough; Rate of peristalsis adjusted to rate of urine formation -SNS and PNS innervate ureters but has an insignificant role in peristalsis 3. Adventitia: outer fibrous connective tissue

URETHRA -What is it? -Made of what tissue except where? -What is the involuntary internal urethral sphincter? -What is the voluntary external urethral sphincter? -What are levator ani? FEMALE VS MALE URETHRA Female: -How long? -Where is it? -What is the external urethral orifice? Male: -Function? -3 regions: 1. Prostatic urethra 2. Intermediate urethra 3. Spongy urethra

-Urethra: Muscular tube that drains urinary bladder -Made of pseudostratified columnar epithelium, except there is transitional epithelium near bladder and stratified squamous epithelium near externalurethral orifice -Involuntary internal urethral sphincter is smooth muscle at bladder-urethra junction; it contracts to open -Voluntary external urethral sphincter is skeletal muscle surrounding urethra as it passes through pelvic floor -Levator ani are pelvic floor muscles also made of voluntary skeletal muscle (kegel muscles) FEMALE VS MALE URETHRA Female: -3-4 cm -Tightly bound to anterior vaginal wall -External urethral orifice: Anterior to vaginal opening; posterior to clitoris Male: -Male urethra carries semen and urine -3 regions: 1. Prostatic urethra (2.5 cm): within prostate 2. Intermediate urethra (membranous urethra) (2 cm); Prostate to beginning of penis 3. Spongy urethra (15 cm): makes up most of the male urethral length; Passes through penis; Opens via external urethral orifice

URINALYSIS -Urine is examined for: -Assessing renal functions requires both: >ie: >what is needed to determine renal clearance?

-Urine is examined for signs of disease; Can also test for illegal substances -Assessing renal function requires both blood and urine examination >Ex: renal function can be assessed by measuring nitrogenous wastes in blood only >To determine renal clearance, both blood and urine are required

STIs -Used to be called: -Can be bacterial, viral or parasitic -Which country has highest rates of infection? -What is used to prevent spread? -What does STIs cause the most?

-Used to be called sexually transmitted diseases (STDs) or venereal diseases (VDs) -Can be bacterial, viral or parasitic: >Bacterial: chlamydia, gonorrhea, syphilis >Viral: herpes, HIV, HPV, hepatitis, zika >Parasitic: Trichomoniasis -U.S. has highest rates of infection among developed countries -Latex condoms are the best tool to help prevent spread; However many people use them inconsistently or wrong and it does not prevent the spread of many viral STIs -STIs are single most important cause of reproductive disorders

UTERINE PROLAPSE -What happens? -Risk factors:

-Uterus sinks inferiorly, until tip of cervix protrudes through the external vaginal opening -Risk factors: Weak pelvic muscles, straining with constipation, chronic cough, obesity

REABSORPTION IN DCT AND COLLECTING DUCT (CD) -Varies with: 1. Antidiuretic hormone (ADH) -Stimulates: -Increases: -Results in: 2. Aldosterone -Stimulated by: -Increases: -Exchanges: -Results in: 3. Atrial Natriuretic Peptide (ANP_ -Increases: -Dilates: -Inhibits: -Results in: 4. Parathyroid Hormone (PTH): -Acts on:

-Varies with body's needs (Hormonally regulated) 1. Antidiuretic hormone (ADH) -Stimulates insertion of more aquaporins in CD -Increases H20 reabsorption -Result in concentrated urine and reduced urine volume output 2. Aldosterone -Stimulated by renin/ low blood volume or BP -Increases Na+ reabsorption in DCT (H2O follows) -"Aldosterone effect:" Exchanges sodium reabsorption for potassium excretion -Result in increased BP and decreased K+ levels 3. Atrial natriuretic peptide (ANP) -Increases sodium excretion -Dilates afferent arteriole- increases GFR -Inhibits aldosterone release and renin release from granular cells of JGC -Results in decreased blood volume and systemic BP 4. Parathyroid hormone (PTH) -Acts on DCT to increase Ca2+ reabsorption

WATER INPUT AND OUTPUT -What intake must = what: -Where do we get our water intake? -How is water outputted? -Additional fluid is secreted/reabsorbed though? -What changes the PH of alimentary canal?

-Water intake must equal water output: ~2500 ml/day -Water intake: >90% Food and Beverages >10% Metabolism -Water output >60% Urine >40% Insensible loss through skin, lungs, perspiration, and feces -Additional fluid is secreted in the digestive tract and reabsorbed in the intestines -Digestive secretions change the pH of the alimentary canal

OSMOLALITY EQUAL IN ALL TISSUES -Water moves freely between: -Rise in osmolality of ECF (becomes concentrated; ie: sweating) causes: -Decrease in ECF osmolality (becomes less concentrated) causes:

-Water moves freely between all fluid compartments and osmolality is the same for all at ~300 mOsm -Rise in osmolality of ECF causes: >Shift of water out of cells (osmosis) >Hypothalamus to stimulate thirst and release ADH >Kidneys concentrate urine >Systemic vasoconstriction -Decrease in ECF osmolality causes: >Inhibited thirst and ADH >Kidneys dilute urine

REABSORPTION IN NEPHRON LOOP -Water reabsorption is not coupled with salts due to: -What can leave in descending limb? -What can leave in ascending limb? -Does resorption vary with body's needs? -How much of Na and water are reabsorbed in loop?

-Water reabsorption is NOT coupled with salts due to difference in permeability of parts of loop -In descending limb: H2O can leave, solutes cannot -In ascending limb: H2O cannot leave (no aquaporins) but solutes can -Resorption does not vary with body's needs in PCT or loop -25% of Na and water reabsorbed in loop

EFFECTS OF PROGESTERONE -Works with ____ to: -Promotes: -Effects ____ during pregnancy: -Inhibits: -What happens with progesterone withdrawal?

-Works with estrogen to establish and regulate uterine cycle -Promotes changes in cervical mucus -Effects of placental progesterone during pregnancy: Inhibits uterine motility and helps prepare breasts for lactation -Progesterone inhibits sodium retaining activity of aldosterone/ estrogen -Progesterone withdrawal temporarily increases sodium and fluid retention

FLUID COMPARTMENTS 1. ____% ICF: >contains more: >low levels of: >major cation: >major anion: 2. ____% ECF: > > >major cation: >major anion:

1. 66% Intracellular fluid (ICF): fluid inside cells >contains more soluble proteins than plasma >low Na+ and Cl- >major cation: K+ >major anion: HPO42- (phosphate) 2. 33% Extracellular fluid (ECF): fluid in two compartments outside cells >8% Blood Plasma: 3L >25% Interstitial fluid (IF): 12L in between cells; Includes: Lymph, CSF, humors of the eye, synovial fluid, serous fluid and gastrointestinal secretions >major cation: Na+ >major anion: Cl-

3 CHEMICAL BUFFERING SYSTEMS 1. Bicarbonate (most important chemical buffer; found in lungs) -Only buffer in: -Mixture of: -Converts: -If strong acid is added, then: -If strong base is added, it causes: 2. Phosphate (action nearly identical to bicarbonate buffer) -Buffers Ph of: -Not active in: -Phosphate concentrations are high in: -Components are: -What happens to strong acids? -What happens to strong bases? 3. Protein -Includes: -Protein molecules are: -When PH rises: -When PH falls:

1. BICARBONATE -Only buffer in ECF (plasma and interstitial fluid), but it also works in ICF -Mixture of carbonic acid and its salt, sodium bicarbonate (Mixture of H2CO3 which is a weak acid and salts of HCO3-) -Converts CO2 +H2O to carbonic acid and then to HCO3- + H+ in blood -If strong acid is added, HCO3- ties up H+ and forms a weaker acid, H2CO3 >pH decreases only slightly, unless all available HCO3- (alkaline reserve) is used up >[HCO3-] is closely regulated by kidneys -If strong base is added, it causes H2CO3 to dissociate and donate H+ which ties up the base (ex: OH-) >pH rises only slightly >H2CO3 supply is almost limitless (from CO2 released by respiration), subject to respiratory controls 2. PHOSPHATE -Buffers pH of urine and ICF -Not active in plasma b/c bicarbonate buffer is in plasma -Phosphate concentrations are high in urine and ICF -Components are sodium salts of phosphates: >Dihydrogen phosphate (H2PO4-), a weak acid >Monohydrogen phosphate (HPO42-), a weak base -H+ released by strong acids is tied up with a weak acid: HCl (strong acid) + Na2HPO4 (weak base) = NaH2PO4 (weak acid) + NaCl (salt) -Strong bases are converted to weak bases: NaOH (strong base) + NaH2PO4 (weak acid) = Na2HPO4 (weak base) + H2O (water) 3. PROTEIN -The most powerful ICF buffering system; Includes amino acids inside cells (ICF), plasma proteins, and hemoglobin to buffer H+ ions >When hemoglobin unloads oxygen it has a negative charge and binds rapidly with H+ -Protein molecules are amphoteric (can function as both weak acid and weak base) -When pH rises, organic acid or carboxyl (COOH) groups can release H+ (R-COOH = R-COO- + H+) -When pH falls, NH2 groups can bind H+ (R-NH2 + H+ = R-NH3 (ammonia))

MALE SEXUAL RESPONSE 1. Desire 2. Arousal 3. Plateau 4. Orgasm 5. Ejaculation 6. Resolution 7. Refractory period

1. Desire: Psychological and sensory; Often visual or fantasy 2. Arousal: Increased heart rate and blood flow; Vasocongestion leads to erection; Testicles swell; scrotum tightens 3. Plateau: Vasocongestion and myotonia intensifies; Testes draw up 4. Orgasm: Involuntary muscle contractions; Forceful release of muscle tension 5. Ejaculation 6. Resolution: return to unaroused state 7. Refractory period: recharge before next cycle

STAGES OF LABOR 1. Dilation Stage -How long does it last? -What happens? 2. Expulsion Stage -How are contractions? -What is crowning? -What is an episiotomy? -What is breech? 3. Placental Stage -When does it occur? -What happens with contractions? -What does early breastfeeding stimulate?

1. Dilation stage -Lasts from labor's onset to fully dilated cervix (10 cm); Longest stage of labor: 6-12 hours or more -What happens? >Initial weak contractions 15-30 minutes apart, 10-30 seconds long; Become more vigorous and rapid >Cervix effaces and dilates fully to 10 cm >Amnion ruptures, releasing amniotic fluid >Engagement occurs: head enters true pelvis 2. Expulsion Stage -Strong contractions every 2-3 min, each ~ 1 min; Urge to push increases -Crowning occurs when largest dimension of head distends vulva; Baby's neck extends as head exits perineum -Episiotomy: incision made to widen vaginal orifice, may be done to reduce tearing -Breech position: buttock-first; Makes delivery more difficult; often forceps or C-section is required 3. Placental Stage -Delivery of afterbirth (placenta and membranes) occurs within 30 minutes after birth -Strong contractions continue, causing detachment of placenta and compression of uterine blood vessels; Contractions limit bleeding and shear placental from uterine wall, causing detachment -Early breastfeeding stimulates constriction of uterine vessels and reduces postpartum bleeding

DUCT SYSTEM (carries sperm from testes to body exterior) 1. Epididymis -Production line for: -What enters here? -How many sperm can healthy men produce daily? -What happens to epidiymis during ejaculation? 2. Ductus Deferens -How long? -Originates at: Joins: Forms: Enters: -Path of sperm: -Lined with: -What is a vasectomy? 3. Ejaculatory Duct 4. Urethra -Conveys: -3 Regions: 1. 2. 3.

1. Epididymis -Production line for sperm maturation -Non-motile sperm enter, pass slowly through (~20 days), become motile -Can be stored several months, eventually phagocytized if not ejaculated -Healthy men can produce over a million sperm daily -During ejaculation, myoid cells in epididymis contract, expelling sperm into ductus deferens 2. Ductus Deferens -18 in long tubular passage way for sperm -Originates at tail of epididymis; Joins duct of seminal vesicle, forms ejaculatory duct; Enters prostate, empties into urethra -Path of sperm: Epididymis -> ductus deferens -> ejaculatory duct -> urethra -Lined with pseudostratified epithelium over smooth muscle -Vasectomy: Severing of the vas deferens; Permanent male birth control >If a male undergoes a vasectomy, which of the following can no longer take place? passage of sperm cells from the epididymis to the penis/urethra 3. Ejaculatory Duct 4. Urethra •Much longer than in women; Conveys both urine and semen (at different times) -3 regions 1. Prostatic urethra: surrounded by prostate 2. Intermediate part of the urethra 3. Spongy urethra: runs through penis; opens at external urethral orifice

4 STEPS TO BABY

1. Fertilization >sperm transport and capacitation 2. Implantation (~6 days post fertilization) >zygote to blastocyst >Embryonic development continues; Embryo travels through uterine tube to uterus, where it floats freely until it implants >Cleavage, blastocyst formation, blastocyst implantation >placentation 3. Embryonic Development (through Week 8) >gastrulation: germ layer formation >organogenesis >neurulation >development of fetal circulation 4. Fetal Development (week 9 through parturition)

7 FUNCTIONS OF THE KIDNEY 1. 2. 3. 4. 5. 6. 7.

1. Filters waste and removes urea from the blood plasma 2. Regulates total fluid volume / solute concentration 3. Regulates ion concentrations in extracellular fluids 4. Ensures long-term acid-base balance 5. Excretes metabolic wastes, toxins and drugs 6. Produces hormone Erythropoietin (regulates RBC production) and enzyme Renin (regulates/ raises blood pressure) 7. Activates vitamin D

SEXUAL DIFFERENTIATION 1. Genetic stage -Established at? -When do sexes develop identically? 2. Gonadal stage -Period during which: -Dependent on: -Inequality of X and Y genetic material has effects on: 3. Hormonal stage: -What happens to a genetic male? 4. Phenotypic stage: -Response to: -What develops? 5. Psychological:

1. Genetic stage: Established at fertilization from the 23rd pair of chromosomes; XY = male and XX = female -During week 1-7, the sexes develop identically 2. Gonadal stage -Period during which indifferent gonads develop into either ovaries or testes -Dependent on hormones -Inequality of X and Y genetic material in the two sexes has effects throughout the body (brain, disease manifestations lupus/autism), not just on the gonads 3. Hormonal stage -If an embryo is genetically male (46, XY), the indifferent gonad differentiates to testes under influence of the SRY gene on the Y chromosome, which encodes testis-determining factor. 4. Phenotypic stage -Response to gonadal differentiation -Internal and external genitalia develop into characteristic male or female structures 5. Psychological -Gender expectations -Orientation

3 PROCESSES TO MAKE URINE 1. Glomerular filtration -location -function 2. Tubular Reabsorption -location -function 3. Tubular Secretion -location -function How is urine production like a conveyor belt?

1. Glomerular filtration -in glomerulus -produces filtrate (cell and protein free; essentially plasma) 2. Tubular Reabsorption -in PCT, DCT, collecting ducts -Process by which nephron removes water and solutes from filtrate/tube (preurine) and selectively returns 99% of them to blood in peritubular capillaries; Anything not reabsorbed becomes urine 3. Tubular Secretion -In PCT, DCT and collecting ducts -Process of adding solutes from the blood to the filtrate that were not originally filtered Urine production is like a conveyor belt (Tubules are the conveyor belt) -Glomerular filtration: loads most of the contents (ie: water, glucose, electrolytes, urea) of plasma onto the conveyor belt (filtrate) -Tubular reabsorption: retrieves some substances and returns them to blood -Tubular secretion: adds substances to conveyor belt that were not originally filtered

3 NEPHRON CAPILLARY BEDS 1. Glomerulus (ball of yarn) -What are they? -Fed by: -Drained by: 2. Peritubular capillaries -Surround: -How is the BP? 3. Vasa recta -Surround: -Help form:

1. Glomerulus -Filtration capillaries driven by high BP -Fed by cortical radiate artery into afferent arteriole -Drained by efferent arteriole into >Peritubular capillaries (cortical nephrons) >Vasa recta (juxtamedullary nephrons) 2. Peritubular capillaries -Surround PCT and DCT in cortical nephrons -Low BP to resorb most of filtrate 3. Vasa recta -Capillaries which surround JM nephrons -Help form concentrated urine

CONGENITAL URINARY ABNORMALITIES 1. Horseshoe kidney: 2. Hypospadias: 3. Polycystic kidney disease:

1. Horseshoe kidney: 2 kidneys fuse across midline, forming single U-shaped kidney; Usually asymptomatic 2. Hypospadias: urethral orifice located on ventral surface of penis; Corrected surgically at ~1 year 3. Polycystic kidney disease: many fluid-filled cysts interfere with function of kidneys; Can be inherited as autosomal dominant (most common, less severe form) or autosomal recessive (more severe form)

PRESSURES THAT AFFECT FILTRATION 1. Hydrostatic Pressure -Promotes: -Forces: -High pressure = 2. Inward Pressure -Inhibits: -Causes ____ pressure: -Pressure in capsular space:

1. Hydrostatic Pressure of blood coming into glomerulus -Promotes filtrate formation -Blood flow forces water and solutes out of blood into capsular space -High: double most capillary beds >Efferent arteriole is smaller than afferent >Too high for reabsorption to occur 2. Inward Pressures: -Inhibits filtrate formation -Protein Colloid osmotic pressure: Proteins provide gradient to "Pull" / suck some of the filtered fluid back into capillaries -Pressure in capsular space: Pressure of filtrate already in capsule pressing against glomerular capillaries

PHYSIOLOGIC BUFFER SYSTEMS 1. Respiratory -What is the greatest factor affecting PH of tissues? -What does it eliminate? -What is the equation? -During CO2 unloading, reaction shifts: -During CO2 loading, reaction shifts: -If PCO2 accumulates in blood then: -What sends signal to increase rate/depth? -Exercise example: -When blood PH rises (alkalosis) then: -How long does it take? -Any condition which impairs the respiratory system causing hypoventilation can cause: -Medical conditions which cause alkalosis: 2. Renal (ultimate acid-base regulatory organ) -Lungs eliminate: ,but only the kidneys can: -Kidneys respond to acidosis by: -Where does H+ come from? -Excreted H+ is? -How does the renal system regulate bicarbonate and replenish alkaline reserve?

1. RESPIRATORY -Partial pressure of CO2 is the greatest factor affecting pH of tissues (as it rises, we see a decrease in PH) -Respiratory system eliminates CO2 (an acid) during gas exchange. Expiring CO2 raises pH -A reversible equilibrium exists in blood, similar to bicarbonate buffer system: CO2 + H2O <-> H2CO3 <-> H+ + HCO3- -During CO2 unloading, reaction shifts to left (and H+ is incorporated into H2O) -During CO2 loading, reaction shifts to right (and H+ is buffered by proteins) -If PCO2 accumulates in blood (hypercapnia), plasma H+ increases, pH falls (acidosis) -Chemoreceptors in the medulla oblongata send a signal when PH falls to increase respiratory rate and depth -example: as we exercise, we produce more CO2, causing H+ to accumulate, PH falls and becomes acidic. Brain sends signal to breath faster so that we blow off more CO2 to raise PH -When blood pH rises (alkalosis) then CO2 is too low in the blood (hypocapnia); This causes chemoreceptors in the medulla to send a signal to depress respiration (Breaths become shallow) -Respiratory regulation of pH is quick; Adjustments only take a few minutes to work -Any condition which impairs the respiratory system causing hypoventilation can cause acidosis: >COPD (emphysema or bronchitis) >Alcohol, narcotics and CNS depressants >Obesity -Medical conditions which cause hyperventilation cause alkalosis: Anxiety and panic attacks 2. Renal -Lungs can eliminate volatile carbonic acid by eliminating CO2, but only the kidneys can: >Secrete H+ (into urine) >Eliminate nonvolatile (fixed) acids produced by cellular metabolism (Phosphoric, and lactic acids and ketones) to prevent metabolic acidosis >Regulate blood levels of alkaline substances >Replenish the alkaline reserve -Kidney responds to acidosis (body PH to low) by: >Secreting H+ into filtrate in PCT and DCT, removing CO2 and reabsorbing HCO3- -H+ comes from dissociation of carbonic acid; H+ secretion is dependent on the amount of CO2 -Excreted H+ is: >Exchanged with Na+ to maintain electrical balance >Buffered by phosphate buffering system >Most important buffer in urine >Coupled with a reabsorbed HCO3- to increase blood pH or maintain alkaline reserve -Renal mechanisms for regulating bicarbonate in blood replenish the alkaline reserve of HCO3- in 3 ways: 1. Conserving (reabsorbing) HCO3- 2. Generating new HCO3- 3. Excreting HCO3- >Generating or reabsorbing one HCO3- reduces blood pH the same as losing one H+ >To resorb HCO3- the kidney has to secrete H+ >When the kidney excretes excess HCO3- , H+ is retained (not secreted)

3 REGIONS OF INTERNAL KIDNEY 1. Renal Cortex 2. Renal Medulla - - - 3. Renal Pelvis - -

1. Renal cortex: granular superficial edge 2. Renal medulla: central region, deep to cortex -Medullary pyramids: composed of urine producing units (nephrons) -Renal columns: inward extensions of cortex, separate pyramids -Papillae = apex of pyramids 3. Renal pelvis: Funnel-shaped collecting tube, continuous with ureter -Minor calyces: Cup-shaped areas that collect urine from papillae -Major calyces: Areas that collect urine from minor calyces; Empty urine into renal pelvis

CELLS IN THE TESTES/SEMINIFEROUS TUBULES 1. Sustenocytes (Sertoli cells) -Form the -Function: -What acts on this? 2. Leydig Cells -Surrounds: -Makes: -What acts on this? 3. Myoid Cells -Made of: -Surround: -Function:

1. SUSTENOCYTES (Sertoli cells) -Non-replicating supporting cells -Provide nutrients and signals to dividing cells -Moves toward lumen -Phagocytize faulty germ cells and excess cytoplasm -Epithelial cells which form the blood-testis barrier using tight junctions -Surround and support sperm-forming cells -Target cells for FSH to regulate spermatogenesis 2. LEYDIG cells -Interstitial endocrine cells surrounding seminiferous tubules -Produce male hormones/ androgens (testosterone) -LH acts on this 3. MYOID CELLS -Smooth muscle -Surround seminiferous tubules -Squeezes spermatids through seminiferous tubules/out of testes

SPERMATOGENESIS: 3 Step production of sperm in seminiferous tubules Stage 1: -When does it begin and occurs in? -Divides through? -Types: 1. 2. Stage 2: -Daughter cells are called: How many are there? -Spermatids are: Stage 3: -What happens to the sperm? -Major regions of sperm: 1. 2. 3. -How long does it take?

3 Step production of sperm in seminiferous tubules Stage 1: Forming spermatagonium to Spermatocytes -Begins at puberty and occurs in seminiferous tubules -Spermatogonia divide through mitosis to produce 2 types of daughter cells (2n) -Types: 1. Type A (spermatogonia/ stem cells) remain at edge of tubule; Continue to divide by mitosis to maintain pool for next generation of gametes 2. Type B moves toward lumen; Becomes primary spermatocyte (2n) destined to produce 4 sperm; They undergo Meiosis I to form 2 haploid (1n) secondary spermatocytes Stage 2: Haploid secondary spermatocytes undergo Meiosis II to become spermatids -Daughter cells are called spermatids; There are 2 per secondary spermatocytes and 4 total from primary spermatocyte; They move midway to lumen -Spermatids are haploid, immature, spherical, immobile sperm Stage 3: Spermiogenesis; spermatid to mature spermatozoa -Sperm elongate, grow tail, shed cytoplasm -Major regions of mature sperm: 1. Head: Genetic region that includes nucleus and helmet-like acrosome >Acrosome contains hydrolytic enzymes that enable sperm to penetrate egg 2. Midpiece: metabolic region containing mitochondria that produce ATP to move tail 3. Tail: locomotor region that includes flagellum -Spermatogenesis takes 64-72 days

2 CLASSES OF NEPHRONS 1. Cortical Nephrons -What % of nephrons? -Located -Makes up the: 2. Juxtamedullary nephrons -Makes up: -Important for:

Based on location, variations in function 1. Cortical nephrons -85% of nephrons -Almost entirely in cortex -Short loop of Henle 2. Juxtamedullary nephrons -Long nephron loops of Henle dip deeply into medulla -Important in maintaining body water, BP and production of concentrated urine

MECHANISMS TO REGULATE PH Chemical Buffer Mechanisms: 1. Chemical Buffer systems: Physiologic Mechanisms: 2. Respiratory Mechanisms: 3. Renal Mechanisms:

Chemical buffer mechanisms: Convert strong acids/bases to weak acids/bases 1. Chemical buffer systems -Rapid, first line of defense (ie: blood buffer) -Temporary because H+ are not eliminated Physiologic mechanisms: Eliminates acids and bases from the body; alter the PH by converting strong acids/bases to weaker acids/bases to minimize the change in PH; control PH by regulating the amount of acid or base in the body; they are slower than chemical systems but have more power 2. Respiratory mechanisms regulated by the brain (Acts within 1-3 minutes); ie: exercise 3. Renal mechanisms: Strongest, but require hours to days to change pH

DISORDERS OF WATER BALANCE Dehydration -What happens? -Symptoms? -Can lead to: Water intoxication -What happens? -Due to: -Symptoms? -Treated with:

Dehydration -ECF water loss due to hemorrhage, severe burns, prolonged vomiting or diarrhea, profuse sweating, water deprivation -Sx: Dry mouth, thirst, dry flushed skin, oliguria -Can lead to weight loss, fever, mental confusion, hypovolemic shock, electrolyte or acid-base imbalance Water intoxication -Cellular overhydration causing hyponatremia -Due to kidney disease or rapid excess water ingestion -Sx: metabolic imbalance, nausea, vomiting, muscle cramps, cerebral edema, and possible death, -Treated with hypertonic saline

FEMALE PELVIC DISORDERS Ectopic Pregnancy Pelvic Inflammatory Disease (PID)

Ectopic pregnancy: Oocyte is fertilized in peritoneal cavity or distal uterine tube and begins developing there; Causes sharp abdominal cramps, dizziness or weakness; This is incompatible with life; Can cause fallopian tube to burst or rupture and life-threatening bleeding; May abort naturally with substantial bleeding or may require surgery Pelvic inflammatory disease (PID): Spread of infection from reproductive tract to peritoneal cavity; Consequence of untreated STI; May cause scar tissue and lead to infertility

FEMALE REPRODUCTIVE SYSTEM External Genitalia (Vulva): 1. Mons pubis 2. Labia majora 3. Labia minora >clitoris 4. Vestibule 5. Bulbs of vestibule 6. Greater vestibular (Bartholin's) glands 7. Lesser vestibular (Skene's) glands Internal Genitalia: 1. Ovaries -Produce: -Secrete: -Suspended by several ligament: -Blood supply: 2. Duct System

External genitalia (vulva): external sex organs 1. Mons pubis: -Fatty protective cushion for missionary -Pubic hair 2. Labia Majora -Equivalent to scrotum -Has hair; outer lips 3. Labia minora: -Equivalent to skin of penile shaft -Hairless skin folds; inner lips -Apocrine glands secrete sweat and sebum >Clitoris : equivalent to glans penis; has erectile tissue glans of the clitoris = exposed portion; crura = anchors clitoral legs to pubic bones; prepuce of the clitoris = hood glans 4. Vestibule: -Cavity between labia minora -Houses openings to urethra and vagina 5. Bulbs of vestibule: -Lie on either side of vaginal orifice -Similar to penile bulb/spongiosum: 6. Greater vestibular (Bartholin's) glands -Equivalent to bulbo-urethral gland -Located below vaginal opening -Secretes moisture 7. Lesser vestibular (Skene's) glands: -Similar to prostate gland -Ducts drains into urethra as well as external -Associated with female ejaculation (squirting) Internal genitalia (in pelvic cavity) includes: 1. Ovaries: female gonads -Produces female gametes (ova); equivalent to male testes -1 or 2 released eggs each month x 40 years (age 15-55) (~ 500) >Have between 500,000 and 1,500,000 at birth -Secrete female sex hormones: Estrogen (estradiol, estrone, estriol), Progesterone, testosterone -Suspended by several ligaments: >Ovarian ligament: anchors ovary medially to uterus >Broad ligament: anchors ovary laterally -Blood supply: Ovarian arteries and ovarian branch of the uterine arteries 2. Duct System -Uterine tubes >Uterine tube system does not have direct contact with ovaries; ovulated oocyte is cast into peritoneal cavity; some oocytes never make it to tube system -Uterus -Vagina

SURGICAL METHODS OF CONTRACEPTION Female Sterilization -Tubal litigation: >Essure: -Hysterectomy: -Rare side effects: Male Sterilization: -Vasectomy: -Rare side effects: -Advantages: -Disadvantages: -Effectiveness:

Female Sterilization -Tubal ligation: fallopian tubes sealed to block sperm; Menstrual cycle continues, released eggs disintegrate >Essure: placement of micro-coils into the fallopian tubes -Hysterectomy: major surgery that removes uterus -Rare side effects include infection, pulmonary embolism, hemorrhage, anesthesia complications, and ectopic pregnancy Male Sterilization -Vasectomy: piece of vas deferens is removed and ends are tied or sewn shut -Rare side effects include formation of a blood clot in the scrotum, infection, or inflammatory reactions -Advantages: >Permanent- but may be possible to be reversed >Rare side effects >No negative effect on sex drive-may increase -Disadvantages: >Permanent >General risks of surgery-much lower for man >No protection from STIs -Effectiveness alone: >99.5 % Female >99.85% Male

Suppose that a patient has a failing liver and is unable to make normal levels of albumin for the blood plasma. If all other factors remain the same, what would be the effect on the amount of filtrate produced?

Filtrate production would increase

PHYSIOLOGICAL CHANGES IN THE PREGNANT MOTHER Gastrointestinal System -Why do we experience nausea? -Why do we experience heartburn and constipation? Urinary System -Why do we have increased urine production? -What happens as bladder is compressed? Respiratory System -Estrogens may cause: -What happens to tidal volume? Cardiovascular System -What happens to blood volume? -What happens to cardiac output? -What happens to venous return?

Gastrointestinal system -Nausea due to higher levels of hCG, estrogen, and progesterone -Heartburn and constipation due to compression of the stomach and intestines from growing fetus Urinary system -Increased urine production due to increased maternal metabolism and fetal wastes -Frequent, urgent urination and stress incontinence may occur as bladder is compressed Respiratory system -Estrogens may cause nasal edema and congestion -Tidal volume and dyspnea increase due do growing fetus compressing lung space Cardiovascular System -Undergoes most dramatic physiological change -Blood volume increases 25-40% >Increased volume helps transport nutrients and wastes to and from fetus >Also safeguards against blood loss during childbirth -Cardiac output rises 35-40% -Venous return from lower limbs may be impaired, resulting in varicose veins

This chemical equation shows the reaction of a strong acid and weak base in the bicarbonate buffer system. Provide the products of the following reaction. HCl + NaHCO3 →

H2CO3 + NaCl

If a woman has just ended her menstrual phase, when is she most likely to ovulate?

In about 14 days

REGULATION OF GFR Intrinsic (Renal/Kidney Autoregulation) -Maintains: -Prevails until: -Use feedback from: -2 mechanisms: 1. Myogenic Mechanism -Maintains: -What dilates or constricts? -What happens when system BP is high? -What happens when system BP is too low? 2. Tubuloglomerular Feedback -Important for: -Located where: -3 cells that regulate flow: -Directed by: Extrinsic (System BP/Endocrine/Neural) -Sacrifices: -What happens in blood volume crisis? 1. Neural Mechanism = SNS fight/flight -Releases: -Causes -Risks: 2. Hormonal Mechanism = Renin-Angiotensin-Aldosterone System (RAAS) -In response to low system BP, what happens? -Angiotensin raises BP by stimulating: -ACE inhibitors are:

Intrinsic (Renal/Kidney Autoregulation) -Maintains GFR in kidney -Intrinsic mechanisms prevail until MAP (avg blood pressure) drops <80mmhg -Use feedback from Juxtaglomerular complex 1. Myogenic Mechanism -Maintains GFR between 80 and 180mmhg, normal fluctuations in BP -Afferent artery dilates or constricts to maintain safe pressure to glomerulus -When systemic BP is high, afferent arteries contract to prevent glomerular BP from getting to high and causing damage -When systemic BP is low from low blood volume, afferent muscles dilate to increase glomerular pressure and blood flow so there is enough pressure to create filtration 2. Tubuloglomerular feedback -Important for tubule to glomerular feedback in the intrinsic regulation of GFR -Located where the DCT comes between the afferent and efferent arteries -3 cells regulate flow of filtrate and systemic BP: Macula densa, Juxtaglomerular/ Granular "JG cells" and Mesangial cells -Directed by macula densa cells of JGC (chemoreceptors) Extrinsic (System BP/Endocrine) -Sacrifices kidney to maintain systemic BP when MAP <80 mmhg detected by JGC -In blood volume crisis (shock/hemorrhage/dehydration/hypovolemic shock/extremely low BP) extrinsic system will override intrinsic system in order to shunt blood to vital organs; without adequate BP, glomerular filtration is not possible 1. Neural Mechanism = SNS fight/flight -Releases epinephrine from adrenal medulla and NE from SNS fibers which causes systemic vasoconstriction to increase peripheral resistance; Thus, blood is shunted away from kidney toward vital organs (Kidneys hold 25% of blood volume) -Increases BP but risks damage to kidney if normal kidney blood volume is not restored quick enough 2. Hormonal Mechanism = Renin-Angiotensin-Aldosterone System (RAAS) -In response to low system BP: granular cells release renin, renin triggers angiotensin-aldosterone -Angiotensin II raises BP by stimulating adrenal cortex to secrete aldosterone; This Increases sodium resorption and potassium excretion in DCT to cause obligatory H2O reabsorption; Also causes posterior pituitary to release ADH (vasopressin) which increases water reabsorption in DCT/CD to increase thirst and cause systemic vasoconstriction -ACE inhibitors: Hypertensive meds which prevent conversion to angiotensin II and prevents BP from rising

BARRIER: MALE CONDOM -What is it? -Effectiveness to prevent pregnancy? -Effectiveness for safer sex? -How do you get it? -Advantages: -Disadvantages: BARRIER: FEMALE CONDOM -What is it? -Effectiveness to prevent pregnancy? -Effectiveness for safer sex? -How do you get it? -Advantages: -Disadvantages:

Male Condom -A thin sheath worn on the penis to catch semen -Effectiveness to prevent pregnancy: 98% percent (perfect); 85% (typical) -Effectiveness for safer sex: >Excellent for bacterial STIs >The best thing we have for viral and parasitic >Not effective for STIs passed in skin to skin contact -How do you get it: OTC (Available in latex, polyurethane, or lambskin) -Advantages: >Cheap, easy to buy OTC, no prescription >No negative health effects >Very effective against pregnancy and STIs -Disadvantages: >Must be used for every act of vaginal, oral, or anal intercourse >Never use OIL BASED PRODUCTS with a condom >Potential for high user error >Does not protect from herpes, warts/HPV Female Condom -Internal barrier for vaginal or anal sex -Effectiveness to prevent pregnancy: 79% effective/typical use; 95% effective perfect use -Effectiveness for safer sex: BEST OPTION -How do you get it: OTC -Must be used for vaginal, oral, or anal intercourse -Advantages: >Easy to buy OTC, no prescription >No negative health effects >Loose fitting-fits all sizes >Transfers heat, more sensation >Very effective against STIs >Can be placed up to 8 hours in advance -Disadvantages: >Potential for high user error >Noisy >Looks weird

MEIOSIS PHASES

Meiosis I -# of chromosomes is halved -Centromeres do not split/sister chromatids stay together -1 Diploid Parent cell (46) to 2 Haploid Daughter Cells (23) -Meiosis I accomplishes two important tasks: 1. Reduces chromosomal number by half 2. Introduces genetic variability -Random alignment of homologous pairs in meiosis I leads to variability of gametes -Crossover = variability of gametes -Results in no two gametes being exactly alike -All are different from original mother cells ---------------------- Prophase 1 -Spermatogenesis begins at puberty -Oogenesis begins in the fetal period -Diploid stem cells multiply rapidly by mitosis -Eventually Primary Oocytes form and begin the 1st stage of Meiosis but never complete Prophase 1 -Chromosomes double and form sister chromatids -Sister chromatids of homologous chromosomes from mom and dad pair up- form tetrads in a process called synapsis ("snapping" together); Sister chromatids are identical copies (chromatids) formed by the DNA replication of a chromosome -Crossing Over AKA Chiasmata; Tetrads swap segments of DNA among homologous chromosomes -End of Prophase 1 Unique results after Crossing Over -In female gametogenesis, the primary oocyte (2n) is stalled in late Prophase I until puberty -In males, meiosis begins at puberty and primary spermatocytes complete Meiosis I and II Metaphase 1 -In women, each month only one primary oocyte begins Metaphase 1 and completes Meiosis I -In men, the primary spermatocyte continues through Meiosis I and II -More genetic diversity: Tetrads Line Up On Random Sides Anaphase 1 -Homologous chromosomes (Tetrads) separate but centromeres do not -Sister chromatids (duplicated chromosomes) stay together Telophase 1 -Tetrads separate but centromeres do not -Sister chromatids (duplicated chromosomes) stay together (Considered a single chromosome with twice the DNA) -Results in 2 "haploid" daughter cells (Secondary oocyte/spermatocytes) ---------------------- Meiosis II -Centromeres split, chromatids separate -2 Haploid Daughter Cells to 4 Haploid Daughter cells -Events are similar to mitosis, except there is no chromosome replication before process begins -Sister chromatids from meiosis I are separated and pulled toward opposite poles which results in one per cell ---------------------- Prophase II -Begins with the products of Meiosis I (2 haploid daughter cells) >In men, 2 secondary spermatocytes >In women, 1 secondary oocyte and 1 polar body (occurs after puberty/ovulation) >The polar body contains half of the genetic material but no organelles or cytoplasm Metaphase II -Secondary spermatocytes continue through Meiosis II -The secondary oocyte remains suspended in Metaphase II unless fertilization occurs (the ovum never completes meiosis unless fertilized) -The 1st Polar Body often divides into 2 smaller polar bodies in Metaphase II, but not always -Polar bodies eventually deteriorate and die -Sister chromatids line up Anaphase II -Sister chromatids move to opposite ends of the cell and become individual chromosomes -A secondary oocyte is ovulated each month. -Only a fertilized secondary oocytes proceed to Anaphase II Telophase II -Sister chromatids move to opposite ends then cells divide -Result:4 genetically unique haploid spermatids (immature sperm) ORThe fertilized secondary oocyte divides into a haploid functional Ovum and 3 haploid polar bodies (2 formed earlier)

METABOLIC ACIDOSIS AND ALKALOSIS Metabolic Acidosis -How is PH? -Causes: Metabolic Alkalosis -How is PH? -Causes:

Metabolic Acidosis -pH < 7.35 and low HCO3- -Causes (everything except respiratory): >Excessive alcohol (converts to acetic acid) >Excessive loss of HCO3- (ex: persistent diarrhea) >Accumulation of lactic acid (exercise or shock) >Ketosis in diabetic crisis, starvation, and kidney failure Metabolic Alkalosis (much less common than acidosis) -pH > 7.45 and rising HCO3- -Causes include vomiting of stomach acid contents intake of too many antacids

MITOSIS VS MEIOSIS Mitosis -For: -Results in: -Where does it occur? -How are the genetics? Meiosis -For: -Results in: -Occurs in: -How are the genetics? -Functions of meiosis?

Mitosis -Reproduction for growth and repair -Results in 2 identical diploid daughter cells -Occurs in all body cells, except gametes -Genetically identical; clones Meiosis -Sexual reproduction and gamete production -Starts with 2 diploid parent cells and results in 4 genetically unique haploid cells -Occurs in gametes (egg and sperm) -Genetic diversity, synapsis and independent assortment -2 rounds of nuclear division, after only one 1 round of DNA replications -Functions of meiosis: number of chromosomes are reduced to half

SPECIALIZATION OF ECTODERM Neuralation: -First major event of: -Gives rise to: -What happens by day 22? -Neural crest cells migrate widely to form: -By end of month 1, what is formed? -When can brain waves be recorded?

Neurulation: -First major event of organogenesis -Gives rise to brain and spinal cord -By day 22, neural folds fuse into neural tube -Neural crest cells migrate widely to form: >Cranial, spinal, and sympathetic ganglia and nerves >Adrenal medulla >Pigment cells of skin >Contributes to some connective tissues -By end of month 1, forebrain, midbrain, and hindbrain are formed; -Brain waves can be recorded by end of month 2

OSMOSIS -What is it? -How does the solution move? -Define osmolality: -Define osmolarity:

OSMOSIS -Movement of water through a semipermeable membrane from a less concentrated solution into a more concentrated one, thus equalizing the concentrations on each side of the membrane (Equilibrium); SOLUTE DOES NOT MOVE IN OSMOSIS -Water always follow salt; Solvent follows salt -Osmolality: Concentration of solutes dissolved in 1 kg water -Osmolarity: Concentration of solutes dissolved in 1 L of solvent

OVARIAN CYCLE -What is it? -Two phases: 1. Follicular phase -What is stimulated? -What happens as a follicle develop? -What happens as estrogen level increase/decrease? 2. Luteal phase -When does it begin? -What happens? -What occurs around day 14? -How does the corpus luteum form? -How many women have a normal cycle? -How long are the phases?

OVARIAN CYCLE: -Monthly (~28 day) series of events associated with maturation of egg -Two consecutive phases, with ovulation occurring midcycle between phases 1. Follicular phase: period of vesicular follicle growth (days 1-14/to ovulation) -GnRH stimulates FSH secretion; FSH stimulates growth and development of ovarian follicles; One becomes dominant -As follicle develops FSH levels decrease due to negative feedback of inhibin and estrogen levels increase -At low levels of estrogen (Day 1-10) LH is inhibited; As estrogen levels increase (After Day 10), positive feedback for LH secretion 2. Luteal phase: period of corpus luteum activity (days 14-28) -Begins at ovulation -GnRH pulses and increased estrogen stimulates LH secretion -Around Day 14 massive surge of LH triggers: Primary oocyte to complete meiosis I, rupture of follicle wall and ovulation ~ 9 hours after LH peak -Progesterone increases and estrogen decreases which inhibits GnRH -Formation of corpus luteum: >Secretes progesterone to develop and sustain endometrium >If no pregnancy CL degenerates after 12 days >Progesterone decreases, GnRH increases, new cycle begins -Only 10-15% women have 28-day cycle; 21-40 days is considered "normal" -Follicular phase varies, but luteal phase is always 14 days from ovulation to end of cycle

NEPHRON PART 1: RENAL CORPUSCLE (coffee filter) Parts of the Renal Corpuscle: 1. Glomerulus: -What is it? -What acts as filters? -What does it filter? 2. Glomerular capsule/aka Bowman's capsule: -What is it? -Where is the filtration membrane? -What should not be found here?

Parts of the Renal corpuscle 1. Glomerulus -Highly porous cluster of capillaries -Capillaries act as filters -Filters blood, creates filtrate (Plasma derived, protein free; "Pre-urine"; Blood minus proteins and blood cells) 2. Glomerular capsule/ aka Bowman's capsule -Hollow structure surrounding glomerulus; Its filtration slits allow filtrate to pass from glomerulus into capsule -Filtration membrane is between blood and filtrate -White blood cells should not be found here

MALE REPRODUCTIVE SYSTEM Primary Sex Organs (Gonads): 2 testes -Analogous to: -Functions: 1. 2. Accessory reproductive organs: - - -

Primary sex organs (gonads): 2 TESTES -Analogous to female ovaries -Functions: 1. Produce gametes (sex cells)/sperm 2. Secrete steroid sex hormones (androgens / testosterone housed within scrotum) Accessory reproductive organs: -Seminal glands -Prostate -Bulbo-urethral glands (makes pre-ejaculation to neutralize and lubricate)

PROSTATE DISORDERS Prostatitis: >Chronic prostatitis (aka): -What helps this? Benign Prostatic Hyperplasia (BPH): Prostate Cancer: -Risk factors: -Symptoms: -Screening: -Survival rate: -Treatment:

Prostatitis: inflammatory disorders; Bacterial infection, either acute or chronic that is treated with antibiotics >Chronic prostatitis (aka pelvic pain syndrome): UTI symptoms, pain in external genitalia and lower back; May or may not produce leukocytes in urine -Frequent ejaculations are healthy for the prostate Benign prostatic hyperplasia (BPH): Prostate enlarges and distorts urethra; Causes changes in urine flow; Risk increases with age; Treated with surgery, radiation, balloon compression Prostate cancer: -Risk Factors: Smoking, high fat; low lycopene diet, African American decent, Cryptorchidism (Undescended testes- causes sterility and lack of 2ndary characteristics to form), mumps with inflammation of testis -Symptoms: often symptomless early then slow or weak urinary stream, increased frequency, blood in the urine or semen or ED -Screening: Digital exam screening, PSA levels -2nd most common cause of cancer death in men but 90% survival -Treatment: surgical removal of prostate and chemo

What is major difference between male and female reproductive systems?

Reproductive structures are similar but the major difference is that females urinary and reproductive systems are separate; While male urethras carry both sperm and urine

RESPIRATORY ACIDOSIS AND ALKALOSIS Acidosis -How is PCO2? >how is CO2 and PH? >common cause of: -Caused by: -Treated by: Alkalosis -How is PCO2? -Usually caused by: -Common result of: -Treatment:

Respiratory Acidosis -PCO2 above 45 mm Hg; pH < 7.35 >CO2 accumulates in blood; blood pH drops >Common cause of acid-base imbalances; more common than alkalosis -Caused by underlying respiratory medical conditions which decrease ventilation or gas exchange (Ex: emphysema, pneumonia, cystic fibrosis) -Treatment aimed at underlying respiratory disorder: Bronchodilators, CPAP Oxygen and removal of obstructions Respiratory Alkalosis -PCO2 below 35 mm Hg; pH > 7.45 -Usually caused by anxiety, stress or pain. CO2 is eliminated faster than produced -Common result of hyperventilation, often due to stress or pain or rapid breathing due to high altitude or asthma -Treatment: Breathe into a paper bag to increase CO2 in the blood but it usually resolves itself

ACID-BASE IMBALANCES Respiratory Acidosis and Alkalosis -Caused by: -Hypoventiliation leads to: -Hyperventiliation leads to: -Single most important indicator is: -PCO2 is normally: Metabolic Acidosis and Alkalosis -What is it? -Indicated by: -HCO3- is normally:

Respiratory Acidosis and Alkalosis -Caused by failure of respiratory system to perform pH-balancing role -Hypoventilation leads to acidosis -Hyperventilation leads to alkalosis -Single most important indicator is blood PCO2 -PCO2 is normally 35-45 mm Hg Metabolic Acidosis and Alkalosis -All abnormalities other than those caused by PCO2 levels in blood -Indicated by abnormal HCO3- levels -HCO3- is normally 22-26 mEq/L

THE URINARY SYSTEM: 4 KEY STRUCTURES Structures that make urine: 1. Kidneys Structures for urine transport, storage and elimination: 2. Ureters 3. Urinary bladder 4. Urethra

Structures that make urine: 1. Kidneys -Remove liquid waste from the blood by forming urine -Balance of salts and fluids in the blood -Produce hormone Erythropoietin (EPO) and enzyme Renin (BP regulation) Structures for urine transport, storage and elimination: 2. Ureters -Transport urine from kidneys to bladder 3. Urinary bladder -Storage reservoir for urine 4. Urethra -Transports urine out of body

A couple is undergoing evaluation for difficulty conceiving a child. The female is able to ovulate, and the male produces adequate normal sperm. The woman reports 20 days between menses. What problem does this suggest?

The corpus luteum may cease production of progesterone too soon.

What is the correct pathway for sperm cells as they leave the testes?

seminiferous tubule -> rete testis -> epididymis -> ductus deferens Sperm are stored in the tail of the epididymis until they are ejaculated. If they are not ejaculated, they will eventually break down and be phagocytized.