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CHAPTER 38 The Female Reproductive System 683 REVIEW QUESTIONS DIRECTIONS: Each of the numbered (E) Increased secretion of FSH (A) The oviduct and has entered the items or incomplete statements in this 5 order alendronate 35 mg with amex. The theca interna cells of the graafian second meiotic division section is followed by answers or by follicle are distinguished by (B) The uterus and has completed the completions of the statement purchase alendronate 70mg without a prescription. Select the (A) Their capacity to produce first meiotic division ONE lettered answer or completion that is androgens from cholesterol (C) Metaphase of mitosis BEST in each case. Estradiol synthesis in the graafian (C) Aromatization of testosterone to (E) The uterus, extruding the second follicle involves estradiol polar body and implanting (A) Activation of LH-stimulated (D) The lack of a blood supply 10. The enzyme, 5 -reductase is granulosa production of androgen (E) The production of inhibin responsible for (B) Stimulation of aromatase in the 6. Disruption of the hypothalamic- (A) Conversion of cholesterol to granulosa cell by FSH pituitary portal system will lead to pregnenolone and enhancing (C) Decreased secretion of (A) High circulating levels of PRL, low steroidogenesis progesterone from the corpus luteum, levels of LH and FSH, and ovarian (B) Conversion of testosterone to resulting in increased LH atrophy dihydrotestosterone (D) Inhibition of the LH surge during (B) Enhanced follicular development as (C) Aromatization of testosterone to the preovulatory period a result of increased circulating levels estradiol (E) Synergy between FSH and of PRL (D) Increasing the synthesis of LH progesterone (C) Ovulation, followed by increased (E) Female secondary sex 2. Granulosa cells do not produce circulating levels of progesterone characteristics estradiol from cholesterol because they (D) A reduction of ovarian inhibin do not have an active levels, followed by increased SUGGESTED READING (A) 17 -Hydroxylase circulating FSH Carr BR, Blackwell RE. Textbook of Re- (B) Aromatase (E) Excessive androgen production by productive Medicine. Textbook of En- (E) Steroidogenic acute regulatory (A) Inhibits the secretion of LH and docrine Physiology. A clinical sign indicating the onset of (B) Is produced by granulosa cells and Johnson MH, Everitt BJ. Essential Repro- the menopause is inhibits the secretion of FSH duction. Oxford: Blackwell Science, (A) The onset of menses near age 50 (C) Only has local ovarian effects and 2000.

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Answer D: The inability of this man to control the distance buy generic alendronate 70mg online, normal contractions of the facial muscles) is compression of the fa- power order alendronate 35 mg with visa, and accuracy of a movement is dysmetria; this is charac- cial root by a loop of the anterior inferior cerebellar artery, or per- teristically seen in cerebellar lesions. Aberrant loops of the superior lowing, and dysarthria is difficulty speaking. The inability to per- cerebellar artery may compress the trigeminal root (trigeminal neu- form rapid alternating movements is dysdiadochokinesia, and ralgia), and the posterior inferior cerebellar artery serves the lateral bradykinesia is a slowness to initiate movement. The anterior and pos- acteristic of individuals with disease of the basal nuclei. Answer A: The territory served by the anterior choroidal artery are adjacent to each other in lateral portions of the midbrain and includes the optic tract, inferior portions of the posterior limb of are served largely by the same vessel(s), these being penetrating the internal capsule, thalamocortical radiations within the poste- branches of the quadrigeminal artery. This area may also receive rior limb, and structures in the temporal lobe. A lesion of the right op- Throughout the spinal cord, medulla, and into about the mid- to tic tract results in a loss of vision in the opposite (left) visual fields; more rostral pons, these fiber bundles are spatially separated from this being the temporal visual field of the left eye and the nasal vi- each other and have separate blood supplies. This constellation of deficits is known as the anterior choroidal artery 75. Quadrantanopia specifies a lesion in a portion of the tion sense from the right upper extremity originate from cell bod- optic radiations, and a nasal hemianopsia indicates a small lesion in ies located in the right cuneate nucleus. These cuneate neurons the lateral aspect of the optic chiasm on one side. Answer B: This woman has sensory losses on the left side of her right medial lemniscus, and the gracile nucleus (right or left) con- body and face that include pain/thermal sensations and the gen- veys information from the lower extremity. Posterior root ganglia eral category of proprioception (discriminative touch, vibratory neurons project to the gracile or cuneate nuclei. Answer E: Dystonia is a movement disorder characterized by fibers projecting from the ventral posteromedial and ventral pos- abnormal, sometimes intermittent, but frequently sustained, con- terolateral thalamic nuclei to the somatosensory cortex. Alternat- tractions of the muscles of the trunk and extremities that force the ing hemianesthesia refers to a sensory loss on one side of the face body into a twisted posture.

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Other interneurons mediate the spread of Lateral group of nuclei impulses over several levels 35mg alendronate amex, either on the! Posterolateral nucleus (A12) cending and descending fibers run in basic! Retroposterolateral nucleus (A13) bundles generic alendronate 70 mg with mastercard, fasciculi proprii (E21), which border directly on the gray matter. In general, the Central group of nuclei in the cervical spi- ascending and descending fibers reach only nal cord one or two root levels. Accessory nucleus connecting the cervical spinal cord and the lumbar spinal cord (as shown in cats and For example, in the cervical spinal cord (B), monkeys). These fibers transmit excitatory the anterior horn is subdivided somatotopi- and inhibitory impulses to anterior horn cally so that the neurons of the medial motor cells, a fact that is thought to be im- group of nuclei supply neck and back portant for coordinated movement of the muscles, intercostal, and abdominal anterior and posterior extremities during muscles (B14). About half of the posterolateral lateral nucleus supply the muscles of tract (Lissauer’s tract) (E5) consists of fibers shoulder girdle and upper arm (B15), and of the intrinsic system. Finally, the retroposterolateral nu- cleus contains particularly large motor neu- rons that supply the small finger muscles (B17). Gray Substance and Intrinsic System 53 5 4 3 1 8 2 19 7 6 13 10 20 12 9 11 18 – A Gray substance + and spinal roots D Neuronal relay in the spinal cord 17 20 16 15 14 18 B Somatotopic organization of gray substance in the cervical spinal cord 5 21 C Somatotopic organization of gray E Fasciculi proprii substance, overview (according to Bossy) Kahle, Color Atlas of Human Anatomy, Vol. In the regions of cervical enlarge- The lateral horn forms in the thoracic spi- ment and lumbar enlargement, the cross- nal cord the lateral intermediate substance sectional area is larger than in the rest of the (B6). It contains sympathetic nerve fibers spinal cord; it is largest at the C4–C5 and mainly for the vasomotor system, the effer- L4–L5 levels. In both swellings, the numer- ent fibers of which emerge via the anterior ous nerves that supply the extremities root. In the sacral spinal cord, parasympathetic neurons Thewhitematterismostextensiveinthecer- form the intermediolateral nucleus und in- vical region and diminishes gradually in termediomedial nucleus (D8). Posteromedial nucleus (A10) so does the posterolateral tract (Lissauer’s Lateral group of nuclei tract) (A–D1).

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