Embryology and Congenital Defects

Question 1

Primary heart field is formed around ___ from ___derm

Answer 1

wk3

mesoderm

Question 2

Primary heart field undergoes ___ + ___ folding

Answer 2

lateral and cranio-caudal folding

Question 3

Heart tube regions cranial > caudal

Answer 3

truncus arteriosus
bulbus cordis
ventricle
atrium
sinus venosus

Question 4

truncus arteriosus becomes ___

Answer 4

aorta and pulmonary trunk

Question 5

bulbus cordis becomes ___

Answer 5

muscular/trabeculated part of RV

outflow of ventricles

Question 6

ventricle becomes ___

Answer 6

trabeculated/muscular part of L ventricle

Question 7

atrium becomes ___

Answer 7

trabeculated/muscular part of both atria

Question 8

sinus venosus becomes ___

Answer 8

R horn = smooth part R atrium and IVC

L horn = coronary sinus

Question 9

3rd aortic arches become

Answer 9

common carotid

1st part int. carotid

Question 10

4th aortic arches become

Answer 10

R = subclavian artery
L = part of arch of aorta

Question 11

6th aortic arches become

Answer 11

pulmonary artery and ductus arteriosus

Question 12

vitelline veins drain the ____

become ____

Answer 12

yolk salk

hepatic sinusoids and veins and hepatic portion of IVC

Question 13

Part of umbilical vein that bypasses the liver

Answer 13

ductus venosus

Question 14

Remnant of umbilical vein in adults

Answer 14

ligamentum teres

Question 15

cardinal veins drain the ___

Answer 15

systemic venous system

Question 16

2 umbilical arteries branch off of ___

Answer 16

iliac arteries

Question 17

1 umbilical vein joins to ___ to => IVC

Answer 17

ductus venosus

Question 18

Function = foetal homeostasis, gas exchange, acid-base balance, nutrient transport, waste transport, hormone productoin, IgG transport, produces PGE2

Answer 18

placenta

Question 19

maintains patency of ductus venosus during gestation =

produced in ___

Answer 19

PGE2

placenta

Question 20

R/L heart is of greater pressure in the foetus

Answer 20

R

Question 21

3 foetal shunts

Answer 21

ductus venosus
foramen ovale
ductus arteriosus

Question 22

carries nutrients from umbilical vein to IVC bypassing portal circulation

Answer 22

ductus venosus

Question 23

R->L atrium shunt

Answer 23

foramen ovale

Question 24

is a link from the pulmonary bifurcation to the descending aorta

Answer 24

ductus arteriosus

Question 25

Ibruprofen in foetus =

Answer 25

PGE2 inhibited and ductus arteriosus closes | prevents aorta and carotids getting best oxygenated blood

Question 26

First breath causes the lungs to ___ => increased ___ and pulmonary vessels ___ => ____ pulmonary resistance

Answer 26

inflate ->increased pO2 => decreased pulmonary resistance

Question 27

systemic vascular resistance increases in a baby when ____

Answer 27

the umbilical cord is clamped - placenta (large, low resistance vascular bed) removed

Question 28

____ and ____ at birth cause foramen ovale to shut

Answer 28

first breath AND cord being clamped

Question 29

Factors that decrease PDA after birth =

Answer 29

decreased pulm resistance - less flow through less PGE2 from placenta and more metabolised by lungs increased O2 => SM of duct constricts

Question 30

metabolises PGE2 after birth

Answer 30

lungs

Question 31

Functional closure of PDA occurs after ___ Anatomical closure occurs at ___ becomes ____

Answer 31

hrs-days 7-10 days ligamentum arteriosus

Question 32

In preterm PDA remains patent as ___

Answer 32

SM not developed enough

Question 33

Treatment for PDA =

Answer 33

NSAIDS | surgery - duct ligation

Question 34

congenital defect that requires PDA eg. | so give ___ to keep patent until deifinitive surgery

Answer 34

interruption of aortic arch | IV PGE2

Question 35

PPHN (persistent pulmonary hypertension of the newborn) is due to ___ =>

Answer 35

lung resistance not falling after birth => PDA and patent foramen ovale => cyanosis

Question 36

In PPHN there is a ___ in the pre(Rarm) and post (Lleg) ductal SaO2

Answer 36

big difference

Question 37

Treatment of PPHN

Answer 37

ventilate O2 + NO inhaled - vasodilators ECLS - extra-corporeal life support - bypasses lung

Question 38

PPHN is commoner in ___ babies due to

Answer 38

sick | sepsis, acidotic, hypoxic ischaemic insult, meconium aspiration syndrome, cold

Question 39

Congenital diaphragmatic hernia is an example of an anatomical abnormality that can cause ___

Answer 39

PPHN - persistent pulmonary hypertension of the newborn

Question 40

Congenital heart defects detected within 1-2 days of life usually present with

Answer 40

murmurs abnormal pulses cyanosis

Question 41

Congenital HDs detected in day 3-7 of life usually present with

Answer 41

sudden circulatory collapse, shock, cyanosis, sudden death

Question 42

Congenital HDs detected 4-6wks after birth usually present with

Answer 42

signs of HF, less feeding, SOB, sweaty

Question 43

Cyanotic congenital heart defects =

Answer 43

transposition of the great vessels tetralogy of fallot tricuspid atresia pulmonary atresis with intact ventricular septum total anomalous pulmonary venous connections

Question 44

Systemic circulation PDA dependant lesions eg.s

Answer 44

hypoplastic LH critical aortic stenosis interrupted aortic arch critical coarctation of the aorta

Question 45

pulmonary circulation PDA dependant lesions eg.s

Answer 45

pulmonary or tricuspid atresia

Question 46

If have duct dependant lesion with no PDA then presents:

Answer 46

``` 3-5 days (if undiagnosed) pale tachypnoeic pallor prolonged cap refill poor pulses hepatomegaly crepitations ```

Question 47

tetralogy is a(n) a/cyanotic heart defect

Answer 47

cyanotic

Question 48

ASD is a(n) a/cyanotic heart defect

Answer 48

acyanotic (initially)

Question 49

VSD is a(n) a/cyanotic heart defect

Answer 49

acyanotic (initially)

Question 50

Machine gun murmur =

Answer 50

PDA