Embryology and Devo Flashcards
1
Q
Found at base of limbs. Anterior-posterior and CNS development. Mutation leads to holoprosencephaly
A
Sonic hedgehog gene
2
Q
Produced at apical end of limbs at ectodermal ridge. Needed for dorsal-ventral axis organization.
A
Wnt-7
3
Q
Produced at apical ectodermal ridge. Stimulates mitosis of mesoderm.
A
FGF
4
Q
Segmental organization from cranium to caudum. Mutations cause appendages in wrong locations.
A
Hox
5
Q
Codes for transcription factors
A
Hox
6
Q
Which week does bilaminar disc (epiblast, hypoblast) form
A
Week 2
7
Q
Gastrulation occurs
A
Week 3
8
Q
Endoderm, mesoderm and ectoderm arise from
A
Epiblast primitive streak
9
Q
Notochord arises from
A
Midline mesoderm
10
Q
Neural plate arises from
A
Overlying ectoderm
11
Q
Beginning of organogenesis and increased susceptibility to teratogens
A
Weeks 3-8
12
Q
Ultrasound can see fetal heartbeat by
A
Week 6
13
Q
Male female genitalia can be distinguished by
A
Week 10
14
Q
Bones of skull are derived from
A
Neural crest
15
Q
C cells of thyroid, chromaffin cells of adrenal medulla, melanocytes, pia and arachnoid, aorticopulmonary septum and endocardial cushions are derived from
A
Neural crest
16
Q
Autonomic ganglia, DRG, cranial nerves and Schwann cells are derived from
A
Neural crest
17
Q
Anal canal below pectinate, parotid, sweat and mammary glands, anterior pituitary lens of eye are derived from
A
Surface ectoderm
18
Q
What induces formation of neuroectoderm (neural plate)
A
Notochord
19
Q
Upper vagina, lymphatics, spleen, peritoneum, wall of gut tube, are derived from
A
mesoderm
20
Q
Gut tube epithelium, most of urethra and lower vagina, lungs, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, thyroid follicular cells derived from
A
Endoderm
21
Q
When does malformation occur
A
Weeks 3-8
22
Q
A woman with vaginal clear cell adenocarcinoma or abnormal uterus likely had mother who consumed
A
Diethylstilbestrol
23
Q
Absence of skin from the scalp is suggestive of which teratogen
A
Methimazole
24
Q
Discolored teeth, inhibited bone growth suggest maternal use of
A
Tetracycline
25
Thalidomide use to tx leprosy or MM increases risk of what in fetus
Limb defects ("flipper" limbs)
26
Warfarin can cause what in fetus
bone deformities, fetal hemorrhage, abortion, olpthalmologic abnormalities
27
Can cause placental abruption, low birth weight, preterm birth, IUGR
Cocaine
28
Low birth weight, preterm labor, SIDS can occur due to maternal use of
cigarettes (smoking)
29
Cretinism results from
Lack or excess Iodine in maternal diet
30
Anal atresia to sirenomelia, congenital heart defects, neural tube defects and macrosomia are consequences of which maternal condition
Diabetes
31
Swofrdfish, shark, tilefish and king mackerel consumption increase risk of neurotoxicity in fetus due to
methylmercury
32
Fetal alcohol syndrome occurs due to failure of
Migration
33
Smooth philtrum, thin upper lip (vermilion border), small palpebral fissures (eye openings) and low set ears in baby indicate
Fetal alcohol syndrome
34
First to differentiate after fertilization
Trophoblast
35
Secretes beta-hCG after implantation
Synctiotrophoblast
36
Trophoblastic layer that facilitates exchange of nutrients and waste between mother and fetus
Synctiotrophoblast
37
Function of hCG
Maintain progesterone and sustain pregnancy
38
Failure of trophoblast to invade endometrium adequately can lead to
Pre-eclampsia
39
Dizygotic twins result from
2 separate eggs fertilized by two separate sperm (dichorionic, diamniotic)
40
What is the chorion
Outer layer of amniotic sac that attaches to endometrium and allows nutrient exchange between fetus and mother
41
What is the amnion
Inner layer of amniotic sac that protects developing fetus
42
Monozygotic twins that have two separate chorion and two separate amnion likely arose from
Cleavage at 2-cell stage
43
Monozygotic twins that share a chorion and have two separate amnion likely arose from
Cleave at morula stage (4-8 days)
44
Monozygotic twins that share one chorion and one placenta likely arose from
Blastocyst stage cleavage (8-12 days)
45
Conjoined twins result due to cleavage at which stage
>13 days, formed embryonic disc
46
Monozygotic twins most commonly occur due to cleavage of
Morula (one chorion, two amnion)
47
Leading cause of intellectual disability in the US
Fetal alcohol syndrome
48
Inner layer of chorionic villi that produces cells
Cytotrophoblast
49
Outer layer of chorionic villi that synthesizes hCG stimulate progesterone secretion from corpus luteum during first semester. Lacks MHC I so will not be attacked by maternal immune system
Synctiotrophoblasts
50
Umbilical arteries and umbilical vein are derivatives of
allantois
51
How many umbilical arteries and veins
2 umbilical arteries (carry deoxygenated blood from fetus to mother), 1 umbilical vein (carry oxygenated blood from mother to fetal IVC)
52
Urine from umbilicus indicates
Patent urachus
53
Urachus is derived from
Allantois
54
Fluid-filled cavity between umbilicus and bladder that can lead to infection or adenocarcinoma
Urachal cyst (partial failure of urachus to obliterate)
55
Outpouching of bladder
Vesicourachal diverticulum (slight failure of urachus to obliterate)
56
Congenital persistence of urachus occurs due to errors in which week of devo?
3rd week
57
Meconium discharge from umbilicus
Vitelline fistula (vitelline duct fails to close)
58
Melena (dark poop with blood), hematochezia (vomit with blood), and abdominal pain in child. Tissue biopsy presents gastric or pancreatic tissue.
Meckel diverticulum (partial closure of vitelline duct)
59
Congenital persistence of vitelline duct (connects yolk sac to midgut lumen) occurs due to error in which week of devo?
7th week
60
Nerve associated with 1st arch
CN V2 and V3
61
Muscles associated with 1st arch
Muscles of mastication (Temporalis, masseter, anterior digastric, tympani)
62
Bones associated with 1st arch
Zygoma, Maxillary process, mandibular process, malleus and incus
63
Ectoderm associated with 1st arch
External auditory meatus
64
CN associated with 2nd arch
VII (Facial)
65
Muscles associated with 2nd arch
Muscles of facial expression, stapedius, stylohyoid
66
Bones associated with 2nd arch
Stapes, stylohyoid, lesser horn of hyoid, stylohyoid ligament
67
Artery associated with 1st arch
Maxillary artery (of ECA)
68
Artery associated with 2nd arch (
Stapedial and hyoid arteries
69
Lateral neck mass that doesn't move upon swallowing is remnant of
Temporary cervical sinus of branchial clefts 2-4
70
Failure of NC derivatives of 1st and 2nd arches (deafness, micrognathia)
Treacher-Collins syndrome
71
Small jaw, glossoptosis, cleft palate, airway obstruction suggest
Pierre Robin Sequence (abnormal 1st and 2nd arch development)
72
Superior laryngeal nerve (swallowing) is derivative of which arch
4th
73
Aortic arch and proximal SCA are derivatives of which arch
4
74
Common carotid and proximal ICA are derivatives of which arch
3
75
CN IX is derivative of which arch
3
76
CN X is part of which arch
4 and 6
77
Recurrent laryngeal nerve (voice) is part of which arch
6
78
L: Proximal pulmonary artery and ductus arteriosus are part of which arch
6
79
Superior parathyroids are derived from which pouch
dorsal 4th
80
C cells of thyroid are derived from which pouch
Ventral 4th
81
Thymus is derived from which pouch
Ventral 3rd
82
Inferior parathyroids are derived from which pouch
Dorsal 3rd
83
Epithelial lining of palatine tonsils are derived from
2nd pouch
84
Middle ear, eustachian tube and mastoid air cells are derived from
1st branchial pouch
85
Clefts, Arches and Pouches represent which embryologic layers respectively
Ectoderm, mesoderm, endoderm
86
Lower portion of vagina develops from
Urogenital sinus
87
Failure of fusion of maxillary and medial nasal processes
Cleft lip
88
Failure of fusion of lateral palatine shelves
Cleft palate
89
Failure of fusion of lateral palatine shelves with nasal septum
Cleft Palate
90
Failure of fusion of lateral palatine shelves with median palatine shelf
Cleft palate
91
Mesonephros develops into
Ureter, epididymis and vas deference
92
Fallopian tubes, uterus and upper portion of vagina are derived from
paramesonephric duct
93
Mayer-Rokitansky-Kuster-Hauser syndrome is
Failure of Mullerian (paramesonephric) duct development. Primary amenorrhea in woman with secondary sexual characteristics
94
Seminal vesicles, epididymis, ejaculatory duct, ductus deferens (SEED) derived from
Mesonephric ducts
95
What is the Gartner duct
Remnant of mesonephric duct in females
96
Decreased fertility (woman has difficulty getting pregnant) due to a resorption defect of Mullerian duct implies
Septate uterus
97
Incomplete failure of Mullerian ducts
Bicornuate uterus
98
Presents with recurrent miscarriages and multiple UTIs
Bicornuate uterus
99
Complete failure of Mullerian ducts
Uterus didelphys
100
Prostate gland arises from
Urogenital sinus
101
Hormone that induces development of female external genitalia
Estrogen
102
Hormone that induces formation of male external genitalia
DHT
103
failure of urethral folds to fuse. Associated with inguinal hernia and cryptorchidism
Hypospadias
104
Faulty positioning of genital tubercle. Associated with exstrophy of bladder
Epispadias
105
Anchors testes to scrotum
Gubernaculum
106
Forms tunica vaginalis
Processus vaginalus
107
Forms ovarian ligament and round ligament of uterus
Gubernaculum
108
Why are left varicoceles more common than right ones
Left spermatic vein enters left renal vein at 90 degree angle so there is more turbulent flow so greater pressure
109
Lymphatic drainage of superior bladder, cervix and body of uterus
External iliac
110
Lymph drainage of ovaries and testes
para-aortic
111
Lymph drainage of distal vaginal/vulva/scrotum/distal anus
superficial inguinal
112
Lymph drainage of glans penis
Deep inguinal
113
Lymph drainage of prostate, cervix, corpus cavernosum, proximal vagina
internal iliac
114
Which vessels are ligated during oophorectomy to avoid bleeding?
Ovarian vessels in Infundibulopelvic ligament (suspensory ligament of ovary)
115
Infundibulopelvic ligament (suspensory ligament of ovary)
Connects ovaries to lateral pelvic wall
116
Which structure is at risk of injury during ligation of ovarian vessels?
Ureter
117
Cardinal ligament
Connects cervix to side wall of pelvis
118
Which vessels are contained by cardinal ligament
Uterine vessels
119
Which structure is at risk of injury during ligation of uterine vessels
Ureter
120
Round ligament of uterus
Connects uterine fundus to labia majora
121
What is the artery of Sampson
Anastamoses between ovarian and uterine vessels. Runs under Round ligament of Uterus
122
Broad ligament
connects uterus, fallopian tubes, and ovaries to pelvic side wall
123
Ovaries, fallopian tubes, round ligaments of uterus are contained in
Broad ligament
124
Ovarian ligament
Connects medial pole of ovary to lateral uterus
125
Pathway of sperm ejaculation (SEVEN UP)
Seminiferous tubules --> Epididymis --> Vas deferens --> Ejaculatory ducts --> Nothing --> Urethra --> Penis
126
In a perineal straddle injury, which fascia is torn
Deep fascia of Buck
127
In perineal straddle injury, where does urine escape into
superficial perineal space
128
Posterior urethral injury where urine leaks into retropubic space occurs due to
Pelvic fractures
129
Anterior urethral injuries occur due to
Straddle-type falls
130
Erection occurs due to
PSNS of pelvic nerve: NO--> cGMP--> vasodilation
131
Emission occurs due to
SNS of hypogastric nerve: NE --> intracellular Ca+2--> smooth muscle contraction--> anti-erectile
132
Ejaculation occurs due to
visceral and somatic nerves of pudendal nerve
133
Granulosa cell male homolog
Sertoli cell
134
Theca cell male homolog
Leydig cell
135
Sertoli cells regulate spermatogenesis in response to
FSH
136
Sertoli cells secrete Inhibin B to
Inhibit FSH secretion
137
Leydig cells secrete testosterone in response to
LH
138
Carry aromatase to convert testosterone and androstendione to estrogen
Sertoli cells
139
Form blood testis barrier
Sertoli cells
140
Why do varicoceles lead to low sperm count?
Sertoli cells need cool temperatures to function
141
When in process of sperm become haploid?
After meiosis I (secondary spermatocyte)
142
What disinhibts lactation
drop in progesterone and estrogen after labor
143
Appearance of breast bud indicates which stage of Tanner
Tanner Stage 2, thelarche
144
Testicular enlargement begins in which Tanner Stage
2
145
Breast "mound on mound" describes which Tanner stage?
Stage IV
146
Penis size and length begins to increase in which Tanner stage
III
147
Pines width/glans starts to increase in which stage?
Stage IV
148
Define APGAR
```
Appearance (blue or pink 0-2)
Pulse (0 - >100; 0-2)
Grimace (Cry and pull; 0-2)
Activity (movement; 0-2)
Respiration (strength of cry and breath; 0-2)
```
149
Hormonal changes in menopause
Increased FSH/LH ratio, decreased estrogen, increased GnRH
150
Amennorrhea for 12 months, decreased estrogen production, preceded by abnormal cycles for 4-5 years
Menopause
151
Spike in which hormone levels is specific for Menopause?
FSH spike (due to loss of negative feedback due to decreased estrogen)
152
hCG levels in ectopic/failing pregnancy, Edward syndrome and Patau syndrome
decreased
153
hCG levels in hyatidiform moles, choriocarcinomas and Down syndrome
Increased
154
Where is estrone produced
Adipose tissue via aromatase
155
Where is estradiol produced
Ovary (primary follicles)
156
Where is estriol produced
Placenta (pregnancy)
157
Where are estrogen receptors expressed
Cytoplasm, translocate to nucleus when bound
158
Stimulates endometrial gland secretions, spiral artery development, maintenance of pregnancy, decreases myometrial excitability, produces thick cervical mucus to trap sperm, increases body temperature, inhibits FSH and LH, prevents contractions, decreases ER expression, prevents endometrial hyperplasia
Progesterone
159
Development of female sexual characteristics, female fat distribution, bone growth, follicle growth, increases myometrial excitability, upregulates ER, FSH, LH receptors, inhibition of FSH and LH and then LH surge, increases HDL, decreases LDL
Estrogen
160
Young female presenting with unilateral painful cystic lesion along vaginal canal that produces mucus-like fluid likely has
Bartholin cyst
161
3 places that HPV infects and how it appears
Vulva (genital warts 6 + 11), Vaginal canal, Cervix (16, 18, 31, 33); biopsy shows koilocytes (cells with raisin-like nuclei)
162
How to classify low-risk vs high-risk HPV
DNA sequencing
163
"Paper thin epidermis" with fibrosed or thickened dermis that presents as white patch (leukoplakia) in post-menopausal woman is
Lichen sclerosis (slight risk of squamous cell carcinoma)
164
Leukoplakia with thick leathery vulvar skin is
Lichen simplex chronicus (no risk of squamous cell carcinoma)
165
Which three conditions present with vulvar leukoplakia?
Lichens sclerosis, Lechen simplex chronicus, Vulvar carcinoma
166
Woman who develops vulvar carcinoma in her 40s-50s likely was infected by
HPV 16, 18, 31, 33
167
Woman who develops vulvar carcinoma in her 70s
non-HPV related
168
Characterized by malignant epithelial cells in epidermis of vulva; presents as erythematous, pruritic, ulcerated vulvar skin
Extramammary Paget disease
169
PAS+, keratin+ and S100-
Paget disease
170
PAS-, Keratin-, S100+
Melanoma
171
What is PAS a marker for?
Mucus (only epithelial cells make mucus)
172
Important distinction between Paget disease of nipple vs vulva
Paget disease of nipple suggests cancer of breast. Paget dz of vulva does not indicate cancer
173
Early in development, upper 2/3 of vagina and lower 1/3 of vagina are composed of
Upper: columnar epithelium
Lower: non-keratinizing squamous
174
Persistance of columnar epithelium in upper vagina is tied to which teratogen
Maternal use of DES-- vaginal adenosis
175
"Grape like mass" protruding from vagina of 5yo girl is a malignant proliferation of what tissue
Mesenchyme, immature skeletal muscle
176
Desmin and myogenin staining confirm
Embryonal rhabdomyosarcoma
177
Lymph node spread of lower 1/3 vagina carcinoma
Superficial inguinal
178
Lymph node spread of upper 2/3 vagina carcinoma
Iliac nodes
179
Which part of cervix is most susceptible to HPV infection?
Transformation zone (point between endocervix and exocervix)
180
HPV E6 protein function
Destroys p53
181
HPV E7 protein function
destroys Rb
182
90% of HPV is cleared by body. T/F?
True
183
What are the four defining features of Cervical Intraepithelial neoplasia?
Koilocytic change, nuclear atypia, disordered cellular maturation, increased mitotic activity within cervical epithelium
184
Key feature of invasive carcinoma
Dysplasia goes through basement membrane
185
Most common type of cervical carcinoma
Squamous cell (80%)
186
Why is postrenal failure the most common cause of death in women with cervical carcinoma?
Cancer can invade anterior wall and into bladder, block ureters, causing hydronephrosis and lead to postrenal failure
187
Screening test and confirmatory test for cervical cancer
Pap smear for screen, colposcopy for confirmation
188
HPV vaccine has antibodies against which strains?
6, 11, 16, 18
189
A woman who develops amenorrhea after a D&C likely lost which cells
Basalis (regenerative layer of endometrium)-- Asherman syndrome
190
What are anovulatory cycles
Estrogen-driven proliferation phases without progesterone-driven secretory phases--> lead to abnormal cycles, heavy bleeding due to excessive endometrial growth
More common in menarche and menopause due changes in HPA
191
What is the histologic diagnostic cell for chronic endometritis
Presence of plasma cells
192
Why can Tamoxifen cause endometrial polyps?
Though it has anti-estrogenic effects on breast, has pro-estrogenic effects on endometrium
193
Pain during menstruation, pelvic pain, and potential infertility can be caused by
Endometriosis
194
Most common site of endometriosis
Ovary
195
What is endometriosis?
Ectopic location of endometrial tissue and glands outside of uterus. Could be due to retrograde menstruation, abnormal development of Mullerian duct or lymphatic dissemination
196
Postmenopausal bleeding in a woman with PCOS, obesity or HRT is likely due to
Endometrial hyperplasia from unopposed estrogen
197
In a woman with postmenopausal bleeding, what is the most important indicator for progression to endometrial carcinoma?
Cellular atypia
198
Three tumors that produce psammoma bodies
Mengingeomas, mesothelioma, papillary carcinoma of thyroid, Endometrial carcinoma serous type
199
Two most common type of surface epithelial ovarian tumors
Serous and mucinous
200
Single simple cyst with flat lining in woman in her 30s-40s suggests
Cyst adenoma (benign ovarian tumor)
201
Complex cysts with thick, shaggy lining in postmenopausal woman. Bilaterality, suggests
Malignant cystadenocarcinoma
202
Which type of ovarian carcinoma is increased in pts with BRCA1
Serous cystadenocarcinoma of ovary and fallopian tube
203
Ovarian tumor with bladder-like (urothelial) epithlium is
Brenner tumor, usually benign
204
Serum marker for surface epithelial ovarian tumor to monitor treatment
CA-125
205
A 20-30 woman presenting with symptoms of hyperthyroidism and elevated thyroid levels but normal thyroid gland likely has
R Unilateral Teratoma
206
Most common immature tissue in teratoma with malignant potential
Neural ectoderm
207
Woman presenting with ovarian tumor, pleural effusion and ascites has
Fibroma Meigs syndrome (resolves with removal of tumor)
208
Krukenberg tumor (Bilateral mets to ovary) is commonly from
Diffuse type gastric carcinoma (Signet cells)
209
Pseudomyxoma peritonei mets to ovary likely originated in; presentation is "jelly belly" due to massive production of mucus in peritoneum
appendix
210
What does third-trimester bleeding suggest
Placenta previa; requires CS
211
Third trimester bleeding, painful contractions and fetal insufficiency suggest
Placental abruption (separation of placenta from decidua); common cause of stillbirth
212
Presents with difficult delivery (delayed) of placenta and excessive postpartum bleeding (risk of hemorrhage)
Placenta accreta (implantation of placenta into myometrium)
213
A woman with placenta accreta often requires
Hysterectomy
214
Woman presenting with hypertension, proteinuria and edema in the third trimester (> 20 weeks) of pregnancy likely has
Pre-eclampsia
215
Mechanism that causes pre-eclampsia
Decreased organ perfusion between placenta and uterus, leading to vasospasm and endothelial activation
216
Best way to resolve preeclampsia
Deliver baby
217
Define HELLP syndrome
Hemolysis, Elevated Liver enzymes, Low Platelets
| Preeclampsia with thrombotic microangiopathy involving liver
218
What is Eclampsia
Preeclampsia + seizures
219
Uteroplacental ischemia--> oxidative stress--> activation of secondary mediators-->endothelial dysfunction, vasospasm, activation of coagulation-> widespread vasoconstriction--> hypoxic/ischemic damage to vascular beds is pathophysiology of
Preeclampsia
220
What is seizure prophylaxis in a woman with preeclampsia
Magnesium sulfate
221
How to reverse magnesium sulfate toxicity
Calcium gluconate
222
Normal ovum fertilized by two sperm (or one that duplicates itself); 69 chromosomes
Partial mole
223
Empty ovum fertilized by two sperm; 46 chromosomes
Complete mole
224
Fetal tissue is present
Partial mole
225
Fetal tissue is absent
Complete mole
226
Some villi are hydropic, some are normal
Partial mole
227
Most villi are hydropic (edematous)
Complete mole
228
Focal proliferation of trophoblast
Partial mole
229
Complete proliferation of trophoblast ("snowstorm" on US)
Complete mole
230
Risk for choriocarcinoma is minimal
Partial mole
231
Risk for choriocarcinoma is increased
Complete mole
232
What are the two defining features of molar pregnancy
Uterus expands as pregnancy progresses but uterus is much larger than expected and beta-hCG is higher than expected for date of gestation
233
When and how does molar pregnancy classically present in a woman without prenatal care?
Second trimester as passage of grape-like masses
234
When and how is molar pregnancy diagnosed in woman with prenatal care
1st trimester via US; absent fetal heart sounds and "snowstorm" appearance
235
Choriocarcinoma from gestation vs choriocarcinoma from GCT
Gestational responds to chemotherapy, GCT does not
236
Woman who presents with elevated beta-hCG, shortness of breath, hemoptysis after giving birth may have
gestational choriocarcinoma
237
Risk factors for placental abruption
Smoking, trauma, hypertension, preeclampsia and cocaine abuse
238
4 Ts of postpartum hemorrhage
aTony, Trauma, Thrombin (coagulopathy), Tissue (retained prodcuts of conception)
239
Too little amniotic fluid due to fetal inability to "pee"
Oligohydramnios (can cause Potter sequence)
240
Too much amniotic fluid due to fetal inability to "swallow"
Polyhydramnios
241
Hypertension <20 weeks of pregnancy suggests
Molar pregnancy
242
Which phospholipid ratio assesses lung maturity/surfactant production?
Lecithin(dipalmitoylphosphatidylcholine)/sphingomyelin (>2 = mature)
