Exam II Qs Flashcards
An increase incidence of what condition is strongly associated with increase in maternal age?
Trisomy 21 Trisomy 18 Trisomy 13 Anencephaly Ambiguous external genitalia
Trisomy 21
Cleft palate is a result in a defect in what developmental mechanism?
Failure to fuse Failure to merge Faulty inductive tissue interaction Disturbance in tissue reabsorption Absence of normal cell death
Failure to fuse
Which condition is related to maternal imprinting?
Accessory placental lobes Placenta previa Oligohydramnios Single umbilical artery Hydratidform mole
Hydratidform mole
Phocomelia is most likely to be seen after maternal exposure to which teratogenic agent during first trimester of pregnancy?
Alcohol Aminopterin Androgens Ionizing radiation Thalidomide
Thalidomide
The most serious threat of hydrop fetalis is CNS damage. The affected brain is enlarged and edematous, and when sectioned has a bright yellow color, particularly basal nuclei, thalamus, cerebellum, and cerebral gray matter, and spinal cord. The CNS damage is known as which of the following? Erythroblastosis fetalis Kernicterus Phenylketonuria Galactosemia
Kernicterus
What is the initial initiator of future forelimb development? Hoxd Tbx5 Shh Gli3
Tbx5
A high concentration in amniotic fluid results in neural tube defects? Lecithin Alpha fetoprotein Kernicterus Creatinine
Alpha fetoprotein
The most serious threat of hydrop fetalis is CNS damage. The affected brain is enlarged and edematous, and when sectioned has a bright yellow color, particularly basal nuceli, thalamus, cerebellum, cerebral gray matter and spinal cord. The CNS damage is known as which of the following?
Erythroblastosis fetalis
Kernicterus
Phenylketonuria
Galactosemia
Kernicterus
The sclerotome arises from cells that were located in which of the following locations
Notocord
Paraxial mesoderm
Intermediate mesoderm
Lateral mesoderm
Paraxial mesoderm
The cardiogenic plate arises from where?
Embryonic endoderm Somatic mesoderm Splanchnic mesoderm Intermediate mesoderm Neural crest
Splanchnic mesoderm
An inductive stimulus from which structure stimulates the transformation of the epithelial sclerotome into secondary mesenchyme?
Neural crest Somite Ectodermal placodes Embryonic endoderm Notochord
Notochord
Intermediate mesoderm is the precursor of the:
Urogenital system Heart Somites Body wall Vertebral bodies
Urogenital system
Name the 4 stages in the development of the chorionic villi, state characteristics of each
- Previllous embryo - no villi via trophoblast
- Primary villous stage - solid, cytotrophoblastic, ectodermal primary villi appear
- Secondary villous - mesodermal cores appear within primary villi
- Tertiary villous stage - blood vessels within mesenchymal core of secondary villi
What tissue in the mature placenta directly interfaces with the maternal uterine connective tissue?
Cytotrophoblast cells Syncytiotrophoblast cells Trophoblast cells Decidual cells None of the above
Cytotrophoblast cells
Describe the location of the chorionic plate in the mature placenta
(mesoderm) faces away from the chorionic villi towards the chorionic cavity
Describe the location of the cytotrophoblast shells in the mature placenta, what are they formed by?
Formed by expansion of the cytotrophoblastic columns over the maternal decidual cells
List the 5 structures involved in the final development of the placenta
Cytotrophoblast Cytotrophoblast columns Cytotrophoblast shells Anchoring villi Chorionic plate
What are the anchoring villi of the mature placenta anchored to?
The cytotrophoblastic shell (as opposed to floating villi)
What maternal tissues are lost at childbirth? (3)
Decidua capsularis
Chorion laevae
Amnion
What is the fate of the decidua capsularis?
Undergoes atrophy
Distinguish between early vs. late placenta
Early:
Thick, low permeability, small SA, total diffusion conductance is miniscule
Late:
Thin, high permeability, large SA, large increase in placental diffusion
State the oxygen pressure gradient near the end of pregnancy of the mother and fetus
PO2 mother = 50mmHg
PO2 fetus = 30mmHg
How does adequate oxygenation occur with such a low pressure gradient near the end of pregnancy?
Fetal Hb has a greater affinity for O2
Fetal blood has more Hb than mother (50%)
Bohr effect
Define Bohr effect
Hb can carry more O2 at a low PCO2
Curve is shift left for fetal, right and down for maternal
Define the double Bohr effect
The double shift in the maternal blood and fetal blood
Where is hCG secreted from, when, and what is its function?
Via syncytial trophoblast cells into maternal fluids
Measurable at 8-9d after ovulation, max = 10-12w pregnancy
Prevents degradation of corpus luteum & give growth
Causes CL to secrete more progesterone & est
Exerts interstitial cell-stimulating effect on testes of male fetus = testosterone production
Where is estrogen secreted from, when, and what is its function?
Syncytiotrophoblast cells of placenta
Toward end of pregnancy, 30X more via androgenic steroid compounds (mom&fetal adrenal glands) Converted by trophoblast cells into estradiol, estrone, and estriol
Uterine, breast, external genitalia enlargement
Breast ductal growth
Relaxation of pelvic ligaments
Where is progesterone secreted from and what is its function?
Small quantities = corpus luteum
Large quantities = placenta
Causes decidual cells to develop in the endometrium
Decreases contractility of pregnant uterus
Increases secretions of fallopian tubes and uterus
May work w/ est to prepare breast for lactation
When is human chorionic somatomammotropin secreted and what is its function?
5th week
Decreased insulin sensitivity and decreased utilization of glucose by mother
General metabolic hormone
Define malformation
Primary errors of morphogenesis.
Usually multifactoral, involving a number of etiological agents like genetic and environmental factors
Define disruption, what’s an example?
Disturbances in otherwise normal morphogenetic processes
i.e. amniotic bands
Define deformation, what makes it different from disruption? Give an example
Distrubances in otherwise normal morphogenetic processes
Typically caused by abnormal biomechanical forces = uterine constraints
i.e. clubfoot
Define sequences
A series/cascade of events triggered by one initiating factor
i.e. oligohydramnios which leads to a variety of events (bilateral renal agenesis)
Define syndromes
Constellations of congenital anomalies that are thought to be pathologically related but cannot be explained on the basis of a single local initial event
Often caused by a single event i.e. virus
Explain why developmental insults during the first 3 weeks of development are unlikely to result in defective development
The insults either kill the embryo or are compensated for by the powerful regulatory properties of the early embryo
Effects of thalidomide?
Limb defects, ear defects, cardiovascular anomalies
Phocomelia (mermaid), amelia
Effects of alcohol? What are the characteristics of fetal alcohol syndrome?
Growth and mental retardation, microcephaly, face and trunk malformations, heart defects
Holoprosencephaly = severe
Effects of RA
Cranial neural crest problems; facial structures, outflow tract of heart and thymus
Effect of folic acid
Neural tube defects = Anencephaly, growth retardation, cleft lip and palate, hydrocephaly, hypoplastic mandible, low set ears
What is surfactant? Function? How does it related to neonatal respiratory distress syndrome. Why is this referred to as hyaline membrane disease?
Protein and lipid component that coats walls of alveoli, so when lungs collapse they do not stick together
Hyaline membrane disease = bc it affects the respiratory membranes
Define fetal hydrops, what is the cause?
The accumulation of edema fluid in fetus during intrauterine growth due to bilirubin being released and causing water accumulation
Hemolytic amenia due to blood group incompatibility = immune hydrops
Nonimmune hydrops via cardiovascular defects and arrhythmias
What is the major factor in immune hydrops when the fetal blood mixes with maternal blood?
D Antigen of the Rh group
Blood mixes during last trimester or during birth
ABO incompatibility not an issue bc maternal Ab removes incompatible fetal RBCs that cross placenta
What is the major cause of nonimmune hydrops?
Cardiovascular defects = congenital cardiac defects and arrhythmias
What are the chromosomal anomalies that are associated with nonimmune hydrops?
Turner syndrome and trisomies 18,21 due to cardiac structural aberrations that accompany these anomalies
Define kernicturus and describe the consequences
Related to fetal hydrops
Results in CNS damage; enlarged and edematous brain that’s bright yellow color when sectioned
Define pregnancy-induced hypertension, at what week of pregnancy does it developed?
Persistent elevated bp (140/190) that develops after 20 weeks of gestation and returns to normal after birth
Define preclampsia, what are the symptoms?
Severe case of preclampsia
Higher BP
Proteinuria
Weight gain
Edema
Define Eclampsia, symptoms?
Most serious condition from preclampsia
Fatal
Grand mal seizures or coma
List the 3 immigrant cells, where they’re derived from and function
MML - Many Messicans Live
M - melanoblasts - via neural crest, migrate into dermis then epidermis, produce pigment mid-pregnancy
M - Merkel cells - via neural crest, slow-adapting mechanoreceptors
L - Langerhans - via BM, APCs
What is derived from the ectoderm during the development of hair?
Sebaceous glands
Part of follicle
Hair shaft
What is derived from the mesoderm during the development of hair?
Arrector pili
State the role of these hormones in mammary gland development:
Est
Prog
Prolactin
Oxytocin
Est = duct system growth
Prog = formation of secretory alveoli
Prolactin = synthesis of milk protein and fat
Oxytocin = causes milk letdown