Repro from FA (quick associations) Flashcards
Fetus has renal damage: what medication (teratogen) caused that?
ACE inhibitors
(causes vasodilation; used for hypertension, CHF)
Fetus has absence of digits/multiple anomalies: what medication (teratogen) caused this?
Alkylating agents
(chemotherapy agents; used to damage DNA)
Fetus has CN VIII toxicity: what medication (teratogen) caused that?
Aminoglycosides
(protein synthesis inhibitors, bacteriocidal, gram-negative antibacterial)
“A MEAN GUY hit the baby on the ear”
Fetus has neural tube defects, cranifacial defects, fingernail hypoplasia, dev delay, IUGR: what medication (teratogen) caused that?
Carbamazepine
(for epilepsy and bipolar; anticonvulsant, mood stabilizer)
Fetus has vaginal clear cell adenocarcinoma, congenital Mullerian anomalies: what medication (teratogen) caused that?
Diethylstilbestrol (DES)
(synthetic nonsteroidal estrogen, thought from 1940s-1970s to cause fewer birth defects. no longer used though exposure may occur via eating beef or from breast cancer treatment)
Fetus has neural tube defects: what medication (teratogen) caused that?
Folate antagonists
(inhibit cell division, DNA/RNA synthesis and repair and protein synthesis. Proguanil, pyrimethamine and trimethoprim selectively inhibit folate’s actions in microbial organisms such as bacteria, protozoa and fungi. The majority of antifolates work by inhibiting dihydrofolate reductase (DHFR).)
Fetus has Ebstein abnormality (atrialized right ventricle): what medication (teratogen) caused that?
LIthium
(treatment for bipolar, depression, Schizoaffective)
Fetus has aplasia cutis congenita: what medication (teratogen) caused that?
Methimazole
(antithyroid, used for hyperthroidism. major SE = agranulocytosis)
Methimazole caused that hole!
Fetus has fetal hydantoin syndrome (microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR, intellectual disability): what medication (teratogen) caused that?
Phenytoin
(voltage-dependent block of voltage-gated sodium channels; used for complex partial seiz and tonic-clonic)
Fetus has discolored teetn: what medication (teratogen) caused that?
Tetracyclines
(Antibiotic. It is a protein synthesis inhibitor. It is commonly used to treat acne today, and, more recently, rosacea, and is historically important in reducing the number of deaths from cholera.)
Fetus has limb defects (phocomelia, micromelia - ie flipper limbs): what medication (teratogen) caused that?
Thalidomide
Fetus has neural tube defects due to inhibition of maternal folate absorption: what medication (teratogen) caused that?
Valproate (same effect as insufficient maternal folate)
(anticonvulsant and mood-stabilizing drug, primarily in the treatment of epilepsy, bipolar disorder and prevention of migraine headaches.)
Fetus has bone deformities, fetal hemorrhage, abortion, opthalmologic abnormalities: what medication (teratogen) caused that?
Warfarin
“Don’t wage WARfarin on the baby; keep it HEPpy with Heparin” (heparin does not cross placenta)
Common cause of birth defects and intellectual disability
Mom used what substance?
Alcohol
leads to Fetal Alcohol Syndrome (CNS damage, memory/functional issues, predisposition to addictions)
Abnormal fetal growth and fetal addiction; placental abruption
Mom used what substance?
Cocaine
Leading cause of low birth weight in developed countries; associated with preterm labor, placental problems, IUGR, ADHD
Mom used what substance?
Nicotine, CO from smoking
Congenital goiter or hypothyroidism (cretinism)
What happened?
Lack or excess of iodine in utero
Caudal regression syndrome (anal atresia to sirenomelia), congenital heart defects, neural tube defects
What happened in utero?
Maternal diabetes
High risk for spontaneous abortions and birth defects (cleft palate, cardiac abnormalities)
What happened in utero?
Excess of Vit A
Microcephaly, Intellectual disability
What happened in utero?
X-rays
Umbilical arteries return blood from where to where?
Deoxygenated blood (so opposite of what you would normally think about arteries) from fetal internal iliac arteries (off of fetal descending aorta) –> placenta
Umbilical vein carries blood from where to where?
Oxygenated blood from placenta to fetus (drains into fetal IVC via liver or ductus venosus)
Generally, aortic arch derivatives develop into what?
Arterial system
1st aortic arch –> ?
Part of maxillary artery (branch of external carotid)
“1st is MAXimal”
2nd aortic arch –> ?
Stapedial artery and hyoid artery
3rd aortic arch –> ?
Common Carotid artery and prox part of internal Carotid
4th aortic arch –> ?
Left: part of aortic arch
Right: prox part of right subclavian
“4th arch –> 4 limbs ie systemic”
5th aortic arch –> ?
nothing. degenerates for the most part
6th aortic arch –> ?
proximal part of pulmonary arteries and (left side only) ductus arteriosus
1st branchial cleft develops into what structure?
external auditory meatus
2nd through 4th branchial clefts develop into what structures?
temporary cervical sinuses (later obliterated by proliferation of 2nd arch mesenchyme)
what happens if there is a persistent cervical sinus?
there will be a branchial cleft cyst within the lateral neck
Branchial apparatus: also called what?
consists of what?
aka Pharyngeal apparatus
Consists of Clefts, Arches, Pouches
Branchial Clefts, Arches, Pouches: what embryoligical tissue is each derived from?
Clefts: from ectoderm
Arches: from mesoderm/NCC
Pouches: from endoderm
“CAP covers from outside to inside”
Derivatives of the 1st Branchial Arch:
Cartilage? Muscles? Nerves?
Cartilage: Meckel cartilate: Mandible, Malleus, inclus, spheno-Mandibular ligament
Muscles: Muscles of Mastication (temporalis, Masseter, lateral/Medial pterygoids), Mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini
Nerves: CN V2 and V3 (chew)
Abnormalities of the 1st Branchial arch?
Treacher Collins syndrome
1st arch neural crest fails to migrate -> mandibular hypoplasia, facial abnormalities
Derivatives of the 2nd Branchial Arch:
Cartilage? Muscles? Nerves?
Cartilage: Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament
Muscles: of facial expression, Stapedius, Stylohyoid, platysma, belly of digastric
Nerves: CN VII (facial expression/smile)
Derivatives of the 3rd Branchial Arch:
Cartilage? Muscles? Nerves?
Cartilage: greater horn of hyoid
Muscles: Stylopharyngeus (think of it as being innervated by the glossopharyngeal nerve)
Nerve: CN IX (glossopharyngeal nerve -> stylopharyngeus m.)
“swallow stylishly”
Derivatives of the 4th-6th Branchial Arch:
Cartilage?
Cartilage: thyroid, cricoid, arytenoids, corniculate, cuneiform
(laryngeal cartilage)
Derivatives of the 4th Branchial Arch:
Muscles? Nerves?
Muscles: Most pharyngeal constrictors, cricothyroid, levator veli palatini
Nerves: CN X (superior laryngeal branch) - simply swallow
Derivatives of the 6th Branchial Arch:
Muscles? Nerves?
Muscles: all intrinsic muscles of larynx except cricothyroid
Nerves: CN X (recurrent laryngeal branch) - speak
which arches make up the posterior 1/3 of the tongue?
Arches 3 and 4
Abnormalities from the 2nd branchial arch?
Congenital pharyngocutaneous fistula: persistence of 2nd arch cleft and pouch -> fistula between tonsillar area and lateral neck
Cleft lip… what didn’t happen?
Failure of fusion of maxillary and medial nasal processes (formation of 1’ palate)
Cleft palate… what didn’t happen?
Failure of fusion of the two lateral palatine processes
OR
failure of fusion of lateral palatine processes with the nasal septum and/or medial palatine process (formation of 2’ palate)
1st branchial pouch develops into what?
middle ear cavity, eustachian tube, mastoid air cells
endoderm-lined structures of ear
2nd branchial pouch develops into what?
Epithelial lining of palatine tonsil
3rd branchial pouch develops into what?
Dorsal wings develop into inferior parathyroids
Ventral wings develop into thymus
3rd pouch contributes to 3 structures (thymus, L and R inferior parathyroids…. 3rd pouch structures end up BELOW 4th pouch structures)
4th branchial pouch develops into what?
Dorsal wings develop into superior parathyroids
DiGeorge syndrome: aberrant development of what structures?
3rd and 4th branchial pouches
How is Men 2A associated with branchial pouches?
Mutation of germline RET (neural crest cells). Parathyroid (-> tumor) is associated with 3rd/4th pharyngeal pouch. Parafollicular cells (-> medullary thyroid cancer) is derived from NCCs; associated with 4th/5th pharyngeal pouches.
Embryo -> female: what ducts develop, which ones degenerate?
Paramesonephric (Mullerian) develop
Mesonephric (Wolffian) degenerate
Embryo -> male: what signals are required? what does each one cause?
- SRY gene (Y chromosome): produces testis-determining factor -> testes development)
- Sertoli cells: secrete Mullerian inhibitory factor (MIF). suppresses dev of Paramesonephric ducts
- Leydig cells: secrete androgens, stimulate dev of Mesonephric (Wolffian) ducts
Mullerian ducts dev into what?
fallopian tubes
Uterus
upper vagina (lower vag from urogenital sinus)
Mullerian duct abnormalities result in what?
anatomical defects: may be 1’ amenorrhea in females with fully developed 2’ sexual characteristics (which indicates functional ovaries)
Wolffian ducts develop into what?
SEED: Seminal vesicles, Epididymus, Ejaculatory duct, Ductus deferens
Ovary: epithelial cell type?
simple cuboidal aka germinal
Fallopian tube: epithelial cell type?
simple columnar
has cilia to move the ova along
Peg cells secrete nutrients
Uterus epithelial cell type?
simple (pseudostratified) columnar
contains tubular cells
divided into functional and basal layers
undergoes cyclic changes
Cervix: epithelial cell type?
- Simple columnar (endocervix)
- Stratified squamous (ectocervix)
- associated with condyloma accumulatum, adenocarcinoma, squamous cell cancer
Vagina: epithelial cell type?
stratified squamous non-keratinized
contains glycogen.
associated with squamous cell cancer.
which hormones share an identical alpha unit but have unique ß units?
acronym: Top-HALF
TSH, hCG, (alpha unit), LH, FSH
(remember that a urine preg test detects ß-hCG)
cervical carcinoma: associated with what virus? what exactly causes pathology?
HPV 16 and HPV 18
produce E6 gene product -> inhibits p53 tumor suppressor
E7 gene product -> inhibits RB tumor suppressor
Urothelial cell carcinoma: where does this occur?
lower urinary tract, usually bladder
cell type = urothelial (aka transitional)
Urothelial cell carcinoma: risk factors?
cigarette smoke
naphthylamine, azo dyes (hairdressers), cyclophosphamide or phenacetin use
Urothelial cell carcinoma: presentation?
two types?
painless hematuria
Flat and Papillary types
Urothelial cell carcinoma, flat type: mutation? pathway?
p53 mutation
develops as high grade, then invades
Urothelial cell carcinoma, papillary type: mutation? pathway?
not associated with mutation
low grade -> high grade -> invasion
Urothelial cell carcinoma: why does it tend to be multifocal and have recurrence?
(“field defect”)
all of bladder cells have been bathed in carcinogens (if reason is smoking/toxins) - just a matter of time before others become cancerous
urinary tract squamous cell carcinoma: risk factors?
- Schistosoma hematobium (infection typically in Egyptian male)
- chronic nephrolithiasis (due to irritation)
urinary tract adenocarcinoma: classic picture?
embryological defect = urachial remnant - tumor at the dome of the bladder.
urachus lined by glandular cells hence adenocarcinoma.
