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152 Cards in this Set
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umbilical hernias
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occure due to weakness of abdominal wall at the umbilicus; common in kids, close by 2yo
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amniotic fluid measurements
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AFP: neural tube defects; bilirubin: erythroblastosis fetalis; 17-hydroxyprogesterone: congenital adrenal hyperplasia; phospholipids: pulmonary surfactant (IRDS)
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hCG level elevation: how many days after fertilization?
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6 to 11 (blastocyst formation, which secretes hCG)
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failure of closure of cephalic folds
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sternal defects
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failure of fusion of lateral folds
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omphalocele
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failure of closure of caudal folds
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bladder exstrophy (posterior bladder exposed through anterior abdmonal wall; mucosa exposed to outside of body, risk for ucleration, metplasia, adenocarcinoma, and UTI); a/w epispadias
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three major cyanotic heart diseaes caused by abnormal migration of neural crest cells
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Tetralogy of Fallot, transposition of the great vessels, and truncus arteriosus
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changes in pulmonary resistance before/after birth
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in utero: severe pulmonary hypertension; after birth: pulm vascular pressure and resistance drop (lungs expand with air)
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vessel that takes blood from placenta to fetus
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umbilical VEIN
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remnant of umbilical vein in adults
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ligamentum teres
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potter syndrome
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pulmonary hypoplasia, limb deformities and characteristic facies, and bilateral renal agenesis; lack of fetal urine causes oligohydramnios, and amniotic fluid is necessary for proper lung development
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HELLP syndrome
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Hemolytic anemia, Elevated Liver enzymes, Low Platelets; a/w maternal hypertension (pre-eclampsia)
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MEN I
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men oncogene; 3Ps: Parathyroid, Pancreas, Pituitary Tumors; ("1 is easier than 2")
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MEN II
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ret oncogene, neural crest cells; "Think Medullas:" Medullary carcinoma of the thyroid, Medullary carcinoma of the adrenals (Pheo); MEN IIA adds parathyroid tumor; MEN IIb adds mucosal neuromas;
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MEN IIA
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Medullary carcinoma of thyroid, medulla of adrenals (pheo), and parathryoid (A is closer to I)
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MEN IIB
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Medullary carcinoma of thyroid, medulla of adrenals (pheo), and mucosal neuromas
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origin of parafollicular c-cells in the thyroid
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neural crest (think MEN II: medullary carcinoma of thyroid, medulla of adrenals (pheo: chromaffin cells), and parathyroid/mucosal neuromas)
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embryologic origin of uterine tubes, uterus, cervix, and superior 1/3 of vagina
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paramesonephric ducts
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transposition of the great vessels vs tetralogy of fallot
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two main CV causes of cyanosis at birth; transposition is more severe, b/c it results in two independent loops -- death unless R-L shunt like PDA or PFO
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aorta anterior to and to the right of pulm artery
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transposition of the great arteries (TGA) -- life threatening cyanosis (need to keep PDA open, e.g. give misoprostol or alprostadil)
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nonfusion of urethral folds in males and females
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F: Normal (forms vestibule of vagina); M: Abnormal (HYPOspadias --> risk of UTIs; a/w chordee)
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patent urachus
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presistent allantois remnant; connects umbilicus to bladder --> urine discharge from unbilicus
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persistent yolk stalk
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vitelline duct -- connects small intestine with skin at umbilicus --> meconium discharge from umbilicus;
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vit A overdose during pregnancy
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similar to DiGeorge syndrome: craniofacial abnormalities, post fossa CNS defects, auditory defects, abnormalities of the great vessels
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false vs true diverticuli
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false (eg Colonic and Zencker) contain only mucosa and submucosa; true (eg Meckel's) contain muscularis too -- all 3 layers
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2nd week of development
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rule of 2s: 2 germ layers (bilaminar disk), epiblast and hypoblast; 2 components of placenta, cytotrohpoblast and syncytiotrophoblast; 2 cavities, amnionic and yolk sac;
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3rd week of development
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three germ layers (ectoderm, mesoderm, and endoderm)
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primitive streak
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(invaginated form of epiblast); gives rise to mesoderm and endoderm
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endoderm derivatives
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gut tube epithelium and derivatives (lungs, liver, pancreas, thymus, parathyroid, thyroid follicular cells)
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ectoderm divisions
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surface ectoderm, neuroectoderm, neural crest
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surface ectoderm derivatives
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epidermis, epithelium of sensory (eyes, nose, ears)
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neuroectoderm derivatives
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CNS neurons, neuroglia
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neural crest derivatives
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PERIPHERAL NERVOUS SYSTEM: (ANS, dorsal root ganglia, CRANIAL NERVES, schwann cells, chromaffin cells of adrenal medulla); melanocytes, parafollicular (C) cells of thyroid, odontoblasts (make enamel)
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mesoderm derivatives
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blood, bones, muscles, connective tissue, lymphatics; SPLEEN, ADRENAL CORTEX, KIDNEYS (organs you could live without)
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None
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thalidomide teratogenicity
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"flipper limbs" (phocomelia)
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iodide teratogenicity
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goiter or hypothyroidism
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diethylstilbestrol (DES) teratogenicity
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clear cell adenocarcinoma of the vagina
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ACE inhibitors teratogenicity
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renal damage
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monozygotic vs dizygotic twins
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both: 2 amnionic sacs; monozygotic has only 1 placenta and 1 chorion, dizygotic has 2 of each
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fetal erythropoesis
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3-8wks: yolk sac; 8-28wks: liver and spleen; 28+ wks: bone marrow
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umbilical vein in adult
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ligamentum teres
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umbiLical arteries in adults
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mediaL umbilical ligaments (vs mediaN umbilical ligament = allantois)
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allaNtois in adults
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urachus (part of allantoic duct between bladder and umbilicus), mediaN umbilical ligament
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notochord in adults
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nucleus pulposus of intervertebral disk
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aortic arch derivatives
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1st: MAXillary; 2nd: Stapedial (Second) and Hyoidal; 3rd: Carotids (C is the 3rd letter of the alphabet): 4th: aortic arch + proximal r. subclavian; 6th: proximal pulm artery (L) and ducturs areteriosus
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branchial apparatus
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CAP (Clefts/grooves: ectoderm; Arches: mesoderm; Pouches: endoderm)
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branchial arch 1 nerve and derivatives
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CN V2 and V3: Muscles of Mastication, Mylohyoid, ANTERIOR 2/3 of tongue (sensation from V3, taste from VII), ANTERIOR belly of digastric, TENSOR tympani, TENSOR veli palatini
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branchial arch 2 nerve and derivatives
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CN VII: muscles of fascial expression, posterior belly of digastric, Stapedius, Stylohyoid
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branchial arch 3 nerve and derivatives
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CN IX: posterior 1/3 of tongue, stylopharyngeus
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branchial arch 4 nerve and derivatives
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CN X (superior laryngeal branch): most pharyngeal constrictors, cricothyroid, levator veli palatini-
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branchial arch 6 nere and derivatives
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CN X (recurrent larygneal branch): all intrinsic musles of larynx EXCEPT cricothyroid
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branchial POUCH derivatives
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1: ear; 2: palatine tonsils; 3/4: thymus and parathyroid
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development of tongue
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anterior 2/3 = 1st branchial arch (1st is all the ANTERIORS, incl anterior tongue and anterior digastric); posterior 1/3 comes from 3rd and 4th branchial arches (CN X)
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development of ear
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all from 1st arch and cleft except: Stapedius and Stapes (2nd arch, CN VII)
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cleft lip
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failure to fuse of nasal/maxillary processes (primary palate)
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cleft palate
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failure of (medial/lateral) palatine process fusion or nasal septum formation (secondary palate)
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embyonic components of diaphgragm
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"Several Parts Build Diaphragm": Septum transversum, Pleuroperitoneal folds, Body wall, Dorsal esophageal mesoderm
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hiatal hernia
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incomplete development of diaphragm --> abdominal contents herniate into thorax
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whats special about spleen embryology
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arises from dorsal mesentary but supplied by artery of the foregut
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what forms the pancreatic head
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ventral pancreatic bud (foregut)
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ventral pancreatic bud forms: _______
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pancreatic head, pancreatic duct
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dorsal pancreatic bud forms? _________
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body, tail, isthums of pancreas; accessory pancreatic duct
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annular pancreas
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ventral and dorsal pancreatic buds abnormally encircle and strangle duodenum
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most common site of ectopic thyroid tissue
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TONGUE (remember, thyroid attached to tongue in development by thyroglossal duct -- persistance = pyramidal lobe)
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remnants of thyroglossal duct
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normal: foramen cecum; abnormal: pyramidal lobe
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imperforate anus often accompanied by:
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urinary tract defects (fistulas); also, VACTREL (Vertebral, Anal atresia, Cardiac anomalies, Tracheoesophageal fistulas, Renal anomalies, Esophageal atresia, Limb anomalies)
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hormonal control of fetal lung maturation
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cortisol -- absent in fetus early in development (outer adrenal cortex is called the "dormant adult zone," activated late in fetal development); positive feedback on CRH coming from placenta causes rapid activation
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neural tube defects
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folic acid deficiency; failure of neural fold fusion; anterior failure => anencephaly; posterior failure => spina bifida occulta, meningocele, meningomyelocele, rachischisis
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causes of polyhydramnios
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decreased fetal swallowing (duodenal/esophageal/intestinal atresia, or anencephaly) or increased fetal urination (anemia --> high cardiac output, twin-twin transfusion syndrome)
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ASD on physical exam
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loud S1, wide fixed splitting of S2
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teratogenicity of valproic acid
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1-3% chance of neural tube defect (valproate --| folic acid absorption)
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turner syndrome congenital defects
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coarctation of the aorta (usually PROXIMAL to subclavian --> decrease in both upper and lower extremity pulses)
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duodenal atresia presentation
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bilious vomiting w/o abdominal distention from 1st day of life; usu also see polyhydramnios; a/w Down syndrome
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potter syndrome
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renal agenesis, oligohydramnios, facial dysmorphism
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ebstein's anomaly
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"atrialized right ventricle" from tricuspid valve pushed down too far -- a/w lithium use
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lingual thyroid
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failed thyroid migration down from tongue (along thyroglossal duct)
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amniotic signs of neural tube defect
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elevated AFP and acetylcholinesterase
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hirschsprung's disease (mech, location)
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failed migration of neural crest cells into intestinal wall --> absence of myenteric and submucosal plexi; always involves the anus and the rectum, plus sigmoid colon in 75% of cases
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sx of hirschsprung's disease
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failure to pass meconium in first 48 hrs; bilious vomiting, abdominal distention, bowel filled with stool (rectum empty)
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hormonal regulation of male sexual development
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SRY --> TDF (testes determining factor) --> male gonads; SRY gene --> sertoli cells --> MIF --> involution of paramesonephric ducts; SRY gene --> leydic cells --> testosterone --> internal male genitalia; testosterone --> DHT --> external male genitalia
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urogenital sinus develops into:
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M: urethra, bladder, prostate, bulbourethral glands; f: urethra, bladder, lower vagina, Bartholin glands
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foregut
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celiac artery: esopagus, stomach, liver, gallbladder, pancreas, upper duodenum
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midgut
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SMA: lower duodenum, small intestine, ascending colon, proximal 2/3 of transverse colon
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hindgut
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IMA: distal 1/3 of transverse colon, descending and sigmoid colon
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potential consequences of malrotation of gut tube (2)
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1) Intestinal osbtruction (comrpression by adhesive bands); 2) volvulus (intestinal ischemia due to twisting around blood vessels --> gangrene, perforation)
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meckel's diverticulum:
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rule of 2s: 2% of population, 2 types of ectopic tissue (gastric and pancreatic), 2in long, 2ft from ileo-cecal junction, 2% have complications, 2 different complications (volvulus and intusscuption), presents in first 2 yrs of life
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three portal-systemic anastamoses: veins and name
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1) esophageal varices: L. gastric v. to azygous; 2) external hemorrhoids: superior rectal to inferior rectal veins; 3) caput meduae: paraumbilical v. to inferior epigastric v.
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myenteric and submucosal plexi
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myenteric (auerbach's): controls MOTILITY (since it's between the muscular layers); submucosal (meissner's): controsl SECRETIONS (contained in glandular layer)
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brunner's glands
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located in duodenal submuscal layer; secrete alkalkine mucus -- neutralize acid entering duodenum; hypertrophied in peptic ulcer disease
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m cells
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cells in small intestin mucosa that take up antigen for presentation to B cells in peyer's patches
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pectinate line
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where hindgut (endoderm) meets ectoderm
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internal vs external hemorrhoids
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INTERNAL: above pectinate line, not painful, a/w adenocarcinoma, blood from superior rectal artery, portal drainage; EXTERNAL: below bectinate line, painful, a/w squamos cell carcinoma, somatic innervation, arterial supply from inferior rectal artery, venous draining to IVC
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astrocytes
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neuroectoderm derivatives, support CNS: physical support, K+ metabolism, BBB; marked by GFAP (useful in determining glioblastoma multiforme)
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embryonic origin of CNS/PNS support cells
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all ectoderm (CNS : neuroectoderm, PNS: neural crest), except microglia (phagocytose, like macrophages --> mesoderm)
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peripheral nerve layers
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endoneurium (single fiber), perineurium (fascicle of nerve fibers), epineurium (entire nerve trunk); need to reattach perineurium to get restoration of function (axons will regenerate);
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sensory corpuscles
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superficial: merkel's (slow; light crude touch), meissner's (fast, light discriminatory touch, glabrous/hairless skin); deep: pacinian (large, fast, pressure, coarse touch, vibration, tension)
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perilymph vs endolymph composition
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endolymph -- think INside cell --> high K+; perilymph -- think OUTside cell --> high Na+
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utricle/saccule vs semicirc canals
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utricle/saccule contain maculae, detect linear acce; semicirc canals contain ampullae and detect angular accel
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base vs apex of cochlea
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base (narrow and stiff) picks up high freq
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BBB
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3 structures: tight jxn between endothel cells, BM, astrocyte processes
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exceptions to BBB
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area postrema (detect toxins), neurohypophysis (release ADH)
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fxns of hypothalamus
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TAN HATS (Thirst and water regulation, Adenohypophysis control, Neurohypophysis hormone production, Hunger/satiety, Autonomic regulation, Temperature regulation, Sexual urges and emotions)
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hunger regulation by hypothalamus
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Lateral nucleus causes hunger, Ventromedial nucleas causes satiety
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autonomic / temperature regulation in hypothal
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A/C: anterior hypothal responsible for cooling and parasympathetic, posterior for heat conservation and sympathetic; also, suprachiasmatic nucleus regulates circadian rhythms
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limbic system functions
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Fs: Feed her, Feel her, sex her, Fight her, Flight her, Forget her
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FEF location, use, lesion
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located in superior frontal lobe, involved in initiating eye movements; lesion --> eyes look in direction of lesioned hemisphere (e.g. left-hemisphere lesion --> eyes look left)
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ACA lesion
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leg/foot motor/sensory loss
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MCA lesion
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hand/body/face motor/sensory loss; aphasia; common site of embolus
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posterior communicating artery lesion
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common area for aneurysm --> CN III palsy
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Ant communicating artery
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common site of berry aneurysms, can cause visual defects
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lateral striate arteries
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come from MCA; "arteries of stroke" --> damage to internal capsule, caudate, putamen, globus pallidus
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location of area postrema / CTZ
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floor of 4th ventricle
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dandy walker malformation
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failure to open of foramina of luschka/magendie --> dilation of 4th ventricle --> agenesis of cerebral vermis and corpus callosum
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most common location of vertebrla disk herniation
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L5->S1
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lumbar puncture location
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L3->L5, goes into subarachnoid space
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lumbar puncture: layers penetrated
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skin --> ligaments (supraspinus, interspinus, flavum) ----epiduralspace----> dura ---subduralspace--> arachnoid ----> subarchnoid space (CSF)
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anterior shoulder dislocation
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axillary nerve palsy --> deltoid paralysis, compromised shoulder flexion/extension
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causes of axillary nerve palsy
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anterior shoulder dislocation; fracture of surgical head of humerous (just below superior head), eg falling on elbow
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brachial plexus: blow to shoulder / trauma during delivery
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upper trunk lesion --> erb duchenne palsy (waiter's tip)
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medial epicondyle fracture
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ulnar nerve lesion --> "claw hand": inability to extend little finger, weak finger adduction, radial deviation
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fracture of supracondyle of humerus
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median nerve damage --> hand of benediction (can only flex last 2 digits -- controlled by ulnar)
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radial nerve
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"great extensor" -- brachioradials, extensors of wrist/figners, supinator, triceps (it's the BEST extensor!)
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"Saturday night palsy"
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radial nerve lesion --> wrist drop (makes sense, it's in the posterior)
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fracture of midhumerus
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radial nerve lesion --> wrist drop
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inability to dorsiflex foot
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if your foot is dropPED, you've lost your Peroneal, which Everts and Dorsiflexes
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loss of plantar flexion
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if you can't stand on your TIP toes, you've lost your Tibial n., which Inverts and Plantarflexes
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loss of knee extension / knee jerk
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if you can't KICK, you have a femoral nerve palsy (FEMales can't play KICKball)
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loss of hip aDduction
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opDurator (opturator) nerve lesion
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what protects brachial plexus from clavicle fracture injury
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subclavius m.
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humerus lesions --> nerve injuries
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surgical neck: axillary; midshaft: radial; supracondyle: median; medial epicondyle: ulnar
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thenar vs hypothenar
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both do the same thing: OAF (oppose, abduct, flex); HYPOthenar does it with the pinky, THenar does THumb)
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location of pudendal nerve block
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ischial spine
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location of lumbar puncture
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iliac crest (L3-L5)
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level of C2
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posterior skull cap
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level of C3
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high turtleneck shirt
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level of C4
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low collar shirt
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level of T4
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nipple (teat pore)
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level of T7
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xiphoid process
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level of T10
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umbilicus
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level of L1
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inguinal ligament ("L1 = IL")
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level of L4
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kneecaps, knee jerk reflex (down on L FOURS)
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embryonic origin of ductus arteriosus
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6th arch
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cause of death in fetuses with bilateral renal agenesis
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pulomnary failure (prolonged oligohydramnios --> pulmonary hypoplasia); swallowed amniotic fluid contributes to dev and maturation of fetal lungs
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vertical diplopia MCC
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cranial nerve IV palsy (trochlear nerve)
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cause of foot drop
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injury to common peroneal nerve
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sustained dorsiflexion/eversion of foot, sensory loss on sole of foot
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tibial nerve injury
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pseudotumor cerebri
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overwieght young females --> decreased csf outflow at arachnoidvilli --> increased intracranial pressure, papilledema
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None
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radial head subluxation
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damage to deep branch of radial nerve --> weakenss of extensors w/o sensory deficit
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what firmly binds scapula to calvicle (normally prevents dislocation of clavicle)
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acromioclavicular ligament
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sma-aortic occlusion of intestines occurs where
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transverse duodenum --> epigastrci pain, bilious vomiting
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anterior motion of tibia (anterio drawer sign) indicates
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rupture of ACL (part of "unhappy triad": ACL, medial collateral ligament, and medial meniscus
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sharp pleuritic pain in mediastinal/diaphrgamatic parietal plerua carried by
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phrenic nerve (c3-c5)
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