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152 Cards in this Set

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