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176 Cards in this Set

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What comes from first pharyngeal arch? aortic?
Associated with CN V. Maxillary artery comes from first aortic arch.
What comes from second pharyngeal arch? aortic?
facial muscles, ear, hyoid. CN VII.

Stapedial artery
What comes from third pharyngeal arch? Aortic?
Hyoid, stylopharyngeus. CN IX.

Common carotid, proximal internal carotid.
What comes from fourth pharyngeal arch? Aortic?
Pharynx muscles, soft palate. CN X.

True aortic arch, subclavian.
What comes from fifth pharyngeal arch? Aortic?
Nothing!
What comes from sixth pharyngeal arch? Aortic
Larynx. Recurrent laryngeal from X. Pulmonary arteries, ductus arteriosus.
How does cleft lip happen?
Maxillary prominences don't fuse with intermaxillary segment
How does cleft palate happen?
Palatine shelves of maxillary prominence fail to fuse or fail to fuse with the primary palate
Background of pharyngeal fistula?
2nd pharyngeal pouch and groove fail to regress. See it on lateral neck
What is choanal atresia?
Bone maldevelopment, obstruction of 1 or both nasal passages
What is the most common cause for fetal hydronephrosis?
Inadequate recanalization of ureteropelvic junction. Last segment to canalize.
What is hypospadias?
Incomplete fusion of urethral folds. Get abnormal urethral opening along ventral shaft of penis
What is epispadias?
Abnormal opening of urethra on dorsal penile shaft from faulty genital tubercle
What is bifid scrotum?
Malunion of labioscrotal folds. Get two separate sacs of scrotum.
What two pathologic processes can result from patent processus vaginalis?
Hydrocele and indirect inguinal hernia
What are paramesonephirc ducts?
Uterine tubules, uterus, cervix, superior 1/3 of vagina. Failure to fuse = bicornuate uterus or uterus didelphys.

In men = involute and become vestige appendices of testes.
What are male mesonephric tubules?
Testes--> epididymis
What are male mesonephric ducts?
Epididymis, ductus deferens, seminal vesicles.
Female mesonephric ducts?
Gartner's
Where do primordial germ cells come from in the embryo?4
wall of yolk sac
What is a primary oocyte?
Formed during fifth month of fetus. Doubled DNA, arrested in prophase of meiosis I. 46,4N
What is a secondary oocyte?
formed during ovulation. 23, 2N. Arrested in metaphase of meiosis II until fertilization occurs.
When is a female's body temperature elevated during menstrual cycle?
Secretory phase.
What is the chromosome change for meiosis I?
462N --> 46,4N --> 23,2N
Why are newly ejaculated sperm incapable of fertilization?
Need to undergo capacitation, involves the unmasking of sperm glycosyltransferases and removal of proteins coating the surface of the sperm.
Advanced paternal age associated with?
Achondroplasia or Marfan
What is primary spermatocyte vs secondary spermatocyte?
Primary spermatocyte = 46,4N. Secondary = 23,2N. Spermatid = 23,1N.
Ova stages pre zygote?
Oogonia - 46,2N; primary oocyte - 46,4N; secondary oocyte - 23, 2N; mature oocyte - 23,1N
Where does fertilization occur?
ampulla of uterine tube
What does sperm binding to seocndary oocyte trigger?
acrosome reaction
What is the cortical reaction?
renders the secondary oocyte impermeable to other sperm after one sperm gets in
What is morula?
After eight cell blastula, at 16- to 32- cell stage, an inner and outer cell mass will form = morula. Outer cell mass = trophoblast.
where does blastocyst implant?
posterior superior wall of uterus w/in functional layer
What predispose to ectopic?
PID, endometriosis
What two layers do the embryoblast differentiate into?
Dorsal epiblast and ventral hypoblast. Together forming bilaminar embryonic disk
What forms from within epiblast?
amniotic cavity
What forms when hypoblast cells migrate and line inner surface of cytotrophoblast?
Yolk sac
What is the prochordal plate?
Epiblast and hypoblast fuse. Marks site of future mouth.
What produces hCG?
syncytiotrophoblast
What forms the primary chorionic villi?
cytotrophoblast
What forms the extraembryonic mesoder?
Epiblast
What is the extraembryonic somatic mesoderm (somatopleuric mesoderm)
lines the cytotrophoblast, forms the connecting stalk, and covers amnion
What is the extraembryonic visceral mesoderm (splanchnopleuric)?
Covers the yolk sac
When can hCG be assayed for pregnancy?
day 8 to 10
What forms chorion?
extraembryonic somatic mesoderm, cytotrophoblast, syncytiotrophoblast
When does placenta take over production of progesterone?
week 8. corpus luteum until then
What is basic segmentation of the human embryo controlled by?
Hox genes
What is gastrulation?
From primitive streak within epiblast.
What is a chordoma?
either a benign or malignant tumor that arises from remnants of the notochord

can be intracranial or in sacral region
Which structures are regular ectoderm?
epidermis, hair, nails, adenohypophysis
What structures are neuroectoderm?
all neurons in brain and spinal cord, retina, optic nerve, dilator and sphincter pupillae muscles, astrocytes, oligodendrocytes, ependymocyte, choroid plexus cells, neurohypophysis, pineal gland
What structures are neural crest?
neurons within ganglia, Schwann cells, pia and arachnoid, adrenal medulla, melanoycytes, aorticopulmonary septum, phayngeal arch bones
What structes are mesoderm?
Dura mater, connective tissue, muscles not for accomodation, dermis, subq, endothelium of blood vessels, RBCs, WBCs, microglia, kuppfer, kidney, adrenal cortex
What structures are endoderm?
hepatocytes, acinar and islet cells of pancreas, epithelial lining of GI, trachea bronchi lungs, urinary bladder, female urethra, most of male urethra
What is sacrococcygeal teratoma?
arises from primitive streak. Usu female infants.
What is caudal dysplasia? associations?
caused by abnormal gastrulation wiht poor mesoderm migration.

VATER - vertebral defects, anal atresia, tracheoesophageal fistula, renal defects
What composes the primitive streak?
primitive pit, prmitive groove, primitive node
What is notochord?
Mesoderm located between primitive node and prochordal plate. It induces formation of neural tube.
Which epiblast cells become endoderm?
Those that insert themselves in hypoblast.
What is the decidua parietalis?
endometrium other than the site of implantation
What is the decidua capsularis?
The portion of endometrium that covers the blastocyst and separates it from the uterine cavity. It becomes attenuated and degenrates at week 22.
What is the smooth chorion?
No villus development here
What is velamentous placenta?
umbilical vessels abnormally travel through the amniochorionic membrane before reaching the placenta proper.
What is placenta previa?
When placenta attaches in lower part of uterus, covering the internal os. Most common cause of bleeding in third trimester
What is human placental lactogen?
Protein hormone inducing lipolysis and elecates free fatty acid levels in mother. Growth hormone for fetus.
What hormones does placenta make?
estrogens, progesterone, Hpl, hCG
What changes happen with placental membrane between early and late pregnancy?
cytotrophoblast degenerates, leaving syncytiotrophoblast and fetal capilary endothelium
What is kernicterus?
pathologic deposition of bilirubin in the basal ganglia
What produces amniotic fluid?
direct transfer from maternal circulation. excretion of fetal urine by kidneys also goes there.
What resorbs amniotic fluid?
fetus swallowing, maternal resorption
What is polyhydramnios commonly associated with?
maternal diabetes
What results from oligohydramnios?
Potter syndrome and hypoplastic lungs
Reasons for increased AFP?
neural tube defects, omphalocele, esophageal and duodenal atresia
What structures pass through primitive umbilical ring?
Yolk sac (vitelline duct), connecting stalk, and allantois
What does the allantois become?
median umbilical ligament
What is the order of hematopoiesis in utero?
yolk sac starts with zeta2, epsilon2. - week3

Fetal liver starts with alpha and gamma. - week 5

Bone marrow around wk 30 then does alpha2beta2
What do right and left umbilical arteries become?
Medial umbilical ligaments
What does left umbilical vein become?
Ligamentum teres
What does ductus venosus become?
ligamentum venosum
What does foramen ovale become?
fossa ovale
What does ductus arteriosus become?
ligamentum arteriosum
What changes facilitate utero to life circulation?
Decrease in right atrial pressure from occlusion of placental circulation, increase in Left atrial pressure
How is the aorticopulomary septum formed?
neural crest cells coming down
What causes persistent truncus arteriosus? what is it?
Aorta and pulm trunk not split at bottom. Partial devo of AP septum. Marked cyanosis R-->L
What forms from truncus arterious?
Aorta and pulm trunk
What comes from bulbus cordis?
Smooth part of RV - conus arteriosus
Smooth part of LV - aortic vestibule
What comes from primitive ventricle?
Trabeculated parts of ventricles
What comes from primitive atria?
Right and left trabeculated atria
What comes from sinus venosus?
Smooth part of RA (sinus venarum)
Coronary sinus
Oblique vein of left atrium
What causes D-transposition of the great arteries?
Abnormal neural crest cell migration. Nonspiral development. Completely separate circulations
What causes L-transposition of the great vessels?
Transposed great vessels but also inverted heart anatomy.
What leads to tetralogy of Fallot? What conveys severity?
Abnormal neural crest cell migration. Skewed AP septum devo.

Pulm stenosis, RVH, Overriding aorta, VSD

Pulm stenosis = dangerous
How does atria septum form?
Septum primum comes down with foramen primum that goes away. Foramen secondum forms. Septum secundum comes down with its own foramen ovale. Septa fuse later. Ovale closes with decrease in RAP and increase in LAP.
Most common cause for atrial septal defect? Second?
foramen secundum defect.

Common atrium.
What is consequence of premature closure of foramen ovale?
RVH, hypoplastic LV
How does the AV septum form?
Dorsal and ventral AV cushions approach and fuse
Consequences of persistent common AV canal?Cause?
AV cushions fail to fuse.

See L-R shunting.
Mitral valve regurg.
What causes Ebstein's anomaly?
Failure of tricuspid to form normally. RV is atrialized with smaller normal function. Usu assoicated with an ASD.
What is tricuspid atresia/hypoplastic right ventricle?
insufficient amount of AV cushion to make tricuspid. No communication between RA and RV. Accompanied by patent foramen ovale, VSD, overdevo of LV, underdevo RV.
What is most common VSD?
Membranous VSD. Failure fusion of left bulbar ridge, right bulbar ridge and AV cushions. L-->R shunt. Enlarged pulmonary artery. Fatigue on exertion.
what is eisenmenger syndrome?
L--R shunting that turns other way from proliferation of tunica media/intima.
Keep a PDA open?
supply PGE.
Signs of ASD?
fixed split S2.
Signs of VSD?
holosystolic murmur
Sign of PDA?
continuous machine-like
how is the esophagus formed?
Tracheoesophageal folds - dividing dorsal esophagus and ventral trachea
What causes esophageal atresia?
Tracheoesophageal septum deviates too far dorsally
What causes achalasia?
Loss of ganglion cells in the myenteric (Auerbach) plexus
How does the stomach form?
rotation of stomach 90degrees around longitudinal axis. Carries dorsal mesentery to the left forming the greater omentum.
What is linked to a cause of hypertrophic pyloric stenosis?
Erythromycin
How does the liver form?
endodermal lining forms an outgrowth into surrounding mesoderm of septum transversum. Cords of hepatoblasts from diverticulum grow into the mesoderm. Vitelline veins and umbilical veins form hepatic sinusoids.

Liver bulges into the abdominal cavity stretching the septum transversum to form the ventral mesentry, consisting of falciform ligament and lesser omentum.
What is in hepatoduodenal ligament?
Portal triad.
Clinical findings of biliary atresia?
NO PROJECTILE VOMITING. Progressive jaundice, white, clay-colored stool, dark-colored urine
How is the midgut formed?
U shaped loop herniates through umbilical ring into extraembryonic coelom. Cranial limb = small intestine; caudal = cecal diverticulum and lower ileum to proximal 2/3 of colon.

270 degree CCW around SMA. Small intestine ends up on left.
What is omphalocele?
abdominal contents herniate through the umbilical ring and persist outside body. Associated with some trisomies
What is gastoschisis?
Herniation through wall but no peritoneal membrane covering
What is nonrotation of the midgut loop?
Only 90 degree rotation.Small intestine ends up on the right. Cecum in either upper left quadrant or left iliac fossa.
Major complication of malrotation of the small intestine?
volvulus
What is reversed rotation of the midgut loop?
Occurs when midgut loop rotates CW instead of CCW. Large intestine enters abdominal cavity first and is posterior to duodenum and SMA
What are general causes for intestinal atresia and stenosis?
Failure to recanalize or ischemic event.

Distal - no projectile vomiting immediate, but yes failure to pass meconium. Normal amniotic fluid levels
What happens with the terminal end of the hindgut?
Ends in endoderm-lined pouch called the cloaca, which contacts the surface ectoderm of the proctodeum to form the cloacal membrane.

Urorectal septum comes down to split it into rectum and urogenital sinus. Cloacal membrane partitioned into anal membrane and urogenital membrane. Urorectal septum fuses with cloacal membrane at the future site of perineal body.
What is the most common type of anorectal malformation?
Anorectal agenesis - when rectum ends as blind sac above the puborectalis muscle due to abnormal formation of the urorectal septum.
What forms the urogenital ridge?
Intermediate mesoderm forms longitudinal elevation.
What gives rise to the nephrogenic cord?
Urinary system.
What becomes of the mesonephros?
Mesonephric tubules and the mesonephric duct (Wolffian duct)

Most of tubules regress but the duct persists and opens into the urogenital sinus
How does the nephron develop?
inductive influence of the collecting ducts of causes the metanephric mesoderm to differentiate into metanephric vesicles, later give rise to S-shaped renal tubules.

S-shaped tubules differentiate into connecting tubule, distal convoluted tubule, loop of Henle, proximal convoluted tubule, Bowman's capsule.
How does the bladder develop?
formed from upper portion of the urogenital sinus, continuous with the allantois. Becomes a fibrous cord called the urachus. Lower ends of the mesonephric ducts become incorporated into the posterior wall to form the trigone.
Characterize renal agenesis?
occurs when the ureteric bud fails to develop, eliminating induction of metanephric vesicles and nephron formation.
With what population is unilateral renal agenesis more common?
men
What can horseshoe kidney get snatched by on ascension?
IMA
What is the most common congenital obstruction of the urinary tract?
Ureteropelvic junction --> if see significant atresia can see multicystic dysplastic kidney
What is the most common primary tumor of childhood?
Wilms tumor. From deletion of tumor suppressor gene WT1. Associated with WAGR.

Aniridia, genitourinary malforations and mental retardation
Urine drainage from umbilicus suggests?
Remnant of urachus or allantois.
What do the ovaries form from?
intermediate mesoderm forms urogenital ridge which forms gonadal ridge. Primary sex cords develop from there which migrate into the gonad from the wall of the yolk sac. Primary sex cords extend into medulla and develop into rete ovarii which degenerates.

Secondary sex cords develop and incorporate primordial germ cells as a thin tunica albuginea forms.
What do the secondary sex cords form in women?
Break apart and make primordial follicles with primary oocytes.
What happens to gubernaculum in girls?
fibrous tissue from posterior wall that extends from the medial pole of the ovary to the uterus at the junction of the uterine tubes, forming the ovarian ligament.
What does the paramesoneprhic interaction with cloaca induce?
formation of sinovaginal bulbs. Form to make vaginal plate for inferior two thirds.
What are the remants of the paramesonephric duct?
hydatid of Morgagni
What is Gartner's duct?
remnant of mesonephric duct in girls
What causes a unicornuate uterus?
one paramesonephric duct fails to develop or incompletely develops.
How do you get didelphys anomaly of uterus?
complete lack of fusion of the paramesonephric ducts.
How do you get bicornuate uterus?
Partial fusion of the paramesonephric ducts.
How do you get septate uterus anomaly?
Medial walls of the caudal portion of the paramesonephric ducts partially or completely fail to resorb.
What can diethylstilbestrol-related anomalies do?
DES. Can lead to T shaped uteri and increased levels of cervical and vaginal adenocarcinoma to those exposed in utero.
In men what happens with primary sex cords?
Primary sex cords come in and lose connection with surface eptihleium as thick tunica albuginea forms. Primary cords then form seminiferous cords, tubuli recti, and rete testes.
What do the seminiferous cords form?
Primordial germ cells and Sertoli cells which make MIF.
Remnants of paramesonephric ducts in male?
Appendix testes
What do mesonephric ducts become in men? Tubules?
ducts = epididymis, ductus deferens, seminal vesicle, ejaculatory defect.

Tubules regress = efferent ductules of the testes
What is hypospadias?
Incomplete fusion of urogenital folds/urethral folds. Ventral orifice of urethra. Associated with poorly devo penis that curves ventrally = chordee.
What is epispadias?
When external urethral orifice opens onto the dorsal surface of penis. Associated with exstrophy of the bladder.
What do labia minora come from? Labia majora? Mons pubis?
Labia minora = urogenital folds

Labioscrotal folds = labia majora/mons pubis
What comes from the first pharyngeal arch?
Nerve = V
Mesoderm - muscles of mastication, mylohyoid, anterior belly of digastric, tensor veli palatine, tensor tympani
Neural crest - maxilla, mandible, incus, malleus, zygomatic bone, squamous temporal bone, palatine bone, vomer, sphenomandibular ligament
What comes from the 2nd pharyngeal arch?
VII

Mesoderm - facial expression, posterior belly of digastric, stylohyoid, stapedius
Neural crest - stapes, styloid process, stylohyoid ligament, lesser horn and upper body of hyoid bone
What comes from the 3rd arch?
Nerve - IX

Mesoderm - stylopharyngeus, common carotid arteries, internal carotid arteries

Neural crest - greater horn and lower body of hyoid bone
What comes from the 4th arch?
Nerve X (superior laryngeal nerve)

Mesoderm - muscles of soft palate, muscles of phayrnx, cricothyroid, cricopharyngeus, larygneal cartilages, right subclavian, arch of aorta

No neural crest

note tensor veli palatine and stylopharyngeus not part of this
What comes from sixth arch?
Nerve - X - recurrent laryngeal

Mesoderm - intrinsic muscles of larynx except cricothyroid, upper muscles of esophagus, laryngeal cartilages, pulmonary arteries, ductus arteriosus
What comes from first pouch?
epithelial lining of auditory tube and middle ear caavity
What comes from 2nd pouch?
epithelial lining of palatine tonsil crypts
What comes from 3rd pouch?
Inferior parathyroid gland, thymus
What comes from the 4th pouch?
Superior parathryoid gland, ultimobranchial body (becomes parafollicular cells of thyroid)
What comes from the first groove?
epithelial lining of the external auditory meatus
What comes from the first pharyngeal membrane?
Tympanic membrane
How does thyroid gland develop?
connects to tongue by thyroglossal duct which is indicated by foramen cecum
How does the tongue form?
from medial tongue bud and two distal tongue buds from pharyngeal arch. Come together to form median sulcus. General sensation = CN V. Taste = CN VII.

Posterior 1/3 of tongue = copula and hypobranchial eminence- general sensation from mucosa = CN IX; taste CN IX
What is the intermaxillary segment?
from medial growth of maxillary prominences causes the two medial nasal prominences to fuse together at the midline.

Intermaxillary segment = philtrum of the lip, four incisor teeth, primary palate
Where do nasal placodes come from?
frontonasal prominence
What is Treacher collins syndrome?
mandibulofacial dysostosis. From pharyneal arch 1 problems. Underdevo of zygomatic bones, mandibular hypoplasia, lower eyelid issues, down slanting palpebral fissures. Autosomal dominant for treacle protein.
What is pharyngeal fistula?
Pouch and groove 2 still there.
How does pharyngeal cyst happen?
Still have pharyngeal grooves 2-4
How does cleft lip happen?
Neural crest cell issue.

maxillary prominence fails to fuse with medial nasal prominence

Underlying mesoderm and neural crest fail to expand. Persistent labial groove.
How does Cleft palate happen?
Anterior - palatine shelves don't fuse with primary palate

Posterior - palatine shelves don't fuse with each other and nasal septum
What brain pathological finding would you see in Downs patients?
Neurofibrillary tangles
High AFP and high acetylcholinesterase suggest?
Neural tube defects
Urine from umbilicus suggests?
Allantois remnant/urachus
Varciocele results from?
Pampiniform plexus - bag of worms. Goes away with recumbency. Venous blocked upstream. NOT EMBRYOLOGICAL.
Arterial defects with Di George syndrome?
Truncus Arteriosus