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173 Cards in this Set
- Front
- Back
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When does hCG secretion begin after blastocyst implantation
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within week 1
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What is Weeks 3-8 referred to as
What happens during this time |
"Embryonic period"
organogensis, teratogen susceptibility, neural tube formed by neuroectoderm and closes by week 4 |
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when does the fetal period begin
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Week 8
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what are the alar plate and basal plate
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have the same orientation as the spinal cord
alar: dorsal = sensory basal: ventral = motor |
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what is a craniopharyngioma
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benign Rathke's pouch tumor w/cholesterol crystals, calcification
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what is the nucleus pulposus derived from
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notochord
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what are mesodermal defects
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VACTERL
Vertebral defects Anal atresia Cardiac defects Tracheo-Esophageal fistula Renal defects Limb defects (bone and muscle) |
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what is the leading cause of birth defects and mental retardation
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EtOH
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what is the leading cause of congenital malformation in the US
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Fetal Alcohol syndrome
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what drug causes discolored teeth in the fetus
what effect does valproate cause on the fetus |
tetracyclines
Valproate inhibits intestinal folate absorption |
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what drug causes CN VIII toxicity in the fetus
what effect do alkylating agents have on the fetus |
aminoglycosides
absence of digits, multiple anomalies |
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What drug causes abnormal fetal development and fetal addiction, placental abruption
What effect does Lithium have on the fetus |
cocaine
Einstein's anomaly = atrialized R ventricle |
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what is the decidua basalis
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maternal component of the placenta
derived from endometrium maternal blood in the lacunae |
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how many umbilical arteries and veins are there in the umbilical cord
and what are their functions |
2 umbilical arteries: return deO2 blood from fetal internal iliac arteries to placenta
1 umbilical vein: supplies O2 blood from placenta to fetus |
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where are the umbilical arteries and vein derived from
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from the allantois
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what does a single umbilical artery mean
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is assoc w/congenital and chromosomal anomalies
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allantois
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yolk sac forms allantois in 3rd week, it extends into urogenital sinus
allantois becomes urachus, a duct b/w bladder and yolk sac |
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urachus
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duct b/w bladder and yolk sac
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what happens if the urachus fails to obliterate
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1. patent urachus: urine discharge from umbilicus
2. vesicourachal diverticulum: outpouching of bladder |
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what is the vitelline duct
what happens in 7th week |
connects yolk sac to midgut lumen
duct gets obliterated |
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what is the coronary sinus derived from
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left horn of the sinus venosus
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what is the smooth part of the right atrium derived from
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Right horn of the sinus venosus
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what is the progression of where fetal erythropoiesis happens
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Yolk sac (3-8 wk)
Liver (6-30 wk) Spleen (9-28) Bone marrow (28 wk onward) "Young Liver Synthesizes Blood" |
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what is the postnatal derivative of the umbilical arteries
of the allantois/urachus |
mediaL umbilical ligaments (umbiLical)
mediaN umbilical ligaments (allaNtois) |
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in what adult ligament is the ligamentum teres contained in
what is the ligamentum teres a postnatal derivative of |
falciform ligament
the umbilical vein |
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what are the 1st and 2nd aortic arch derivatives
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1- part of Maxillary artery
2- Stapedial artery and hyoid artery |
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what are the 3rd and 4th aortic arch derivates
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3: common Carotid artery and proximal part of the ICA
4- on L: aortic arch on R: proximal part of the R subclavian artery |
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what is the 6th aortic arch derivative
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proximal part of the pulmonary arteries
on L only, ductus arteriosus |
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what markers are elevated in a neural tube defect:
in serum? in CSF? |
serum: AFP increased (and in amniotic fluid)
CSF: increased ASP and acetylcholinesterase |
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in what situation does anencephaly occur
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polyhydramnios
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what is Holoprosencephaly
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decreased separation of hemispheres across midline -> cyclopia
assoc w/Patau's syndrome, severe fetal alcohol syndrome, cleft lip/palate |
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what is Arnold Chiari Type II
what does it often present with |
cerebellar tonsillar herniation through foramen magnum w/aqueductal stenosis and hydrocephaly
presents w/syringomyelia, thoracolumbar myelomeningocele |
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what is dandy-walker
what can it lead to |
large posterior fossa, absent cerebellar vermis w/cystic enlargement of 4th ventricle
lead to hydrocephalus and spina bifida |
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what nerves supply the 1st and 2nd branchial arches
what are the functions of the first 2 arches |
Arch 1: CN V2 and V3
function is chewing Arch 2: CN VII facial expression |
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what nerves supply the 3rd, 4th and 6th branchial arches
what are their functions |
Arch 3: CN IX
pharynx (stylopharyngeus) Arch 4: CN X (superior laryngeal branch) swallowing (cricothyroid) Arch 6: CN X (recurrent laryngeal branch) speaking (all intrinsic larynx muscles, except cricothyroid) |
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what is Treacher Collins syndrome
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1st arch neural crest fails to migrate -> mandibular hypoplasia, facial abnormalities
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what is the mutation in MEN2A
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germline RET (neural crest cells)
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what does the 1st branchial cleft develop into
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the external auditory meatus
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what do the 2nd and 4th branchial clefts develop into
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form temporary cervical sinuses but are obliterated by proliferation of the 2nd branchial arch mesenchyme
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what does the 1st branchial pouch develop into
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middle ear cavity, eustachian tube, mastoid air cells
contributes to endoderm-lined structures of ear |
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what does the 3rd branchial pouch develop into
what does the 4th branchial pouch develop into |
3rd: inferior parathyroids
4th: superior parathyroids 3rd ends up below 4th |
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what does the 1st branchial membrane develop into
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the tympanic membrane
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what branchial aches form the ant 2/3 and post 1/3 of the tongue
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ant 2/3: 1st arch
post 1/3: 3rd and 4th arches |
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what is the foramen cecum
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normal remnant of the thyroglossal duct
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what is the most common ectopic thyroid tissue site
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the tongue
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what causes a cleft lip
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failure of fusion of maxillary and medial nasal processes
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what causes a cleft palate
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failure of fusion of lateral palatine processes, nasal septum +/or medial palatine process
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what is the diaphragm derived from
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Septum transversum -> central tendon
Pleuroperitoneal folds Body wall Dorsal mesentery of esophagus- > crura "Several Parts Build Diaphragm" |
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what causes bladder exstrophy
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failure of caudal fold closure in abdominal wall
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what is gastroschsis
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failure of lateral body folds to fuse -> extrusion of ab contents thru ab folds
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what is omphalocele
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persistence of herniation of ab contents into umbilical cord, covered by peritoneum
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what is the difference b/w gastroschisis and omphalocele
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gastroschisis is not usually covered by peritoneum and is not usually in midline, unlike omphalocele
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what is an apple peel atresia
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jejunal, ileal, colonic atresia due to vascular accident
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what time during gestation do the intestines return to the ab cavity and rotate around SMA
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10th week
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around what artery do fetal intestines rotate around
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SMA
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what does failure of rostral fold closure cause
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sternal defects
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what are the signs of a tracheo-esophageal fistula
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cyanosis, choking and vomiting w/feeding, air bubble on CXR, polyhydramnios
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what causes a palpable "olive mass" in epigastric region and nonbilious projectile vomiting at ~ 2 weeks of age
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congenital pyloric stenosis
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what causes congenital pyloric stenosis
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hypertrophy of the pylorus causes obstruction
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the GI foregut gives rise to what
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pharynx to duodenum
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what does the ventral pancreatic bud give rise to
what does the dorsal pancreatic bud give rise to |
ventral: pancreatic head, uncinate process (lower half of head), and main pancreatic duct
dorsal: everything else |
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what is pancreas divisum
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ventral and dorsal parts fail to fuse at 8 weeks
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annular pancreas
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ventral pancreatic bud abnormally encircles 2nd part of duodenum forming a ring of pancreatic tissue that may cause duodenal narrowing
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from what does the spleen arise
and what is its blood supply |
arises form dorsal mesentery (it's mesodermal)
celiac artery (artery of foregut) is its blood supply |
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what is the most common site of obstruction in the fetus
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uteropelvic junction w/kidney
last to canalize -> hydronephrosis |
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What does the metanephric mesenchyme give rise to
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glomerulus and renal tubules to DCT
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what causes Potter's syndrome
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malformation of ureteric bud
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what are the findings in Potter's syndrome
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bilateral renal agenesis -> oligohydramnios -> limb deformities, facial deformities, pulm hypoplasia
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under what artery do horseshoe kidneys get trapped
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IMA
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what does the SRY gene on the Y chromosome code for
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testis determining factor
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what secretes Mullerian inhibiting factor/substance
what does it do |
sertoli cells
suppresses development of paramesonephric ducts |
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what does the mesonephric duct develop into
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male internal structures
SEED Seminal vesicle, Ejaculatory Duct Epididymis, Ductus deferens |
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how does a bicornuate uterus form
what is it assoc w/ |
incomplete fusion of paramesonephric ducts
assoc w/urinary tract abnormalities and infertility |
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what causes hypospadias
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failure of urethral folds to close
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what causes epispadias
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faulty positioning of genital tubercle
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what congenital penile abnormality is exstrophy of the bladder assoc w/
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epispadias
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what is a complication of hypospadia (why does it need to be fixed)
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to prevent UTIs
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what does the labioscrotal swelling develop into
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male: scrotum
female: labia majora |
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what do the urogenital folds develop into
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male: ventral shaft of penis (penile urethra)
female: labia minora |
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what is the order of epidermal layers from surface to base
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stratum Corneum
Lucidum Granulosum Spinosum Basalis "Californians Like Girls in String Bikinis" |
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what are cadherins
where are they found in the skin |
Ca-dependent Adhesion molecules, connect to actin in the intermediate junction (zona adherens) b/w epithelial cells
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what three things are torn in an unhappy triad
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MCL, ACL, lateral meniscus
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what does abnormal passive abduction in a knee indicate
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a torn MCL
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what is the landmark for an LP
what is the landmark for a pudendal nerve block (in labor) |
iliac crest
ischial spine (pudendal nerve block) |
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what do these muscles do
Supraspinatus? Infraspinatus? |
supra: helps deltoid abduct arm
infra: laterally rotates arm |
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what do these muscle do
teres minor? subscapularis? |
teres: adducts and laterally rotates arm
subscapularis: medially rotates and adducts arm |
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what nerve affected by fracture of surgical neck of humerus
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axillary n
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what nerve affected by a midshaft humerus fracture
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radial n
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what can cause an ulnar nerve injury
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fracture of hook of hamate
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what nerve affected by incorrect use of a crutch
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radial n
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what nerve is affected by a supracondylar fracture of humerus; pronator teres syndrome
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median n
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what nerve is affected by fracture of medial epicondyle of humerus
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ulnar n
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what nerve is affected by dislocated lunate
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median n
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what can cause compression of the lower trunk of the brachial plexus
what can that lead to |
Pancoast tumor or cervical rib
can lead to Klumpke's palsy |
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what are Type 1 muscle fibers
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slow twitch, red fibers (increased mitochondria and myoglobin concentration) oxidative phosphorylation
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what are Type 2 muscle fibers
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fast twitch, white fibers (decreased mitochondria and myoglobin concentration) anaeorbic glycolysis
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what is the mechanism of smooth muscle contraction
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Ca binds to calmodulin -> activates myosin light-chain kinase, which phosphorylates myosin -> + actin -> cross-bridge formation w/contraction
(myosin light-chain phosphatase dephosphorylates myosin -> relaxation) |
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what is the mechanism of longitudinal bone growth
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endochondral ossification
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what is the mechanism of flat bone growth
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membranous ossification (woven bone directly made w/o cartilage)
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what is mechanism in achondroplasia
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failure of longitudinal growth (membranous ossification is NOT affected, b/c NL head size)
-constitutive activation of FGFR3 which inhibits chondrocyte proliferation |
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what drugs are contraindicated in osteoporosis
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glucocorticoids
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what happens in osteopetrosis
what are the lab findings what is the mechanism of action |
failure of NL bone resorption -> thickened, dense bones prone to fracture
labs: serum Ca, PO4, and Alk Phos are NL MOA: genetic deficiency in carbonic anhydrase; abNL fxn of osteoclasts |
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what disease shows "Erlenmeyer flasks" on X-ray
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osteopetrosis (marble bone dz)
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what is a consequence of osteopetrosis
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cranial nerve impingement and palsies due to narrowed foramina
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what are the lab findings in osteomalacia/rickets
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Vit D deficiency ->
decreased Ca and PO4 increased PTH (leads to soft bones) |
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what causes osteitis fibrosa cystica
what is its main characteristic |
hyperparathyroidism
"brown tumors" (cystic spaces lined by osteoClasts, filled w/fibrous stroma and sometimes blood) high Ca and Alk Phos, low PO4 |
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what causes Paget's dz (osteitis deformans)
what is the main lab finding |
increase in both osteoBlastic and osteoClastic activity
could also be viral (paramyxovirus) increase in Alk Phos |
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in what dz can the hat size increase
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Paget's disease
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what syndrome is polyostotic fibrous dysplasia assoc w/
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McCune-Albright syndrome
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What is polyostotic fibrous dysplasia
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bone replaced by fibroblasts, collagen, and irregular bony trabeculae
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What is McCune-Albright syndrome
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form of polyostotic fibrous dysplasia characterized by multiple unilateral bone lesions
assoc w/endocrine abnormalities (precocious puberty) unilateral pigmented skin lesions (cafe au lait/"coast of Maine") spots |
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what disease are osteomas assoc w/
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Gardner's syndrome
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what is the most common benign bone tumor
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Osteochondroma (exostosis)
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what bone tumor has a "double bubble" or "soap bubble" appearance on X-ray
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Giant cell tumor (osteoclastoma)
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where are giant cell tumors usually found
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distal femur and proximal tibial region (knee)
(same as osteosarcoma) |
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what is the most common primary malignant bone tumor
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multiple myeloma
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what is the 2nd most common primary malignant bone tumor
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osteosarcoma
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what are predisposing factors to Osteosarcoma
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Paget's dz, familial retinoblastoma, bone infarcts, radiation
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what is an anaplastic small blue cell malignant tumor
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Ewing's sarcoma
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what bone tumor has a characteristic "onion skin" appearance in the bone
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Ewing's sarcoma
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what is the translocation in Ewing's sarcoma
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11;12
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what are the 4 main findings of osteoarthritis
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osteophytes, joint space narrowing, sclerosis, subchondral bone cysts
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Where are Herberden's nodes
Where are Bouchard's nodes |
Herberden's: DIP
Bouchard's: PIP |
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Baker's cyst
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behind the knee
in RA |
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what type of hypersensitivity rxn is RA
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Type 3
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anti-CCP antibody
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less sensitive more specific for RA
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what do you see in RA at the joint
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pannus formation, increased synovial fluid, bone and cartilage erosion
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what is triad for Sjogren's syndrome
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Xerophthalmia (dry eyes, conjunctivitis, "sand in my eyes")
Xerostomia (dry mouth, dysphagia) Arthritis |
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What is Sicca syndrome
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dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis
NO arthritis |
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what is at increased risk in Sjogren's
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B-cell lymphoma
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in what dz do you see parotid enlargement
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Sjogren's
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what is the classic presentation of gout
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painful MTP joint of the big toe (podagra)
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acute attacks of gout are seen after what and why?
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after a large meal or alcohol consumption
(EtOH metabolites compete for same excretion site in kidney as uric acid -> buildup in blood) |
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Lesch-Nyhan dz syndrome and von Gierke's dz can lead to what
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gout
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Contrast gout and pseudogout
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Gout: monosodium urate crystals
needle-shaped negatively birefrigent yellow crystals under parallel light Pseudogout: Ca pyrophosphate crystals basophilic, rhomboid weakly positive birefringent yellow under perpendicular light |
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what orgs are common in infectious arthritis
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S. aureus, Strep, N. gonorrhea
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How does gonococcal arthritis present
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monoarticular, migratory arthritis w/an asymmetrical pattern
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what orgs common in chronic infectious arthritis
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TB (from mycobacterial dissemination),
Lyme |
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what are the features of anklyosing spondylitis
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ankylosis, uveitis, aortic regurgitation
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what is the triad of Reiter's syndrome (Reactive arthritis)
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Conjunctivitis and ant uveitis
Urethritis Arthritis |
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what disease presents post-GI or chlamydia infections
|
Reiter's syndrome
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what are the features of psoriatic arthritis
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dactylitis (sausage fingers), pencil-in-cup deformity on X-ray, joint pain and stiffness assoc w/psoriasis
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what do SLE pts die from
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renal failure and infections
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What dz has false positive on syphilis tests (RPR/VDRL)
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SLE
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How do you trx sarcoidosis
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steroids
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what are the features of sarcoidosis
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GRAIN
Gammaglobulinemia RA ACE increase Interstitial fibrosis Noncaseating granulomas |
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what is polymyalgia rheumatica
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pain and stiffness in shoulders and hips (often w/fever, malaise, wt loss)
NOT cause muscular weakness assoc w/temporal/giant cell arteritis |
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What are the lab findings of polymylagia rheumatica
What is the trx |
increased ESR, NL CK
Prednisone |
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what dz have malar rashes
|
SLE and dermatomyositis
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what are the features of dermatomyositis
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malar rash, heliotrope rash, "shawl and face" rash, Gottron's papules, increased risk of malignancy
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What is polymyositis
What causes it what is needed for dx |
progressive symmetric proximal m weakness
caused by CD8 T-cell induced injury to myofibers dx: muscle biopsy w/evidence of inflammation is diagnostic |
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what is the most common NMJ disorder
|
Myasthenia gravis
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Contrast myasthenia gravis and Lambert-Eaton syndrome
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MG: autoAb to POSTysynaptic ACh-R
ptosis, diplopia, general weakness Sx worsen w/muscle use Reverse Sx w/AChE inhibitors LE: autoAb to PREsynaptic Ca channels extraocular muscles spared Sx improve w/muscle use NO reversal of Sx w/AChE inhibitors alone |
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What is myasthenia gravis assoc w/
What is Lambert-Eaton syndrome assoc w/ |
MG: assoc w/thymoma
LE: assoc w/paraneoplastic dz (like SCLC) |
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what are the features of Mixed CT disease
what is the mechanism of action What is the trx |
Raynaud's, Fatigue, Arthralgias, Myalgias, Esophageal hypomotility
"Raynaud's FAME" MOA: autoAb to U1RNP Trx: response to steroids |
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What are the 2 types of scleroderma
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diffuse and CREST
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What is diffuse scleroderma
what is the mechanism of action |
widespread skin involvement, rapid progression, early visceral involvement
assoc w/anti-Scl-70 Ab (anti-topoisomerase I antibody) |
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What is CREST syndrome
what is the mechanism of action |
Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly, Telangiectasias
-limited skin involvement, often fingers and face MOA: anti-Centromere Ab |
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what is the most common soft tissue tumor of childhood
|
Rhabdomyosarcoma
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Leser-Trelat
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sudden appearance of multiple seborrheic keratoses indicating an underlying malignancy (e.g., GI, lymphoid)
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what is melasma and what is it assoc w/
|
hyperpigmentation
assoc w/pregnancy or OCP use |
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what causes albinism
what causes vitiligo |
decreased melanin production from decreased activity of tyrosinase
vitiligo: decrease in melanocytes |
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what happens in Staph scalded skin syndrome (SSSS)
|
exotoxin destroys keratinocyte attachments in stratum granulosum only
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what is hairy leukoplakia
what type of patients does it occur in |
white painless plaques on tongue that can NOT scraped off
-EBV-mediated occurs in HIV-positive pts |
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Contrast Pemphigus Vulgaris and Bullous Pemphigoid
|
Pemphigus Vulgaris: IgG to desmosomes, positive Nikolsky's sign
Bullous Pemphigoid: IgG to hemidesmosomes, negative Nikolsky's sign |
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acanthosis nigricans
what is it assoc w/ |
hyperplasia of stratum spinosum
assoc w/hyperinsulinemia (Cushing's, diabetes, etc.) and visceral malignancy |
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what is the risk of carcinoma in actinic keratoses
|
risk is proportional to epithelial dysplasia
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"herald patch" assoc w/what disease
|
pityriasis rosea
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what is pityriasis rosea
|
"herald patch" followed days later by "Christmas tree" distribution, multiple papular eruptions
remits spontaneously |
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what is the tumor marker assoc w/melanoma
|
S-100
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what is the risk of metastasis in melanoma
|
depth of tumor correlates w/risk of metastasis
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what is a precursor to melanoma
|
dysplastic nevi (atypical mole)
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what is the physical finding in basal cell carcinoma
|
rolled edges w/central ulceration
pearly papules w/telangiectasias |
