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173 Cards in this Set
- Front
- Back
When does hCG secretion begin after blastocyst implantation
|
within week 1
|
|
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 |
|
when does the fetal period begin
|
Week 8
|
|
what are the alar plate and basal plate
|
have the same orientation as the spinal cord
alar: dorsal = sensory basal: ventral = motor |
|
what is a craniopharyngioma
|
benign Rathke's pouch tumor w/cholesterol crystals, calcification
|
|
what is the nucleus pulposus derived from
|
notochord
|
|
what are mesodermal defects
|
VACTERL
Vertebral defects Anal atresia Cardiac defects Tracheo-Esophageal fistula Renal defects Limb defects (bone and muscle) |
|
what is the leading cause of birth defects and mental retardation
|
EtOH
|
|
what is the leading cause of congenital malformation in the US
|
Fetal Alcohol syndrome
|
|
what drug causes discolored teeth in the fetus
what effect does valproate cause on the fetus |
tetracyclines
Valproate inhibits intestinal folate absorption |
|
what drug causes CN VIII toxicity in the fetus
what effect do alkylating agents have on the fetus |
aminoglycosides
absence of digits, multiple anomalies |
|
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 |
|
what is the decidua basalis
|
maternal component of the placenta
derived from endometrium maternal blood in the lacunae |
|
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 |
|
where are the umbilical arteries and vein derived from
|
from the allantois
|
|
what does a single umbilical artery mean
|
is assoc w/congenital and chromosomal anomalies
|
|
allantois
|
yolk sac forms allantois in 3rd week, it extends into urogenital sinus
allantois becomes urachus, a duct b/w bladder and yolk sac |
|
urachus
|
duct b/w bladder and yolk sac
|
|
what happens if the urachus fails to obliterate
|
1. patent urachus: urine discharge from umbilicus
2. vesicourachal diverticulum: outpouching of bladder |
|
what is the vitelline duct
what happens in 7th week |
connects yolk sac to midgut lumen
duct gets obliterated |
|
what is the coronary sinus derived from
|
left horn of the sinus venosus
|
|
what is the smooth part of the right atrium derived from
|
Right horn of the sinus venosus
|
|
what is the progression of where fetal erythropoiesis happens
|
Yolk sac (3-8 wk)
Liver (6-30 wk) Spleen (9-28) Bone marrow (28 wk onward) "Young Liver Synthesizes Blood" |
|
what is the postnatal derivative of the umbilical arteries
of the allantois/urachus |
mediaL umbilical ligaments (umbiLical)
mediaN umbilical ligaments (allaNtois) |
|
in what adult ligament is the ligamentum teres contained in
what is the ligamentum teres a postnatal derivative of |
falciform ligament
the umbilical vein |
|
what are the 1st and 2nd aortic arch derivatives
|
1- part of Maxillary artery
2- Stapedial artery and hyoid artery |
|
what are the 3rd and 4th aortic arch derivates
|
3: common Carotid artery and proximal part of the ICA
4- on L: aortic arch on R: proximal part of the R subclavian artery |
|
what is the 6th aortic arch derivative
|
proximal part of the pulmonary arteries
on L only, ductus arteriosus |
|
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 |
|
in what situation does anencephaly occur
|
polyhydramnios
|
|
what is Holoprosencephaly
|
decreased separation of hemispheres across midline -> cyclopia
assoc w/Patau's syndrome, severe fetal alcohol syndrome, cleft lip/palate |
|
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 |
|
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 |
|
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 |
|
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) |
|
what is Treacher Collins syndrome
|
1st arch neural crest fails to migrate -> mandibular hypoplasia, facial abnormalities
|
|
what is the mutation in MEN2A
|
germline RET (neural crest cells)
|
|
what does the 1st branchial cleft develop into
|
the external auditory meatus
|
|
what do the 2nd and 4th branchial clefts develop into
|
form temporary cervical sinuses but are obliterated by proliferation of the 2nd branchial arch mesenchyme
|
|
what does the 1st branchial pouch develop into
|
middle ear cavity, eustachian tube, mastoid air cells
contributes to endoderm-lined structures of ear |
|
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 |
|
what does the 1st branchial membrane develop into
|
the tympanic membrane
|
|
what branchial aches form the ant 2/3 and post 1/3 of the tongue
|
ant 2/3: 1st arch
post 1/3: 3rd and 4th arches |
|
what is the foramen cecum
|
normal remnant of the thyroglossal duct
|
|
what is the most common ectopic thyroid tissue site
|
the tongue
|
|
what causes a cleft lip
|
failure of fusion of maxillary and medial nasal processes
|
|
what causes a cleft palate
|
failure of fusion of lateral palatine processes, nasal septum +/or medial palatine process
|
|
what is the diaphragm derived from
|
Septum transversum -> central tendon
Pleuroperitoneal folds Body wall Dorsal mesentery of esophagus- > crura "Several Parts Build Diaphragm" |
|
what causes bladder exstrophy
|
failure of caudal fold closure in abdominal wall
|
|
what is gastroschsis
|
failure of lateral body folds to fuse -> extrusion of ab contents thru ab folds
|
|
what is omphalocele
|
persistence of herniation of ab contents into umbilical cord, covered by peritoneum
|
|
what is the difference b/w gastroschisis and omphalocele
|
gastroschisis is not usually covered by peritoneum and is not usually in midline, unlike omphalocele
|
|
what is an apple peel atresia
|
jejunal, ileal, colonic atresia due to vascular accident
|
|
what time during gestation do the intestines return to the ab cavity and rotate around SMA
|
10th week
|
|
around what artery do fetal intestines rotate around
|
SMA
|
|
what does failure of rostral fold closure cause
|
sternal defects
|
|
what are the signs of a tracheo-esophageal fistula
|
cyanosis, choking and vomiting w/feeding, air bubble on CXR, polyhydramnios
|
|
what causes a palpable "olive mass" in epigastric region and nonbilious projectile vomiting at ~ 2 weeks of age
|
congenital pyloric stenosis
|
|
what causes congenital pyloric stenosis
|
hypertrophy of the pylorus causes obstruction
|
|
the GI foregut gives rise to what
|
pharynx to duodenum
|
|
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 |
|
what is pancreas divisum
|
ventral and dorsal parts fail to fuse at 8 weeks
|
|
annular pancreas
|
ventral pancreatic bud abnormally encircles 2nd part of duodenum forming a ring of pancreatic tissue that may cause duodenal narrowing
|
|
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 |
|
what is the most common site of obstruction in the fetus
|
uteropelvic junction w/kidney
last to canalize -> hydronephrosis |
|
What does the metanephric mesenchyme give rise to
|
glomerulus and renal tubules to DCT
|
|
what causes Potter's syndrome
|
malformation of ureteric bud
|
|
what are the findings in Potter's syndrome
|
bilateral renal agenesis -> oligohydramnios -> limb deformities, facial deformities, pulm hypoplasia
|
|
under what artery do horseshoe kidneys get trapped
|
IMA
|
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what does the SRY gene on the Y chromosome code for
|
testis determining factor
|
|
what secretes Mullerian inhibiting factor/substance
what does it do |
sertoli cells
suppresses development of paramesonephric ducts |
|
what does the mesonephric duct develop into
|
male internal structures
SEED Seminal vesicle, Ejaculatory Duct Epididymis, Ductus deferens |
|
how does a bicornuate uterus form
what is it assoc w/ |
incomplete fusion of paramesonephric ducts
assoc w/urinary tract abnormalities and infertility |
|
what causes hypospadias
|
failure of urethral folds to close
|
|
what causes epispadias
|
faulty positioning of genital tubercle
|
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what congenital penile abnormality is exstrophy of the bladder assoc w/
|
epispadias
|
|
what is a complication of hypospadia (why does it need to be fixed)
|
to prevent UTIs
|
|
what does the labioscrotal swelling develop into
|
male: scrotum
female: labia majora |
|
what do the urogenital folds develop into
|
male: ventral shaft of penis (penile urethra)
female: labia minora |
|
what is the order of epidermal layers from surface to base
|
stratum Corneum
Lucidum Granulosum Spinosum Basalis "Californians Like Girls in String Bikinis" |
|
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
|
|
what three things are torn in an unhappy triad
|
MCL, ACL, lateral meniscus
|
|
what does abnormal passive abduction in a knee indicate
|
a torn MCL
|
|
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) |
|
what do these muscles do
Supraspinatus? Infraspinatus? |
supra: helps deltoid abduct arm
infra: laterally rotates arm |
|
what do these muscle do
teres minor? subscapularis? |
teres: adducts and laterally rotates arm
subscapularis: medially rotates and adducts arm |
|
what nerve affected by fracture of surgical neck of humerus
|
axillary n
|
|
what nerve affected by a midshaft humerus fracture
|
radial n
|
|
what can cause an ulnar nerve injury
|
fracture of hook of hamate
|
|
what nerve affected by incorrect use of a crutch
|
radial n
|
|
what nerve is affected by a supracondylar fracture of humerus; pronator teres syndrome
|
median n
|
|
what nerve is affected by fracture of medial epicondyle of humerus
|
ulnar n
|
|
what nerve is affected by dislocated lunate
|
median n
|
|
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 |
|
what are Type 1 muscle fibers
|
slow twitch, red fibers (increased mitochondria and myoglobin concentration) oxidative phosphorylation
|
|
what are Type 2 muscle fibers
|
fast twitch, white fibers (decreased mitochondria and myoglobin concentration) anaeorbic glycolysis
|
|
what is the mechanism of smooth muscle contraction
|
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) |
|
what is the mechanism of longitudinal bone growth
|
endochondral ossification
|
|
what is the mechanism of flat bone growth
|
membranous ossification (woven bone directly made w/o cartilage)
|
|
what is mechanism in achondroplasia
|
failure of longitudinal growth (membranous ossification is NOT affected, b/c NL head size)
-constitutive activation of FGFR3 which inhibits chondrocyte proliferation |
|
what drugs are contraindicated in osteoporosis
|
glucocorticoids
|
|
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 |
|
what disease shows "Erlenmeyer flasks" on X-ray
|
osteopetrosis (marble bone dz)
|
|
what is a consequence of osteopetrosis
|
cranial nerve impingement and palsies due to narrowed foramina
|
|
what are the lab findings in osteomalacia/rickets
|
Vit D deficiency ->
decreased Ca and PO4 increased PTH (leads to soft bones) |
|
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 |
|
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 |
|
in what dz can the hat size increase
|
Paget's disease
|
|
what syndrome is polyostotic fibrous dysplasia assoc w/
|
McCune-Albright syndrome
|
|
What is polyostotic fibrous dysplasia
|
bone replaced by fibroblasts, collagen, and irregular bony trabeculae
|
|
What is McCune-Albright syndrome
|
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 |
|
what disease are osteomas assoc w/
|
Gardner's syndrome
|
|
what is the most common benign bone tumor
|
Osteochondroma (exostosis)
|
|
what bone tumor has a "double bubble" or "soap bubble" appearance on X-ray
|
Giant cell tumor (osteoclastoma)
|
|
where are giant cell tumors usually found
|
distal femur and proximal tibial region (knee)
(same as osteosarcoma) |
|
what is the most common primary malignant bone tumor
|
multiple myeloma
|
|
what is the 2nd most common primary malignant bone tumor
|
osteosarcoma
|
|
what are predisposing factors to Osteosarcoma
|
Paget's dz, familial retinoblastoma, bone infarcts, radiation
|
|
what is an anaplastic small blue cell malignant tumor
|
Ewing's sarcoma
|
|
what bone tumor has a characteristic "onion skin" appearance in the bone
|
Ewing's sarcoma
|
|
what is the translocation in Ewing's sarcoma
|
11;12
|
|
what are the 4 main findings of osteoarthritis
|
osteophytes, joint space narrowing, sclerosis, subchondral bone cysts
|
|
Where are Herberden's nodes
Where are Bouchard's nodes |
Herberden's: DIP
Bouchard's: PIP |
|
Baker's cyst
|
behind the knee
in RA |
|
what type of hypersensitivity rxn is RA
|
Type 3
|
|
anti-CCP antibody
|
less sensitive more specific for RA
|
|
what do you see in RA at the joint
|
pannus formation, increased synovial fluid, bone and cartilage erosion
|
|
what is triad for Sjogren's syndrome
|
Xerophthalmia (dry eyes, conjunctivitis, "sand in my eyes")
Xerostomia (dry mouth, dysphagia) Arthritis |
|
What is Sicca syndrome
|
dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis
NO arthritis |
|
what is at increased risk in Sjogren's
|
B-cell lymphoma
|
|
in what dz do you see parotid enlargement
|
Sjogren's
|
|
what is the classic presentation of gout
|
painful MTP joint of the big toe (podagra)
|
|
acute attacks of gout are seen after what and why?
|
after a large meal or alcohol consumption
(EtOH metabolites compete for same excretion site in kidney as uric acid -> buildup in blood) |
|
Lesch-Nyhan dz syndrome and von Gierke's dz can lead to what
|
gout
|
|
Contrast gout and pseudogout
|
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 |
|
what orgs are common in infectious arthritis
|
S. aureus, Strep, N. gonorrhea
|
|
How does gonococcal arthritis present
|
monoarticular, migratory arthritis w/an asymmetrical pattern
|
|
what orgs common in chronic infectious arthritis
|
TB (from mycobacterial dissemination),
Lyme |
|
what are the features of anklyosing spondylitis
|
ankylosis, uveitis, aortic regurgitation
|
|
what is the triad of Reiter's syndrome (Reactive arthritis)
|
Conjunctivitis and ant uveitis
Urethritis Arthritis |
|
what disease presents post-GI or chlamydia infections
|
Reiter's syndrome
|
|
what are the features of psoriatic arthritis
|
dactylitis (sausage fingers), pencil-in-cup deformity on X-ray, joint pain and stiffness assoc w/psoriasis
|
|
what do SLE pts die from
|
renal failure and infections
|
|
What dz has false positive on syphilis tests (RPR/VDRL)
|
SLE
|
|
How do you trx sarcoidosis
|
steroids
|
|
what are the features of sarcoidosis
|
GRAIN
Gammaglobulinemia RA ACE increase Interstitial fibrosis Noncaseating granulomas |
|
what is polymyalgia rheumatica
|
pain and stiffness in shoulders and hips (often w/fever, malaise, wt loss)
NOT cause muscular weakness assoc w/temporal/giant cell arteritis |
|
What are the lab findings of polymylagia rheumatica
What is the trx |
increased ESR, NL CK
Prednisone |
|
what dz have malar rashes
|
SLE and dermatomyositis
|
|
what are the features of dermatomyositis
|
malar rash, heliotrope rash, "shawl and face" rash, Gottron's papules, increased risk of malignancy
|
|
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 |
|
what is the most common NMJ disorder
|
Myasthenia gravis
|
|
Contrast myasthenia gravis and Lambert-Eaton syndrome
|
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 |
|
What is myasthenia gravis assoc w/
What is Lambert-Eaton syndrome assoc w/ |
MG: assoc w/thymoma
LE: assoc w/paraneoplastic dz (like SCLC) |
|
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 |
|
What are the 2 types of scleroderma
|
diffuse and CREST
|
|
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) |
|
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 |
|
what is the most common soft tissue tumor of childhood
|
Rhabdomyosarcoma
|
|
Leser-Trelat
|
sudden appearance of multiple seborrheic keratoses indicating an underlying malignancy (e.g., GI, lymphoid)
|
|
what is melasma and what is it assoc w/
|
hyperpigmentation
assoc w/pregnancy or OCP use |
|
what causes albinism
what causes vitiligo |
decreased melanin production from decreased activity of tyrosinase
vitiligo: decrease in melanocytes |
|
what happens in Staph scalded skin syndrome (SSSS)
|
exotoxin destroys keratinocyte attachments in stratum granulosum only
|
|
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 |
|
Contrast Pemphigus Vulgaris and Bullous Pemphigoid
|
Pemphigus Vulgaris: IgG to desmosomes, positive Nikolsky's sign
Bullous Pemphigoid: IgG to hemidesmosomes, negative Nikolsky's sign |
|
acanthosis nigricans
what is it assoc w/ |
hyperplasia of stratum spinosum
assoc w/hyperinsulinemia (Cushing's, diabetes, etc.) and visceral malignancy |
|
what is the risk of carcinoma in actinic keratoses
|
risk is proportional to epithelial dysplasia
|
|
"herald patch" assoc w/what disease
|
pityriasis rosea
|
|
what is pityriasis rosea
|
"herald patch" followed days later by "Christmas tree" distribution, multiple papular eruptions
remits spontaneously |
|
what is the tumor marker assoc w/melanoma
|
S-100
|
|
what is the risk of metastasis in melanoma
|
depth of tumor correlates w/risk of metastasis
|
|
what is a precursor to melanoma
|
dysplastic nevi (atypical mole)
|
|
what is the physical finding in basal cell carcinoma
|
rolled edges w/central ulceration
pearly papules w/telangiectasias |