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First Aid 2012 pp124-143
53
Medical
Graduate
02/09/2013

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Term
limb growth
Definition
SHH -- zone of polarizing activity (base) --> anterior-posterior
Wnt-7 -- apical ectodermal ridge --> dorsal-ventral
FGF -- apical ectodermal ridge --> stim mitosis for lengthening
Term
rules of early development
Definition
Week 2 (rule of 2s): 2 germ layers, 2 cavities, 2 parts of placenta
Week 3 (rule of 3s): 3 germ layers
Week 4 (rule of 4s): 4 heart chambers, 4 limb buds
Term
how does neural tube form? when does neural tube close?
Definition
notochord induces overlying ectoderm to become neural plate --> neural tube and neural crest cells (by week 4!!)
Term
prochordal plate
Definition
fusion of epiblast and hypoblast --> future mouth!
Term
when organogenesis??
Definition
3-8 wks
embryonic period
most susceptible to teratogens!! gasp!!
Term
fetal movement??
Definition
8 wks
fetal period
Term
genitalia??
Definition
10 wks
Term
alar vs. basal plate
Definition
alar = sensory, dorsal
basal = motor, ventral
Term
sacrococcygeal teratoma
Definition
remnant of primitive streak! remove by 6 mo!!
Term
caudal dysplasia
Definition
sirenomelia
abnormal mesoderm migration during gastrulation
Term
association with imperforate anus
Definition
urogenital tract anomalies!!!!
also VACTERL (mesoderm defects)
Term
malformation vs. deformation
Definition
malformation -- intrinsic, within 3-8wks (embryonic period)
deformation -- extrinsic, after 3-8wks
Term
agenesis vs aplasia
Definition
agenesis -- no organ b/c no primordial tissue
aplasia -- no organ despite having primordial tissue
Term
twinning
Definition
# chorions/# amnions
dizygotic --> di/di
0-4 days (25%) --> di/di
4-8 days (75%) --> mono/di
8-12 days --> mono/mono
>13 days --> conjoined
Term
urachal duct
Definition
allantois becomes urachus -- connects bladder and yolk sac (future umbilicus)
Term
vitelline duct
Definition
connects midgut to yolk sac (future umbilicus)
Term
Meckel's diverticulum vs. vitelline sinus vs. vitelline duct cyst
Definition
Meckel's -- part by midgut patent
vitelline sinus -- part by umbilicus patent
vitelline duct cyst -- middle part patent
Term
forming aorta and pulm trunk
Definition
NEURAL CREST --> truncal and bulbar ridges that SPIRAL and fuse to form aorticopulmonary septum (AP septum)
Term
problems with AP septum formation
Definition
failure to spiral --> D-transposition
skewed --> tetrology
partial development --> persistent TA
Term
IV septum
Definition
1. muscular portion forms
2. AP septum, endocardial cushions, and muscular portion of IV septum form membranous IV septum
Term
IA septum
Definition
1. septum primum grows down, making foramen primum smaller
2. perforations in septum primum form foramen secundum as foramen primum closes
3. septum secundum grows down to right of septum primum and has permanent foramen ovale
4. top of septum primum goes away, bottom part is valve for foramen ovale
5. fusion of septums
Term
problems with IV septum
Definition
1. foramen primum defect -- bottom -- foramen primum and AV septum didn't fuse
2. foramen secundum defect -- foramen ovale too big (septum secundum too small, leftover septum primum too small)
3. probe patent foramen ovale -- incomplete fusion of septums (considered "normal variant"!)
Term
fetal erythropoiesis
Definition
1. yolk sac (3-8wk) -- zeta2epsilon2
2. liver (6-30wk)
3. spleen (9-28wk)
4. bone marrow
HbF = alpha2gamma2
adult Hb = alpha2beta2
HbF --> adult Hb @ 6 mo
Term
fetal blood flow
Definition
umbilical vein (~80%!!) --> ductus venosus --> IVC --> RA --> foramen ovale --> LA --> LV --> aorta --> carotids

carotids --> SVC --> RA --> RV --> pulm artery --> ductus arteriosis --> descending aorta --> umbilical arteries (off internal iliacs)
Term
closing fetal holes
Definition
1. decreased pulm resistance --> increased LA pressure --> close foramen ovale
2. increased O2 --> close ductus arteriosis
Term
NTD measurements
Definition
high AFP
high acetylcholinesterase
Term
elevated AFP
Definition
wrong gestational age!!
NTD, multiple gestations, abd wall defects
Term
holoproencephaly
Definition
telencephalon fails to divide!! --> cyclopia
Term
Trecher-Collins
Definition
1st arch neural crest fails to migrate -> micrognathia, facial abnormalities
can be part of Pierre-Robin syndrome
Term
parts of brachial arch derived from...
Definition
cartilage/bones -- neural crest
muscles -- mesoderm
nerves -- neural ectoderm
Term
sensation for vagus n
Definition
above vocal cords --> superior laryngeal branch (internal branch)
below vocal cords --> recurrent laryngenal
Term
cricothyroitomy
Definition
1. skin
2. superficial cervical fascia
3. investing and pretracheal layers of deep cervical fascia
4. cricothyroid ligament
Term
congenital pharyngocutaneous fistula
Definition
persistence of 3rd cleft and pouch --> fistula b/t tonsillar area and cleft in lateral neck!!
Term
cleft lip
Definition
failure of fusion between
1) maxillary process
2) medial nasal process
Term
cleft palate
Definition
failure of fusion between
1) lateral palatine processes of maxillary prominences
2) nasal septum
3) median palatine process (primary palate)
Term
abd wall defects
Definition
rostal fold --> sternal defects
lateral fold --> omphalocele, gastroschisis
caudal fold --> bladder exstrophy
Term
duodenal vs. distal GI atresia
Definition
duodenal -- failure to recanalize (trisomy 21, other defects)
distal GI -- vascular accident (isolated defect)
Term
distal GI segment winding around thin vascular stalk
Definition
apple peel atresia
jejunal, ileal, colonic atresia!!
Term
most common type of TE fistula
Definition
blind esophagus
distal esophagus comes of trachea
Term
ventral vs. dorsal pancreatic duct
Definition
ventral -- uncinate process, inferior part of head, prox 1/3 of main pancreatic duct
dorsal -- everything else!
Term
weird thing about spleen
Definition
mesodermal, but uses celiac artery!
Term
kidney formation
Definition
intermediate mesoderm --> urogenital ridge --> nephrogenic cord --> everything else

1. pronephros (most rostral) -- week 4, degenerates
2. mesonephros -- functions for 1st trimester
3. metanephros (within mesonephros) -- ureteric bud (caudal end of mesonephros) --> ureter, pelvises, calyces, CDs; metanephric mesenchyme --> glomerulus and tubules to DCT with interaction of ureteric bud
Term
kidney badness
Definition
ureteropelvic junction last to canalize --> most common site of obstruction
Potter's -- malformation of ureteric bud
Term
mesonephric duct derivatives
Definition
= Wolffian duct
SEED
Seminal vesicles
Epididymis
Ejaculatory duct
Ductus deferens
(NOT prostate -- urogenital sinus!!)
Term
paramesonephric duct derivatives
Definition
= Mullerian ducts
fallopian tube, uterus, upper 2/3 vagina
(NOT lower 1/3 vagina -- urogenital sinus!!)
Term
primary amenorrhea + fully developed secondary sexual characteristics
Definition
Mullerian defect!!
Term
bicornuate uterus
Definition
incomplete fusion of Mullerian ducts
Term
signaling for genitalia
Definition
Sertoli cell --> anti-Mullerian hormone --> NO internal female genitalia

Leydig cell --> testosterone --> develop Wolffian ducts --> internal male genitalia

DHT --> male external genitalia, prostate
Term
what do get if you're XY and...
1) no Sertoli cells
2) no 5alpha-reductase
3) androgen insensitivity syndrome
Definition
1) male AND female internal genitalia, male external genitalia
2) male internal genitalia, female/ambiguous external genitalia (until puberty - "penis at 12!!")
3) no internal genitalia (have AMH, but no response to testosterone!), female/ambiguous external genitalia
Term
hypospadias
Definition
ventral opening
failure of urethral folds to close
more common
fix to prevent UTIs
Term
epispadias
Definition
dorsal opening
faulty positioning of genital tubercle
associated with exstrophy of bladder!!
Term
gubernaculum in ladies
Definition
ovarian ligament + round ligament
Term
congenital torticollis
Definition
usually, malposition/birth trauma --> SCM injury and fibrosis
rarely, ervical spine deformities -- get cervical x-rays!!
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