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First Aid for the USMLE Step 1 2011 EXPRESS workbook

page 31

Embryology
Questions
1. 2. 3. 4. At what time during embryonic development does organogenesis occur? (p. 118) _____________ During what week of development does the heart of an embryo begin to beat? (p. 118) _________ During embryonic development, when does implantation occur? (p. 118) ____________________ The alar plate is on the _______________ (dorsal/ventral) side of the neural tube, whereas the basal plate is on the _______________ (dorsal/ventral) side. (p. 118) What are the functions of neurons derived from the alar and basal plates? (p. 118) ___________ ______________________________________________________________________________ 6. During fetal development, bones generally are derived from the _______________ (ectoderm/ endoderm/mesoderm), except for bones of the skull, which arise from _______________. (p. 119) An infant is born with vertebral defects, anal atresia, and limb defect. What other defects is this patient most likely to experience? (p. 119) _____________________________________________ A 2-week-old embryo is exposed to a teratogen; what is the likely effect on development? (p. 120) ______________________________________________________________________________ 9. Match each teratogen with its most common effect(s). (p. 120) _____ A. _____ B. _____ C. _____ D. _____ E. _____ F. _____ G. _____ H. _____ I. _____ J. _____ K. _____ L. _____ M. _____ N. _____ O. _____ P. _____ Q. 10. ACE inhibitors Alcohol Alkylating agents Aminoglycosides Cocaine Diethylstilbestrol (DES) Folate antagonists Iodine (lack or excess) Lithium Maternal diabetes Smoking (nicotine, CO) Tetracyclines Thalidomide Valproate Vitamin A excess Warfarin X-rays, anticonvulsants 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Abnormal fetal development, fetal addiction Absence of digits, multiple anomalies Bone deformities, fetal hemorrhage, abortion Caudal regression syndrome Cleft palate, cardiac abnormalities CN VIII toxicity Congenital goiter or hypothyroidism Discolored teeth Ebsteins anomaly Flipper limb Inhibited intestinal folate absorption Leading cause of birth defects in U.S. Multiple anomalies Neural tube defects Preterm labor, placental problems Renal damage Vaginal clear cell carcinoma

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7.

8.

What congenital abnormalities are associated with fetal alcohol syndrome? (p. 120) ___________ ______________________________________________________________________________

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

11. 12. 13. 14. 15. 16. 17.

How many chorions and amniotic sacs do conjoined twins have? (p. 121) ____________________ If a zygote splits between day 3 and day 8, what type of twins will result? (p. 121) ______________ How many arteries and how many veins are contained in the umbilical cord? (p. 122) ___________ The umbilical arteries carry _______________ (oxygenated/deoxygenated) blood. (p. 122) What structure connects the fetal bladder with the yolk sac? (p. 122) ________________________ What is the term for a fistula between the umbilicus and terminal ileum? (p. 122) ______________ In the embryonic heart, the right common cardinal vein and the right anterior cardinal vein jointly give rise to which vein in the adult? (p. 123) ___________________________________________ Which two cardiac structures are created by migration of neural crest cells? (p. 123) __________ ______________________________________________________________________________

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Which embryonic shunt diverts oxygenated blood from the inferior vena cava into the left atrium? (p. 125) ________________________________________________________________________ Which embryonic shunt directs oxygenated blood around the hepatic circulation? (p. 125) ______ ______________________________________________________________________________

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Which embryonic shunt bypasses the high-resistance pulmonary circulation? (p. 125) _________ ______________________________________________________________________________

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What is the approximate oxygen saturation (%) of the blood returning from the placenta in the umbilical vein? (p. 125) ___________________________________________________________ Which drug can close the ductus arteriosus? Which drug can keep it open? (p. 125) ___________ ______________________________________________________________________________

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What adult structure is derived from the cavity in the embryonic metencephalon and myelencephalon? (p. 126) _________________________________________________________ Neural tube defects are associated with low intake of what substance during pregnancy? (p. 126) ______________________________________________________________________________

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Neural tube defects are associated with elevated levels of what substance in amniotic fluid and maternal serum? (p. 126) __________________________________________________________ In the fetus, failure of the bony spinal canal to close (without structural herniation) will result in what type of neural tube defect? (p.126) __________________________________________________ A _______________ is characterized by the meninges herniating through a spinal canal defect. (p. 126) A _______________ is characterized by the meninges and spinal cord herniating though a spinal canal defect. (p. 126)

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28.

29.

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

page 33

30.

What is the term for a malformation of the anterior neural tube that causes agenesis of the brain and calvarium? (p. 127) ___________________________________________________________ What happens to amniotic fluid if a fetus has anencephaly? (p. 127) ________________________ An infant has cyclopia. What other defects is this patient most likely to experience? (p. 127) _____ ______________________________________________________________________________

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An MRI scan of the cervical spine of an infant shows an enlargement of the central canal of the spinal cord. What is the term for this lesion? (p. 127) ____________________________________ A patient presents with syringomyelia, thoracolumbar myelomeningocele, and hydrocephalus. What is the most likely diagnosis? (p. 127) ____________________________________________ What is the Dandy-Walker malformation? (p. 127) ______________________________________ A patient develops loss of pain and temperature sensation in the hands, but touch is intact. Where is the lesion most likely located? (p. 127) ______________________________________________ Fill in the chart below to identify which arteries are derived from which aortic arch derivatives. (p. 127) Aortic Arch First aortic arch Arteries

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35. 36.

37.

Second aortic arch

Third aortic arch

Fourth aortic arch

Sixth aortic arch

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

38.

Fill in the chart below to identify which structures are derived from which branchial arch. (p. 128) Branchial Arch Derivative Cartilage

Muscles

Nerves

First branchial arch

Second branchial arch

Third branchial arch

Fourth branchial arch

Sixth branchial arch

39.

Which cranial nerve mediates taste and sensation in the extreme posterior portion of the tongue? (p. 129) ________________________________________________________________________ Which structure connects the thyroid gland with the tongue? (p. 130) ________________________ How do the etiologies of cleft lip and cleft palate differ? (p. 130) ____________________________ ______________________________________________________________________________

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What is the term for the persistence of herniated abdominal contents into the umbilical cord? (p. 130) __________________________________________________________________________ A newborn is noted to choke and vomit with routine feedings. The mother had polyhydramnios during pregnancy. What is the most likely diagnosis? (p. 131) _____________________________ In congenital pyloric stenosis, hypertrophy of the pylorus leads to what problem? (p. 131) _______ ______________________________________________________________________________

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What is the treatment for congenital pyloric stenosis? (p. 131) _____________________________ Copyright 2011 by MedIQ Learning, LLC All rights reserved

First Aid for the USMLE Step 1 2011 EXPRESS workbook

page 35

46.

The head of the pancreas is derived from the _______________ (ventral/dorsal) pancreatic bud, the body is derived from the _______________ (ventral/dorsal) pancreatic bud, and the tail is derived from the _______________ (ventral/dorsal) pancreatic bud. (p. 131) The main pancreatic duct is derived from the _______________ (ventral/dorsal) pancreatic bud, whereas the accessory pancreatic duct is derived from the _______________ (ventral/dorsal) pancreatic bud. (p. 131) Which fetal structure functions as the interim kidney for the first trimester? (p. 132) _____________ Which hormone inhibits development of the paramesonephric duct in males? (p. 133) __________ ______________________________________________________________________________

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48. 49.

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In male development, the _______________ gene on chromosome _______________ codes for testis-determining factor. (p. 133) In male development, the mesonephric duct develops into all genitourinary internal structures except the _______________. (p. 133) Which cells produce the androgens that promote development of the mesonephric ducts? (p. 133) ______________________________________________________________________________

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What condition results from an abnormal opening of the penile urethra on the inferior (ventral) side of the penis, as a result of failure of the urethral folds to close? (p. 134) ______________________ What condition results from an abnormal opening of the penile urethra on the superior (dorsal) side of the penis, as a result of faulty positioning of the genital tubercle? (p. 134) __________________

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Answers
1. 2. 3. 4. 5. Weeks 3 through 8. Week 4. Day 6. Dorsal; ventral. Neurons derived from the alar plate are sensory, whereas neurons derived from the basal plate are motor. Mesoderm; neural crest cells. Cardiac, renal, and tracheoesophageal defects. (Remember: VACTERL = Vertebral defects, Anal atresia, Cardiac defects, TracheoEsophageal fistula, Renal defects, Limb defects) Before week 3, there is usually an all-or-none effect: either embryonal death or no abnormalities. A-16, B-12, C-2, D-6, E-1, F-17, G-14, H-7, I-9, J-4, K-15, L-8, M-10, N-11, O-5, P-3, Q-13.

6. 7.

8. 9.

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

10.

Developmental retardation (both pre- and postnatal), microcephaly, holoprosencephaly, facial abnormalities, limb dislocation, and heart and lung fistulas. One chorion and one amniotic sac. The twins will be monochorionic and diamniotic. Two arteries and one vein. Deoxygenated. Urachus. Vitelline fistula. Superior vena cava. The ascending aorta and pulmonary trunk are created from the truncus arteriosus. Foramen ovale. Ductus venosus. Ductus arteriosus. 80%. Indomethacin closes a PDA, while prostaglandins can keep it open. Fourth ventricle. Folic acid. -Fetoprotein. Spina bifida occulta. Meningocele. Myelomeningocele. Anencephaly. There is polyhydramnios due to the lack of a swallowing center in the brain, so the fetus cannot swallow amniotic fluid. Holoprosencephaly is associated with cyclopia, Pataus syndrome, severe fetal alcohol syndrome, and cleft lip/palate. Syringomyelia. (Remember: syrinx is Greek for tube, as in syringe) A Chiari type II malformation.

11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31.

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33. 34.

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

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35.

A posterior fossa malformation that is associated with a large posterior fossa and an absent cerebellum, with a cyst in its place. Most commonly at C8-T1. (This describes the "cape-like" distribution of syringomyelia.)

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Aortic Arch First aortic arch Second aortic arch Third aortic arch Fourth aortic arch

Arteries Part of maxillary artery Stapedial artery Hyoid artery Common carotid artery Proximal part of ICA Aortic arch (on left) Proximal part of RCA (on right) Proximal part of pulmonary arteries Ductus arteriosus (on left only)

Sixth aortic arch

38. Branchial Arch Derivative Cartilage Meckels cartilage: mandible, malleus, and sphenomandibular ligament Reicherts cartilage: stapes, styloid process, lesser horn of hyoid Cartilage: greater horn of hyoid Cartilage: thyroid, cricoids, arytenoids, corniculate, cuneiform Cartilage: thyroid, cricoids, arytenoids, corniculate, cuneiform

Muscles Muscles of mastication Mylohyoid Anterior belly of digastric Tensor tympani Tensor veli palatini Muscles of facial expression Stapedius Stylohyoid Posterior belly of digastric Stylopharyngeus Most pharyngeal constrictors Cricothyroid Levator veli palatini All intrinsic muscles of larynx except cricothyroid

Nerves CN V2 and V3

First branchial arch

CN VII (facial expression)

Second branchial arch

Third branchial arch

CN IX CN X (superior laryngeal branch)

Fourth branchial arch

Sixth branchial arch

CN X (recurrent laryngeal branch)

39.

CN X.

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40. 41.

The thyroglossal duct (a common site of ectopic thyroid tissue). Cleft lip occurs when the maxillary and medial nasal processes fail to fuse. Cleft palate occurs when the lateral palatine processes, the nasal septum, and/or the median palatine process fail to fuse. Omphalocele. Tracheoesophageal fistula. Gastric outlet obstruction. (A classic sign is projectile vomiting.) Surgical incision to relax the pyloric muscle (pyloromytomy). Ventral; dorsal; dorsal. Ventral; dorsal. Mesonephros. Mllerian inhibiting substance (secreted by Sertoli cells). (In females, it prevents development of the fallopian tubes, uterus, and upper third of the vagina.) SRY; Y. Prostate. Leydig cells. Hypospadias. (Patients have an increased risk of urinary tract infection). Epispadias.

42. 43. 44. 45. 46. 47. 48. 49.

50. 51. 52. 53. 54.

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