Green Book Embryology Questions (paper 1)

March 1997 q. 11, September 2000 q. 12

(1)In the fetal circulation:
The ductus venosus delivers blood directly into the superior vena
cava
The umbilical artery returns blood from the placenta
The ductus arteriosus carries blood to the lungs
Blood returning from the lungs is 90% saturated with oxygen
Blood from the inferior vena cava is largely directed through the
foramen ovale

FFFFT

The ductus venosus is a large venous shunt that forms within the liver
and connects the umbilical vein with the IVC. The umbilical arteries run
through the connecting stalk and become continuous with vessels in the
chorion. Proximal parts become the internal iliac arteries and superior
vesicular arteries, while distal parts obliterate and become medial
umbilical ligaments. The ductus arteriosus runs from the pulmonary
trunk to the arch of the aorta. About 75% of blood from the IVC goes
through the foramen ovale, guided by a valve. The rest of the blood
from the IVC and SVC flows from the right atrium to the right ventricle.

March 19997 q. 12, March 2000 q. 13

(2)The ductus venosus:
Is part of the embryonic heart
Is a shunt preventing blood from passing to the fetal lungs
Gives rise to the liagmentum teres
Carries blood with a higher pO2 than umbilical arterial blood
Is derived from the anterior cardinal vein

FFFTF

The ductus venosus is made from the left hepatic vein and umbilical
vein and joins the IVC to allow blood to bypass the liver. Blood
bypasses the lungs in the ductus arteriosus. The umbilical vein forms
the ligamentum teres, while the ductus venosus forms the ligamentum
venosum. The umbilical vein carries oxygenated blood from the
placenta to the ductus venosus, while the umbilical arteries carry
deoxygenated blood back to the placenta. The right anterior cardinal
vein forms the SVC, while the right posterior cardinal vein forms the
IVC.

March 1997 q. 13
(3)The following structures take part in the formation of the anterior
fontanelle in the fetal skull:
Lamboidal suture
Occipital suture
Saggital suture
 Glabella
Frontal suture

FFTFT

The lamboidal suture is involved in the formation of the posterior

fontanelle. The saggital suture lies between the parietal bones and the
glabella is between the orbits. The frontal suture is present between
the two halves of the frontal bones at birth.

March 1997 q. 14, March 2001 q. 13

(4)Concerning the embryology of the urinary tract:
The detrusor has mesodermal origin
The urogenital sinus is derived from the cloaca
The allantois gives origin to the lateral umbilical ligaments
The metanephric ducts (ureteric buds) arise from the mesonephric
ducts
The mesonephric duct remnants form the epoophoron in the adult
female

TTFTT

The epithelium of the bladder is endodermal in origin while all other

layers form from splanchnic mesoderm. The cloaca is divided by the
urorectal septum and the bladder forms from the urogenital sinus. The
allantois forms the urachus, which gives rise to the median umbilical
ligament. The epoophoron is a remnant of the mesonephros, while the
paroophoron is a mesonephric remnant of tubules (the mesonephric
tubules open into the mesonephric duct). The Gartners duct is the
mesonephric duct remnant in females. The metanephric diverticulum
(ureteric bud) is an outgrowth from the mesonephric duct.

March 1997 q. 15
(5)The following tissues are paired with the appropriate primary germ
cell layer of origin:
Mammary duct epithelium: ectoderm.
Epithelium of tongue : mesoderm
Pineal gland : ectoderm
Ovarian stream : mesoderm
Endometrium : mesoderm

TFTTF

The ectoderm forms: the epidermis, CNS, PNS and retina of the eye. It
also forms the epithelium of the skin, oral cavity, cornea, lens, and
sensory receptors of the eyes, ears and nose.
The mesoderm forms: smooth muscle, connective tissue and the
epithelium of blood vessels, the pleural and peritoneal cavities. It is
also the source of blood cells and bone marrow, the skeleton, striated
muscles, and the reproductive and excretory system.
The endoderm forms: the epithelial lining of the respiratory tract,
gastrointestinal tract, functional cells of the liver, pancreas, gallbladder,
thyroid gland and parathyroid gland.

The mammary bud forms from ectoderm as does the epithelium of the
oral cavity. The pineal gland is part of the CNS, which develops from
the ectoderm. The muscular walls of the uterus and cervix are formed
from mesoderm surrounding the paramesonephric ducts. The
paramesonephric ducts form the uterus and tubes and are also derived
from the mesoderm. The ovaries and testes are also mesoderm
derivatives, although the endometrium is endodermal in origin.

September 1997 q. 12, September 2000 q. 11

(6)The following are derived from the urogenital sinus:
The bladder trigone
The ureters
The female urethra
Greater vestibular glands
Paraurethral glands

FFTTT

The cloaca is divided into two parts by the urorectal septum: the rectum
and upper part of the anal canal dorsally; the urogenital sinus ventrally.
The urogenital sinus has three parts: the vesical part is continuous with
the allantois; the middle pelvic part becomes the entire female urethra;
and the caudal phallic part grows towards the genital tubercle. The
bladder develops mainly from the urogenital sinus, except for the
trigone, which develops from the caudal part of the mesonephric ducts.
The epithelium of the entire bladder is from the endoderm of the
urogenital sinus. The metanephric diverticulum (ureteric bud) is an
outgrowth from the mesonephric duct and forms the ureter, renal
pelvis, calices and collecting tubules. Outgrowths from the urogenital
sinus form the greater vestibular glands (of Bartholin), while buds from
the urethra grow to form the urethral glands and paraurethral glands
(of Skene).

September 1997 q. 13, September 2001 q. 12

(7)The following statements concerning the uterus are correct:
It is formed from the mesonephric ducts
It has a lymphatic drainage in part to the inguinal glands
The uterine artery passes below the ureter
The uterine veins communicate with the vesical plexus of veins
Pain sensation from the body of the uterus is carried by pelvic
splanchnic nerves

FTFFF

The uterus and tubes are formed from the paramesonephric ducts,
while the male genital system develops from the mesonephric ducts.
Lymph drainage from the Fundus travels with the ovarian arteries to the
Para-aortic nodes, while lymph from the body and cervix drain into the
internal and external iliac nodes. A few lymph vessels follow the round
ligament through the inguinal canal and drain into the superficial
inguinal nodes. The uterine artery, a branch of the internal iliac artery,
runs medially in the base of the broad ligament to reach the uterus. It
crosses above the ureter at right angles and ascends along the lateral
margin of the uterus in the broad ligament. It ends by anastamosing
with the ovarian artery, which also assists in supplying the uterus.
Veins from the bladder form the vesical venous plexus, which
communicate with the prostatic plexus in men then drain into the
internal iliac vein. The uterine vein follows the uterine artery and
drains into the internal iliac vein. The nerve supply of the uterus is
from sympathetic and parasympathetic nerves from branches of the
inferior hypogastric plexuses. Visceral afferent fibres run in the inferior
hypogastric plexuses, which carry pelvic splanchnic nerves. Pain from
the cervix is in the pelvic splanchnic nerves while pain from the uterus
is in sympathetic nerves of the hypogastric plexus.

September 1997 q. 14, March 2001 q. 14

(8)In the fetal cardiovascular system:
The heart arises from endoderm
The heart is formed by fusion of endocardial tubes
Cardiac pulsation is present by the 30th day after fertilisation
Oxygenated blood is transferred to the left atrium through the
foramen ovale
The ductus arteriosus closes during the last 4 weeks of pregnancy

FTTTF

The cardiovascular system forms from mesoderm. The heart forms from
two angioblastic cords, which canalise to form the endocardial heart
tubes. They fuse to form the tubular heart late in the third week (day
21). The primordium of the heart begins to beat at 22 to 23 days.
Blood flow begins during the fourth week and can be visualised by
Dopplers. The foramen ovale allows most (75%) of the oxygenated
blood from the IVC to pass into the left atrium. The ductus arteriosus
constricts at birth but there is often a small shunt of blood from the
aorta to the left pulmonary artery for the first few days in healthy, full-
term infants.

March 1998 q. 10
(9)In the development of the heart:
The primitive heart consists of five parts
The septa are formed within 6 weeks of conception
The septum secundum forms a complete partition in the atrial
cavity
Obliteration of the right atrioventricular orifice is frequently
associated with a ventricular septal defect
 Anatomical closure of the ductus arteriosus occurs within 1 hour of
birth.

TTFTF

The primitive heart consists of the bulbus cordis, ventricle and atrium,
followed by the truncus arteriosus and sinus venosus. The partitioning
of the primordial heart (atrioventricular canal, primordial atrium and
ventricle) begins around the middle of the 4th week and is essentially
completed by the end of the 5th week. The septa secundum grows from
the ventrocranial wall of the atrium immediately to the right of the
septum primum to form an incomplete partition of the atria;
consequently the foramen ovale forms. Functional closure of the ductus
arteriosus occurs soon after birth more permanent closure by fibrosis
occurs a few days later. Tricuspid atresia is associated with an ASD.

March 1998 q. 11
(10)Concerning the development of the nervous system:
The posterior neuropore closes before the anterior neuropore
At 3 months of age, the spinal cord extends the length of the
vertebral canal
At birth, the spinal canal terminates at L3
At birth, the dura mater extends as far as L3
Myelin formation in the spinal cord is completed before birth

FFFFF

The anterior neuropore closes on day 25 and the posterior neuropore

closes 2 days later. The spinal cord extends the length of the vertebral
canal in the embryo but the vertebral canal grows faster than the spinal
cord at birth the spinal cord stops at L2 or L3. The spinal canal
continues to the first coccygeal vertebra where a long fibrous thread
from the pia mater (filum terminale) attaches. The dura and arachnoid
mater usually terminate at S3 in the newborn and S2 in the adult.
Myelin sheaths in the spinal cord begin to form during the late fetal
period and continue to form during the first postnatal year.

March 1998 q. 12
(11)The urogenital sinus in the female gives rise to the following:
Ureter
Paraurethral glands
Bartholins glands
Urachus
Gartners duct

FTTFF

The metanephric diverticulum (ureteric bud) is an outgrowth from the

mesonephric duct and forms the ureter, renal pelvis, calices and
collecting tubules. Outgrowths from the urogenital sinus form the
greater vestibular glands (of Bartholin), while buds from the urethra
grow to form the urethral glands and paraurethral glands (of Skene)
the whole of the female urethra is formed from the urogenital sinus.
The urachus is formed from the allantois and Gartners ducts are
remnants of the mesonephric duct.

March 1998 q. 13, September 2001 q. 13

(12)The mesoderm gives rise to:
Striated muscle
Blood
Peritoneum
Transitional epithelium of the bladder
Ovarian stroma

TTTFT

The mesoderm forms striated muscle and is also the origin of blood
cells and bone marrow. It forms the serous membranes forming the
lining of body cavities and gives rise to the ovaries and testes. The
epithelial lining of the bladder is derived from the endoderm of the
vesical part of the urogenital sinus. The primordial germ cells of the
ovary, located in the primary sex cords, are endodermal in origin (from
endodermal cells of the yolk sac).

September 1998 q. 11
(13)The umbilical cord:
Contains mid-gut during embryological development
Is covered by amnion
Consists chiefly of fetal endodermal cells
Contains two veins and an artery
Is approximately 50cm long at term

TTFFT

As the midgut forms it forms a ventral elongated loop, which projects

into the proximal end of the umbilical cord at the beginning of the sixth
week. The midgut loop rotates 90o anticlockwise, around the SMA as an
axis, while in the umbilical cord. During the 10th week the intestines
return to the abdomen. The umbilical cord comprises the connecting
stalk (extra-embryonic mesoderm), the umbilical vessels (originating
from the allantois, which is from endodermal cells of the yolk sac) and
the amnion (extraembryonic ectoderm). The amnion forms the
epithelial lining of the umbilical cord, which contains two arteries and a
vein. The umbilical cord is 30-90cm long at term (average 55cm).

September 1998 q. 12, March 1999 q. 14

(13)The fetal testes:
Are morphologically distinguishable 4 weeks after conception
Contain cells which have migrated from the wall of the yolk sac
Are usually intra-abdominal 12 weeks after conception
 Are necessary for the persistence of the mesonephric (Wolffian)
ducts
Secrete androgens

FTTTT

The indifferent gonad begins to form during the fifth week and
eventually contain sex cells derived from endodermal cells of the yolk
sac. By the eighth week interstitial cells of Leydig begin to secrete
androgenic hormones (testosterone and androstenedione). The sertoli
cells produce anti-mullerian hormone. The mesonephric ducts form the
epididymis, vas deferens and ejaculatory duct under the influence of
testosterone (in females they regress due to a lack of testosterone). By
26 weeks the testes have reached the deep inguinal rings and descend
into the scrotum over the next 2 or 3 days.

September 1998 q. 13
(14)Concerning embryological development:
The amnion has an endodermal origin
Uterine epithelium is developed from the paramesonephric ducts
The hymen develops at the junction of the sinovaginal bulbs and
the urogenital sinus
The round ligament of the uterus is derived from the
gubernaculum
The adrenal cortex is derived from neural crest cells

FFTTF

The amnion is not part of the embryo, although epiblast cells of the
bilaminar embryonic disc give rise to the ectoderm of the amnion, the
embryonic ectoderm and the primitive streak. The paramesonephric
ducts give rise to the tubes, uterus and superior part of the vagina. The
endometrial stroma and myometrium and derived from adjacent
splanchnic mesenchyme. The sinovaginal bulbs are endodermal
outgrowths of the urogenital sinus, which grow cranially to meet the
paramesonephric ducts (uterovaginal primordium). The sinovaginal
bulbs fuse to form a vaginal plate in which the central cells eventually
break down to form the vagina. The hymen separates the lumen of the
vagina from the urogenital sinus. The adrenal cortex develops from
mesoderm, while the adrenal medulla develops from neural crest cells.

March 1999 q. 11
(15)The following are derivatives of the mesonephros:
Appendix of testis
Efferent ductules of the testis
Gartners duct cyst
Gubernaculum testis
Prostatic utricle

FTFFF
The mesonephroi (plural of mesonephros) are the second kidneys,
which function as interim kidneys until the permanent kidneys develop
from the metanephroi. They degenerate towards the end of the first
trimester and their tubules become the efferent ductules of the testes.
The appendix of the testis forms from the paramesonephric duct in the
male, while the Gartners duct is the female derivative of the
mesonephric duct. The gubernaculum testis forms from the
gubernaculum while the prostatic utricle forms from the urogenital
sinus.

March 1999 q. 12
(16)The following are present in the developing umbilical cord:
Allantois
Extra-embryonic mesoderm
Intestinal loops
Two umbilical arteries
Yolk sac stalk

TTTTT

The connecting stalk is made of extra-embryonic mesoderm and the

allantois starts to enter at about 16 days. The midgut loop protrudes
into the umbilical cord between the 6th and 10th weeks. The cord
contains two umbilical arteries and one umbilical vein. The yolk stalk
connects the yolk sac and midgut also called the vitelline duct. It
usually detaches at 6 weeks and in 2% of adults remains as the Meckels
diverticulum.

March 1999 q. 13
(17)During development of the female reproductive system:
Primordial germ cells arise in the yolk sac
Ovarian development is dependent upon oestrogen activity
The paramesonephric ducts give rise to the cervix
The greater vestibular glands arise from the urogenital sinus
Differentiation of the external genitalia is dependent upon ovarian
activity

TFTTF

Primordial germ cells are visible in the fourth week among the
endodermal cells of the yolk sac. Development of the male phenotype
from indifferent gonads requires the SRY gene on the Y chromosome to
code for TDF. The absence of the Y chromosome results in the
development of the ovary. Primary female sexual differentiation is not
hormone dependent and occurs in the absence of ovaries. Feminisation
of the external genitalia appears to involve oestrogens from the
placenta and fetal ovary. The paramesonephric ducts form the
uterovaginal primordium. The greater vestibular glands form from the
urogenital sinus.
March 1999 q. 15
(18)In a neonate at birth:
Closure of the ductus arteriosus is due to increased arterial
oxygen tension
The ductus arteriosus closes before the lungs are expanded
Pressure in the IVC falls
The foramen ovale seals immediately
Closure of the foramen ovale is due to increased carbon dioxide
tension in venous blood

TFTFF

Cord clamping causes a reduction in venous return to the right heart.

The pressure in the RA drops and the FA closes. As the first breath is
taken pulmonary arteriolar vasodilatation occurs so the pulmonary
circulation pressure falls so more RV output is directed into the
pulmonary circulation. The DA closes chiefly in response to the
increased arterial oxygen concentration, which stimulates bradykinin,
prostaglandin E2 and prostacyclin. The FA and DA close functionally
soon after birth.

September 1999 q. 13
(19)After birth:
The allantois forms the median umbilical ligament
The umbilical vein forms the medial umbilical ligament
The umbilical artery forms the superior vesicular artery
The ductus venosus forms the ligamentum teres
The ductus arteriosus forms the arch of the aorta

TFTFF

The umbilical vein becomes the ligamentum teres and the ductus
venosus becomes the ligamentum venosum. Intra-abdominally the
umbilical artery forms the medial umbilical arteries, and proximally it
persists as the superior vesicular artery. The ductus arteriosus forms
the ligamentum arteriosum.

September 1999 q. 14
(20)The normal neonate delivered at term has:
A head circumference between 40cm and 50cm
A liver palpable on abdominal examination
A blood glucose concentration above 1.66 mmol/l (30g/dl)
Brown adipose tissue
No adult haemoglobin

FTTTF

The average head circumference is 36cm. 40-50cm indicates

hydrocephalus. Blood glucose above 2.5 mmol/l is considered normal.
The liver is usually palpable 2cm below the costal margin. At term cord
blood contains 50-80% HbF and 15-40% HbA.

March 2000 q. 14
(21)Concerning gonadal development:
The histological appearance of the primitive gonad is similar in
both sexes until 42 days after fertilisation
The ovary develops in the medulla of the primitive gonad
The histo-differentiation of the testis begins later than that of the
ovary
Primary sex cells (gonocytes) have a haploid number of
chromosomes
Mitosis in oogonia is not completed by the end of the first year of
life

TFFTF

Before the 7th week the gonads and identical and indifferent. Primary
sex cords form in the medulla of the primitive gonads, then degenerate
and disappear. The secondary sex cords (cortical cords) extend from
the surface epithelium into the underlying mesenchyme. The ovary is
not identifiable histological until the 10th week, whereas the testes are
secreting androgens by the 8th week. Gametes are haploid, containing
23 chromosomes. Oogonia have completed prophase I at the time of
birth and remain in prophase I until puberty. Shortly after ovulation the
primary oocyte completes the first meiotic division. At ovulation the
secondary oocyte reaches metaphase II where it is arrested until
fertilisation.

March 2000 q. 15
(22)Trophoblast:
Develops from the blastocyst
Gives rise to the fetal blood vessels in the placenta
Enters the maternal circulation during normal pregnancy
Replaces endothelium of pregnant spiral arterioles
Is genetically identical to decidua

TTFTF

The trophoblast gives rise to the embryonic part of the placenta. The
outer cell layer of the blastocyst proliferates to form the primary
trophoblastic cell mass from which cells infiltrate between those of the
endometrial epithelium. These then degenerate so the trophoblast
comes into direct contact with the endometrial stroma complete by
the 10th or 11th post-ovulatory day. Cytotrophoblastic cells grow into the
spiral arteries and destroy the media and replace the endothelium.
Decidual cells are endometrial, therefore maternal, in origin and are
known as decidual cells following the accumulation of glycogen and
lipid in their cytoplasm.
September 2000 q. 13
(23)Following fertilisation in humans:
The first polar body is formed
The first cleavage division occurs within 12 hours
The zona pellucida is shed at the second cleavage division
Cleavage divisions are mitotic
The mean cell volume decreases with each cleavage division

FFFTT

The first polar body is formed at about the time of ovulation, while the
second polar body is formed following fertilisation. The first cell
division occurs within 30 hours of fertilisation. During the pre-
implantation period there is no growth and successive daughter cells
become progressively smaller. Cleavage consists of repeated mitotic
divisions of the zygote. The zona pellucida degenerates and disappears
after the blastocyst has floated in uterine secretions for about 2 days
this allows the blastocyst to increase in size.

September 2001 q. 14
(24)Concerning embryological development:
The amnion has an endodermal origin
Uterine epithelium is developed from the paramesonephric ducts
The ducts of Bartholins glands open above the hymen
The round ligament of the uterus is derived from the
gubernaculum
The adrenal cortex is derived from neural crest cells

FFFTF

The amnion is not part of the embryo, although epiblast cells of the
bilaminar embryonic disc give rise to the ectoderm of the amnion, the
embryonic ectoderm and the primitive streak. The paramesonephric
ducts give rise to the tubes, uterus and superior part of the vagina. The
endometrial stroma and myometrium and derived from adjacent
splanchnic mesenchyme. The hymen separates the lumen of the vagina
from the urogenital sinus. The ducts of the Bartholins glands open into
the posterolateral part of the vestibule, just below the hymen. The
adrenal cortex develops from mesoderm, while the adrenal medulla
develops from neural crest cells.

Dr .Dolieb Hassan
With Best Wishes