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Medicine MBBS year 2 > Development and Ageing > Flashcards

Development and Ageing Flashcards

1
Q

state 3 types of prenatal stresses that are associated with increased risk of changes to cognitive development and behaviour in the child?

A 
Anxiety and depression 
Maternal daily hassles 
Pregnancy specific anxiety 
Domestic abuse 
Distress caused by war
Acute disasters eg. hurricane
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2
Q

State 3 different effects on the child of prenatal stress.

A
  • Anxiety and depression
  • ADHD, conduct disorder and other behavioural problems
  • Impaired cognitive disorder
  • Schizophrenia
  • Victimisation in childhood
  • Autism spectrum
  • Personality disorder
  • Preterm delivery
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3
Q

What is the effect of 11-βHSD2 release in mother?

A

Breaks down cortisol in placenta and allows more cortisol to pass to fetus

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4
Q

What patterns are observed in children with increased in utero cortisol?

A

fMRI studies show: Reduced attention, Increased anxiety

BSID2 - Lower cognitive function

Sensitive early mothering can reverse effects of high in utero cortisol

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5
Q

State 2 other MRI studies and the changes shown for children with increased prenatal stress

A
  • Structural MRI: Thinner cortex ( associated with depression and cognitive problems), Enlarged amygdyla ( associated with increased anxiety)
  • Diffusion MRI: Alterations in uncinate fasciculus which connects amygdyla with frontal cortex ( associated with mood disorders and antisocial behaviour)
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6
Q

what is the effect of breastfeeding on child development?

A
  • Exclusive breastfeeding at one month improves, IQ ( 3 points) and hyperactivity at 8 years
  • but not emotional problems and conduct disorder after allowing for confounders
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7
Q

How is preeclampsia diagnosed?

A

New onset hypertension (>140/90) + proteinuria or end organ dysfunction (order LFTS and kidney function tests) after 20th week of pregnancy

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8
Q

what are the symptoms and signs of preeclampsia?

A
  • Reduced fetal movement and or amniotic fluid volume (by ultrasound)
  • Oedema common but not discriminatory for PE
  • Headache, abdominal pain
  • visual disturbances, seizures and breathlessness associated with severe PE
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9
Q

What are the different forms of preeclampsia? distinguish between them

A

Early onset <34 weeks -> fetal and maternal symptoms, changes in placental structure

Late onset > 34 weeks -> more common, mostly maternal symptoms, no placental changes, less fetal risk

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10
Q

What maternal risk factors may predispose to developing PE?

A
  • Pre-existing hypertension/gestational, diabetes, CKD, autoimmune disorders, age >40, race, BMI >30, PCOS, subfertility,
  • family history, previous pregnancy with pre-eclampsia
  • multiple pregnancy, first pregnancy, new paternity
  • IVF
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11
Q

What are the risks of PE to the fetus and the mother during pregnancy?

A
  • Placental abruption
  • coagulopathy, renal failure, pulmonary oedema, uteroplacental insufficiency
  • May lead to Eclampsia (PE + seizures), HELLP Syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets).
  • Fetal growth restriction, preterm birth, still birth
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12
Q

What structural/developmental changes in the placenta are believed to underpin pre-eclampsia?

A

Abnormal placenta spiral arteries/reduced conversion -> endothelial dysfunction, vasoconstriction and ischemia

EVT invasion of maternal spiral arteries is limited to decidual layer -> restricted placental perfusion

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13
Q

How might soluble Flt1 (aka soluble VEGF1R) and PLGF contribute to the maternal symptoms of pre-eclampsia?

A

Increased levels of placental Flt1 trap circulating vascular endothelial growth factor (VEGF), placental growth factor (PLGF) and transforming growth factor β (TGFβ) decreasing their free levels, leading to endothelial dysfunction by preventing their interaction with endothelial cell surface receptors.

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14
Q

describe tests carried out to predict the likelihood of Pre-eclampsia

A

PLGF <100 pg/ml is abnormal. Increased risk of preterm delivery.

PLGF >100 pg/ml is normal. Unlikely to progress to delivery within 14 days of the test.

sFlt-1/PLGF ratio > 38 = increased risk of preeclampsia

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15
Q

What management options are available for women who develop PE during pregnancy?

A
  • Antihypertensives
  • IV magnesium sulfate to prevent seizures.
  • Immediate delivery - eclampsia, HELLP syndrome

<34 weeks -> try and maintain pregnancy. Give corticosteroids to promote fetal lung development before delivery

> 37 weeks -> delivery preferable

In between 34-37 -> case by case

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16
Q

Are there preventative measures that can be taken to avoid PE developing?

A

Weight loss

Exercise throughout pregnancy

Low-dose aspirin from 11-14 weeks for high risk groups

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17
Q

Are there any ongoing risks to the mother after pregnancy with preeclampsia?

A

Elevated risk of cardiovascular disease, T2DM, renal disease.
Recurrence of PE in next pregnancy

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18
Q

Describe 3 ways in which humans adapt

A

Homeostasis
Developmental plasticity - changes in neural connections
Selection

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19
Q

What is the Barker hypothesis?

A

The seeds of most diseases are sown during organogenesis and periods of rapid cell division

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20
Q

Give 2 examples of challenges that a fetus may face in utero that may affect long term health

A 
Infection 
Maternal malnutrition 
Maternal illness 
Maternal medication 
Environmental factors
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21
Q

State some adult diseases that are affected by foetal programming

A

Allergic and auto-immune diseases
Cancer
Lung disease
Diabetes type 2

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22
Q

give examples screening tests during or after pregnancy as part of the NHS screening programme

A

diagram in notes

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23
Q

How is COPD diagnosed?

A

FEV1/FVC ratio <70%

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24
Q

State some factors that affect FEV in children

A

More rapid FEV decline - born in winter, smoking mothers

Less rapid FEV decline - day-care attendance, pets

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25
Q

learn common genogram symbols

A

picture in notes

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26
Q

State 3 ways of measuring embryo-fetal development

A

Fertilization age

Gestational age

Carnegie Stage - uses 23 stages of embryo development based on embryo features. Covers 0-60 days fertilization

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27
Q

How do you calculate gestational age?

A

From the start of last menstrual cycle

It is fertilization age + 14

Can take early obstetric ultrasound and compare embryo size to charts

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28
Q

What are the stages in embryo-fetal development (starting with the earliest)?

A

Embryogenic
Embryonic
Fetal

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29
Q

What happens during the embryogenic stage?

A

Pluripotent embryonic cells form - contribute to fetus

Extraembryonic cells form - contribute to placenta

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30
Q

What happens during the embryonic stage?

A

Establishment of germ layers and differentiation of tissue types.

Establishment of body plan

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31
Q

What happens during the fetal stage?

A

Major organs systems now present
Organ systems can migrate
Growth and acquisition of fetal viability

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32
Q

What makes up the 1st trimester?

A

Embryogenic and embryonic stages

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33
Q

What makes up the 2nd and 3rd trimesters?

A

fetal stage

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34
Q

Describe the stages in blastocyst formation from an oocyte

A

Oocyte -> zygote -> cleavage stage embryos (2-8 cells) -> Morula 16+ cells and compaction of morula -> Blastocyst

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35
Q

What happens during the maternal-to-zygotic transition (4-8 cell stage)

A

Transcription of embryonic genes (zygotic genome activation)

Increased protein synthesis

Organelle (mitochondria, Golgi) maturation

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36
Q

What happens during compaction?

A

Outer cells become pressed against zona

Change from spherical to wedge-shaped.

Outer cells connect to each other through tight gap junctions and desmosomes

Forms barrier to diffusion between inner and outer embryo

Outer cells become polarised

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37
Q

what is the main goal of compaction?

A

start the formation of 1st two cell types:

  • inner cell mass - gives rise to pluripotent embryonic cells
  • trophectoderm - gives rise to extraembryonic cells
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38
Q

The first 2 distinct cell types that can be recognised in the developing embryo are?

A

inner cell mass and trophectoderm

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39
Q

The fluid filled cavity in the blastocyst is called the ___. It forms because the trophoblast pumps __ into cavity

A

blastocoel

Na+

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40
Q

___ is the escape of the blastocyst from the zona pellucida. It as achieved through the use of ___ ____ and ___ ____.

A

Hatching
Enzymatic digestion
Cellular contraction

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41
Q

What separation takes place during peri-implantation?

A
  • Trophoectoderm lineage separates to form syncytiotrophoblast and cytotrophoblast
  • Inner cell mass separates into epiblast and and hypoblast
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42
Q

During peri-implantation, ___Invades and destroys maternal cells in the endometrium. It also creates an interface between embryo and maternal blood supply.

A

Syncytiotrophoblast

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43
Q

___ divides to form syncytiotrophoblasts.

A

Cytotrophoblast

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44
Q

During peri-implantation, the fetal tissues are derived from ___

A

epiblast

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45
Q

During peri-implantation __ forms the yolk sac - an extraembryonic structure.

A

hypoblast

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46
Q

What happens during bilaminar embryonic disc formation? (day 12+)

A

Epiblast cells become separated in two by the formation of a new cavity – the amniotic cavity.

The cells above the amniotic cavity - amnion cells will contribute to the extra-embryonic membranes.

This leaves a two-layer disc of epiblast and hypoblast, sandwiched between cavities.

Embryo is now ready for gastrulation

Syncytiotrophoblast starts secreting hCG

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47
Q

What subunit in hCG in blood/urine is detected during pregnancy?

A

beta

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48
Q

What is gastrulation?

A

The process whereby the bilaminar embryonic disc undergoes reorganization to form a trilaminar disc. Three primary germ layers form.

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49
Q

How do the 3 germ layers form in gastrulation?

A

Primitive streak forms in epiblast -> primitive groove -> invagination of cells into primitive streak -> hypoblast cells replaced by definitive endoderm -> remaining cells of epiblast now called ectoderm (exterior layer) -> some of the invaginated epiblast cells remain in space between ectoderm and endoderm and form mesoderm

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50
Q

What defines the head-tail and left-right axes of an embryo?

A

Primitive streak formation

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51
Q

draw a diagram showing the separation of embryonic cell lineages from morula all the way to 3 germ layers

A

(refer to notes for answer)

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52
Q

what structures does the ectoderm give rise to?

A

external body systems + nervous system

  • CNS and neural crest
  • Skin epithelia (epidermis)
  • tooth enamel
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53
Q

what structures does the mesoderm give rise to?

A

Things between digestive system and skin:

  • circulatory system - blood
  • MSK - muscle, bone, cartilage, connective issue
  • dermis

And also gonads, kidneys and adrenal cortex.

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54
Q

what structures give rise to the endoderm?

A

Digestive system + systems budding off:

  • Gi tract
  • Liver, pancreas
  • lungs
  • thyroid
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55
Q

what is a notochord?

A

A tube structure elongating from primitive streak. It forms along the embryo midline, under the ectoderm.

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56
Q

function of notochord?

A

Organizing centre for neurulation and mesoderm development

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57
Q

How does the notochord direct neurulation?

A

Uses signals to direct neural plate (thickened ectoderm) to form neural tube

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58
Q

How specifically does the neural tube form?

A

Notochord sends signals directing neural plate to invaginate forming neural groove. Two ridges are created on the sides (neural folds)

Neural folds contain neural crest cells

Neural folds migrate and fuse over neural groove -> neural tube

59
Q

In order for brain structures to develop, __ of neural tube at head end must occur

A

closure

60
Q

State 2 developmental defects resulting from neural tube closure

A

Anencephaly - failure to close at head end

Spina bifida - usually lower spine due to failure to close tail end

61
Q

State 4 different types of neural crest cells

A

Cranial NC
Cardiac NC
Trunk NC
Vagal & Sacral NC

62
Q

State 3 types of defects of neural crest migration/specification

A

Pigmentation disorders
Deafness
Cardiac and facial defects
Failure to innervate gut

63
Q

what is somitogenesis?

A

Paired Blocks of MESODERM condense and bud off and subsequently differentiate into sclerotome and dermomyotome

Form form head -> tail

64
Q

What 2 types of embryonic tissue do somites give rise to?

A
  1. Sclerotome - form vertebrae and rib cartilage
  2. Dermomyotome which divides into:
    - Dermatome - gives dermis of skin, some fat and connective tissues to neck and trunk
    - Myotome
65
Q

How does the gut tube form?

A

Ventral and lateral folding -> pinches off part of the yolk sac

66
Q

The gonads form from ___ as bipotential. In XY embryos, the presence of SRY gene on Y chromosome directs gonadal cells to become ___ cells.

A

Mesoderm

Sertoli

67
Q

using arrows, draw out the sequence of events from fertilisation to week 8

A

Fertilization -> morula -> blastocyst (blastocyst sticks at day SIX) -> bilaminar disc (epiblast & hypoblast) in week 2 -> primitive streak-> gastrulation (3 layers forming in week 3 -> germ layers -> neural tube forms and closes by week 4. organogenesis

68
Q

What fraction of fertilised eggs are estimated to spontaneously miscarry in the early stages of pregnancy? What proportion of pregnancies are lost after a pregnancy has been biochemically confirmed?

A

~40% before implantation/pregnancy detection

Loss after clinically determined pregnancy 10%

Total loss between fertilization and birth between 46%-90%

69
Q

What is likely to be the major contributor to pregnancy loss before 12 weeks’ gestation?

A

Chromosomal errors in embryo/aneuploidy

70
Q

How does maternal age affect the chance of miscarriage? what are the molecular mechanisms that underpin this?

A

loss of cohesin proteins holding homologous chromsomes in oocytes together with increasing age

71
Q

What are recurrent miscarriage and recurrent implantation failure and what is the key difference between them?

What potential common/overlapping causes would you explore in the first instance for patients experiencing these conditions?

A

Recurrent miscarriage = loss of three or more consecutive pregnancies by natural pregnancies

Recurrent implantation failure = women have had 3 failed IVF attempts with good quality embryos

Overlapping causes - uterine anatomical defects (fibroids/polyps), paternal DNA sperm integrity/fragmentation,
auto-immune antibodies (anti-nuclear, anti-phospholipid antibodies)

72
Q

what signalling pathway(s) might underpin recurrent miscarriage or RIF?

A

Reduced LIF (Leukemia inhibitory factor) in the uterine secretions of subfertile women.

LIF promotes decidualization of human endometrial stromal cells in culture

LIF promotes adhesion of blastocyst to endometrial cells

73
Q

What is endometrial scratching and how might it help a patient experiencing RIF?

A

Use of pipette or hysteroscope to damage endometrial mucosa before embryo transfer in IVF

It may stimulate immune cell infiltration and wound healing cytokine production - unsure if it works

74
Q

Histologically, how is the fallopian tube adapted to support transit of the fertilised embryo to the uterus?

A

Smooth muscle - contractions drive embryo along the fallopian tube

Epithelium coated in cilia(microvilli) to promote fluid movement

75
Q

why might cigarette smoking increases the risk of ectopic pregnancy?

A

Continine - a component of cigarette smoke regulates expression of PROKR1 (a regulator of fallopian tube smooth muscle contraction)

Continine also increases expression of pro-apoptotic proteins in fallopian tube explants

Tobacco smoke also likely to inhibit ciliary function - reducing transit of embryo through tube

76
Q

Cannabis use is also believed to elevate the risk of ectopic pregnancy. what is the described mechanism?

A

Fallopian tube expresses CB1 and CB2 cannabinoid receptors

CB1 reduced in ectopic pregnancy patients and CB1 KO in mice causes embryo retention in the fallopian tubes

Levels of endocannabinoids elevated in ectopic pregnancy fallopian tubes

Components such as THC in cannabis may act directly on the fallopian tube to perturb transit, or alter the balance of endocannabinoids in the tube leading to a disrupted embryo environment.

77
Q

Early embryo nutrition is ___. There is a switch to _ support at the start of the 2nd trimester.

A

Histiotrophic (breakdown of endometrial tissues by syncytiotrophoblast, breakdown of maternal capillaries, uterine gland secretions)

Haemotrophic

78
Q

Humans have what type of placenta?

A

Haemochorial-type

79
Q

When the fetal membranes are created, what other structures then develop?

A

connecting stalk, trophoblastic lacunae(maternal blood will flow through)

80
Q

The amnion is the _ fetal membrane and arises from the _

A

Inner

Epiblast

81
Q

The chorion is the ___ fetal membrane. It is derived from the __ __ and ___. Unlike the amnion it is highly ___. It gives rise to __ ___ which are outgrowths of cytotrophoblast that form the basis of the fetal side of the placenta.

A 
Outer 
Yolk sac 
Trophoblast 
Vascularised 
Chorionic villi
82
Q

What forms the amniotic sac?

A

Fusion of amnion and chorion due to accumulation of amniotic fluid

83
Q

Like the chorion, the ___ is another fetal membrane derived from yolk sac. It grows along the connecting stalk and forms the __ ___.

A

Allantois

Umbilical cord

84
Q

What are the 3 phases of chorionic villi development?

A

Primary - outgrowth of cytotrophoblasts from chorion to form finger-like projections

Secondary - mesoderm cells invade into the cytotrophoblasts /primary villi

Tertiary - Growth of blood vessels from umbilical artery and vein into villus to provide blood supply

85
Q

What slows blood flow enabling exchange between maternal and fetal blood?

A

Convoluted knot of vessels and vessel dilation in chorionic villi

86
Q

What coats the vessels in chorionic villi?

A

Trophoblast

87
Q

Describe the maternal blood supply to the endometrium and its branches

A

Ovarian artery-> uterine artery -> arcuate artery -> radial artery -> basal artery -> spiral artery

88
Q

When do maternal spiral arteries form?

A

During menstrual cycle and endometrial thickening

89
Q

How does the endovascular EVT form? What is the process called?

A

EVT cells coating the villi invade into maternal spiral arteries

Conversion - from high pressure spiral arteries to low pressure arteries with increased capacity

90
Q

How do amino acids reach the fetus?

A

Reduced excretion of maternal urea and active transport of amino acids to fetus

91
Q

State 2 differences in circulatory system of fetus vs adult

A

Placenta acts as a site of gas exchange for fetus not lungs

Ventricles act in parallel rather than series (vascular shunts bypass pulmonary & hepatic circulation-> close at birth)

92
Q

what is the meconium?

A

First stool - formed from debris (from swallowed amniotic fluid) and bile acids

93
Q

What coordinates organ maturation in the fetus?

A

Fetal cortico-steroids

94
Q

Give two pieces of evidence to show that pregnancy is a pro-inflammatory reaction

A

Immune cell infiltration

Cytokine and prostaglandin secretion

95
Q

State and describe the different phases of labour

A

Phase 1 - quiescence - cervical softening

Phase 2 - activation - uterine prepared for labour, cervical ripening

Phase 3 - stimulation - uterine contraction, cervical dilation, fetal and placenta expulsion

Phase 4 - involution - uterine involution, cervical repair, breastfeeding

96
Q

During phase 3, what are the 3 stages of labour?

A

Stage 1 - contraction starts, cervix dilation (latent and active phase)

Stage 2 - delivery of fetus

Stage 3 - delivery of the placenta

97
Q

What enables the cervix to retain the fetus in the uterus?

A

High connective tissue content -> Bundles of collagen fibres embedded in proteo-glycan matrix

98
Q

Cervical __ is marked by monocyte infiltration

A

ripening

99
Q

Cervical dilation is marked by increased __ expression and ___

A

Hyaluronidase

MMPs

100
Q

How might the fetus determine the timing of/ cause labour?

A
  1. Increase in CRH production by fetus and decline in CRH binding protein levels
  2. Promotes fetal ACTH and cortisol release
  3. Increasing cortisol drives placental production of CRH (+ve)
  4. CRH also stimulates DHEAS production by the fetal adrenal cortex -> estrogen production by placenta -> induces oxytocin receptor expression and oxytocin production -> oxytocin stimulates contractions and stimulates placenta to make PGs -> vigorous contractions
101
Q

High __ level through pregnancy maintains uterine relaxation by inhibiting OXTR expression

A

progesterone

102
Q

Which progesterone receptors are more present during labour?

A

PR-B and PR-C (repressive) isoforms -> functional progesterone withdrawal

103
Q

Estrogen receptors alpha expression __ during pregnancy

A

rises

104
Q

What 2 things prompt oxytocin production?

A

Estrogen

Stretch receptors in cervix signal to hypothalamus, pituitary oxytocin release -> ferguson reflex

105
Q

What inhibits OXTR expression pre-labour? What increases expression?

A 
Decreases = progesterone 
Increases = estrogen
106
Q

State 3 functions of oxytocin

A

Increases connectivity of myocytes in myometrium

Destabilizes membrane potentials to lower threshold for contraction

Enhances liberation of intracellular Ca2+ stores

107
Q

Describe 2 ways in which rising estrogen drives prostaglandin action

A

Rising estrogen activates phospholipase A2 enzyme, generating more arachidonic acid for PG synthesis

Estrogen stimulation of oxytocin receptor expression promotes PG release

108
Q

What is the role of PGE2?

A

Cervix remodelling: promotes leukocyte infiltration

109
Q

What is the role of PGF2alpha?

A

Myometrial contractions: destabilises membrane potentials and promotes connectivity of myocytes

110
Q

What is the role of PGI2?

A

Myometrium: promotes myometrium SMC relaxation and relaxation of lower uterine segment

111
Q

Other than PGS, what other molecules may be implicated in cervix remodelling?

A

Relaxin

NO

112
Q

State ways in which PG inhibition can prevent pre-term labor

A

Inhibits leukocyte recruitment
Inhibit interleukin release
Inhibit membrane destabilization

Inhibit myocyte connectivity
Inhibit uterine lower segment relaxation

113
Q

Which part of myometrium do contractions start? What are the gap junctions that muscle cells form called?

A

Fundus, spread down

Syncytium

114
Q

Muscle contractions in labour are __ this causes the lower segment to be pulled up forming birth canal

A

brachystatic

115
Q

What 3 factors bring about placental expulsion?

A

Uterine shrinkage - fetal membranes fold off, area of contact of placenta with endometrium decreases

Clamping of umbilical cord after birth

Contractions

116
Q

what are the WHO guidelines for breastfeeding?

A

6 months exclusively

Up to 2 years and beyond

117
Q

What is the full duration of breastfeeding per child?

A

between 4 and 7 years

118
Q

what are the positive impacts of breastfeeding?

A

Reduced risk Postnatal depression
Reduced risk ovarian and endometrial cancer
Reduced risk of breast cancer

119
Q

How often do babies feed?

A

8-12 times per 24 hours

120
Q

What are the key barriers to breastfeeding and how can these be overcome?

A

attitudes/cultural norms
Physical discomfort and inconvenience
Readily available formula

121
Q

where can doctors be signposted for breastfeeding support?

A

UNICEF the baby friendly initiative

Hospital infant feeding network

122
Q

functions of pre-frontal cortex?

A

Executive function and concentration

Can be impaired in ADHD

123
Q

state and describe the 4 key domains of child neurodevelopment

A

Gross motor skills - position, head lag, sitting, walking, running

Fine motor skills - use of hands, grasp and fine pincer, bricks, crayon, puzzles

Speech and language skills - vocalization, words, understanding, imaginative play

Social skills - interaction, stranger reaction, eating skills, dressing

124
Q

When an infant is unable to raise its head to 45 degrees when prone by 2 years limit, what are some signs of cerebral palsy?

A

Unable to lift head or push up on arms

Stiff extended legs

Pushing back with head

Constantly fisted hand and stiff leg on one side

125
Q

When an infant is unable to sit properly by the 6 years limit, what are some signs of cerebral palsy?

A

Unable to left head when sitting up, floppy trunk, stiff arms, extended legs

Arms flexed and held back, stiff crossed legs

126
Q

what does the Healthy Child Program in the UK include?

Name some commonly used assessment tools for child development

A

Screening

Examination and immunisation

Health education/promotion

  • Bailey developmental scale
127
Q

causes of developmental impairments in a child?

A

Prenatal - iron, folate deficiency

Perinatal - delivery/oxygen deprivation

Postnatal - trauma, meningitis

128
Q

Factors influencing developmental delay?

A

sensory/motor impairments

Ill health

Lack of physical/psychological stimuli

Reduced inherent potential

129
Q

causes of global developmental delay?

A

Chromosomal abnormalities - downs syndrome, fragile X

Chronic illness

Metabolic - hypothyroidism

Antenatal and perinatal factors - infections, drugs, toxins, trauma, folate def, anoxia

Environmental-social issues

130
Q

Causes of motor delay in a child?

A

Cerebral palsy
DMD

Hydrocephalus
Neural tube defects
Congenital dislocation of hip

Global delay e.g. Downs syndrome

Social deprivation

131
Q

causes of language delay in a child?

A

Hearing loss
Stammer

Learning disability
Autism spectrum disorder

Impaired comprehension of language - developmental dysphasia

Lack of stimulation

132
Q

state the 3 primary vesicles in the developing brain (3-4 weeks)

A

Forebrain - prosencephalon
Midbrain - Mesencephalon
Hindbrain -rhombencephalon

133
Q

What are the 3 flexures in the embryo at 4 weeks?

A

Cephalic flexure
Pontine flexure
Cervical flexure

134
Q

Describe the 5 secondary vesicles of the brain at 5 weeks and how they arise

A

Forebrain -> telencephalon and diencephalon(give rise to cerebral hemispheres)

Midbrain -> Midbrain (cerebral aqueduct also later develops)

Hindbrain -> metencephalon (gives rise to pons and cerebellum) and myelencephalon(gives rise to medulla)

135
Q

Positive impacts of breastfeeding on baby

A

Brain development
Metabolic programming
Antiviral functions of human milk - contains cytokines, vitamin A, etc
Variance in gut microbiome

136
Q

__ feeding involves a mother responding to her babies cues about when he/she wants to be fed. What is it associated with?

A

Responsive feeding
Higher prolactin, longer duration of breastfeeding, fewer breastfeeding difficulties, increased milk supply, lower risk of being overweight, satiety responsiveness

137
Q

Factors that decrease supply of milk to baby?

A

Using a dummy
Supplementing with formula
Sleep training, trying to follow a routine, separating mother and baby

138
Q

At the physiological level, what developmental changes are thought to occur to the fetus during its development in response to these challenges that may predispose to health issues in later life?

A

Altered endocrinology/metabolism
Changes in foetal bone, lean and fat mass
Altered blood flow/vascular loading
Altered immune responses

139
Q

What inactivates catecholamines and has gene variants associated with ADHD and working memory?

A

COMT

140
Q

What are some evolutionary benefits of changes caused by prenatal stress?

A

impulsive - more willing to explore new environments
- conduct disorder- more willing to break rules
autism spectrum - understand things in different ways

141
Q

Define decidualisation

What interleukin is involved?

A

Endometrial changes due to high PROGESTERONE.

IL-11

141
Q

What links developing embryo to the chorion?

A

Connecting stalk

Allantois grows along the connecting stalk and becomes the umbilical cord

141
Q

What are trophoblastic lacunae?

A

Large spaces filled with maternal blood formed from breakdown marker all capillaries

Medicine MBBS year 2 (11 decks)

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