HIGH YIELD EMBRYOLOGY

General Embryology
Hydatidiform mole
Complete: no embryo, only trophoblast; abnormally high hCG; diploid,
only paternal chromosomes
Incomplete: partial embryo; high hCG; triploid with two sets of paternal
chromosomes
Choriocarcinoma: malignancy arising from invasive hydatidiform mole
Sacrococcygeal teratoma: most common tumor in newborns; arises from
persistent primitive streak and contains tissues from all three germ layers
Hemolytic Disease of the Newborn (HDN) or Erythroblastosis fetalis: mother
is Rh- and fetus is Rh+; mother produces antibody that results in hemolysis of
fetal red cells. Giving mother Rh immunoglobulin prevents HDN.
Head and Neck
Branchial apparatus
Branchial clefts (grooves): four pairs; ectoderm that forms only epithelium
1st:
external acoustic meatus
2nd - 4th:
usually regress but may unite to form cervical sinus that may
form a branchial fistula
Branchial pouches: four pairs; endoderm that forms only epithelium
1st:
auditory tube, mastoid antrum and tympanic cavity
2nd:
palatine tonsil
rd
3 :
thymus and inferior parathyroid
4th:
superior parathyroid and C cells of thyroid
Branchial arches: five pairs; mesoderm that forms only skeletal muscle; neural
crest grows into each arch to give rise to all connective tissue elements
(cartilage, bone and blood vessels)
ARCH

NERVE

First

CN V3

Second

CN VII

Third
Fourth

CN IX
CN X: pharyngeal branch
superior laryngeal nerve
CN X: recurrent laryngeal
nerve

Sixth

MUSCLES
Muscles of mastication, anterior belly of digastric,
mylohyoid, tensor tympani, tensor veli palatini
Muscles of facial expression, stapedius, posterior
belly of digastric, stylohyoid
Stylopharyngeus
Muscles of palate except tensor veli palatini,
pharyngeal muscles, cricothyroid
Muscles of larynx except cricothyroid, inferior
pharyngeal constrictor, cricopharyngeus, superior
portion of esophagus

Arteries of branchial arches:

Fourth left: small part of arch of aorta
Fourth right: part one of subclavian artery
Sixth left:
ductus arteriosus, portion of pulmonary artery
Sixth right: portion of pulmonary artery
Cartilages of branchial arches:
First (Meckels):
malleus, incus
Second (Reicherts):
stapes, styloid process, lesser horn and
superior portion of body of hyoid
Third:
greater horn and inferior portion of body of
hyoid
Thyroglossal duct cyst: located along the course that the thyroid migrated
from the tongue to the neck
Congenital torticollis: shortening of the sternocleidomastoid causing the chin to
elevate to contralateral side; result of problems with birth (tearing or stretching of
muscle)
Cleft lip and cleft palate a favorite COMLEX question
General comments: although they often occur in association with each other,
they are distinct; they are the result of very different processes and they occur at
different times. Neural crest is involved with both.
Cleft lip: failure of maxillary prominence to join paired (fused) medial nasal
prominence (to form intermaxillary segment)
Cleft palate: (1) Anterior (to incisive foramen): lateral palatine process (palatine
shelf) fails to meet and fuse with primary palate; (2) Posterior (to incisive
foramen): lateral palatine process does not meet or fuse with opposite side or
with nasal septum; (3) Complete cleft: involves both primary and secondary
palates
Gastrointestinal
Omphalocele: intestines do not return to abdominal cavity following their normal
herniation; covered by amniotic sac. It may contain the liver as well as the
intestinal tract. It is different from an umbilical hernia, which is covered by skin
and connective tissue (rather than peritoneum and amnion).
Congenital pyloric stenosis: projectile vomiting is key feature; usually occurs
during weeks 2 4. It occurs most commonly in first-born males (1:150)
Hirschsprungs disease (aganglionic megacolon): Neural crest defect
whereby cells fail to migrate into a portion of the hindgut resulting in a segment of
bowel, which is noncontractile

Imperforate anus: anal membrane is thickened (from excessive growth of the

genital fold) and does not perforate; more common in males than in females.
When present, it is associated with intestinal atresia
Meckels diverticulum: outpocketing of distal ileum; portion of bowel that was
continuous with the vitelline stalk and yolk sac. This portion of the ileum is the
central portion for the preaxial and postaxial limbs of intestinal rotation (axis of
rotation is superior mesenteric artery). Present on the antimesenteric wall
(opposite the mesentery) about two feet from the ileocecal junction in an adult.
Diverticulum may present as a cyst, ligament, fistula or simple outpocketing; it
often contains gastric tissue or pancreatic tissue
Rule of 2s: May be involved in case studies on COMLEX:
2% of population
Discovered by age of 2 yrs.
Located approx. 2 ft. from ileocecal junction
2 in length
Contains 2 types of ectopic tissue (as stated above)
Cardiovascular
Tetralogy of Fallot: classic four (tetra) associated problems include the
following: (1) ventricular septal defect, (2) over-riding aorta (dextroposition of
aorta), (3) pulmonary stenosis, and (4) right ventricular hypertrophy
Undivided truncus arteriosus (persistent truncus arteriosus): neural crest
defect whereby bulbar ridges fail to form
Patent ductus arteriosus (PDA): common defect; associated with Rubella virus
(German measles) and mother living in high altitudes during her pregnancy;
frequency in females is 2 3 X that in males; often seen with other heart defects
Atrial septal defect (ASD): very common; may involve first and/or second septa
Ventricular septal defect (VSD): very common; invariably involves membranous
portion of septum (rather than muscular part)
Transposition of great arteries: most common cause of cyanosis in newborn;
often seen with ASD and/or VSD
Coarctation of aorta: most commonly (90%) constriction is juxtaductal (opposite
ductus arteriosus); more common in males (2X) and often associated with
bicuspid aortic valve
Retroesophageal right subclavian artery: fairly common; forms vascular ring
around trachea and esophagus, but usually no problem clinically; forms as
variation involving right seventh intersegmental artery

Nervous system
Early development: notochord induces formation of neural plate that gives rise to
neural tube and neural crest
Notochord persists as nucleus pulposus of intervertebral disc
Neural crest gives rise to all ganglia (sensory, sympathetic, parasympathetic),
Schwann cells, arachnoid and pia, pigment cells (melanocytes), and cartilages,
bones and blood vessels of the head
Spina bifida: improper closure of neural tube (caudal neuropore); all forms of
spina bifida have high levels of alpha-fetoprotein in amniotic fluid; most benign
form is spina bifida cystica. Spina bifida with a meningocele has sac with dura,
arachnoid and CSF; spina bifida with a meningomyelocele also contains nerve
rootlets
Arnold-Chiari malformation: cerebellum herniates through foramen magnum;
seen with spina bifida cystica accompanied by hydrocephalus
Hydrocephalus: often due to congenital aqueductal stenosis that results from a
fetal viral infection (Toxoplasma gondii or cytomegalovirus)
Mental retardation: maternal alcohol abuse is the most common cause of
mental retardation
Urogenital: Derivatives of Wolffian and Mullerian ducts
Male embryo: high level of testosterone (further stimulates Wolffian duct) and
Mullerian inhibiting factor (prevents further development of Mullerian duct).
Female embryo: low level of testosterone (no further stimulation of Wolffian
duct) and no Mullerian inhibiting factor (allows Mullerian duct to develop)
Mesonephric (Wolffian) duct in both sexes gives rise to collecting tubules and
ducts, major and minor calices and ureter
Males:
Females:

epididymis, ductus deferens, seminal vesicle, ejaculatory

duct
epoophoron, paroophoron, Gartners duct

Paramesonephric (Mullerian) duct:

Males:
Females:

appendix of testis and prostatic utricle

uterine tube, uterus, and superior part of vagina

Horseshoe kidney: inferior poles of both contact each other and fuse; ascent is
checked by inferior mesenteric artery

Epispadias: rare; seen with exstrophy of urinary bladder

Hypospadias: common; failure of urethral folds to completely meet; affects
glans, midshaft or base of penis
Turners syndrome: 45 XO, infantile female genitalia, ovarian streaks, and
webbed neck
Klinefelters syndrome: 47 XXY; very common (1/500); gynecomastia, infertile
males
Bicornuate uterus: inferior portion of Mullerian ducts fail to fuse resulting in two
horns
Testicular hydrocele: abdominal end of processus vaginalis does not
completely seal allowing peritoneal (serous) fluid to drain to a persistent
processus vaginalis
Congenital inguinal hernia: communication between peritoneal cavity and
tunica vaginalis persists; intestines pass through deep inguinal ring and follow
path of testicular descent
Androgen insensitivity syndrome: also known as testicular feminization;
genetic male (46 XY) but phenotypic female; testes are located in inguinal canal
or in labia majora; legally, medically and socially these people are females
Changes at Birth
Umbilical arteries:
Umbilical vein:
Urachus:
Foramen ovale:
Ductus arteriosus:
Ductus venosus:

paired medial umbilical ligaments

round ligament of the liver
(unpaired) median umbilical ligament
fossa ovalis
ligamentum arteriosum
ligamentum venosum