(B) They are the primitive kidney and ureter that will mature into the adult
urinary tract.
(C) They develop as the primitive kidney and migrate caudally and laterally
to form the mesonephros.
(D) They will serve as the fetal kidney until 16 weeks and the development
of the metanephros.(E) They form the primitive kidney and primitive
upper genital ducts.
DIRECTIONS (Questions 1 through 22): For each of the multiple choice questions in this
section, select the lettered answer that is the one best response in each case.
1. You are counseling a couple about infertility. In your discussion about conception,
tubal disease, and implantation, you explain to them that implantation in the
uterus occurs at which stage of development?
(A) eight-cell embryo
(B) zygote
(C) morula formation
(D) blastocyst
(E) embryonic disk
7.
An amniocentesis results show a fetus with 45XO. In counseling the parents, how
would you explainthat the genetic sex is determined?
(A) at ovulation
(B) at conception
(C) by the presence or absence of testosterone
(D) in the absence of Mllerian-inhibiting factor
(E) psychosocially after birth
8.
9.
3.
4.
5.
6.
In this pregnancy you counsel her that her fetus has what chance of recurrence?
(A) 50% chance of recurrence(B) 25% chance of recurrence
(C) <5% chance of recurrence
(D) 100% chance of recurrence
(E) Impossible to predict recurrence because of incomplete penetrance
She would like to prevent a recurrence. You offer her maternal dexamethasone in
order to do which ofthe following?
(A) calm her anxiety
(B) suppress fetal adrenal glad
(C) block fetal genital steroid receptors
(D) provide negative feedback to the maternal pituitary
(E) block transplacental passage of maternal androgens
In counseling a woman about an alcohol binge she had at 6 weeks after her last
menstrual period youexplain that, with the exception of the brain, organogenesis
is completed within how many weeks after her last period?
(A) 4 weeks after ovulation
(B) 10 weeks after ovulation(C) 18 weeks after ovulation
(D) 26 weeks after ovulation
(E) 38 weeks after ovulation
A couple of Southeast Asian ancestry are both thalassemia carriers. In
counseling them you explain thatthe main form of hemoglobin in the normal
fetus is which of the following?
(A) Gower 1
(B) hemoglobin A (HbA)
(C) Gower 2
(D) hemoglobin F (HbF)
(E) Barts hemoglobin
A woman has had a previous child with renal agenesis. She is a middle school
biology teacher andwants to understand more about development of the
kidneys. Which of the following best describes the function of pronephros?
(A) They begin the developmental sequence that forms the permanent
excretory ducts and kidneys.
10. You are counseling a 32-year-old nulligravida with breast cancer about
preserving fertility. Youexplain that the maximal number of oogonia is found at
what age?
(A) 1 months gestational age
(B) 5 months gestational age
(C) birth
(D) puberty
(E) 21 years of age
11. The paramesonephric ducts will form which of the following?
(A) the prostatic utricle
(B) seminal vesicles
(C) oviducts, uterus, and upper vagina
(D) upper vagina only(E) the ureters
12. Vaginal epithelium and the fibromuscular wall of the vagina originate from which
of the following,respectively?
(A) mesonephric duct and endoderm of the urogenital sinus
(B) mesonephric duct and the uterovaginal primordium
(C) endoderm of the urogenital sinus and the mesonephric duct
(D) endoderm of the urogenital sinus and the uterovaginal primordium
(E) endoderm of the urogenital sinus and the paramesonephric ducts
(J)
gamete
4.
(B) Fifty-six days gestational age or 10 weeks after the last menstrual period is
generally accepted as ending the embryonic period. Prior to this time teratogens
can cause severe defects, with partial to complete absence of organ structures,
depending upon the stage of development when the teratogen was present.
Beyond this time period, fetal effects of teratogens are significantly less.
5.
(E) All these types differ in the globin moiety and can be differentiated by
electrophoresis. Fetal hemoglobin (HbF) has more oxygen-binding capacity than
adult hemoglobin (HbA). Gower 1 and Gower 2 are embryonic hemoglobins and
the most primitive of human hemoglobins. They are less efficient oxygen carriers
than HbF.
6.
(A) The pronephros and the mesonephros are two primitive urinary systems that
precede the development of the metanephros which will develop into the mature
urinary system. The mesonephric ducts grow caudally, and by week 5 of
development they open into the lateral wall of the cloaca. The pronephros
degenerate by the end of the fourth week (2 weeks embryologic age) but do
initiate the events that will lead to the formation of the adult kidney and
collecting ducts.
7.
8.
23. The name applied to the 16-cell mass that precedes the blastocyst
24. A fertilized ovum
25. The name applied to the cells capable of invading endometrium
26. The name applied to the products of conception from the third to the eighth
week after ovulation
27. The name applied to the cell or cells capable of uniting to reproduce
Questions 28 through 30 apply to the following patient:
A 16-year-old girl presents with primary amenorrhea. She has normal breast
development, pubic hair, and axillary hair. Match the diagnosis with the physiologic
explanation.
(A) anomalous partitioning of the vagina
(B) secondary to incomplete or partial canalization of the vaginal plate
(C) anomaly of caudal fusion
(D) Mllerian duct aplasia
(E) in utero exposure to androgenic hormones
(F) anomalous development of the pronephros at 810 weeks after ovulation
(G) maternal viral infection during the first trimester
28. Transverse vaginal septum
29. Absent vagina
9.
1.
2.
3.
(B) Dexamethasone, given to the mother, crosses the placenta and suppresses
ACTH secreting cells in the fetal pituitary. This inhibits fetal adrenal androgen
secretion and prevents masculinization. The drug does not block fetal genital
receptors. The purpose is not related to maternal androgens or maternal
pituitary since these are not causative of the syndrome. Once the sex of the
fetus is known and if the fetus is male, the androgen treatment can be stopped.
10. (B) An oogonium becomes an oocyte when it enters the first stage of meiosis.
This occurs prior to birth. After birth there is a slow decrease in the number of
oocytes. By menopause none can be found. By 5 months gestation there is a
maximum number of oocytes, of about 4 to 7 million! At birth, the number of
oocytes has decreased to 1 or 2 million. There continues to be attrition of
oocytes during childhood so that by the onset of puberty fewer than 500,000
oocytes remain.
11. (C) The genital ducts (mesonephric or Wolffian and paramesonephric or
Mllerian) are present in both sexes. The mesonephric ducts will become the
male ducts and seminal vesicles. The female paramesonephros will form the
oviducts, uterus, and upper two-thirds of the vagina. The lining of these ducts
becomes the epithelial lining of the adult structures. Muscle and connective
tissue originate from the adjoining mesenchyme. The prostatic utricle and the
appendix testis in the male may indeed be remnants of paramesonephric duct
but are not really formed by the ducts (see Figure 31).
18. (D) If germ cells do not reach the developing ovary, gonadoblastomas may form
with 46, XY karyotype. The ovary does not develop normally. This lack of
development is called gonadal dysgenesis.
19. (D) True hermaphroditism is characterized by ambiguous genitalia at birth. The
gonads maybe any combination of ovary, testis, or ovotestis. Interestingly, a
testis or ovotestis is usually located on the right side. Mllerian structures are
usually present on the side ipsilateral to an ovary or ovotestis. Most true
hermaphrodites are 46, XX with no identifiable Y chromosome but rather small
portions of the Y chromosome incorporated into their genome.
20. (B) The physical examination of the newborn with ambiguous genitalia may
reveal gonads that are palpable in the scrotum or lower inguinal canal. These
gonads may be testes or ovotestes. High circulating androgens in the female
fetus are not sufficient to cause descent of normal ovaries and therefore
descended gonads cannot be ovaries. Pelvic ultrasound is frequently useful in
identifying Mllerian structures while the presence of a normal uterus rules out
the possibility of normal testicular tissue.
21. (A) Only the distal one-third of the vagina is formed from the urogenital sinus.
The proximal vagina is formed by fusion of the Mllerian ducts. This explains
why, in cases of Mllerian agenesis, patients have a rudimentary vagina. The
bladder and rectum are formed from endo-dermal tissue not the urogenital sinus.
22. (E) Abnormalities of fusion of the paramesonephric ducts often cause pregnancy
wastage. The various types of uterine duplication and vaginal malformation that
occur with improper fusion include uterus didelphys, which is a double uterus
with a double vagina, bicornuate uterus with a fusion defect isolated to the
uterine fundus but not vagina, unicornuate uterus with a rudimentary horn, and
a longitudinal septum where a caudal fusion problem exists but uterine fusion is
adequate. Gartners duct cysts do not affect pregnancy in general.
2327. (23-A, 24-E, 25-C, 26-D, 27-J) The zygote is the cell resulting from the union of
the sperm and ovum (egg), the gametes, or the fertilized ovum. Blastocele is the
name applied to the 12 to 16 blastomeres composing the ball of cells from the
division of the zygote. The embryonic period begins at the third week of
development. During this time, most of the major structures are formed, and the
greatest risk from teratogens exists. The fetal period begins in the ninth
developmental week and extends to birth. The ninth week to birth is more
remarkable for rapid growth than for major developmental change. This is a period
of growth and maturation of the existing structures.
Trophoblastic invasion is the process by which the embryo implants into the
uterine lining at the blastocyst stage. The blas-tocele is the fluid-filled cavity that
forms immediately prior to blastocyst formation.
2830. (28-B, 29-D, 30-B) A transverse vaginal septum and an imperforate hymen
imply that canalization of the vaginal plate at its junction with the sinusal
(Mllerian) tubercle did not proceed completely. A longitudinal septum implies that
the caudal fusion of the Mllerian ducts did not result in complete canalization of
the uterovaginal primordium. When the vagina is absent, in most cases it will be
due to aplasia of the Mllerian ducts. When the urogenital sinus persists, it causes
any number of anomalies, most representing either no opening for the anus or an
aberrant opening.