A researcher is studying the brains of patients who recently died from stroke-related causes. One specimen has a large thrombus in an area of the brain that is important in relaying many modalities of sensory information from the periphery to the sensory cortex. Which of the following embryologic structures gave rise to the part of the brain in question?
Q52
An 11-year-old girl is brought to the office by her mother due to complaint of intermittent and severe periumbilical pain for 1 day. She does not have any significant past medical history. She provides a history of a recent school trip to the suburbs. On physical examination, there is a mild tenderness around the umbilicus without any distension or discharge. There is no rebound tenderness. Bowel sounds are normal. An abdominal imaging shows enlarged mesenteric lymph nodes, and she is diagnosed with mesenteric lymphadenitis. However, incidentally, a mass of tissue was seen joining the inferior pole of both kidneys as shown in the image. Which of the following best describes this renal anomaly?
Q53
A 2-day-old infant dies of severe respiratory distress following a gestation complicated by persistent oligohydramnios. Upon examination at autopsy, the left kidney is noted to selectively lack cortical and medullary collecting ducts. From which of the following embryological structures do the cortical and medullary collecting ducts arise?
Q54
A 23-year-old woman, gravida 2, para 1, at 26 weeks gestation comes to the physician for a routine prenatal visit. Physical examination shows a uterus consistent in size with a 26-week gestation. Fetal ultrasonography shows a male fetus with a thick band constricting the right lower arm; the limb distal to the constrictive band cannot be visualized. The most likely condition is an example of which of the following embryological abnormalities?
Q55
A 35-year-old G2P1 delivers a boy in the 40th week of gestation. The pregnancy was uncomplicated. The newborn had Apgar scores of 7 and 9 at the 1st and 5th minutes, respectively. On physical examination, the newborn is noted to have a left-sided cleft lip. The hard palate and nose are normal. Which of the following statements describes the cause of the abnormality?
Q56
A 16-year-old boy comes to the physician because of a 1-week history of difficulty swallowing, a foreign body sensation at the back of his throat, and trouble breathing at night. He has just recovered from an upper respiratory tract infection that began 5 days ago. On questioning, he reports that he has had similar symptoms in the past each time he has had an upper respiratory tract infection. Physical examination shows a 3 x 2-cm, nontender, rubbery midline mass at the base of the tongue. His skin is dry and cool. An image of his technetium-99m pertechnetate scan is shown. Which of the following is the most likely underlying cause of this patient’s condition?
Q57
A 31-year-old G2P2 female at 40 weeks gestation presents to the hospital following a rush of water that came from her vagina. She is 4 cm dilated and 80% effaced. Fetal heart tracing shows a pulse of 155/min with variable decelerations. About 12 hours after presentation, she gives birth to a 6 lb 15 oz baby boy with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. Which of the following structures is responsible for inhibition of female internal genitalia?
Q58
A 23-year-old man comes to the physician for evaluation of decreased hearing, dizziness, and ringing in his right ear for the past 6 months. Physical examination shows multiple soft, yellow plaques and papules on his arms, chest, and back. There is sensorineural hearing loss and weakness of facial muscles bilaterally. His gait is unsteady. An MRI of the brain shows a 3-cm mass near the right internal auditory meatus and a 2-cm mass at the left cerebellopontine angle. The abnormal cells in these masses are most likely derived from which of the following embryological structures?
Embryology US Medical PG Practice Questions and MCQs
Question 51: A researcher is studying the brains of patients who recently died from stroke-related causes. One specimen has a large thrombus in an area of the brain that is important in relaying many modalities of sensory information from the periphery to the sensory cortex. Which of the following embryologic structures gave rise to the part of the brain in question?
A. Metencephalon
B. Diencephalon (Correct Answer)
C. Mesencephalon
D. Telencephalon
E. Myelencephalon
Explanation: ***Diencephalon***
- The **thalamus**, a key relay center for sensory information to the cerebral cortex, develops from the diencephalon.
- A thrombus in this area would severely impair the transmission of **sensory modalities** from the periphery.
*Metencephalon*
- The metencephalon gives rise to the **pons** and the **cerebellum**.
- These structures are primarily involved in motor control, coordination, and respiratory regulation, not direct sensory relay to the cortex.
*Mesencephalon*
- The mesencephalon develops into the **midbrain**.
- The midbrain contains structures involved in visual and auditory reflexes, and motor control, but not the primary sensory relay described.
*Myelencephalon*
- The myelencephalon gives rise to the **medulla oblongata**.
- The medulla is crucial for vital autonomic functions (e.g., breathing, heart rate) and connects the brain to the spinal cord.
*Telencephalon*
- The telencephalon develops into the **cerebral hemispheres** (cerebral cortex, basal ganglia, hippocampus).
- While it processes sensory information, it is not the primary relay center from the periphery; that role belongs to the thalamus.
Question 52: An 11-year-old girl is brought to the office by her mother due to complaint of intermittent and severe periumbilical pain for 1 day. She does not have any significant past medical history. She provides a history of a recent school trip to the suburbs. On physical examination, there is a mild tenderness around the umbilicus without any distension or discharge. There is no rebound tenderness. Bowel sounds are normal. An abdominal imaging shows enlarged mesenteric lymph nodes, and she is diagnosed with mesenteric lymphadenitis. However, incidentally, a mass of tissue was seen joining the inferior pole of both kidneys as shown in the image. Which of the following best describes this renal anomaly?
A. Fused kidneys ascend beyond superior mesenteric artery.
B. Rapid progression to acute renal failure
C. Kidneys are usually non-functional.
D. Increased risk of developing renal vein thrombosis
E. Association with ureteropelvic junction obstruction (UPJO) (Correct Answer)
Explanation: ***Association with ureteropelvic junction obstruction (UPJO)***
- **Horseshoe kidney** is characterized by the fusion of the lower poles (most common) or upper poles of the kidneys, forming a U-shape. This anomaly is associated with an increased incidence of **ureteropelvic junction obstruction (UPJO)** due to the abnormal course of the ureters over the isthmus.
- The abnormal ascent of the fused kidneys can also lead to an increased incidence of other anomalies such as **vesicoureteral reflux**, **renal calculi**, and recurrent urinary tract infections.
*Fused kidneys ascend beyond superior mesenteric artery.*
- The **horseshoe kidney** typically **fails to ascend** completely during development because its isthmus (the fused part) can get trapped under the **inferior mesenteric artery**.
- Therefore, fused kidneys in horseshoe kidney are often found in a **lower position** than normal, not ascended beyond the superior mesenteric artery.
*Rapid progression to acute renal failure*
- While horseshoe kidney can be associated with an increased risk of complications (like UPJO, stones, infections), it does not inherently lead to **rapid progression to acute renal failure**.
- Many individuals with a horseshoe kidney have **normal renal function** without significant clinical manifestations.
*Kidneys are usually non-functional.*
- The presence of a horseshoe kidney **does not typically mean the kidneys are non-functional**.
- In most cases, both renal units of a horseshoe kidney are **functional**, although they may be at increased risk for complications that could impact function over time.
*Increased risk of developing renal vein thrombosis*
- There is **no established increased risk** of developing **renal vein thrombosis** specifically associated with horseshoe kidney.
- The primary vascular anomalies associated with horseshoe kidney relate to the arterial supply and variations in the number and origin of renal arteries, not typically venous thrombosis.
Question 53: A 2-day-old infant dies of severe respiratory distress following a gestation complicated by persistent oligohydramnios. Upon examination at autopsy, the left kidney is noted to selectively lack cortical and medullary collecting ducts. From which of the following embryological structures do the cortical and medullary collecting ducts arise?
A. Mesonephros
B. Pronephros
C. Ureteric bud (Correct Answer)
D. Paramesonephric duct
E. Metanephric mesenchyme
Explanation: ***Ureteric bud***
- The **ureteric bud** is an outgrowth of the mesonephric duct that gives rise to the **collecting ducts**, major and minor calyces, renal pelvis, and ureter.
- Absence or anomaly of the ureteric bud's development leads to conditions like **renal agenesis** or **renal hypoplasia**, which can cause oligohydramnios and Potter sequence due to insufficient urine production.
*Mesonephros*
- The **mesonephros** is a temporary kidney that functions early in development but largely degenerates.
- Its tubules, in males, contribute to the **epididymis**, **vas deferens**, and **ejaculatory duct**.
*Pronephros*
- The **pronephros** is the first and most primitive kidney structure, forming early in embryonic development.
- It rapidly **degenerates** and has no functional role in human development beyond inducing mesonephros development.
*Paramesonephric duct*
- The **paramesonephric (Müllerian) duct** is critical for the development of the female reproductive tract.
- It forms the **fallopian tubes**, **uterus**, and **upper vagina**.
*Metanephric mesenchyme*
- The **metanephric mesenchyme** (or metanephric blastema) differentiates into the structures involved in urine filtration and initial processing.
- This includes the **glomeruli**, Bowman's capsule, proximal convoluted tubules, loops of Henle, and distal convoluted tubules.
Question 54: A 23-year-old woman, gravida 2, para 1, at 26 weeks gestation comes to the physician for a routine prenatal visit. Physical examination shows a uterus consistent in size with a 26-week gestation. Fetal ultrasonography shows a male fetus with a thick band constricting the right lower arm; the limb distal to the constrictive band cannot be visualized. The most likely condition is an example of which of the following embryological abnormalities?
A. Agenesis
B. Disruption (Correct Answer)
C. Aplasia
D. Deformation
E. Malformation
Explanation: ***Disruption***
- A **disruption** is a morphological defect of an organ or a larger body region resulting from an **extrinsic breakdown** of a previously normal developmental process.
- The **amniotic band syndrome**, causing the constricting band and absent distal limb, is a classic example of disruption due to **amniotic bands** entrapping fetal parts.
*Agenesis*
- **Agenesis** refers to the complete **absence of an organ** due to the absence of the primordial tissue from which it develops.
- In this case, the limb was initially present but was subsequently damaged, which is not agenesis.
*Aplasia*
- **Aplasia** refers to the complete **absence of an organ** when the primordial tissue was present but failed to develop.
- This differs from the scenario where a previously normally developing structure is destroyed by an extrinsic factor (disruption).
*Deformation*
- A **deformation** is an abnormality in form or position of a body part caused by **mechanical forces**, usually occurring in later fetal stages.
- Examples include clubfoot due to intrauterine compression, but it does not involve the intrinsic destruction of tissue observed here.
*Malformation*
- A **malformation** is a **primary defect** in the development of an organ or tissue due to an intrinsic abnormal developmental process.
- Examples include **cleft lip** or congenital heart defects; it is not due to an external disruptive force.
Question 55: A 35-year-old G2P1 delivers a boy in the 40th week of gestation. The pregnancy was uncomplicated. The newborn had Apgar scores of 7 and 9 at the 1st and 5th minutes, respectively. On physical examination, the newborn is noted to have a left-sided cleft lip. The hard palate and nose are normal. Which of the following statements describes the cause of the abnormality?
A. Failure of fusion of the left maxillary prominence and the medial nasal process of the frontonasal prominence (Correct Answer)
B. Failure of fusion of the left maxillary prominence and the lateral nasal process of the frontonasal prominence
C. Failure of development of the left maxillary prominence
D. Partial resorption of the first pharyngeal arch
E. Failure of development of the first pharyngeal arch
Explanation: ***Failure of fusion of the left maxillary prominence and the medial nasal process of the frontonasal prominence***
- **Cleft lip** results from the **failure of fusion** between the **maxillary prominence** and the **medial nasal process** during the 6th to 7th week of embryonic development.
- The **medial nasal processes** form the philtrum of the upper lip, the primary palate, and the central part of the upper jaw, while the **maxillary prominences** form the lateral parts of the upper lip and the secondary palate.
*Failure of fusion of the left maxillary prominence and the lateral nasal process of the frontonasal prominence*
- The **lateral nasal processes** form the alae of the nose but do not directly contribute to the upper lip formation; therefore, their failure to fuse with the maxillary prominence would not cause a cleft lip.
- Fusion issues involving the lateral nasal process are associated with anomalies of the nasal structures, not the lip itself.
*Failure of development of the left maxillary prominence*
- Complete failure of development of the maxillary prominence would lead to a more severe facial defect, often involving hypoplasia or absence of the maxilla and not just an isolated cleft lip.
- Such a severe defect would likely impact other craniofacial structures more broadly than described.
*Partial resorption of the first pharyngeal arch*
- The **first pharyngeal arch** forms many structures of the face, including the maxilla and mandible, but cleft lip is a failure of fusion, not a resorption defect of a fully formed structure.
- Resorption issues are typically associated with conditions like Treacher Collins syndrome, affecting bones and soft tissues derived from the arch.
*Failure of development of the first pharyngeal arch*
- Complete or significant failure of development of the **first pharyngeal arch** would result in severe facial malformations, including micrognathia, severe ear abnormalities, and hypoplasia of the maxilla and mandible.
- A simple cleft lip, especially when the nose and hard palate are normal, does not typically point to a global failure of the first pharyngeal arch development.
Question 56: A 16-year-old boy comes to the physician because of a 1-week history of difficulty swallowing, a foreign body sensation at the back of his throat, and trouble breathing at night. He has just recovered from an upper respiratory tract infection that began 5 days ago. On questioning, he reports that he has had similar symptoms in the past each time he has had an upper respiratory tract infection. Physical examination shows a 3 x 2-cm, nontender, rubbery midline mass at the base of the tongue. His skin is dry and cool. An image of his technetium-99m pertechnetate scan is shown. Which of the following is the most likely underlying cause of this patient’s condition?
A. Chronic infection of the palatine and lingual tonsils
B. Ductal obstruction of the sublingual salivary glands
C. Arrested endodermal migration from pharyngeal floor (Correct Answer)
D. Persistent epithelial tract between the foramen cecum and thyroid isthmus
E. Failure of obliteration of the second branchial cleft
Explanation: ***Arrested endodermal migration from pharyngeal floor***
- This describes the embryological origin of a **lingually ectopic thyroid gland** (also known as a **lingual thyroid**), which results from the thyroid's failure to descend from its embryonic origin at the foramen cecum.
- The symptoms of globus sensation, dysphagia, and trouble breathing, especially exacerbated during URI due to swelling of the ectopic thyroid tissue, alongside the midline tongue mass and positive **technetium-99m pertechnetate scan** (which highlights thyroid tissue), are highly indicative of this condition.
*Chronic infection of the palatine and lingual tonsils*
- While chronic tonsillitis can cause symptoms like dysphagia and foreign body sensation, it typically presents with recurrent sore throats, pus, and tender lymphadenopathy.
- It would not explain a distinct midline mass at the base of the tongue that shows uptake on a technetium-99m scan, which specifically targets thyroid tissue.
*Ductal obstruction of the sublingual salivary glands*
- Obstruction of sublingual ducts (e.g., ranula) would typically present as a soft, bluish, fluid-filled mass in the floor of the mouth, not a rubbery midline mass at the base of the tongue.
- This condition is unrelated to URIs and would not show uptake on a technetium-99m pertechnetate scan.
*Persistent epithelial tract between the foramen cecum and thyroid isthmus*
- This describes a **thyroglossal duct cyst**, which is typically a midline neck mass that moves with tongue protrusion.
- While embryologically related to thyroid development, the mass in this patient is described as being at the "base of the tongue," not a mobile neck mass, and represents a completely ectopic thyroid gland rather than a cystic remnant of the duct.
*Failure of obliteration of the second branchial cleft*
- This leads to the formation of a **branchial cleft cyst**, which is usually found laterally in the neck, anterior to the sternocleidomastoid muscle.
- It is not typically a midline mass at the base of the tongue and is generally not associated with symptoms of dysphagia or respiratory distress exacerbated by URIs in this specific manner.
Question 57: A 31-year-old G2P2 female at 40 weeks gestation presents to the hospital following a rush of water that came from her vagina. She is 4 cm dilated and 80% effaced. Fetal heart tracing shows a pulse of 155/min with variable decelerations. About 12 hours after presentation, she gives birth to a 6 lb 15 oz baby boy with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. Which of the following structures is responsible for inhibition of female internal genitalia?
A. Allantois
B. Syncytiotrophoblast
C. Leydig cells
D. Spermatogonia
E. Sertoli cells (Correct Answer)
Explanation: ***Sertoli cells***
- **Sertoli cells** in the male fetus produce **anti-Müllerian hormone (AMH)**, which is crucial for the regression of the **Müllerian ducts**.
- The **Müllerian ducts** are the precursors to the female internal genitalia (uterus, fallopian tubes, and upper vagina), so their inhibition is essential for male sexual development.
*Allantois*
- The **allantois** is a fetal membrane involved in waste storage and gas exchange, contributing to the formation of the **urachus** and parts of the bladder.
- It plays no direct role in the inhibition or development of internal genitalia.
*Syncytiotrophoblast*
- The **syncytiotrophoblast** is a layer of placental tissue that produces hormones vital for maintaining pregnancy, such as **human chorionic gonadotropin (hCG)**.
- It is not involved in the sexual differentiation of the internal genitalia.
*Leydig cells*
- **Leydig cells** produce **testosterone**, which stimulates the development of the **Wolffian ducts** into male internal genitalia (epididymis, vas deferens, seminal vesicles).
- While essential for male development, they do not inhibit female internal genitalia; that function belongs to Sertoli cells.
*Spermatogonia*
- **Spermatogonia** are germ cells that differentiate into spermatozoa in the adult male.
- They are primordials of reproductive cells and do not have an endocrine role in embryonic sexual differentiation.
Question 58: A 23-year-old man comes to the physician for evaluation of decreased hearing, dizziness, and ringing in his right ear for the past 6 months. Physical examination shows multiple soft, yellow plaques and papules on his arms, chest, and back. There is sensorineural hearing loss and weakness of facial muscles bilaterally. His gait is unsteady. An MRI of the brain shows a 3-cm mass near the right internal auditory meatus and a 2-cm mass at the left cerebellopontine angle. The abnormal cells in these masses are most likely derived from which of the following embryological structures?
A. Surface ectoderm
B. Neural tube
C. Neural crest (Correct Answer)
D. Notochord
E. Mesoderm
Explanation: ***Neural crest***
- The patient's symptoms (bilateral sensorineural hearing loss, facial weakness, unsteady gait, central masses) along with cutaneous lesions (soft, yellow plaques) are highly suggestive of **Neurofibromatosis type 2 (NF2)**.
- NF2 is characterized by **vestibular schwannomas** (acoustic neuromas) and other CNS tumors, which are derived from **Schwann cells**. Schwann cells, along with melanocytes and other peripheral nervous system components, originate from the **neural crest**.
*Surface ectoderm*
- The surface ectoderm forms structures such as the **epidermis**, hair, nails, and anterior pituitary.
- While the skin lesions are present, the primary tumors (schwannomas) are not derived from the surface ectoderm.
*Neural tube*
- The neural tube gives rise to the **central nervous system** (brain and spinal cord) and motor neurons.
- While the tumors affect the brain and cranial nerves, the specific cell type forming schwannomas (Schwann cells) does not originate directly from the neural tube.
*Notochord*
- The notochord induces the formation of the neural tube and eventually degenerates, contributing to the **nucleus pulposus** of the intervertebral discs.
- It is not involved in the pathogenesis or cellular origin of schwannomas.
*Mesoderm*
- The mesoderm gives rise to connective tissues, blood, bone, muscle, and most internal organs.
- While some tumors can have mesodermal origins, schwannomas are neuroectodermal in origin.