ACT1-BCM-123-Activities - 1.pptx for education

Education

1. Course Activities INSTRUCTIONS Instructions to Assignments As part of your course, activities are also to be done and handed in within the given deadline/dateline. Generally, they should be done within one week, unless stated otherwise. Activities will be awarded marks as part of continuous assessments (CAT).

2. Embryology Definitions and Overview of Embryology -1 Embryology is : The science of the origin and development of the individual from fertilization of an oocyte to the end of the eighth week of development and, by extension, during any stage of prenatal development * The branch of biology that deals with the formation, early growth, and development of living organisms * The embryonic structure or development of an organism * The study of the origin, growth, development, and function of an organism from fertilization to birth * Overview: Embryology involves periods of Prenatal and Postnatal Development Activity 1.1: Write short notes on Prenatal and Postnatal development and their sub-divisions. *

3. Embryology Pre-fertilization Events – 7a MEIOSIS In meiosis, the chromosomes duplicate (during interphase ) and homologous chromosomes exchange genetic information ( chromosomal crossover ) before a first division, called meiosis I The daughter cells divide again in meiosis II, splitting up sister chromatids to form haploid gametes . Male and female gametes fuse during fertilization , creating a diploid cell with a complete set of paired chromosomes Activity 1 2: Describe in detail, the phases/stages of mitosis and meiosis.

4. Embryology Pre-fertilization Events – 10 Clinical Considerations Offspring of Older Women : The incidence of Down’s syndroms ( Trisomy 21) increases with the age of the mother* Offspring of Older Men : An increased incidence of achondroplasia (a congenital skeletal anomaly characterized by retarded bone growth) and Marfan’s syndrome is associated with advanced paternal age* Male Fertility : This depends on the number and motility of sperm* Assignment 1.3: (i) Define infertility (in medical terms), (ii) outline its common causes and (iii) principles of and challenges during management.

5. Embryology Pre-fertilization Events – 11 Clinical Considerations 4. Hormonal contraception * Assignment 1.4: Synthesize (summarize in your own words) the concept of contraception and the consequent use of various contraceptives. Tabulate the following important information: Name/Type of Contraceptive Route of administration Mode and Length of action before expiry Side Effects/Adverse Effects Contraindications 5. Primordial Germ Cells (PGCs) and Teratomas Teratomas are tumors of disputed origin that often contain a variety of tissues* Examples of tissues with teratomas : Muscle Gut epithelia, Bone Hair Others It is thought that these tumors arise from a pluripotent stem cell that can differentiate into any of the three germ layers or their derivatives

6. Embryology Pre-fertilization Events – 12 Clinical Considerations/Correlates: 6. Challenges of Cultural beliefs versus scientific Embryological facts Activity 1.5 Read the given story (entitled ‘ Clinical Taste r’) then discuss your informed opinion on how to handle this situation if you ever encountered such a patient in your medical practice.

7. Embryology Pre-fertilization Events – 13 Clinical Considerations/Correlates: 7 . Birth Defects and Spontaneous Abortions: Chromosomal and Genetic Factors* Numerical Abnormalities: Haploid* Diploid* Euploid * Aneuploid * Trisomy * Monosomy * Activity 1.6: Define ‘Abortion’ Classify the types of abortions Which type(s) is/are attributable to embryological defects? What are the dangers and related effects of abortion? Outline the management and challenges of abortion.

8. Embryogenesis Embryological Terminology Commonly used Terminology in embryology: * Activity 2.1 To facilitate faster and more efficient learning, describe the following terms and look out for their applications: * Oocyte; Sperm; Zygote; Embryo; Fetus; Conceptus ; Cleavage; Morula Blastocyst; Implantation; Gastrulation; Neurulation Premordium ; Abortion; Gestation; Gestational Age;

9. Embryogenesis Gametogenesis Summary Events Activity 2.2: Label the illustrations opposite. Summarize the main embryological events of gametogenesis [( Larsen’s Human Embryology; p. 15 – 19. ) (Also, s ee additional notes in Chapter 1 of Barry, M. Embryology. 2 nd Ed. Pp. 1 – 8) Refer to Figure Intro-3 (Larsen’s Human Embryology, p. 16) and label the illustrations .

10. Embryology & Neonatology Week 1-2 of Human Development * - 4h Clinical Considerations* Ectopic tubal pregnancy (ETP )* ETP is life-threatening obstetric emergency! Every clinician is expected to know everything about it. Activity 2.3: Describe the clinical types/classifications of ectopic pregnancy. Which are the abnormal sites of implantation? What are the main clinical features of ETP? List the complications of ETP. How is ETP diagnosed? How is ETP managed?

11. Embryology & Neonatology Week 1-2 of Human Development * - 4i Clinical Considerations* In vitro Fertilization (IVF): IVF is an important procedure applicable in embryological studies* IVF requires the sequential application of a number of steps as hereby indicated : ( i ) Clomiphene citrate is administered to stimulate multiple ovulation (ii) Oocytes are collected by needle aspiration from the ovary, assisted by ultrasound visualization (iii) Sperm are collected by masturbation, separated from seminal fluid, and capacitized by exposure to ionic solutions In cases of oligospermy (infertility due to low number of sperm), multiple samples may be obtained over an extended period of time (iv) Sperm and oocytes are cultured together. The success of in vitro fertilization is judged by the presence of two pronuclei with the oocyte (v) Cleavage is allowed to proceed in vitro to the 8-cell stage embryo (vi) Typically, at least three embryos are transferred to the uterus, since there is a low success rate of implantation (vii) the remaining embryos are frozen for future use if the first embryo transfer does not result in a pregnancy Activity 2.4: What are the approaches to the challenges of infertility? (Read the account given in the folder notes below as a hint to some of the challenges and their clinical approach.) Summarize the investigations generally carried out for those affected by infertility. What counseling approaches are used for those affected?

12. Embryology & Neonatology Week 1-2 of Human Development * - 4j Clinical Considerations* Teratocarcinoma (TC): Spontaneous TCs are gonadal tumours TCs contain both differentiated cell types and undifferentiated pluripotent stem cells called embryonic carcinoma (EC) cells TCs can be experimentally produced by implanting a blastocyst in an extrauterine site The ability of blastocysts to form TCs suggests a relationship between the inner cell mass and EC cells This relationship has been confirmed by isolation of cell lines form blastocysts called embryonic stem (ES) cells, which have biochemical characteristics remarkably similar to EC cells Activity 2.5: Summarize the relationship between primordial germ cells (PGC) and Teratocarcinoma (TC). Outline the clinical presentation , diagnosis and management of TC. Write short notes on the origin of PGC.

13. Embryology & Neonatology Development of the Nervous System* – 10h Activity 2.6: Outline the embryological development after the 8 th week. Write short notes on: placodes , vesicle development of the neural tube, histogenesis of the neural tube, development of the spinal cord, myelencephalon , metencephalon , mesencephalon , diencephalon, optic structures and hypophysis ; telencephalon , sympathetic nervous system, parasympathetic nervous system and cranial nerves; choroid plexus. Describe the common congenital malformations of the CNS and how they arise.

14. Embryology & Neonatology Cardiovascular System Development – 5 Clinical Considerations for AorticoPulmonary (AP) Septum Malformations * Persistent truncus arteriosus (PTA)* D-Transposition of the great arteries (complete)* L-Transposition of the great vessels (corrected)* Tetralogy of Fallot (TF)* Dextrocardia * Ectopia cordis * Activity 3.1: Write short notes about ectopia cordis *

15. Embryology & Neonatology Cardiovascular System Development - 19 Clinical Considerations for Ventricular Septal Defects (VSD) * Membranous VSD* Muscular VSD* Common ventricle ( Cor triloculare biatriatum )* =============================== Activity 3.2 : A mother took her 7-year-old son to a pediatrician and complained that her child complains of excessive fatigue upon exertion. After thorough investigations the pediatrician detected a cardiac defect in the child and told his mother that your son is suffering from a defect in the heart that is a common birth defect of heart in children . Answer the following questions: What is the most common congenital defect of the heart?* What is its incidence ?* Discuss the blood flow in this defect and explain the cause of excessive fatigue on exertion .* 2 . A full-term male child, on the first day itself, presented generalized cyanosis. A chest radiograph (PA view) revealed lightly enlarged heart with a narrow base and increased pulmonary vascular markings. A probable diagnosis of‘ complete transposition of the great blood vessels ’ was made. Give the embryological basis of this anomaly and tell how the infant was able to survive after birth with such a severe anomaly ?* 3. The retinoic acid (vitamin A), which is very effective in treating acne (a common ailment in young women), should not be given/prescribed to the pregnant ladies. Why ?*

16. Embryology & Neonatology Cardiovascular System Development - 20 Clinical Considerations for Anomalies of Great arteries and Aortic arch System: Abnormal origin of the Right Sub- clavian Artery* Double Aortic Arch* Right Aortic Arch* Patent Ductus Arteriosus (PDA)* Post- ductal Coarctation * Pre- ductal Coarctation * Aactivity 3.3: List the abnormalities that are commonly associated with PDA*. How is each abnormality listed in previous question, diagnosed and managed?

17. Extra-Embryonic Membranes The Placental Clinical Considerations* - 1g Activity 4.1 In the event that the placenta is wrongly placed or malformed, several abnormalities of clinical importance may result. List the abnormalities associated with the placenta . (N.B: Make effort to see their illustrations in various textbooks indicated)* Describe the clinical features of the commonest placental abnormalities (notably: Placenta praevia and abruptio placenta)*

18. Extra-Embryonic Membranes Umbilical Cord – 3a Contents of Umbilical Cord* Functions of Umbilical Cord* Clinical Considerations* Activity 4.2: Note the contents and functions of the umbilical cord.* In what dimension is the umbilical cord clinically important?*

19. Extra-Embryonic Membranes Clinical Correlates* - 5e Clinical Correlates: Amniocentesis * Oligohydramnios * Polyhydramnios * Premature Rupture of Membranes (PROM)* Activity 4 . 3: Describe the procedure and clinical importance of amniocentesis. * List conditions that may be treated in utero, upon diagnosis by amniocentesis Owing to their clinical importance, write short but comprehensive notes about: Oligohydramnios , Polyhydramnios &PROM Describe how amnion rupture may give rise to fetal anomalies*.

20. Extra-Embryonic Membranes Clinical Considerations – 7h Erythroblastosis Fetalis : Importance Rhesus factor Rhesus-haemolytic disease Kernicterus Hydrops fetalis Polyhydramnios Oligohydramnios Preeclampsia Ecclampsia Activity 4.4 : Discuss erythroblastosis fetalis as an embryonic abnormality and its consequences. Describe the relationship between kernicterus and hydrops fetalis . Describe congenital abnormalities of amniotic flow. Describe pre- ecclampsia and ecclampsia in relation to embryology.

21. Male Reproductive System Development of Gonads - 42 B. Relative descent of the testes 4 . Remnants of the gubernaculum in the adult male serve to anchor the testes within the scrotum . 5. The peritoneum evaginates alongside the gubernaculum to form the processus vaginalis . 6. Later in development, most of the processus vaginalis is obliterated except at its distal end , which remains as a peritoneal sac called the tunica vaginalis of the testes. Activity: 5.5 Name two types of malignancies that commonly affect testes and /or ovaries, respectively. Describe the clinical presentations , diagnosis, management and prognoses of the malignancies in (1) above

22. Male Reproductive System Development of Genital Ducts - 46 B. Mesonephric ( Wolffian ) ducts and tubules 1. The mesonephric ducts and tubules develop in the male as part of the urinary system because these ducts are critical in the formation of the definitive metanephric kidney . 2. The mesonephric ducts then proceed to additionally form the epididymis, ductus deferens , seminal vesicle, and ejaculatory duct. 3. A few mesonephric tubules in the region of the testes form the efferent ductules of the testes . Activity 5.6: Among the disorders of mesonephric duct development is congenital bilateral aplasia of the vas deferens CBAVD). Write short notes, identifying why it is of clinical importance.*

23. Male Reproductive System Clinical Considerations – 53a Congenital Anomalies of Urethra* Congenital Anomalies of Penis* Congenital anomalies of Prepuce (foreskin)) Activity 5.7 : Enumerate congenital anomalies of Urethra, Penis and Prepuce, respectively. * How is each of the congenital anomalies managed? With respect to embryology, distinguish between phimosis and paraphimosis *

24. Male Reproductive System Clinical Considerations – 58a Other Anomalies of the Reproductive System Intersexuality True intersexuality Female pseudo-intersexuality Male RH Disorders: Klinefelter’s syndrome* Hermaphrodites * : True H. Pseudo-H Androgen insensitivity syndrome (AIS)* Activity 5.9 Concerning ‘Sexual Differentiation Defects’, what are the common causes of male and female inter-sexuality, respectively? Describe ‘ female pseudo-hermaphrodites ’; male pseudo-hermaphrodites ’; ‘ True hermaphrodites ’and other related terms. Summarize about the anomalies in male and female Reproductive systems (comparing various information sources and texts) Enumerate male RH disorders.

25. Urinary System Development Clinical Considerations – 58d Inter-sexuality Clinical Taster Read the story herein, which depicts a typical real life account in clinical practice* Activity 5.10: Inter-sexuality offers a real challenge to all stake holders . List the stake holders affected. As a clinician also in the loop, how will you deal with the situation if a case landed in your hands one day? How is inter-sexuality actually managed professionally in health sector?

26. Male Reproductive System Clinical Considerations - 59 Activity 5.11: Write short notes about: ‘Persistent Müllerian Duct Syndrome’ (see it’s picture opposite) . Hypospadias (types) How do they present clinically? How are they managed and what challenges are anticipated during its management?* Persistent Müllerian Duct Syndrome Müllerian ducts fail to regress Possess both male and female sex organs