OB 4

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1

When is organogenesis complete?

12 weeks

2

When is the GB seen?

20 weeks

3
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Fetal GB

4
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Fetal GB

5
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Fetal GB

6

What is suspected when the spleen is enlarged in a fetus?

Rh immunoIncompatibility

7

When can the stomach be seen?

14 weeks

8

If the stomach is not seen by 16 weeks, what could be the problem?

esophageal atresia

9

What is the stomach a landmark for?

AC

10

What does the intestines act as in utero?

resevor for meconium

11

Why does the the fetus not poo in utero

peristalisis does not occur until birth

anal sphincter is closed

*unless in distress

12

kidney / testis crisscross

...

13

what is meconium made of

amniotic fluid + fetal cells

bacteria and enzymes added

14
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spleenomegaly

15
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Pancreas

16

What is the size of the adrenals in a fetus?

20x larger in fetus than adults

can mimic kidneys

17
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adrenal

18
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adrenal

19

______________ is directly proportional to AC.

liver size

20

What is hypoxic?

pertaining to low oxygen

21

What does the umbilical arteries become after birth?

hypogastric ligament

22

What does the umbilical vein become after birth?

ligament venosum

23

What measurements do we take involving the abdomen?

AC

renal length

24

What is the AC landmarks?

trans spine - 3 oss center

J - portal vein

stomach & GB

25

What is esophageal atresia?

congenital atresia of the esophagus

26

What causes esophageal atresia?

failure of recanalization of the GIT

a blind end tube is result

27

What is present in most cases of esophageal atresia?

tracheo-esophageal fistula

28

What percent of esophageal atresia have a tracheo-esophageal fistula present?

90%

29

What is the sonographic appearance of esophageal atresia?

polyhydramnios

stomach usually not identified

30
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Duodenal atresia

31

What is duodenal atresia usually associated with?

Downs syndrome

32

What is the sonographic appearance of duodenal atresia?

Double bubble

polyhydramnios

33
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Duodenal atresia

34
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Double bubble

35

When can duodenal atresia be seen?

24 weeks

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tracheo-esophageal fistula

37

What causes a double bubble?

duodenal atresia

duodenal stenosis

annular pancreas

jejunal atresia

38

What is an annular pancreas?

extension of pancreas tissue around duodenal

forming a ring

39

What problems does annular pancreas cause in infants?

feeding problems

reflux and vomiting

40

What is the sonographic appearance of jejunal atresia?

bowel proximal to the blockage dilated

41

What is the first sign of cystic fibrosis?

meconium ileus

echogenic bowel

42
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meconium ileus

43
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meconium ileus

44

What is a meconium ileus?

small bowel disorder, presense of thick meconium in the distal ileum

impaction of abnormal thick sticky mecomium

45
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Meconium Peritonitis

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Meconium Peritonitis

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Meconium Peritonitis

48

What can obstructed bowel cause?

perforation and infection

49

What is the sonographic appearance of meconium ileus?

echogenic small bowel

50

When is the migration of the kidney to the abdomen complete?

9 weeks

51

What causes pelvic kidneys?

can be physical or hormonal

52

What are horseshoe kidneys?

inferior portion fuses early on

53

When should the kidneys and the bladder be seen?

15 weeks

54
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bubble sign

55

When should the renal cortex and medulla be differentiated?

25 weeks

56
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bubble sign

57
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Cross-over fusion kidneys

58

What happens with bilateral renal agenesis?

olighydramnios usuually resulting in miscarriage - always fatal

59

What is Potter's type 2?

multicystic dysplastic kidneys

60
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Urachal fistula

61
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Urachal fistula

62

What is a urichal fistula?

Urachus doesn't close and belly button leaks urin

63
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Urachal cyst

64
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Urachal cyst

65
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Unilateral renal agenesis

66
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Mesoblastic Nephroma AKA: fetal renal harmatoma & congenital Wilm's tumor

67
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Mesoblastic Nephroma AKA: fetal renal harmatoma & congenital Wilm's tumor

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Wilm's Tumor AKA: Nephroblastoma

69

What is mesoblastic nephroma?

Congenital Wilms' tumors

big benign mass usually expresses its self by 3 months

most common neonatal solid tumor

mostly in boys

70

What is Nephroblastoma?

wilms tumor

71

What is the most common malignant tumor of childhood?

Wilms tumor

72

At what age does wilms tumor usually occur?

commonly occurs at 3 yrs

73

what is a Urachus?

a fibrous cord that extends from the umbilicus to the bladder.

74

What is the sonographic appearance of Potter's type 2?

Severe oligohydramnios

Absent kidneys

Nondistended bladder

75

What is IPKD?

disorder associated with multiple bilateral cysts

76
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Infantile Polycystic Kidney Disease

77
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Infantile Polycystic Kidney Disease

78

What is another name for IPKD?

Potter Type 1

79
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Urachal cyst

80

Is IPKD recessive of dominant?

recessive

81

What are the 4 groups of IPKD?

Perinatal – renal failure in utero

Neonatal

Infantile

juvenile

82

When does neonatal IPKD occur?

within 1st month after birth

83

When does infantile IPKD occur?

3 - 6 months

84

When does juvenile IPKD occur?

1 - 5 years

85

What is the sonographic appearance of IPKD?

enlarged

hyperechoic

homogeneous hyoerechoic large kidneys

increased kidney AC

small bladder

loss of corticomedullary differentiation

86

What is Meckyl-Gruber syndrome?

  1. polucystic kidneys
  2. posterior encephalocoele/holoprosencephaly
  3. polydactyly
87

What is adult polycystic kidney disease?

large

echogenic

88

What age does APKD usually occur?

age 30 with hypertension

89

If one person has APKD what is the chance of passing it on to children?

50%

90

What is polycystic kidney disease?

auto dominant

family history

91

What is multicystic dysplastic kidneys?

disorder associated with unilateral cystic lesions

correspond to dilated collecting tubules

Enlarged

unilateral

nonfunctioning

92
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Bilateral multicystic dysplastic kidney disease

93
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unilateral multicystic dysplastic kidney disease

94
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unilateral multicystic dysplastic kidney disease

95

What happens to the contralateral kidney with MDK?

enlarges to compensate

96

What is the sonographic appearance of bilateral MDK?

multiple, round

various sizes

bladder not seen

olighydramnios

Poor Prognosis

97

What is the sonographic appearance of unilateral MDK?

multiple, round

various sizes

bladder seen

hydronephrosis

98

What is UPJ?

uritopelvis junction

99

What is UVJ?

uritovesicilar junction

100
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Hydronephrosis

101

Where is a double collecting system most likely to have hydro?

the superior collecting system

102

What is the most common fetal anomaly?

hydronephrosis

103

What is hydronephrosis usually caused by?

UPJ or UVJ obstruction

104

What is a UPJ obstruction caused by?

bend or kink in ureter

105

What is a UVJ obstruction caused by?

bad valves at trigone region

106

What do normal ureters measure?

1 mm

107

Prune belly syndrome usually occurs in _____________

boys

108

What is hydronephrosis?

Dilation of the renal pelvis due to blockage

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Pyelectasis

110

What is pyelectasis?

abnormal collection of urine within the renal pelvis 5-9 mm

111
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Caliectasis

112
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Caliectasis

113

What is calyectasis?

rounded calyces with renal pelvis dilatation

114

What is Prune Belly Syndrome?

Rare congenital abnormality. A partial or complete lack of abdominal wall muscles w/ renal abnormalities. Usually in males.

anterior abdominal wall defect

urinary tract obstruction

cryptorchidism

hypoplastic abdominal wall muscles

massive distention of bladder

wrinkling

urethral obstruction

bladder enlarges

mega ureter

hydronephrosis

abdomen enlarges

abdominal muscles becomes abnormal

Babies are delived c-section

115
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Prune Belly

116
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Prune Belly

117

What is another name for prune belly syndrome?

Eagle Barrett syndrome

118

What is the sonographic appearance of prune belly syndrome

hydronephrosis with echogenic renal parenchyma

oligohydramnios

urinary ascites

a dystrophic bladder

peritoneal calcifications

119

What is ureteropelvic junction obstruction?

Obstruction of the urinary outflow. Can be acquired or congenital.

obstruction at the confluence of the kidney and the ureter

Sporadic

120

What is the most common cause of hydronephrosis in neonates?

UPJ obstruction

121
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UPJ obstruction

122
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UPJ obstruction

123

What is the sonographic appearance of ureteropelvic junction obstruction?

will often show a dilated renal pelvis

Doppler: Kidney w/higher resistive indices

hyperechoic kidneys

124

What is Ureterovesicle junction obstruction?

Obstruction of the uretrovesical junction causing urine to back up into the ureters and kidneys.

results from stenotic ureteral valve or fibrosis

125

What is the sonographic appearance of Ureterovesicle junction obstruction?

megaureter

hydronephrosis

126
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Ectopic ureterocele

127

What is a Ectopic ureterocele?

the distal ureter does not insert into the urinary bladder

Congenital cystic dilatations of the terminal submucosal ureter

surgical repair or can lead to loss of function

bad insertion of ureter into trigone region

128

What is the sonographic appearance of a Ectopic ureterocele?

Echogenic thin-walled cyst-like structures within the bladder

129

What is ectopic ureterocele usually associated with?

UVJ obstruction

130
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Posterior urethral valve

131

What is Posterior urethral valves?

most common congenital obstructive lesion of the urethra

congenital folds act of male urethra act as valves to obstruct excretion

132

What is the sonographic appearance of Posterior urethral valves?

marked distention bladder

hydronephrosis

hydroureter

oligohydramnios

keyhole sign

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Posterior urethral valve

134

What is a keyhole sign?

...

135

What is the major concern for babies with posterior urethral valves?

baby can't urinate

leading to

olighydramnios

pulmonary hyperplasia

risk of bladder rupture causing urinary ascites

136

What is the most common cause of death for fetus with posterior urethral valves?

pulmonary hyperplasia

137

What is cloaca?

The cloaca is a structure in the development of the urinary and reproductive organs.

plays a developmental role in

genitals

bladder

rectum

138
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Bladder exstrophy

139

What is the most severe form of bladder exstrophy?

cloacal extrophy

colon is affected

140
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Testicular hydrocele

141
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Testicular hydrocele

142

What causes a testicular hydrocele?

process vaginalis does not close completely causing abdominal secretions in scrotal sac.

143

Many testicular hydroceles _____________ within ____________.

Many testicular hydroceles heal themselves within 24 months.

144

What week do the testicles descend?

28 weeks

145

What is Bladder exostrophy?

congenital anomaly, protrusion of the urinary bladder through a defect in the abdominal wall.

146

WHat is the sonographic appearance of Bladder exostrophy?

soft-tissue mass protruding through abdomen

absence of urinary bladder

separation of pubic bone

147

What is a differential diagnosis of bladder exostrophy?

gastroschisis or omphalocele

148

What is a Testicular Hydrocele?

fluid-filled sac surrounding a testicle

usually benign

149

What is the sonographic appearance of Testicular Hydrocele?

simple fluid collection surrounding the testis.

150

What is Osteochondrodysplasia?

general term for a disorder of the development of bone and cartilage

hard to identify prenatally

* filler in multiple choice...usually missed by U/S

151

Explain the TC of a fetus with Osteochondrodysplasia?

measure small

152

What should you do if the femur measures small?

red flag

marker for trisomy 21

measure humerus

153

What is the key bone measurement?

femur length

154

When do the long bones begin to ossification?

end of embryonic period

week 12

155

What is TC?

thoracic circomuference

156

What are the first bones to ossify?

mandible & clavicle

Week 8

157

what usually occurs with musculoskeletal abnormalities?

polyhydramnios

fetal structural anomalies

family history of recurrent syndrome

158

Why are the most lethal musculoskeletal anomolies easier to identify?

they have severe presentations

159

What bones can be Acromelia?

carpal

metacarpal

tarsels

metatarsels

phalanges

160
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Acromelia

161
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Acromelia

162

What is Acromelia?

Bone abnormality shortening of distal limb segment.

163
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Acromelia

164
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Mesomelia

165

What is Mesomelia?

shortening of middle limb segment.

166

What bones can be Mesomelic ?

tibia

fibula

ulnar

radius

167

What is Rhizomelic shortening?

Shortening of proximal limb segment

168
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Rhizomelia

169
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Rhizomelia

170

What bones can be Rhizomelic ?

femur

humerus

171

What is Micromelia shortening?

Shortening of proximal and distal limb segment

dwarfism

172

What is Extactyly?

Absence of fingers or toes

173
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Hemimelia

174

What is Hemimelia?

Absence of below elbow or knee

175
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Phocomelia

176
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Phocomelia

177
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Phocomelia

178

What is Phocomelia?

Absence of middle segment

foot and hand would be attached to femur and humerus

179

What is Sirenomelia?

fusion of legs

mermaid syndrome

180
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Sirenomelia

181
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Sirenomelia

182
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Sirenomelia

183

What is Dystoes?

Absence or malformation of individual bones

184

What is Arthrogryposis?

rigid extremities

185

What is the possible cause of Arthrogryposis?

olighydramnios

186

What is the sonographic appearance of Arthrogryposis?

joint contractures and rigidity.

head was severely hyperextended

fixed extremities

flexed arms

clubbed feet

clenched hands

187

What is Polydactyly?

extra fingers or toes.

188
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Polydactyly

189
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Polydactyly

190
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Clinodactyly & club foot

191
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Clinodactyly

192

What is Clinodactyly?

curvature of a digit

193

What is Pterygium?

webbing across joints

194
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Pterygium

webbing across joints

195
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Talipes equinovarus

196
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Talipes equinovarus

197
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Ectrodactyly

198
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Ectrodactyly

199

What is Talipes?

AKA Club foot.

front half of the foot turns inwards and downwards

200

What is Rocker-bottom feet?

prominent calcaneus and a convex rounded bottom to the foot. The foot resembles the bottom of a rocking chair.

marker for trisomy 18

201
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Rockerbottom feet

202
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Thanatophoric dysplasia

203

What are the lethal forms of Skeletal dysplasia?

Thanatophoric dysplasia

achondrogenesis

camptomelic dysplasia

osteogenesis imperfectal - Type II

Sirenomelia

204

What is the most common non-lethal bone dysplasia?

achondroplasia

205
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Achondroplasia

206

When can rhyzomelia be diagnosed in utero?

by femur length

27 - 30 weeks

measurement of femur length starts dropping off

207

What are the Non-lethal forms of Skeletal dysplasia?

achondroplasia

osteogenesis imperfecta Type IV

208

What is Thanatophporic Dysplasia?

severe skeletal disorder characterized by extremely short limbs and folds of extra skin on the arms and legs.

rhizomelia

bowed long bones

narrow thorax

large head

209

What is the most common form of lethal dwarfism?

Thanatophporic Dysplasia

causes severe micromelia

210

What is the sonographic appearance of Thanatophporic Dysplasia?

clover leaf skull

narrow chest

short ribs

underdeveloped lungs

enlarged head

large forehead and

prominent, wide-spaced eyes.

211
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Kleeblattshadels

212
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Kleeblattshadels

213

What is another name for cloverleaf skull?

kleeblattschädel

214
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horseshoe

215

What are associated anomolies of Thanatophporic Dysplasia?

cloverleaf skull

horseshoe kidneys

ASD

imperforate anus

216
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Achondrogenesis

217

What is the second most common form of lethal dwarfism?

Achondrogenesis

218

What is Achondrogenesis?

rare lethal form of short limbed dyplasia

severe malformation of bones and cartilage. Babies usually still born or die shortly

219

What are the two types of Achondrogenesis?

...

220

What is the sonographic appearance of Achondrogenesis?

demonstration of the triad

severely shortened limbs

lack of vertebral ossification

large head with slightly decreased ossification

221

What is Camptomelic Dysplasia?

Camptomelic Dysplasia: bowing of the long bones

222

What are the most common bones affected by Camptomelic Dysplasia?

tibia

femur

223

What is the sonographic appearance of Camptomelic Dysplasia?

bowing of long bones

hydrocephalus

hydronephrosis

224

What are the anomolies associated with Camptomelic Dysplasia?

heart disease

hydrocephalus

hydronephrosis

225

What is caudal regression syndrome caused by?

early disruption of caudal portion of the neural tube

(sacral anomolies)

includes a range of anomolies

226

What is caudal regression syndrome?

fusion of the lower extremities

male prevalence 3:1

227

What is a mild case of caudal regression syndrome?

sacral anomalies

228

What is the most severe form of caudal regression syndrome?

Sirenomelia

229
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Caudal regression syndrome

230

What are the associated anomalies of caudal regression syndrome?

diabetes

monozygotic twins

231

Sirenomelia

AKA Mermaid Syndrome, very rare congenital deformityin which the legs are fused together

232

What is Osteogenesis Imperfecta Type II?

disorder of production, secretion or function of collagen

most severe form

233
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Osteogenesis Imperfecta type 2

234

What is Osteogenesis Imperfecta Type II characterized by?

bone fragility caused by hypominerization

235

What can delivery trauma lead to with Osteogenesis Imperfecta Type II?

intracranial hemorrhage

stillbirth

236

What is Osteogenesis Imperfecta Type IV?

AKA Brittle bone

fractured or bowed

demineralization of bone

237

Whe does Osteogenesis Imperfecta Type IV occur?

can occur in 3rd trimester

usually does not present until after birth

238

What is the sonographic appearance of Osteogenesis Imperfecta Type IV?

decreased echogenicity

fractures

cortical bone thinning

excessive trabecular bone transparency

239

What is Achondroplasia?

very short limbs and sometimes a face that is small in relation to the skull

240

What is VACTERL?

Vertebral defects

Anal atresia

Cardiac defects

TracheoEsophageal atresia

Renal anomalies

Limb anomolies

241
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vacterl

242
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Esophageal atresia

243

How many anomalies need to be present to be considered VACTERL?

3