welcome to section 11.1 of genetics in this section we will be memorizing the details of turner syndrome so let's get started this story takes place in a mythical forest as you can see there is a scared little hobbit-like character if you thought he was just standing alone in the forest you were wrong he's actually hanging there all alone in the forest this canopy of spider webs represents the lymphatic system these little bumps on the webs represent lymph nodes turns patients often have lymphatic blockage frequently in the neck region resulting in cystic hygroma a fluid filled neck bulge so the webbing around the neck should help you remember patients have webbed and necks the webbing itself should help you remember lymphatic blockage notice this guy's large hands and feet i guess this hobbit-like character was chosen appropriately this will help you remember that lymphatic blockage can result in lymphedema or swelling of the hands and feet now let's bring in our human hero look as he comes riding in on his stunning horse his weapon of choice is a sling as he turns it around quickly through the air it looks like a t t for turners so it's turning so again this is turner syndrome now notice this arching tree here that our warrior is approaching this is shaped like the aortic arch at the base on the left is the trunk of the tree notice that it is split in two this is to help remind you that turner syndrome patients often have bicuspid aortic valves instead of the normal three cusps of their aortic valve at the top of the arching tree there are branches coming off then we can see this little tiny spot right here this is to remind you of aortic coarctation which is often present in turner's patients when it comes to symptoms of aortic coarctation use some simple logic to deduce them if there is a stricture reducing blood flow to the lower extremities it makes sense that blood pressure or even pulse pressure would be lower in the legs if blood is building up proximal to the blockage then the arms would receive higher pressures which means the upper extremities would have a higher blood pressure or pulse pressure so if you get a question about a patient with higher blood pressure in the upper extremities and lower blood pressure in the lower extremities you should consider turner syndrome and aortic correctation now that we've discussed this aortic tree here let's bring in the villain the big bad spider this beautiful horse hits this giant spider with its head knocking it against this aortic tree really close to this aortic coordination actually now just to clarify the spider in this image isn't used to symbolize anything the value in this giant spider is to be awesome looking and to be an excellent villain to help tie together this whole image especially the webs in the back and a few other items we will discuss shortly here is another hobbit-like creature he's obviously freaked out by the spider though lucky enough not to have fallen victim to its webs like the other guy this little guy will help you remember the short stature in turner syndrome patients and once again he has big puffy hands and feet which will help reinforce the idea of lymphedema of the hands and feet which we discussed before it looks like our hero arrived just in time because this little guy was oblivious to the spider which was about to strike him he was too distracted by his compelling game of tic-tac-toe notice that an x and an o are all that have been etched into the game so far this is to remind you that turner's patients have a 45 exo genotype normally there are two x chromosomes and females contributing to the total number of 46 chromosomes with one x chromosome absent signified by the o that means these females have only 45 chromosomes so xo in tic-tac-toe 45 exogenotype now look back here at these spider eggs it looks like they got all smashed up this is to help you remember that there is ovarian dysgenesis in turner's patients so their ovaries lack the ability to put out healthy eggs if you can remember that ovaries are dysfunctional you can deduce some additional findings which are very intuitive now this is an image of a tertiary follicle within an ovary which is discussed in detail within the reproductive physiology chapter right now i want to draw your attention to the granulosa cells and the the internal cells the granulosa cells indicated by this box normally produce estrogen and they are stimulated by fsh if estrogen is low then the anterior pituitary gland will release more fsh in an attempt to increase estrogen the box on the right represents the internal cells which produce the androgens with which the granulosa cells produce estrogen again if estrogen is low the anterior pituitary will increase lh in order to aid the production of estrogen so lh will be high so if ovaries are dysfunctional deduce that estrogen is low and lh and fsh are high now notice this eggy goo leading away from the nest it's almost as if someone stomped on the eggs and then walked away sure enough this little guy smashed those eggs naturally he is scared he knows he did something to really upset the spider he is even ready to shield his chest from attack this shield over his chest will help you remember that turner's syndrome patients often have a shield shaped chest this just means their nipples are widely spaced and their chest is broad finally look at the patch of kidney beans that this horse galloped through and now look at these nice horseshoes these nice horseshoes in the kidney beans will help you remember that turner's patients often have a horseshoe shaped kidney you may have also noticed that the road in which our two hobbit-like characters are sitting is also shaped like a horseshoe this will just further reinforce this concept and with horseshoe kidneys we have concluded our image mnemonic on turner syndrome