Ch. 27, 28, & 29 Flashcards
(124 cards)
1
Q
Flexion
A
Bending forward
2
Q
Extension
A
Bending backward
3
Q
Abduction
A
moving sideways outward
4
Q
Adduction
A
Moving sideways inward
5
Q
Hip is made of
A
Ilium
Ishium
Pubis
6
Q
Developmental Displacement of Hip (DDH)
A
Development of both sides of the neonatal hip requires the femoral head to be seated normally and congruently within the acetabulum
7
Q
If the femoral head and _ are not in their normal position, both sides of the hip will develop abnormally
A
acetabulum
8
Q
Risk factors for DDH
A
Breech female (2.5x more) left hip (64%)(unilateral 64%) 1st born family hx of DDH
9
Q
Neonatal hip dislocation can be
A
acquired, teratogenic, or developmental
10
Q
Acquired causes of hip dislocation include
A
Traumatic and nontraumatic etiologies (i.e., neuromuscular diseases
11
Q
Teratogenic dislocations
A
occur in utero and are associated with neuromuscular disorders.
12
Q
Upon visual inspection, the dislocated hip shows
A
Symmetric skin folds and shortening of the affected thigh. The knee is lower in position on the affected side when the patient is supine and the knees are flexed, known as the galezzi sign.
13
Q
Two basic maneuvers are helpful in the diagnosis of DDH
A
Barlow
Ortolani
14
Q
Barlow maneuver determines
A
if the hip can be dislocated
15
Q
Ortolani maneuver determines
A
if the dislocated femoral head can be reduced back into the acetabulum
16
Q
Barlow
A
supine w/ hip flexed 90 degrees and adducted. Downward and outward pressure is applied
17
Q
Ortolani
A
supine, the examiners hand is placed around the hip to be examined, with the fingers over the femoral head. The examiners middle finger lies over the greater trochanter. The hip is flexed 90 degrees and the thigh is abducted
18
Q
Sonography of the hip can be performed until
A
femoral head ossifies
19
Q
Once the femoral head is completely ossified, it is difficult to obtain adequate sonographic images because of
A
artifact
20
Q
Transducer used for the neonatal hip
A
high frequency linear array
21
Q
Hip:
Primary sonographic imaging performed from
A
lateral or posterolateral aspect of hip while moving hip from neutral position at rest into position in which hip is flexed. Supine position with feet toward sonographer.
Transducer is shifted from right to left hand when examining each hip. Right hip examined with transducer in left hand. Left hip examined with transducer in right hand.
22
Q
The initial treatment of uncomplicated DDH is
A
Closed reduction
23
Q
Closed reduction of the hip may be accomplished by
A
either placing two diapers on the neonate, or using a spica cast, Pavlik harness, or brace
24
Q
If closed reduction of the hip fails or if the dislocation is teratogenic
A
the patient usually requires open reduction
25
Treatment for DDH should begin
before the patient walks
26
Fontanelles
soft spots
27
Neonate: fontanelles not
closed completely
28
Anterior fontanelle: located
at top of neonatal head and felt as “soft spot”
29
If hydrocephalus present, anterior fontanelle is
Bulging
30
If overlapping of cranial bones, fontanelle may be
difficult to palpate and provides a limited window for transducer to image cranial structures
31
Transducer placed carefully on _ to record multiple images of brain in coronal, axial, sagittal planes
anterior fontanelle
32
Fontanelles are
the spaces between the bones of the skull which allow for compression at birth and rapid brain growth thereafter
33
Cerebrospinal fluid (CSF) surrounds the brain and spinal cord and
protects it from physical impact.
34
Approximately _% of the CSF formed by choroid plexuses of lateral, third, fourth ventricles
40
| Remainder produced by extracellular fluid movement from blood through brain and into ventricles
35
Gyri
convolutions on surface of brain caused by infolding of cortex
36
Sulcus
Groove or depression on the surface of brain separating gyri
37
Sulci further divide hemispheres into
frontal, parietal, occipital, and temporal lobes
38
Interhemisphreic fissure
area in which falx cerebri sits and separates two cerebral hemispheres
39
Sylvian fissure
located along lateral most aspect of brain; area where middle cerebral artery is located
40
For the premature or sick infant, most examinations are performed
portably in the neonatal intensive care unit (NICU)
41
Two key concerns for premature or sick infant sonography are keeping the premature infant
safe and warm
42
Neonatal Head Examination Protocol
Small sector transducer with 120-degree sector angle and multifocal capabilities is used to image through anterior fontanelle.
Small footprint curved or sector array, high-frequency transducers (7-10 MHz) may also be used to image near-field pathology from anterior fontanelle.
Lower frequencies of 5-7 MHz may be needed for older infants with closing fontanelles or infants with thick hair.
A 3-5 MHz transducer may also be necessary to visualize deeper structures
43
Sonography of the neonatal brain is initiated through the
anterior fontanelle coronal and sagittal views to study the supratentorial and infratentorial compartments
44
The posterior cranial bones should always
be present in the standard images to ensure the entire brain is being visualized
45
The _ fontanelle is utilized to better visualize the cerebellum and infratentorial compartment, or posterior fossa, in young infants
mastoid
46
A color Doppler (and pulsed Doppler when indicated) evaluation of the pericallosal artery from the mid-sagittal view is also encouraged
pericallosal artery
47
Neonatal head exam: If imaging is restricted due to overlapping bones in the area of the anterior fontanelle, or if pathology is suspected in the choroid plexus and lateral ventricles
the posterior fontanelle may be used as an alternative window
48
Neonatal Head Examination: The posterior fontanelle approach may also be useful for any critical neonate on_, where the mastoid view is unattainab;e
extracorporeal membrane oxygenation(ECMO)
49
Neonatal Head Examination: Additional views of pathology may be obtained from the
posterior or mastoid fontanelle, the foramen magnum, or thin areas over the temporal and parietal bones.
50
Neonatal Head Examination: Small linear array, high-frequency transducers (10 to 15 MHz), with or without a standoff pad, may also be . utilized to image __.
Additional _ views may be very helpful
near field pathology.
| oblique or axial
51
Head:
To perform the coronal study, the transducer is placed on the _________ fontanelle with the scanning plane following the ________ suture
Anterior
| Coronal
52
Head: Coronal study: The middle of the transducer must be centered in the _ to reduce bone interference and to procure the most extensive image of the brain.
Coronal suture
53
Head: coronal: It is critical that _ images be obtained; this is accomplished by _
Symmetrical
| using the skull bones and the middle cerebral arteries at the sylvian fissure as landmarks
54
Head: coronal: The skull bones and the arteries should be the
same size bilaterally
55
Head: Coronal: the transducer is angles from the
anterior to the posterior of the skull to completely visualize the lateral and third ventricles, the deep subcortical white matter, and the basal ganglia
56
Normal protocol for coronal images of the head begins with the transducer angled toward the _ (A and B), then angled to the _ (C, D, E, and F), and finally angled toward the _ occipital area of the skull (G and H
Anterior skull
Midcoronal section
posterior
57
Head: sag: sagittal study is made by rotating the coronal plane approximately _ degrees, positioned over the anterior fontanelle, and aligning with the ___________suture
90
| sagittal
58
Head: The straight sagittal view is _ and can rule out many _anomalies
critical
| midline
59
Head:
_ should be obtained first and may be used as a guide to stay in axis and determine if a parasagittal study corresponds to the right or left side.
Straight sagittal view
60
Head: parasagittal:
| Parasagittal views are obtained by angling the transducer to the _side of the skul
Right or left
61
Head: parasagittal:
| Three parasagittal studies should be performed at minimum, and often more are taken at the _
caudothalamic groove and at the very lateral brain parenchyma
62
Posterior fossa study: The integration of the mastoid view of the posterior fossa (infratentorial compartment) in the routine neonatal head exam increases the detection of __ relating to the third and fourth ventricles, as well as the cerebellum.
congnital anomalies
63
Posterior Fossa Study: The transducer is placed just behind the ____after gently bending the auricle forward.
Ear
64
Posterior Fossa Study: If the transducer notch is pointing upward in a vertical position, this will correspond to a _, whereas if the notch is turned to the right in a horizontal position, it will correspond to a
coronal plane
| transverse or axial plane
65
_ is the most common disorder of the neonatal brain
Ventriculoegaly
66
Ventriculomegaly
Dilation of the ventricular system
67
Hydrocephalus AKA
ventriculomegaly
68
Ventriculomegaly results from
imbalance between production of cerebrospinal fluid (CSF) and its drainage by arachnoid villi
69
Hydrocephalus: 3 mechanisms for development
Obrstrution to outflow
Decreased absorption
Overproduction of CSF
70
Hydrocephalus: Neonates may be diagnosed in _____, or may present clinically with a bulging _________ fontanelle and/or macrocephaly
Utero
| Anterior
71
The most common cause of both acquired and congenital hydrocephalus is
Aqueductal stenoisi
72
Hydrocephalus: The aqueduct of Sylvius, situated in
the midbrain, is narrowed or replaced by multiple small channels with blind ends
73
Acquired Brain LesionsIntracranial Hemorrhage: _ is at the greatest risk for intracranial hemorrhage (ICH) and it is a major cause of mortality and morbidity (cerebral palsy) in this population
The premature neonate
74
Intracranial hemorrhages, also more specifically termed germinal matrix-intraventricular hemorrhages (GM-IVHs), are the most common _ in preterm neonates.
Hemorrhagic lesion
75
Intracranial hemorrhages (germinal matrix-intraventricular hemorrhages) They affect _% to _% of infants less than 34 weeks of gestation, with an increased risk in infants less than 32 weeks’ gestational age or less than 1500 grams birth weight
40-70%
76
GM-IVHs are a
developmental disease, as they originate in the subependymal germinal matrix
77
While hemorrhage begins in the subependymal germinal matrix, it can spread throughout
the ventricular system and, at worse case, into the parenchyma
78
Classification of Subependymal Intraventricular Hemorrhages
Grade I: SEH or IVH w/o ventricular enlargement
Grade II: SEH or IVH with minimal ventricular enlargement
Grade III: SEH or IVH with moderate or large ventricular enlargement
Grade IV: SEH or IVH with intraparenchymal hemorrhage
79
Neural tube arises from _ and becomes _
ectodermal cells
| the spinal cord and brain
80
_ forms bony spine, meninges, and muscle
Mesoderm
81
Defects of the spine occur in
the first 8.5 wks of life as the fetal nervous system develops
82
House the spinal cord, spinal nerve roots, and meninges
Vertebral column
83
of vertebrae
33
84
of cervical vertebrae
7
85
of thoracic vertebrae
12
86
of lumbar vertebrae
5
87
of sacral vertebrae
5
88
of coccygeal vertebrae
4
89
Cylindrical grayish white structure
Spinal cord
90
Meninges: outer strong, dense, fibrous sheet
Dura mater
91
Meninges: middle layer subarachnoid space: filled with cerebral spinal fluid
Arachnoid mater
92
Meninges: inter vascular layer
Pia mater
93
The spinal cord begins _ and is continuous with _
Above the foramen magna
| Medulla oblongata
94
Spinal cord terminates at _ in adults
Lower border of L1
95
Spinal cord terminates at _ in children
Upper border of L3
96
Inferiority tapered point of the spinal cord
Conis medullaris
97
Prolongation of pia mater that is attached to the coccyx (attached bottom of SC to coccyx
Filum terminale
98
Lower nerve roots “horse tail”
Cauda equina
99
With spinal deformity, conis medullaris
Will be lower
100
of nerve root pairs
31
101
Carries impulses to and from the brain to the rest of the body
Nerve roots
102
Sono technique for spine
```
High frequency linear transducer
Possible standoff pad
*Prone, spine flexed
* lateral decubitus
* upright
```
103
_ allows visualization of the spinal cord
Incomplete ossification of posterior spinal elements
104
Sono spine: where do you begin
1. Sacral area and follow the SC in a cranial direction
| 2. Count from lowest room bearing vertebrae (rib over kidney & follow medially) determine level of conis medillaris
105
Sono appearance of vertebral bodies
Echogenic
| Anterior
106
Sono appearance of lamina
Slightly off midline “overlapping roof tiles”
107
Sono appearance Of spinous processes
Inverted U’s
108
Sono appearance Of coccyx
Hypoechoic
| Do not mistake for a fluid collection
109
Sono appearance Of SC
Hypoechoic with slightly echogenic borders and an echogenic lobe extending along it’s middle
110
Sono appearance Of nerve roots
Echogenic
| Move and change configuration during respiratory variations
111
Sono appearance Of conis medullaris
Normally above end plate of L3; most cords end above L2, most tethered cords are unquestionably low
112
Tethered cord
Fixation off cord @ abnormal caudal location below L3
Diminished cord movement
Cord mechanical stretching, distortion, and ischemia with growth and activity
113
Sono appearance Of tethered cord
Visualization of cord caudal to normal termination
Diminished cord pulsation
Eccentric cord location with the canal
114
Lipoma
Fatty masses that have connections with SC
Continuous with subcutaneous tissues and presents as a fatty back lump.
Frequently associated with tethered cord.
115
Sono appearance Of lipoma
Echogenic mass
116
Hydromelia
Dilation of central canal increased fluid
| Diffuse of focal
117
Sono appearance Of hydromelia
Separation of echogenic linear structure of central canal
118
Diastematomyelia
Split cord
Cord is split at one or more sites by a septum
Vertebral column abnormal on plain radiography
119
Sono appearance Of diastematomyelia
Split segments best seen in trans view
120
Cysts on Spinal Cord may be seen in
Cauda equine or film terminale
Small cysts in filum terminale may be remnants of a terminal ventricle or an arachnoid pseudocyst Related to tethered Cord
121
Myelomeningocele Spina Bifida
Low termination of spinal cord
| Protruding pouch containing CSF and nerves
122
Sono findings of Myelomeningocele Spina Bifida
Flat non- tubulated cord with nerve roots extending into the defect.
123
Small dimple like opening in the midline of the spine connecting deep into the spinal cord.
The majority located at the level of the sacrum or the lumbar region.
Communication with spinal canal contents increases possibility of meningitis Attaches to the end of the spinal cord, causing tethering
Dermal Sinus Tract
124
Sono findings of Dermal Sinus Tract
Easily followed if fluid filled or
disrupts normal soft tissue planes
Dural penetration is difficult to ascertain or exclude on sonography
