Chapter 24: Sonographic Assessment of the Fetal Neck and Spine Flashcards
(147 cards)
1
Q
Examination of the neck region includes evaluation of the ____ and ____
A
spinal structures
soft tissues
2
Q
Examination of the anterior neck region is useful in the detection of different abnormalities that may include:
A
goiter
hemangioma
teratoma
3
Q
As early at the ___ week of gestation, the cervical spine structure allows for detailed investigation of the cervical segment of the spine
A
18th
4
Q
____ images are considered best for evaluating structures of the fetal neck.
A
Coronal
5
Q
abnormally formed organs
A
dysgenesis
6
Q
herniation of abdominal contents without a covering into the abdominal fluid
A
gastrochisis
7
Q
tumor composed of fat
A
lipoma
8
Q
combination of nonimmune fetal hydrops and a cystic hygroma
A
lymphangiectasia
9
Q
spinal defect where the meninges protrude
A
meningocele
10
Q
protrusion of a sac from a spinal defect containing spinal cord and meninges
A
Myelomeningocele
11
Q
Incomplete fusion of the neural tube resulting in a cleft spinal cord
A
Myeloschisis
12
Q
either the rostral or caudal end of the neural tube
A
neuropore
13
Q
herniation of the abdominal contents with a membranous cover
A
omphalocele
14
Q
ability of embryonic cells to differentiate into any type of cell
A
pluripotent
15
Q
The fetal spine images as individual verterbrae, with three brightly echogenic ossification centers in the transverse plane by the ____ week of gestation
A
16th
16
Q
Two ossification centers lie:
A
posterior to the spinal canal within the laminae
17
Q
One ossification center lies:
A
anterior within the vertebral body
18
Q
Three types of scanning planes help with the evaluation of spinal integrity:
A
transverse
coronal
sagittal
19
Q
Three ossification centers surround the _____
A
neural canal
20
Q
At the cervical level, the posterior ossification centers at the cervical vertebrae have a ______ shape.
A
quadrangular
21
Q
At the triangular thoracic and lumbar level, the ossification centers image in an :
A
inverted triangle with the base toward the dorsum of the fetus
22
Q
At the level of the sacrum, the posterior ossification centers have a _____ placement than the upper vertebrae.
A
wider
23
Q
a parallel structure ending in the pointed sacrum
A
spine
24
Q
Divergence of the posterior elements suggests abnormality, probably a ______ or ______
A
meningocele
meningomyelocele
25
Determination of spinal normalcy is through identification of:
intact neural canal
normal location and shape of spinal ossification centers
intact dorsal skin contour
26
AFP is a glycoprotein secreted by the ____ and then by the _____.
yolk sac
fetal liver
27
Maternal serum AFP levels occur through diffusion across the ____ and ____.
placenta
amnion
28
neural tissue is exposed or covered by only a thin membrane
open neural tube defects
29
AFP is elevated in ____ neural tube defects
open
30
Skin-covered or closed neural tube defects result in _____ AFP
normal
31
Typically, ____ MoM is used as the level for a positive screen
2.5
32
AFP elevation disorders
omphalocele
gastrochisis
skin disorders
33
AFP lower disorders
Down Syndrome
34
Jugular lymph sacs fail to communicate with the venous system, they may enlarge as the fill with lymph and form _____
cystic hygromas
35
Failure in lymphatic drainage may accompany hydrops fetalis, resulting in a process called ______
lymphangiectasia
36
Most common located of cystic hygromas
lateral neck region
37
______ trisomies and trisomy ___ demonstrate an increased incidence of hygromas in the first trimester
autosomal
21
38
The large veins linked to the development of cystic hygromas are due to:
increased volume of blood flow resulting from lack of lymphatic drainage
39
Nonimmune hydrops manifests sonographically as:
ascites
pleural effusion
pericardial effusion
skin edema
40
Differential diagnoses of cystic hygromas
cystic teratomas
cephaloceles
hemangiomas
branchial cleft cysts
nuchal edema
41
The central nervous system begins as the ____ in the embryo.
neural tube
42
Infloding of the slipper-shaped ectoderm of the neural plate during the ____ week of embryonic life forms the neural tube.
third
43
The ______ fuses to form the neural tube beginning midembryo and completing at the cranial and caudal neuropore
neural groove
44
If the neural tube fails to fuse:
spina bifida with myeloschisis develops
45
a NTD resulting from incomplete closure of the bony elements of the spine posteriorly
spina bifida
46
Two types of spina bifida lesions
ventral
dorsal
47
involves vertebral body splitting and development of a neurogenic-origin cystic structure
ventral defect
48
Closed spina bifida, or ______, has the split vertebrae covered by skin.
spina bifida occulta
49
Spina bifida _____ is the simplest form, in which there is a failure of the dorsal portions of the vertebrae to fuse with one another.
occulta
50
The expected location of spina bifida occulta is:
sacrolumbar level
51
Open spina bifida, or _______, is a full thickness defect of the skin, underlying soft tissues, and vertebral arches- thus exposing the neural canal.
spina bifida aperta
52
Spina bifida aperta occurs in ___% of all spina bifida cases
85
53
The ______ lesion has a thin meningeal membrane that does not contain neural tissue.
Meninogocele
54
The _____ contains neural tissue inside the protruding sac.
myelomeningocele
55
Causative mechanics of NTDs
genetic factors
nutritional factors
environmental factors
combo
diabetes mellitus
obesity
folate deficiency
56
Location and severity of spina bifida defects have the greatest chance of detection on the _____ views.
sagittal
57
Displacement of cranial structures into the foramen magnum and superior cervical canal is caused by:
cerebrospinal fluid leakage
58
abnormal lateral curvature of the spine caused by anomalous development of the vertebrae, either failure of formation or segmentation
congenital scoliosis
59
Congenital scoliosis can be caused by:
cardiac, genitourinary, and skeletal abnormalities
60
Abnormal anterior angulation of the spine
kyphosis
61
combination of the abnormal lateral and anterior curvature
kyphoscoliosis
62
______, caused by aplasia or dysgenesis of one of the who chondrification centers forming the vertebral bodies , identify sonographically by lateral displacement of the anterior ossifications centers or improperly aligned vertebral bodies
Hemivertebrae
63
a broad term that refers to a heterogeneous group of congenital anomalies affecting the caudal spine and spinal cord, the hindgut, the urogenital system, and the lower limbs
caudal regression syndrome
64
Disruption of the embryonic process of canalization in the third week of gestation results in varying degrees of:
caudal regression syndrome
65
In the normal embryo the conus, filum terminale, sacral nerve roots, and lower genitourinary structures originate from:
caudal mesoderm
66
the main differential for caudal regression syndrome
sirenomelia
67
The mechanism of sirenomelia is thought to be:
shunting of blood from the aorta through the umbilical artery, resulting in a vascular steel
68
Main finding for sirenomelia
fusion of the legs
69
Sirenomelia is also known as:
mermaid syndrome
70
In the fetus, teratomes develops in the _____, ____, _____ or anywhere on the neural tube with the ______ the most common location.
gonads
umbilical cord
placenta
caudal end (sacrococcygeal_
71
Tumor that arising from the presacral area of the spine
sacrococcygeal teratomas
72
most common neoplasm of the newborn
sacrococcygeal teratomas
73
Germ layers of germ cell tumor
ectoderm
mesoderm
endoderm
74
The origin of the sacrococcygeal tumor is thought to be a:
remnant of the primitive streak leading to the inclusion of various embryonic tissue types within the tumor.
75
the pluripotent tissue derived from the area around the Henson node migrates rostrally to lie in the coccyx
sacrococcygeal tumore
76
images as a protrusion between the anus and the coccyx
sacrococcygeal tumor
77
Perinatal mortality and morbidity are most strongly related to high-output cardiac failure because of:
arterivenous shunting within the tumor, subsequent fetal hydrops, polyhydramnios, and preterm delivery
78
The normal fetal spine has three ossification centers:
centrum
right
left neural processes
79
Sagittal images of the spine include:
vertebral body
lateral ossification centers
caudal end tapering
skin integrity
examination of the spinal curvature
80
_____ view of the spine is the best plane to identify spinal defects
Transverse (axial)
81
Elevated MSAFP of ____ MoM raises suspicion for an open neural tube or abdominal wall defect/
2.5
82
_______ are the result of lymph vessel obstruction, usually occurring in the head or neck region.
Cystic hygromas
83
an open spinal defect with varying degrees of severity
spina bifida
84
_____ and _____ are abnormal curvatures of the spine and may be caused by skeletal dysplasias or a hemivertebrae.
scoliosis
kyphosis
85
germ cell tumors found in the sacral area
sacrococcygeal teratomas
86
Examination of the anterior neck region is useful in the detection of different abnormalities that may include all except:
a. goiter
b. hemangioma
c. rachischisis
d. teratoma
c
87
Choose the anatomy that can be detected in the fetal neck.
a. carotid bifurcation
b. anterior communicating artery
c. brachial artery
d. superior vena cava
a
88
How many ossification centers surround the neural canal?
3
89
Select the fetal position that offers a true sagittal view of the spine.
a. transverse
b. oblique
c. cephalic
d. prone
d
90
Determination of spinal normalcy is through identification of all except:
a. an intact neural canal
b. divergence of the posterior ossification elements
c. a normal location and shape of spinal ossification centers
d. an intact doral skin contours
b
91
Screening for neural tube defects is performed by all except:
a. hCG
b. sonography
c. MSAFP
d. biochemical testing
a
92
The most common location for a cystic hygroma is:
at the lateral neck region
93
The form of spina bifida where split vertebrae are covered by the skin is:
spina bifida occulta
94
Anomalies frequently seen in the fetus relating to spina bifida involve the fetal:
cranium
95
Fetuses affected by spina bifida aperta commonly demonstrate:
bilateral club feet
96
Scoliosis is an abnormal:
a. anterior angulation of the spine
b. posterior angulation of the spine
c. lateral curvature of the spine
d. thoracic defect of the spine
c
97
A term that refers to a heterogeneous group of congenital anomalies affecting the distal spine and cord, the hindgut, the urogenital system, and the lower limbs is:
caudal regression syndrome
98
A sacrococcygeal teratoma most commonly images as a protrusion:
between the anus and the coccyx
99
The earliest visible indication of caudal regression syndrome is:
a short crown-rump length and abnormal yolk sac
100
Cystic hygromas are the result of _____ obstruction, usually occurring in the head or neck region.
lymph vessel
101
The normal fetal spine has ___ ossification centers: the centrum, right, and left neural processes.
3
102
The fetal spine images with brightly echogenic ossification centers in the transverse plane by the ____ week of gestation.
16th
103
Three types of scanning planes help with the evaluation of spinal integrity, ______, ______, and ______.
transverse
coronal
sagittal
104
AFP is elevated in NTD, other open fetal defects, such as ______ and ______, as well as skin disorders that increase the diffusion of AFP through fetal skin.
omphalocele
gastroschisis
105
Cystic hygromas appear as either single or ______ fluid-filled cavities and are usually located on the _____ neck.
multiloculated
lateral
106
The two types of spina bifida lesions are _____ and _____. The most common form of the process is _____ spina bifida.
multiloculated
lateral
107
The two types of spina bifida lesions are are ____ and _____. The most common form of the process is ____ spina bifida.
ventral
dorsal
closed
108
The location and severity of spina bifida have the greatest chance of detection on _____ views.
sagittal
109
Fusion of the fetal legs is known as the _____ syndrome, also known as _____.
mermaid
sirenomelia
110
The most common location of a neural tube teratoma is the _____ end.
caudal
111
Sagittal and coronal images of _______ and spinal anatomy assist in detecting spinal normalcy or assist in locating anomalous deviations.
conus medullaris
112
A break in the skin surface directly over the spine is associated with:
myelomeningocele
113
A large herniation of the posterior fossa contents into the foramen magnum with hydrocephalus and myelomeninocele describes which type of Arnold-Chiari malformation
3
114
A markedly retroflexed neck is an indication of
iniencephaly
115
Neural plate development completes at ____ days
18-23
116
What central nervous system malformation is identifiable in the first trimester?
spina bifida
117
What abnormality is most commonly associated with cystic hygroma?
Turner Syndrome
118
A cystic hygroma is the result of
lymphatic fluid
119
What would most likely involve the development of a cystic hygroma?
Turners Syndrome
120
The most common location of a cystic hygroma is within the:
neck
121
A benign congenital neck cyst found most often near the angle of the mandible
branchial cleft cyst
122
A large, mostly cystic mass containing a thick, midline septation is noted in the cervical spine region of the fetus. This most likely represents a:
cystic hygroma
123
Protusion of meninges through a spinal defect
meningoceles
124
The defect that has a cleft spinal cord
myeloschisis
125
A group of anomalies associated with the entrapment of fetal parts and fetal amputations is:
amniotic band syndrome
126
What is the maternal dietary supplement that has been shown to significantly reduce the likelihood of the fetus suffering from a neural tube defect?
folate
127
Talipes equinovarus is associated with:
clubfoot
128
The condition associated with the absence of the sacrum and coccyx:
caudal regression syndrome
129
Spina bifida occulta does not show _____ MSAFP
elevated
130
Spina bifida cystica has normal MSAFP.
false
131
An enlarged posterior fossa is associated with spina bifida.
false
132
The abnormal lateral curvature of the spine is referred to as:
scoliosis
133
Limb body wall complex shows decreased MSAFP
false
134
A disorder that results in abnormal bone growth and dwarfism
achondroplasia
135
______ would increase the likelihood of a fetus developing sirenomelia and caudal regression syndrome.
preexisting diabetes
136
The most common nonlethal skeletal dysplasia is
achondroplasia
137
What abnormalities results in limitation of the fetal limbs as a result of joint contractures?
arthropiosis
138
Shortening of the proximal segments of the limbs
Rhizomelia
139
An absent sacrum and coccyx is referred to as:
caudal regression syndrome
140
absent long bones with the hands and feet arising from the shoulders and hips describes:
phocomelia
141
Upon sonographic interrogation of a 28 week pregnancy, you note that when pressure is applied to the fetal skull, the skull can easily be distorted. This is sonographic evidence of:
osteogenesis imperfecta
142
A bell shaped chest and multiple fetal fractures are indicative of:
osteogenesis imperfecta
143
Synechia is not associated with amniotic band syndrome.
true
144
The exaggerated distance between the first toe and the second toe is:
sandal gap
145
Sirenomelia is commonly referred to as:
mermaid syndrome
146
Absence of the radius referred to as:
radial ray defect
147
