S3L3: Spina Bifida part 1

Question 1

Neural tube defect resulting in vertebral and/or spinal cord malformation

Answer 1

Spina bifida

Question 2

T/F Spina bifida is when the spinal cord of the fetus doesn’t close completely during the third month of pregnancy.

Answer 2

F.
first month of pregnancy.

Question 3

T/F
* Males are more affected in Spina bifida
* they are 4-8 times higher than females

Answer 3

FF

F>M, 3-7 times higher

Question 4

T/F. Etiology of spina bifida is that it’s Both polygenic inheritance and environmental influences

Answer 4

T

Question 5

T/F. First-degree relatives of people with spina bifida have an increased risk of the condition compared with people in the next population

Answer 5

T

Question 6

Choose the correct letter for each number

1) Folate deficiency
2) Maternal obesity
3) African-Americans, Caucasians more commonly have it, and Hispanics have a higher incidence
4) Maternal obesity

A. Environmental
B. Genetic factors

Answer 6

1. A
2. A
3. B
4. A

Question 7

Choose the correct letter for each number

1) (BMI) suggestive of obesity (>29 kg/m)
2) Increase of: Vitamin A, valproic acid, solvents, lead herbicides, glycol ether, clomiphene, carbamazepine, aminopterin, alcohol
3) Mutations/polymorphisms in the enzyme 5,10-methylenetetrahydrofolate reductase (MTHFR)
have been associated with diminished plasma folate levels with commensurate elevated homocysteine levels.

A. Environmental
B. Genetic factors

Answer 7

1. A
2. A
3. B

Question 8

T/F.
* Methylenetetrahydrofolate reductase is Important for a chemical reaction involving the vitamin folate
* vitamin folate is also called vitamin B8

Answer 8

TF

vitamin B9

Question 9

T/F. A shortage of this vitamin (Folate) is an established risk factor for neural tube defects like spina bifida.

Answer 9

T

Question 10

formation of the caudal structures of the neural tube forming the sacral
and coccygeal portion 26th DAY

A. Primary neuralization
B. Secondary neuralization

Answer 10

B

Question 11

-closure of the neural tube forming the brain and spinal cord

A. Primary neuralization
B. Secondary neuralization

Answer 11

A

Question 12

Completely open brain and spinal cord

A. Craniorachischisis
B. Anencephaly
C. Encephalocele
D. Iniencephaly

Answer 12

A.

Question 13

Occipital skull and spine defects with extreme retroflexion of the head

A. Craniorachischisis
B. Anencephaly
C. Encephalocele
D. Iniencephaly

Answer 13

D

Question 14

Herniation of the meninges (and brain)

A. Craniorachischisis
B. Anencephaly
C. Encephalocele
D. Iniencephaly

Answer 14

C

Question 15

Open brain and lack of skull vault

A. Craniorachischisis
B. Anencephaly
C. Encephalocele
D. Iniencephaly

Answer 15

B

Question 16

Closed asymptomatic NTD in which some of the vertebrae are not completely closed

A. Spina bifida occulta
B. Closed spinal dysraphism
C. Meningocele
D. Myelomeningocele

Answer 16

A

Question 17

Open spinal cord (with a meningeal cyst)

A. Spina bifida occulta
B. Closed spinal dysraphism
C. Meningocele
D. Myelomeningocele

Answer 17

D

Question 18

Protrusion of the meninges (filled with CSF) through a defect in the skull or spine

A. Spina bifida occulta
B. Closed spinal dysraphism
C. Meningocele
D. Myelomeningocele

Answer 18

C

Question 19

Deficiency of at least two vertebral arches, here covered with a lipoma

A. Spina bifida occulta
B. Closed spinal dysraphism
C. Meningocele
D. Myelomeningocele

Answer 19

B

Question 20

T/F in PRENATAL DIAGNOSIS

• Measurement of AFP and acetylcholinesterase in maternal seum and amniotic sac is done
• Fetal ultrasound (16-25th weeks)

Answer 20

TF

16-24th weeks

Question 21

T/F in PRENATAL DIAGNOSIS,
* There’s Elevated alpha-fetoprotein (AFP) level in the amniotic fluid.
* Amniocentesis can be done at the 16-18th wk

Answer 21

TT

Question 22

• Closed spinal dysraphism’s, most mild form
• Vertebral arch fails to grow and fuse normally but the spinal cord and meninges are not disturbed. This lesion is most commonly located in the lumbar or sacral

A. SPINA BIFIDA OCCULTA
B. SPINA BIFIDA (Open)
C. MENINGOCOELE
D. MYELOMENINGOCOELE
E. MYELOSCHISIS

Answer 22

A

Question 23

• can occur anywhere along the spinal axis but most commonly is found in the lumbar region. In this condition, the spine is bifid and a cyst forms)

A. SPINA BIFIDA OCCULTA
B. SPINA BIFIDA Cystica
C. MENINGOCOELE
D. MYELOMENINGOCOELE
E. MYELOSCHISIS

Answer 23

B

Question 24

• myeloschisis, tethering of the distal spinal cord, and hydrocephalus.)

A. SPINA BIFIDA OCCULTA
B. SPINA BIFIDA Manifesta
C. MENINGOCOELE
D. MYELOMENINGOCOELE
E. MYELOSCHISIS

Answer 24

B

Question 25

involves a defect of the posterior elements of the spine with extrusion of meninges and cerebrospinal fluid (CSF) without the involvement of the neural elements. A. SPINA BIFIDA OCCULTA B. SPINA BIFIDA (Open) C. MENINGOCOELE D. MYELOMENINGOCOELE E. MYELOSCHISIS

Answer 25

C

Question 26

Extrusion of meninges, CSF, and functional neural elements such as nerve or spinal cord contents. (+) More functional Limitations A. SPINA BIFIDA OCCULTA B. SPINA BIFIDA (Open) C. MENINGOCOELE D. MYELOMENINGOCOELE E. MYELOSCHISIS

Answer 26

D

Question 27

- the neural tissue is exposed to the environment without a sac or meninges A. SPINA BIFIDA OCCULTA B. SPINA BIFIDA (Open) C. MENINGOCOELE D. MYELOMENINGOCOELE E. MYELOSCHISIS

Answer 27

E

Question 28

T/F. During the physical assessment, assess for: open wound * deformities * skin abnormalities * sensation * changes in muscle tone * changes in muscle strength * changes in range of motion * contractures * dislocation * developmental milestones

Answer 28

T

Question 29

Spare the upper extremities, with the exception of decreased ability to abduct the fifth digit (thoracic level 1 = T1). * Partial innervation of the abdominal and intercostal musculature, which may result in respiratory dysfunction or insufficiency. Kyphosis and kyphoscoliosis A. Thoracic lesions B. L1-L3 C. L4-L5 D. SACRAL LESIONS E. SENSORY DEFICITS

Answer 29

A

Question 30

* The usual LE posture in the supine position is partial hip ER, ABD and ankle PF → tightness →Contracture * Deformities develop from sitting, HIP FIx+knee fix, and equinus A. Thoracic lesions B. L1-L3 C. L4-L5 D. SACRAL LESIONS E. SENSORY DEFICITS

Answer 30

A

Question 31

* With L2 sparing, knee extensors have partial innervation but are not at full strength * Distal LE muscle strength is absent. A. Thoracic lesions B. L1-L3 C. L4-L5 D. SACRAL LESIONS E. SENSORY DEFICITS

Answer 31

B

Question 32

* The distribution of muscle imbalance-hip flexion and hip adduction→ hip post dislocation * Gravity-related foot equinus deformity may develop. A. Thoracic lesions B. L1-L3 C. L4-L5 D. SACRAL LESIONS E. SENSORY DEFICITS

Answer 32

B

Question 33

* Innervation of the hip flexors, hip adductors, and knee extensors are usually complete; however, hip abductors and hip extensors remain weakened * Hip dislocation occurs later at the L4-L5 segmental levels A. Thoracic lesions B. L1-L3 C. L4-L5 D. SACRAL LESIONS E. SENSORY DEFICITS

Answer 33

C

Question 34

* When the L5 segment is spared, the gluteus medius, gluteus maximus, and hamstrings have partial strength and knee extensor contracture is less likely. * Because the tibialis anterior is unopposed by its plantarflexion and everter antagonists, a calcaneovarus foot deformity develops. A. Thoracic lesions B. L1-L3 C. L4-L5 D. SACRAL LESIONS E. SENSORY DEFICITS

Answer 34

B

Question 35

* Active plantarflexion is present and some toe movements are present. * Intrinsic foot muscles remain weak and may result in a cavus foot deformity with clawing of the toes. A. Thoracic lesions B. L1-L3 C. L4-L5 D. SACRAL LESIONS E. SENSORY DEFICITS

Answer 35

D

Question 36

* Partial or complete absence of different sensory modalities predisposes individuals with spina bifida to skin injuries because of decreased ability to perceive pressure, pain, trauma, or heat * Skin breakdown tends to occur over areas of prominence and weight bearing. The lower back, intergluteal, perineum, feet, heels, and toes are the sites of predilection A. Thoracic lesions B. L1-L3 C. L4-L5 D. SACRAL LESIONS E. SENSORY DEFICITS

Answer 36

E

Question 37

* A pressure ulcer may be a symptom of a tethered cord. * Long-standing ulceration with deep tissue necrosis may spread to bone and lead to acute or chronic osteomyelitis. A. Thoracic lesions B. L1-L3 C. L4-L5 D. SACRAL LESIONS E. SENSORY DEFICITS

Answer 37

E

Question 38

T/F - An absence of motor and sensory function (usually bilateral) below the level of the spinal defect and loss of neural control of bowel and bladder function. - Unilateral motor and sensory loss has been seen and the pattern of loss may also be asymmetric, with a higher motor or sensory level on one side compared with the other. The functional deficits may be partial or complete, but they are almost always permanent.

Answer 38

TT

Question 39

T/F - Motor and sensory deficits vary according to the level and extent of spinal cord involvement - Neurologic or functional level that gives health care providers prognostic information with respect to long-term expectations and functional outcomes.

Answer 39

TT

Question 40

T/F - Patients may present with symptoms of spasticity, pain, motor deficits, neurogenic bowel and/or bladder, cognitive deficits, seizures, and even endocrine disorders such as precocious puberty. - motor involvement including weakness, flaccidity, spasticity, and contractures.

Answer 40

TT

Question 41

T/F. Foot deformities are common in Neural tube defects and include equinovarus, calcaneus, and rocker bottom deformities.

Answer 41

T

Question 42

T/F Neurologic Complications Of Spina Bifida include * Diastematomyelia * Tethered cord syndrome * Arnold Chiari malformation II * Abnormality of ventricles * Forebrain affectation * Non-neurologic: Latex Allergy

Answer 42

T

Question 43

describes the overlapping of the frontal bones due to a posterior shift of intracranial contents. A. Lemon sign B. Banana sign

Answer 43

A

Question 44

curved cerebellum due to its downward displacement often leading to Arnold-Chiari II malformation at birth. A. Lemon sign B. Banana sign

Answer 44

B

Question 45

T/F - Studies of children with postnatally diagnosed myelomeningocele suggest that less severe ventriculomegaly and a higher anatomic level of lesion on prenatal ultrasonograms predict better developmental outcomes in childhood. - Aggressive treatment with closure in the neonatal period leads to survival in most cases of spina bifida.

Answer 45

FT prenatally diagnosed lower anatomic level of lesion

Question 46

T/F the prognosis depends mostly on the presence of - Hydrocephalus - Level of defect and - Severity of Chiari malformation.

Answer 46

T

Question 47

T/F * Neurogenic bowel and bladder are present in all but the lowest sacral lesions. * The higher the lesion, the lesser the likelihood of cognitive impairment

Answer 47

TF greater the likelihood of cognitive impairment

Question 48

T/F * Children born today have a near-normal lifespan * Folic acid supplementation greatly reduces the risk of neural tube defects.

Answer 48

TT

Question 49

Match the AMBULATION POTENTIAL with ASSOCIATED MOTOR STRENGTH 1) Community Ambulation without AD 2) No complete reliance on W/C use; majority are communit ambulators 3) Partial or complete reliance on W/c A. Grade 4-5 gluteal and TA B. Gr 4-5 iliopsoas and quads C. Gr 0-3 iliopsoas

Answer 49

A B C