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CNIH > Abnormal MSK PT 1 > Flashcards

Abnormal MSK PT 1 Flashcards

1
Q

What is the skeleton composed of?

A
  • 2 tissues

- 3 cell types

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2
Q

What 2 tissues is the skeleton composed of?

A
  • bone

- cartilage

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3
Q

what 3 cell types is the fetal skeleton composed of?

A
  1. osteoblasts
  2. osteoclasts
  3. chondrocytes
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4
Q

Skeletal tissue is derived from what three embryonic cell lineages?

A
  1. cranial neural crest cells
  2. paraxial mesoderm cells or somites
  3. lateral plate mesoderm
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5
Q

What is Cranial neural crest cells?

A

craniofacial skeleton

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6
Q

what is Paraxial mesoderm cells or somites?

A

axial skeleton

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7
Q

what is lateral plate mesoderm?

A

responsible for limb formation

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8
Q

When do limb buds begin to develop?

A

4th week

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9
Q

Development of the Fetal Limbs?

A

Upper limbs antecede the lower lower limbs in bud appearance, development, differentiation and establishment of final relative limb size

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10
Q

Order or development of fetal limbs

A
  1. Humerus and femur
  2. Radius, ulna, tibia and fibula
  3. Metacarpal and metatarsal bones
  4. Phalanges
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11
Q

skeletogenesis 4 steps?

A
  1. patterning
  2. organogenesis
  3. growth
  4. homeostasis
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12
Q

what is patterning?

A

final size, shape, number and arrangement of bones are determined

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13
Q

what is organogenesis?

A

bone and cartilage are formed

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14
Q

what is hemostasis?

A

The tendency of the body to seek and maintain a condition of balance or equilibrium within its internal environment, even when faced with external changes

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15
Q

when can we see limb buds on u/s?

A

7 weeks

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16
Q

what can we see clavicle and mandible on u/s?

A

9-11 weeks

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17
Q

when can we see hands and feet on u/s?

A

12-14 weeks

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18
Q

when can we see distal femoral epiphysis on u/s?

A

29-34 weeks

19
Q

when can we see proximal tibial epiphysis on u/s?

A

35 weeks

20
Q

during woutine 20 week scan what is assessed? MSK

A
  • one femur is measures
  • all 4 limbs are assessed
Femur Bilaterally
Humerus Bilaterally
Radius and Ulna Bilaterally
Tibia and Fibula Bilaterally
Hands and Feet Bilaterally
Chest Diameter is assessed
Ossification of skull, spine and other bones is assessed
Curvature of the spine is assessed
21
Q

How to measure long bone?

A
  • Long bone length is the measurement between the distal and proximal ossification centers of the femoral diaphysis
  • Exclude the proximal and distal epiphysis
22
Q

Indication for careful survey of the fetal skeleton include?

A
  • Family history with a known genetic risk

- Detection of a fetal anomaly during a routine obstetrical study

23
Q

Abnormal Musculoskeleton includes?

A
  • Pattern of limb shortening
  • Degree of limb shortening
  • Presence of bowing, fractures and angulations
  • Hands and Feet
  • Head Circumference
  • Calvarium
  • Facial features
  • Spine
  • Thoracic measurements
  • Assessment of Ribs
  • Serial measurements
24
Q

definition of skeletal dysplasia?

A
  • dwarfism

- umbrella term for a group of hundreds of conditions affecting bone and cartilage growth

25
Q

A child born with skeletal dysplasia will present with?

A
  • abnormal differences in the size and shape of their legs, arms, trunk, or skull.
  • very short structure
  • arms and legs may not be proportional with the rest of the body
26
Q

classification of skeletal dysplasia?

A
  • initially based on clinical or radiologic/pathologic descriptions
  • Now classifications have evolved to include underlying molecular abnormalitie
27
Q

Prenatal sonographic diagnosis of skeletal dysplasia is centered on?

A

combinations of abnormal finding of the limbs, rib cage, skull and spine

28
Q

The most common severe skeletal dysplasias manifest with?

A
  • severe micromelia (generalized shortening of all limbs)

- variable degrees of thoracic dysplasia

29
Q

The most common types of skeletal dysplasia can be detected by what measurement?

A

Measurement of FL

30
Q

further serial measurements are required to determine if a skeletal dysplasia is present when femur length is below?

A

1 to 4 mm below 2 SD point

31
Q

there is high likelihood of skeletal dysplasia if femur length is?

A

FL is greater than 5 mm below the 2 SD point

32
Q

what might be helpful in the diagnosis of skeletal dysplasia?

A
  • fetal biometric ratios

Example:
in severe skeletal dysplasia, abdominal and head circumferences are frequently normal, while thoracic or chest circumference is decreased.

33
Q

Why is Femur Length to Foot Length Ratio helpful?

A

Has been helpful in the diagnosis of skeletal dysplasia and in distinguishing skeletal dysplasia from severe IUGR

34
Q

Why is foot length measurement helpful?

A

Foot length is not usually affected by the most common skeletal dysplasia and can be used to assess GA when skeletal dysplasia is suspected

35
Q

Normal foot length?

A

nearly equal to femur length in the 2nd and 3rd trimester so that a normal femur length to foot length ratio approaches unity (1:1 ratio)

36
Q

Femur Length to Foot Length Ratio with severe IUGR?

A

Femur length may be abnormally small, however, the femur length to foot length ratio remains essentially normal

37
Q

Femur Length to Foot Length Ratio with skeletal dysplasia?

A

The femur length to foot length ratio decreases, since foot length is unaffected, and the femur is shortened to different degrees

38
Q

what are four patterns of shortening of the long bones?

A
  • rhizomelia
  • mesomelia
  • acromelia
  • micromelia
39
Q

Rhizomelia?

A

shortening of proximal segment (femur, humerus)

40
Q

what is mesomelia?

A

shortening of middle segment (radius, ulna, tibia, and fibula)

41
Q

what is acromelia?

A

shortening of distal segment (hands and feet)

42
Q

what is micromelia?

A

shortening of entire limb (mild, mild/ bowed, severe)

43
Q

effect of severe micromelia with skeletal dysplasia?

A
  • lethal

- The earlier the onset, the worse the prognosis

CNIH (69 decks)

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