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OB 2 > Chapter 24: Sonographic Assessment of the Fetal Neck and Spine > Flashcards

Chapter 24: Sonographic Assessment of the Fetal Neck and Spine Flashcards

1
Q

Examination of the neck region includes evaluation of the ____ and ____

A

spinal structures
soft tissues

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2
Q

Examination of the anterior neck region is useful in the detection of different abnormalities that may include:

A

goiter
hemangioma
teratoma

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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

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4
Q

____ images are considered best for evaluating structures of the fetal neck.

A

Coronal

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5
Q

abnormally formed organs

A

dysgenesis

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6
Q

herniation of abdominal contents without a covering into the abdominal fluid

A

gastrochisis

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7
Q

tumor composed of fat

A

lipoma

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8
Q

combination of nonimmune fetal hydrops and a cystic hygroma

A

lymphangiectasia

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9
Q

spinal defect where the meninges protrude

A

meningocele

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10
Q

protrusion of a sac from a spinal defect containing spinal cord and meninges

A

Myelomeningocele

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11
Q

Incomplete fusion of the neural tube resulting in a cleft spinal cord

A

Myeloschisis

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12
Q

either the rostral or caudal end of the neural tube

A

neuropore

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13
Q

herniation of the abdominal contents with a membranous cover

A

omphalocele

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14
Q

ability of embryonic cells to differentiate into any type of cell

A

pluripotent

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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

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16
Q

Two ossification centers lie:

A

posterior to the spinal canal within the laminae

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17
Q

One ossification center lies:

A

anterior within the vertebral body

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18
Q

Three types of scanning planes help with the evaluation of spinal integrity:

A

transverse
coronal
sagittal

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19
Q

Three ossification centers surround the _____

A

neural canal

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20
Q

At the cervical level, the posterior ossification centers at the cervical vertebrae have a ______ shape.

A

quadrangular

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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

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22
Q

At the level of the sacrum, the posterior ossification centers have a _____ placement than the upper vertebrae.

A

wider

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23
Q

a parallel structure ending in the pointed sacrum

A

spine

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24
Q

Divergence of the posterior elements suggests abnormality, probably a ______ or ______

A

meningocele
meningomyelocele

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25
Q

Determination of spinal normalcy is through identification of:

A

intact neural canal
normal location and shape of spinal ossification centers
intact dorsal skin contour

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26
Q

AFP is a glycoprotein secreted by the ____ and then by the _____.

A

yolk sac
fetal liver

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27
Q

Maternal serum AFP levels occur through diffusion across the ____ and ____.

A

placenta
amnion

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28
Q

neural tissue is exposed or covered by only a thin membrane

A

open neural tube defects

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29
Q

AFP is elevated in ____ neural tube defects

A

open

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30
Q

Skin-covered or closed neural tube defects result in _____ AFP

A

normal

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31
Q

Typically, ____ MoM is used as the level for a positive screen

A

2.5

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32
Q

AFP elevation disorders

A

omphalocele
gastrochisis
skin disorders

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33
Q

AFP lower disorders

A

Down Syndrome

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34
Q

Jugular lymph sacs fail to communicate with the venous system, they may enlarge as the fill with lymph and form _____

A

cystic hygromas

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35
Q

Failure in lymphatic drainage may accompany hydrops fetalis, resulting in a process called ______

A

lymphangiectasia

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36
Q

Most common located of cystic hygromas

A

lateral neck region

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37
Q

______ trisomies and trisomy ___ demonstrate an increased incidence of hygromas in the first trimester

A

autosomal
21

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38
Q

The large veins linked to the development of cystic hygromas are due to:

A

increased volume of blood flow resulting from lack of lymphatic drainage

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39
Q

Nonimmune hydrops manifests sonographically as:

A

ascites
pleural effusion
pericardial effusion
skin edema

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40
Q

Differential diagnoses of cystic hygromas

A

cystic teratomas
cephaloceles
hemangiomas
branchial cleft cysts
nuchal edema

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41
Q

The central nervous system begins as the ____ in the embryo.

A

neural tube

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42
Q

Infloding of the slipper-shaped ectoderm of the neural plate during the ____ week of embryonic life forms the neural tube.

A

third

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43
Q

The ______ fuses to form the neural tube beginning midembryo and completing at the cranial and caudal neuropore

A

neural groove

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44
Q

If the neural tube fails to fuse:

A

spina bifida with myeloschisis develops

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45
Q

a NTD resulting from incomplete closure of the bony elements of the spine posteriorly

A

spina bifida

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46
Q

Two types of spina bifida lesions

A

ventral
dorsal

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47
Q

involves vertebral body splitting and development of a neurogenic-origin cystic structure

A

ventral defect

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48
Q

Closed spina bifida, or ______, has the split vertebrae covered by skin.

A

spina bifida occulta

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49
Q

Spina bifida _____ is the simplest form, in which there is a failure of the dorsal portions of the vertebrae to fuse with one another.

A

occulta

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50
Q

The expected location of spina bifida occulta is:

A

sacrolumbar level

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51
Q

Open spina bifida, or _______, is a full thickness defect of the skin, underlying soft tissues, and vertebral arches- thus exposing the neural canal.

A

spina bifida aperta

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52
Q

Spina bifida aperta occurs in ___% of all spina bifida cases

A

85

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53
Q

The ______ lesion has a thin meningeal membrane that does not contain neural tissue.

A

Meninogocele

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54
Q

The _____ contains neural tissue inside the protruding sac.

A

myelomeningocele

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55
Q

Causative mechanics of NTDs

A

genetic factors
nutritional factors
environmental factors
combo
diabetes mellitus
obesity
folate deficiency

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56
Q

Location and severity of spina bifida defects have the greatest chance of detection on the _____ views.

A

sagittal

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57
Q

Displacement of cranial structures into the foramen magnum and superior cervical canal is caused by:

A

cerebrospinal fluid leakage

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58
Q

abnormal lateral curvature of the spine caused by anomalous development of the vertebrae, either failure of formation or segmentation

A

congenital scoliosis

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59
Q

Congenital scoliosis can be caused by:

A

cardiac, genitourinary, and skeletal abnormalities

60
Q

Abnormal anterior angulation of the spine

A

kyphosis

61
Q

combination of the abnormal lateral and anterior curvature

A

kyphoscoliosis

62
Q

______, 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

A

Hemivertebrae

63
Q

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

A

caudal regression syndrome

64
Q

Disruption of the embryonic process of canalization in the third week of gestation results in varying degrees of:

A

caudal regression syndrome

65
Q

In the normal embryo the conus, filum terminale, sacral nerve roots, and lower genitourinary structures originate from:

A

caudal mesoderm

66
Q

the main differential for caudal regression syndrome

A

sirenomelia

67
Q

The mechanism of sirenomelia is thought to be:

A

shunting of blood from the aorta through the umbilical artery, resulting in a vascular steel

68
Q

Main finding for sirenomelia

A

fusion of the legs

69
Q

Sirenomelia is also known as:

A

mermaid syndrome

70
Q

In the fetus, teratomes develops in the _____, ____, _____ or anywhere on the neural tube with the ______ the most common location.

A

gonads
umbilical cord
placenta
caudal end (sacrococcygeal_

71
Q

Tumor that arising from the presacral area of the spine

A

sacrococcygeal teratomas

72
Q

most common neoplasm of the newborn

A

sacrococcygeal teratomas

73
Q

Germ layers of germ cell tumor

A

ectoderm
mesoderm
endoderm

74
Q

The origin of the sacrococcygeal tumor is thought to be a:

A

remnant of the primitive streak leading to the inclusion of various embryonic tissue types within the tumor.

75
Q

the pluripotent tissue derived from the area around the Henson node migrates rostrally to lie in the coccyx

A

sacrococcygeal tumore

76
Q

images as a protrusion between the anus and the coccyx

A

sacrococcygeal tumor

77
Q

Perinatal mortality and morbidity are most strongly related to high-output cardiac failure because of:

A

arterivenous shunting within the tumor, subsequent fetal hydrops, polyhydramnios, and preterm delivery

78
Q

The normal fetal spine has three ossification centers:

A

centrum
right
left neural processes

79
Q

Sagittal images of the spine include:

A

vertebral body
lateral ossification centers
caudal end tapering
skin integrity
examination of the spinal curvature

80
Q

_____ view of the spine is the best plane to identify spinal defects

A

Transverse (axial)

81
Q

Elevated MSAFP of ____ MoM raises suspicion for an open neural tube or abdominal wall defect/

A

2.5

82
Q

_______ are the result of lymph vessel obstruction, usually occurring in the head or neck region.

A

Cystic hygromas

83
Q

an open spinal defect with varying degrees of severity

A

spina bifida

84
Q

_____ and _____ are abnormal curvatures of the spine and may be caused by skeletal dysplasias or a hemivertebrae.

A

scoliosis
kyphosis

85
Q

germ cell tumors found in the sacral area

A

sacrococcygeal teratomas

86
Q

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

A

c

87
Q

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

a

88
Q

How many ossification centers surround the neural canal?

A

3

89
Q

Select the fetal position that offers a true sagittal view of the spine.
a. transverse
b. oblique
c. cephalic
d. prone

A

d

90
Q

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

A

b

91
Q

Screening for neural tube defects is performed by all except:
a. hCG
b. sonography
c. MSAFP
d. biochemical testing

A

a

92
Q

The most common location for a cystic hygroma is:

A

at the lateral neck region

93
Q

The form of spina bifida where split vertebrae are covered by the skin is:

A

spina bifida occulta

94
Q

Anomalies frequently seen in the fetus relating to spina bifida involve the fetal:

A

cranium

95
Q

Fetuses affected by spina bifida aperta commonly demonstrate:

A

bilateral club feet

96
Q

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

A

c

97
Q

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:

A

caudal regression syndrome

98
Q

A sacrococcygeal teratoma most commonly images as a protrusion:

A

between the anus and the coccyx

99
Q

The earliest visible indication of caudal regression syndrome is:

A

a short crown-rump length and abnormal yolk sac

100
Q

Cystic hygromas are the result of _____ obstruction, usually occurring in the head or neck region.

A

lymph vessel

101
Q

The normal fetal spine has ___ ossification centers: the centrum, right, and left neural processes.

A

3

102
Q

The fetal spine images with brightly echogenic ossification centers in the transverse plane by the ____ week of gestation.

A

16th

103
Q

Three types of scanning planes help with the evaluation of spinal integrity, ______, ______, and ______.

A

transverse
coronal
sagittal

104
Q

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.

A

omphalocele
gastroschisis

105
Q

Cystic hygromas appear as either single or ______ fluid-filled cavities and are usually located on the _____ neck.

A

multiloculated
lateral

106
Q

The two types of spina bifida lesions are _____ and _____. The most common form of the process is _____ spina bifida.

A

multiloculated
lateral

107
Q

The two types of spina bifida lesions are are ____ and _____. The most common form of the process is ____ spina bifida.

A

ventral
dorsal
closed

108
Q

The location and severity of spina bifida have the greatest chance of detection on _____ views.

A

sagittal

109
Q

Fusion of the fetal legs is known as the _____ syndrome, also known as _____.

A

mermaid
sirenomelia

110
Q

The most common location of a neural tube teratoma is the _____ end.

A

caudal

111
Q

Sagittal and coronal images of _______ and spinal anatomy assist in detecting spinal normalcy or assist in locating anomalous deviations.

A

conus medullaris

112
Q

A break in the skin surface directly over the spine is associated with:

A

myelomeningocele

113
Q

A large herniation of the posterior fossa contents into the foramen magnum with hydrocephalus and myelomeninocele describes which type of Arnold-Chiari malformation

A

3

114
Q

A markedly retroflexed neck is an indication of

A

iniencephaly

115
Q

Neural plate development completes at ____ days

A

18-23

116
Q

What central nervous system malformation is identifiable in the first trimester?

A

spina bifida

117
Q

What abnormality is most commonly associated with cystic hygroma?

A

Turner Syndrome

118
Q

A cystic hygroma is the result of

A

lymphatic fluid

119
Q

What would most likely involve the development of a cystic hygroma?

A

Turners Syndrome

120
Q

The most common location of a cystic hygroma is within the:

A

neck

121
Q

A benign congenital neck cyst found most often near the angle of the mandible

A

branchial cleft cyst

122
Q

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:

A

cystic hygroma

123
Q

Protusion of meninges through a spinal defect

A

meningoceles

124
Q

The defect that has a cleft spinal cord

A

myeloschisis

125
Q

A group of anomalies associated with the entrapment of fetal parts and fetal amputations is:

A

amniotic band syndrome

126
Q

What is the maternal dietary supplement that has been shown to significantly reduce the likelihood of the fetus suffering from a neural tube defect?

A

folate

127
Q

Talipes equinovarus is associated with:

A

clubfoot

128
Q

The condition associated with the absence of the sacrum and coccyx:

A

caudal regression syndrome

129
Q

Spina bifida occulta does not show _____ MSAFP

A

elevated

130
Q

Spina bifida cystica has normal MSAFP.

A

false

131
Q

An enlarged posterior fossa is associated with spina bifida.

A

false

132
Q

The abnormal lateral curvature of the spine is referred to as:

A

scoliosis

133
Q

Limb body wall complex shows decreased MSAFP

A

false

134
Q

A disorder that results in abnormal bone growth and dwarfism

A

achondroplasia

135
Q

______ would increase the likelihood of a fetus developing sirenomelia and caudal regression syndrome.

A

preexisting diabetes

136
Q

The most common nonlethal skeletal dysplasia is

A

achondroplasia

137
Q

What abnormalities results in limitation of the fetal limbs as a result of joint contractures?

A

arthropiosis

138
Q

Shortening of the proximal segments of the limbs

A

Rhizomelia

139
Q

An absent sacrum and coccyx is referred to as:

A

caudal regression syndrome

140
Q

absent long bones with the hands and feet arising from the shoulders and hips describes:

A

phocomelia

141
Q

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:

A

osteogenesis imperfecta

142
Q

A bell shaped chest and multiple fetal fractures are indicative of:

A

osteogenesis imperfecta

143
Q

Synechia is not associated with amniotic band syndrome.

A

true

144
Q

The exaggerated distance between the first toe and the second toe is:

A

sandal gap

145
Q

Sirenomelia is commonly referred to as:

A

mermaid syndrome

146
Q

Absence of the radius referred to as:

A

radial ray defect

147
Q
A

OB 2 (17 decks)

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