Clinical Qs - Test 1

Question 1

Cleidocranial dysostosis/dysplasia(CCD) is a rare autosomal inherited disorder characterized by

Answer 1

• defective ossification
• delayed bone and tooth development
• stomatognathic and craniofacial abnormalities.

May involve bones of the skull and clavicle.

RUNX2(CBFA1) is the only gene known to be associated with CCS and is responsible for osteoblast differentiation.

Question 2

What are the contents of the vertebral foramen?

Answer 2

• spinal cord
• surrounding meninges
• nerve roots and spinal vessels
• cerebrospinal fluid(CSF)
• fat tissue

Question 3

What are the different meningeal layers surrounding the spinal cord and the brain

Answer 3

• dura matter - outerlayer
• pia matter - innermost layer attached to spinal cord
• arachnoid matter between dura and pia

Question 4

Denticulate ligaments

Answer 4

extensions of pia matter from the surface of the spinal cord to the arachnoid matter support the spinal cord in the vertebral canal and separate the central and dorsal roots of the spinal nerves

Question 5

Describe the intermeningeal spaces and their contents

1. epidural space

Answer 5

between bone(periosteum) and dura matter

contains

• fat
• vertebral veins
• nerve roots

wider in lower parts of the vertebral canal(L2)

Question 6

Describe the intermeningeal spaces and their contents

2. Subdural space

Answer 6

between dura and arachnoid matters

Question 7

Describe the intermeningeal spaces and their contents

3. Subarachnoid space

Answer 7

between arachnoid and pia matter

Contrains:

• CSF
• vessels
• nerve roots

Larger in specific areas of vertebral column call CISTERNS

Question 8

Where is the lumbar cistern and what is found there?

Answer 8

below the termination of the spinal cord as the medullary cone

contains:

• nerve roots
• filum terminale(cordlike extension of pia matter) floating in the CSF

Question 9

Where is the lower extension of the spinal cord in adults and newborns? Clinical significance?

Answer 9

Adult - L1

Newborn - L3

Dura matter continues downward to S2 where dural sac or lumbar cistern is formed and can be used for a lumbar puncture

Question 10

How and where is a lumbar puncture performed?

Answer 10

need is passed in between the spinous process and the interlaminar space between L3-L4 or L4-L5(better for newborn to avoid spinal cord injury), through the skin into the subarachnoid space by piercing through the dura and arachnoid matter.

A line drawn between the iliac crests is at the approximate level of the L4 spinous process.

Pressure of CSF can be measured using a Manometer.

CSF can be withdrawn for analysis.

Anesthetics(spinal block) and other drugs(contrast medium for myelography) can be given through a lumbar puncture.

Question 11

How does spina bifida occur?

Answer 11

failure of the development and/or fusion of the vertebral arches of the L5 or S1 vertebrae.

Several forms may results from a neural tube defect when the caudal neuropore fails to close in the fourth intrauterine week.

Folic acid supplement may decrease the chance of occurance.

Question 12

Spina bifida cystica

Answer 12

more severe form resulting when one or more vertebral arches fails to develop

Question 13

Spina bifida occulta

Answer 13

less servere form resulting when some vertebrae do not close completely.

Malformation is covered by skin

Question 14

Spina bifida cystica

Answer 14

meningocele(herniation of the meninges) or meningomyelocele(herniation of the meninges and roots/spinal cord).

issues:

• sensory
• motor
• autonomic syndromes
  - paralysis of the limbs

Question 15

What is sacralization or lumbarization?

Answer 15

Sacralization
- fusion of L5 vertebrae to the sacrum

lumbarization
- S1 separates from the sacrum

Abnormal fusion of the vertabrae

• pain
• other symptoms

Question 16

What is vertebrobasilar syndrome?

Answer 16

caused by atherosclerosis of the vertebral arteries in and around the suboccipital triangle.

due to insufficient blood supply to the hindbrain.

Blood supply can be lessened by turning the head up and back for a period of time leading to dizziness and light-headedness.

Question 17

Lumbosacral Plexus Syndromes

Since the plexus passes close to the abdominal and pelvic structures it is more prone to damage

Answer 17

trauma following surgery, such as hysterectomy or during labor, may injure the plexus.

Compression from abdominal/pelvic tumors, aortic aneurysm, or radiotherapy may also damage the plexus.