Fetal Spine and Musculoskeletal System Flashcards by ashley Barter

Axial skeleton begins to form between __________ menstrual weeks

6-8

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The axial skeleton consists of the bones of the _______ and _________

cranium and spine

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As pregnancy progresses, the skull and skeletal bones become more:

echogenic

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The spine consists of five sections:

cervical, thoracic, lumbar, sacrum, and coccyx

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Each fetal vertebra consists of 3 echogenic ossification centers:

one centrum and 2 neural processes

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The centrum will eventually form the :

vertebral body

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The neural process of each vertebra will become :

lamina, pedicle, transverse process, spinous process, and articular process.

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The structure that runs the length of the spine and contains the spinal cord:

vertebral column

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The echogenic laminae are normally angled:

inward

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With spina bifida the echogenic laminae will be angled:

outward or be splayed

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The spinal cord appears as a ________ linear structure.

hypoechoic

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The most common neural defects:

anencephaly and spina bifida

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Helpful for detecting neural tube defects is the _______ component of the test

MSAFP

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AFP exits the fetus through an opening in the ____________ if one is present, such as with open spina bifida.

neural tube

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______________ bifida is not associated with elevated MSAFP

closed spina

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A supplement of 4 mg of _____ in a woman’s diet significantly reduces the likelihood of the fetus developing spina bifida

folate (folic acid)

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_____________ neural tube defect that occurs when the embryonic neural tube fails to close.

Spina Bifida

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Spina bifida may also be referred to as :

spinal dysraphism, meningocele, and meningomyelocele (myelomeningocele)

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Spina bifida can be subdivided into two types:

Spina bifida occulta (closed) and Spina bifida aperta (open)

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Occult (closed) lesions are completely covered by _______

skin

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With spina bifida _____, the vertebrae fail to close, there is no herniation of the spinal contents outside of the spinal column.

occulta

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In the postnatal period, spina bifida occulta is suspected when a _________, __________, ___________ or excessive __________ is identified directly over the distal spine.

sacral dimple, hemangioma, lipoma, excessive hair

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_________________, an open lesion, is the most common form of spina bifida and the type more frequently recognized in utero

spina bifida aperta

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____________ and __________ are forms of spina bifida aperta.

meningocele and meningomyelocele

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Meningocele and meningomyelocele are specifically referred to as

spina bifida cystica

Meningocele's contain:

meninges only

Myelomeningocele, contain:

meninges and nerve roots

The most common location of Spina bifida:

lumbosacral area

The _______ the location of the spina bifida, the greater the neurologic impairment.

higher

Spina bifida is often initially recognized by its associated cranial findings, a group of abnormalities referred to as :

Arnold-Chiari II malformation

The pressure of a large mass in the distal spine pulling on the spinal cord causes malformations of the cranium and intracranial contents. The frontal bones become flattened and will yield a _________ shaped cranium.

lemon

The "lemon sign" is often described as :

scalloping of the frontal bones

It is most helpful to analyze the _______ fossa of the cranium for abnormalities when a "lemon sign" is suspected.

posterior

The cerebellum will become displaced inferiorly and posteriorly and appear curved in the presence of spina bifida. This is referred to as:

banana sign

When the cerebellum is displaced inferiorly due to spina bifida, the cisterna magna is:

completely obliterated or non-existent

The lateral ventricles will appear _______ with spina bifida.

enlarged and distorted in shape

With spina bifida the frontal horns will be small and slitlike, while the occipital horns will be enlarged, a condition is known as:

colpocephaly

In the presence of spina bifida, the posterior ossification elements or laminae will often appear:

splayed in the transverse plane

A meningocele will appear as a ______ mass protruding from the spine.

simple cystic

A meningomyelocele tends to appear more ______

complex

Differential diagnosis of meningocele/meningomyelocele:

sacrococcygeal teratoma

A fetus with ______ _____ will most likely have normal head and intracranial anatomy, while the intracranial anatomy of a fetus with spina bifida is often altered.

sacrococcygeal teratoma

Fetal surgery can be performed on the fetus with spina bifida when a mass is identified on spine, as early as :

16 weeks

A deformity of the spine in which there is an abnormal lateral curvature:

scoliosis

The spine will appear ___ shape in the affected region of scoliosis.

An abnormal posterior curvature of the spine:

kyphosis

When there is an abnormal of both the lateral and posterior curvature of the spine it is termed:

kyphoscoliosis

___ referred to as body stalk anomaly, is a rare group of fetal defects.

LBWC - limb body wall complex

The most common sonographic findings of LBWC are :

short or absent umbilical cord, ventral wall defects, limb defects, craniofacial, (exencephaly or encephalocele), and scoliosis

The fetus with Limb body wall complex will appear:

closely connected with the placenta and will have marked scoliosis.

With limb body wall complex, because of the opening in the ventral wall, elevated levels of ____ can be detected in the second trimester.

MSAFP

___________ has very similar sonographic findings and may be seen simultaneously with limb body wall complex.

Amniotic band syndrome

________ denotes the abnormal development of a structure.

dysplasia

Four most common skeletal dysplasias :

achondroplasia, achondrogenesis, osteogenesis imperfecta, and thanatophoric dysplasia

_______ is the most common non-lethal skeletal dysplasia.

heterozygous achondroplasia

Heterozygous achondroplasia is a type of _____

dwarfism

Proximal portions of limbs, the humeri, and femurs, are much shorter than the distal portion of the limbs, a condition known as :

rhizomelia

Achondroplasia can also be _______ this is fatal and occurs when both parents are dwarfs.

homozygous

Rhizomelia is typically not detected until after ____ weeks gestation

When rhizomelia is detected there is a notable difference in the gestational age measurements between the:

BPD and femur length

Sonographic findings of achondroplasia include:

micromelia, macrocrania, frontal bossing, flattened nasal bridge, and trident hand

Achondrogenesis is a rare, lethal condition resulting in:

absent mineralization of the skeletal bones

________ is apparent when there is deficient ossification of the fetal spine, pelvis, and cranium, ultimately leading to stillbirth or early death.

achondrogenesis

With achondrogenesis the fetus will suffer from :

severe limb shortening and may have rib fractures | Polyhydramnios is often present as well

Commonly known as brittle bone disease, is a group of disorders that results in multiple fractures that can occur in utero:

osteogenesis imperfecta

There are ___ different types of osteogenesis imperfecta:

The uniformly fatal form of osteogenesis imperfecta is:

type II - is the most severe type of the disease

Osteogenesis imperfecta type II results in :

multiple fractures in utero, skull demineralization, bell-shaped chest, and decreased fetal movement

One distinctive finding of osteogenesis imperfecta type II is that when the transducer pressure is applied the skull, the shape of the :

soft skull can be distorted

"death bearing” dysplasia is the most common lethal skeletal dysplasia

thanatophoric

The fetus with thanatophoric dysplasia will have a ____ skull with _______ and _______

cloverleaf, frontal bossing, and hydrocephalus

The shortened long bones of a fetus with thanatophoric dysplasia take on a _______ shape

telephone receiver

The diaphysis of the long bones, of the fetus with thanatophoric dysplasia, will be _____ and have prominent metaphyseal ends.

bowed

The ____ and ____ circumference will be remarkably dissimilar, leading to a bell-shaped chest. (thanatophoric dysplasia)

thoracic and abdominal

With thanatophoric dysplasia the thorax will be remarkably narrow, resulting in _____ of the lungs.

hypoplasia

Fetuses with thanatophoric dysplasia typically die shortly after birth, succumbing most often to _________ _____ as a result of pulmonary hypoplasia.

respiratory distress

May also be referred to as sacral agenesis.

caudal regression syndrome

Sonographic findings of caudal regression syndrome:

absence of sacrum and coccyx

___________ _____ ______ has a strong associated with caudal regression syndrome.

Uncontrolled maternal diabetes

Also referred to as mermaid syndrome because of the fusion of the lower extremities that occurs.

sirenomelia

Bilateral _______ _____ often accompanies sirenomelia.

renal agenesis

What else may be seen with sirenomelia:

oligohydramnios, cardiac anomalies, genital absence, and two-vessel cord.

Like caudal regression syndrome, ____ _______ ________ seems to pay a role in the development of this disorder.

uncontrolled maternal diabetes

A germ cell tumor, that has been cited as the most common congenital neoplasm and is more frequently found in females:

sacrococcygeal teratoma, SCT

A SCT will appear ______ or ______ extending posteriorly and inferiorly from the distal fetal spine.

complex / solid mass

A SCT has the potential to grow inside of the pelvis and may cause destruction of the :

sacrum and pelvic bones

The appendicular skeleton begins to form between ____ and ___ menstrual week.

6-8

The appendicular skeleton includes the bones of the :

upper extremities, lower extremities, and pelvic girdle

The first sonographic appearances of the fetal limbs are referred to as:

limb buds

During the second trimester the fetal limb bones take on more of an adult appearance and appear ____

echogenic

The femur, tibia, fibula, humerus, radius and ulna can be measured as early as

12 weeks

The measurement of the long bones should include:

the diaphysis of the bones and not the hypoechoic cartliginous ends

The sonographic determination of the shortening of a limb is made when the long bones measure more than _______ deviations below the norm for gestational age.

4 standard

Described as the absence (aplasia) or underdevelopment (hypoplasia) of the radius.

radial ray defect

Radial ray defect can be seen in the presence of:

trisomy 13, trisomy 18, cardiac abnormalities, and an associated with VACTERL

Referred to as talipes:

clubfoot

With clubfoot the foot is most often :

inverted and rotated medially

Sonographic diagnosis of clubfoot can be made when:

the metatarsals lie in the same plane as the tibia and fibula

Limb reduction Is often caused by :

amniotic band syndrome

_______ _____ result from the rupture of the amnion.

sticky bands

The amniotic bands can entrap fetal parts and cause:

amputation of digits, limbs, and even the skull

Amniotic bands can also lead to :

peculiar facial clefting

Amniotic Bands should not be confused with:

uterine synechaie

Uterine synechiae may be recognized as:

linear, thick membranes with a broad base crossing the amniotic sac.