S3_L3: Spina Bifida Flashcards
1
Q
Most common birth defect
A
Congenital heart defects (cardiac anomalies)
2
Q
Second most common birth defects
A
Spinal dysraphism, spina bifida, neural tube defect
3
Q
Refers to complete absence of skin and sac with exposure of the muscle and presence of a dysplastic spinal cord without evidence of a covering.
A
Rachischisis
4
Q
Caused by tissue attachments that limit the movement of the spinal cord within the spinal column
A
Tethered Cord Syndrome
5
Q
It results in the abnormal stretching and thinning of the spinal cord.
A
Tethered Cord Syndrome
Additional: 20-50% of children with spina bifida defects that are repaired shortly after birth will require surgery to untether spinal cord.
6
Q
Arnold Chiari Type II Malformation refers to the caudal displacement or herniation into the cervical spinal canal of the medulla and lower pons, causing an elongation of what two structures?
A
4th ventricle and cerebellar vermis
7
Q
Neurogenic Sphincter Dysfunction
- Voiding reflex arc is intact
- Low intravesical pressure
- Results from a thoracic lesion
- Emptying is incomplete, leading to
overdistention and retrograde flow
A. Hypertonic Bladder
B. Hypotonic Bladder
A
- A
- B
- A
- B
8
Q
Neurogenic Sphincter Dysfunction
- Results from a sacral lesion, LMNL
- High intravesical pressure leading to reflux
- Weak or absent detrusor muscle
contraction - Prone to infections (i.e., UTI)
A. Hypertonic Bladder
B. Hypotonic Bladder
A
- B
- A
- B
- B
9
Q
Neurogenic Sphincter Dysfunction
- Spastic bladder
- Detrusor contractions are uninhibited
due to loss of central control - High level of affectation
- Leads to incontinence
A. Hypertonic Bladder
B. Hypotonic Bladder
A
- A
- A
- A
- A
10
Q
Detrusor-Sphincter Dyssynergia refers to the specific severe disturbance of the voiding function. The bladder and sphincter contractions occur
simultaneously, resulting in a low intravesical pressure.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
A
A. Only the 1st statement is true
Results in a high intravesical pressure
10
Q
Studies have demonstrated that taking this substance periconceptually and during early pregnancy significantly reduces the occurrence and recurrence of neural tube deficits.
A
folic acid
11
Q
Dosage of folic acid to take at least 1 month before conception and during the 1st trimester of pregnancy
A
400 μg or 0.4 mg
11
Q
Dosage of folic acid to take if the mother already has a child with a neural tube defect or has history of a child with spina bifida
A
4 mg
12
Q
A type of spina bifida that occurs when excessive fatty (lipomatous) tissue is within the vertebral canal and attaches to the spinal cord or filum terminale. It results in the development of motor and sensory deficits as the fatty tissue can pull the spinal cord, thereby causing deficits.
A
Lipomeningocele
12
Q
A _____ team approach is most ideal to treat spina bifida.
A
Multidisciplinary
Note: Not only is the rehab team significant in treatment, but also the neurologists, pediatricians, urologists (to assess kidney problems), orthopedic surgeons, and neurosurgeons (for the closure).
13
Q
A myelocele presents with a cystic cavity in front of the _____ wall of the spinal cord.
A
anterior
14
Q
Prognosticating in myelomeningocele: Critical motor function present
- Lateral hamstring and peroneal muscles
- Hip flexor muscles
- Totally paralyzed lower limbs
A. T12
B. L1-L2
C. L3-L4
D. L5
E. S1
F. S2-S3
A
- E
- B
- A
15
Q
Prognosticating in myelomeningocele: Critical motor function present
- Quadriceps muscles
- Mild loss of intrinsic foot muscles possible
- Medial hamstrings, anterior tibial muscles
A. T12
B. L1-L2
C. L3-L4
D. L5
E. S1
F. S2-S3
A
- C
- F
- D
16
Q
Prognosticating in myelomeningocele - Range: Adult
- Crutches, community ambulation
- Community ambulation
- Wheelchair, household ambulation
A. T12
B. L1-L2
C. L3-L4
D. L5
E. S1
F. S2-S3
A
- D
- E
- B
17
Q
Prognosticating in myelomeningocele - Range: Adult
- Normal
- Wheelchair
- Crutches household ambulation, wheelchair
A. T12
B. L1-L2
C. L3-L4
D. L5
E. S1
F. S2-S3
A
- F
- A
- C
18
Q
Prognosticating in myelomeningocele - Activity: Adolescent
- 50% wheelchair, household ambulation with crutches
- Community ambulation, 50% crutch or cane
- Wheelchair, non functional ambulation
A. T12
B. L1-L2
C. L3-L4
D. L5
E. S1
F. S2-S3
A
- C
- E
- B
19
Q
Prognosticating in myelomeningocele - Activity: Adolescent
- Limited endurance because of late foot deformities
- Wheelchair, no ambulation
- Community ambulation with crutches
A. T12
B. L1-L2
C. L3-L4
D. L5
E. S1
F. S2-S3
A
- F
- A
- D
20
Q
Prognosticating in myelomeningocele - Mobility: School Age
- Community ambulation
- Crutches, braces, wheelchair
- Crutches, braces, household ambulation, wheelchair
A. T12
B. L1-L2
C. L3-L4
D. L5
E. S1
F. S2-S3
A
- E
- B
- C
20
Q
Prognosticating in myelomeningocele - Mobility: School Age
- Standing brace, wheelchair
- Normal
- Crutches, braces, community
A. T12
B. L1-L2
C. L3-L4
D. L5
E. S1
F. S2-S3
A
- A
- F
- D
21
The Reciprocating Gait Orthosis (RGO) is suitable for patients with ___ or lower spinal injury levels, minimal contractures, adequate upper body strength, and sufficient endurance.
T6
21
The Hip Guidance Orthosis enhances function and mobility of children with ____ deficits from 6-15 y/o.
T11-L3
21
TRUE OR FALSE: The Reciprocating Gait Orthosis (RGO) is a useful supplement to the wheelchair, however, it is not as energy efficient and more effort is needed than when using a wheelchair.
True
22
A factor/predictor for ambulation is wheelchair training, which can begin during the ____ year.
second
22
TRUE OR FALSE: An electric wheelchair is recommended at school age for a child with adequate cognitive function and emotional maturity.
True
22
Spina bifida is more common in this sex
Females
23
If the L1-L3 segments were spared, enumerate the muscles that are spared.
Hip flexors & adductors
Additional: Gravity-related equinus foot deformity may also be present.
24
TRUE OR FALSE: If the hip flexors & adductors were spared, the patient can develop early paralytic hip dislocation.
True
25
Enumerate the other 2 names for spina bifida
1. Spinal dysraphism
2. Neural tube defect
26
This condition is caused by congenital malformations of the vertebral column and spinal cord. It is the result of the failure of the neural tube to close spontaneously between the 3rd and 4th weeks of in-utero development.
Spina bifida
27
Development of ____ balance and the level of the motor deficit are good and early predictors of walking.
sitting
Note: The higher the lesion is the poorer is the prognosis of walking
27
Deformities of the spine and lower extremities (contractures) and ____ are unfavorable factors for ambulation.
Obesity
Note: If the child is heavy, it is harder for the child to lift or carry himself. The presence of contractures (e.g., flexion contracture of knee or hip) makes it harder for the child to ambulate.
28
Meningocele, myelomeningocele, and myelocele occur most commonly in these areas of the spine
Lumbar & lumbosacral segments
Note: The remainder are located in the thoracic or sacral area but only rarely at the cervical level
29
Spina bifida occulta occurs most commonly in these levels of the spine
L5 and S1 levels (lumbosacral or sacral region)
30
Refers to the development of the nervous system during embryonic period
Neurulation
30
At week (1)____, the primitive streak appears as a groove in the epiblast layer; cells migrate and form (2)____ germ layers
1. 2
2. 3
31
Outer most germ layer where nervous system is derived
Ectoderm
32
From the neural plate, the edges rise to form neural folds meeting in the midline and fuse to become the ____, which becomes the brain and spinal cord.
neural tube
33
This neural structure becomes the peripheral nervous system & autonomic spinal nerves
Neural crest
34
Neurulation: at the ___ week of development, the notochord appears in the mesoderm.
3rd
35
The notochord secretes growth factor that stimulates differentiation of the ectoderm to neuroectoderm forming the _____.
neural endplate
36
Spina bifida lesions of the lumbosacral level occur before day ___.
53
Note: Caudal regression with rostral extension resulting in fusion with neural tube results in formation of spinal cord by day 53. If it did not close by this time, spina bifida is the result.
36
The nervous system begins to form by the ____ week of gestation.
3rd
Note: Ectoderm - at 3rd week, there’ll be the neural tube
37
Phase 1 is the closure of the neural tube, thus forming brain and spinal cord until day ___.
25
37
Phase 2 is the formation of the caudal structures of the neural tube forming the sacral and coccygeal portions at around day ___ of gestation.
26
Note: Failure of closure of these portions results in varying degrees of spinal dysraphism.
37
Closure of the cranial end of the neural tube occurs on the (1)___ day of gestation or (2)___ days from last menstrual period (LMP)
1. 24th
2. 38
38
Failure of closure of the rostral neuropore results in ____.
anencephaly
Note: As their brain and skull does not form and close, the fetus dies early.
38
Closure of the caudal end of the neural tube occurs on the (1)___ day of gestation or (2)___ days from the last LMP
1. 26th
2. 40
38
TRUE OR FALSE: Failure of fusion or closure of the rostral neuropore initiates spina bifida cystica or myelomeningocele.
False, it's the caudal neuropore
39
Most common complication and cause of death in patients with spina bifida
Urologic cause (Renal failure, kidney problems)
39
Spinal deformities occur most commonly in cases of _____ lesions with 80-100% of patients affected by the age of 14 to 15 years
thoracic
39
Hip dislocation and pelvic obliquity are common in ____.
paralytic scoliosis
40
Intermittent Catheterization Program (ICP) is recommended at about the age of ___ years
2
40
Urologic Treatment: Intermittent Catheterization Program (ICP) should begin when the residual volume of the urinary bladder is ≥ to ___ cc.
20
41
Enumerate the 3 primary aims of urologic treatment in spina bifida cases
1. Control incontinence
2. Preserve kidney function
3. Prevent and control infections
41
Self-independent catheterization may be achieved at the age of __ to __ years with boys learning intermittent catheterization more easily than girls secondary to anatomic differences.
5 to 6
42
Criteria for not performing immediate neurosurgical treatment:
1. Complete paralysis of both legs with lesion at (1)____.
2. Significant hydrocephalus with enlarged head present on the (2)____ day of life
3. Serious associated malformation of other organs (heart/respiratory problem)
4. Evidence of (3)____ injury
1. L1
2. first
3. cerebral birth
42
Delay closure for the spinal defect until ___ to ___ mos of age results to high mortality rate due to infection
3 to 6
Early surgery (3-6 mos.) = better to preserve what is functioning
43
Most common and severe form of spina bifida
Myelomeningocele
44
Spina bifida type that can cause tethered cord syndrome & cause symptoms if the spinal cord is pushed back.
Myelocele
45
TRUE OR FALSE: A thoracic lesion would result in more paralysis (paraplegia) compared to a sacral lesion.
True
Note: weakness of LE (paraplegia) is the most common sx of SB
46
Treatment of spinal deformities
1. ThoracoLumbar Sacral Orthosis (TLSO) with regular follow-up
2. Kyphectomy
3. Check for tethered cord which can cause rapid scoliosis; requires surgical correction
A. Rapidly progressing scoliosis
B. Mild scoliosis
C. Gibbous (kyphotic) deformity
1. B
2. C
3. A
47
Scoliosis in patients with spina bifida occurs 2° to loss of ____ and is seen in 70% above L2 and 40% below L4.
truncal support
48
Knee deformities (i.e., knee flexion contracture) are common in all neurologic levels but most common in ____ and ____ spina bifida lesions.
thoracic and higher lumbar
Note: Possible causes are weak quadriceps, positional factors or poor posture, fractures, and knee contracture due to spasticity. Regular stretching, proper bed positioning, splint, and braces are the orthopedic treatments of choice.
49
Equinus deformity of the foot is often treated with stretching of the ____ tendon or lengthening (through a surgical procedure).
Achilles
50
Flexor tenodesis or transfer and plantar fascia fasciotomy are used to correct severe ____ deformity and pes cavus.
claw toe
51
Finding in the fetal skull due to loss of normal convex shape of frontal bone and appears flat in patients with spina bifida and anencephaly.
Lemon sign
52
Characterized by the combination of anencephaly (absence of the brain and cranial vault, without skin covering) with a contiguous bony defect of the cervical spine (also without meninges covering the neural tissue). It is the affectation of the caudal part, the skin didn't fuse and the brain and spinal cord are exposed.
Craniorachischisis
53
Cystic Sac Formation Present
A. Spina bifida occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
E. B and C only
E. B and C only
54
No Cystic Sac Formation
A. Spina bifida occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
E. B and C only
A. Spina bifida occulta
55
Cystic sac contains spinal fluid and meninges
A. Spina bifida occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
E. B and C only
B. Meningocele
56
Cystic sac contains spinal fluid, meninges, and spinal cord
A. Spina bifida occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
E. B and C only
C. Myelomeningocele
57
A frequent sign in 50% of the children affected with this spina bifida is the presence of:
- A pigmented nevus
- Angioma
- Hirsute patch
- Dimple or Dermal
- Sinus overlying skin
A. Spina bifida occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
E. B and C only
A. Spina bifida occulta
58
May have (+) pigmented nevus [mole], café au lait spots [birthmark], hirsute [hairy] patch, dermal dimple sinus or tuft of hair
A. Spina bifida occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
E. B and C only
A. Spina bifida occulta
59
Mildest form, with no disturbance of neurological and musculoskeletal functioning
A. Spina bifida occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
E. B and C only
A. Spina bifida occulta
60
Associated findings: With or without intact skin at site of sac; Incomplete skin coverage leads to leakage of CSF.
A. Spina bifida occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
E. B and C only
B. Meningocele
61
Associated finding: Arnold Chiari malformation which is complicated by hydrocephalus in over 90% of the cases - with or without intact skin at site of sac
A. Spina bifida occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
E. B and C only
C. Myelomeningocele
62
Occurs in <10% of cases of spina bifida cystica
A. Spina bifida occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
E. B and C only
B. Meningocele
63
Musculoskeletal, Sensory, and Sphincter Dysfunction by Segmental Level
1. Knee extension contracture
2. Hip flexion and adduction & knee flexion contracture
3. Kyphosis, scoliosis, equinus foot, bowel and bladder dysfunction
A. T6-T12
B. L1-L3
C. L4-L5
D. S1-S2
E. S3-S4
F. D and E only
1. C
2. B
3. A
64
Musculoskeletal, Sensory, and Sphincter Dysfunction by Segmental Level
1. Bowel and bladder dysfunction and cavus foot
2. Complete leg paralysis
3. Calcaneovarus or calcaneus foot, bowel & bladder dysfunction
A. T6-T12
B. L1-L3
C. L4-L5
D. S1-S2
E. S3-S4
F. D and E only
1. F
2. A
3. C
65
Musculoskeletal, Sensory, and Sphincter Dysfunction by Segmental Level
1. Late hip dislocation, scoliosis, lordosis
2. Hip and knee flexion contracture
A. T6-T12
B. L1-L3
C. L4-L5
D. S1-S2
E. S3-S4
F. D and E only
1. C
2. A
65
Musculoskeletal, Sensory, and Sphincter Dysfunction by Segmental Level
1. Early hip dislocation, scoliosis, lordosis
2. Knee flexion contracture, equinus foot, bowel and bladder dysfunction
A. T6-T12
B. L1-L3
C. L4-L5
D. S1-S2
E. S3-S4
F. D and E only
1. B
2. B
66
Segmental Innervation (Spared muscles)
1. Lower trunk extensors
2. Iliopsoas, hip flexion
3. Abdominals, trunk flexion
4. Hip adductors
A. T6-T12
B. L1-L3
C. L2-L4
D. L4-S1
E. L5-S2
1. A
2. B
3. A
4. B
67
Segmental Innervation (Spared muscles)
1. Quadriceps, knee extension
2. Foot intrinsics
3. Gluteus maximus, hip extension
A. T6-T12
B. L2-L4
C. L4-S2
D. L5-S2
E. S2-S4
1. B
2. D
3. D
68
Segmental Innervation (Spared muscles)
1. Toe flexors
2. Perineum sphincters
3. Hamstrings, hip extension & knee flexion
A. T6-T12
B. L4-S1
C. L4-S2
D. L5-S2
E. S2-S4
1. D
2. E
3. C
69
Segmental Innervation (Spared muscles)
1. Peroneals, eversion
2. Tibialis anterior, dorsiflexion & inversion
3. Toe extensors
A. T6-T12
B. L4-L5
C. L4-S1
D. L5-S1
E. S2-S4
1. D
2. B
3. C
70
Segmental Innervation (Spared muscles)
1. Triceps surae, plantarflexion
2. Gluteus medius, hip abduction
3. Tibialis posterior, plantarflexion & inversion
A. T6-T12
B. L4-S1
C. L4-S2
D. L5-S2
E. S2-S4
1. D
2. B
3. D
71
Mental age of ___ years is a prerequisite to learn crutch walking
2-3
72
Low thoracic lesion and upper lumbar lesion may achieve crutch walking by ___ years
4-5
72
TRUE OR FALSE: A lower anatomic level of lesion on prenatal ultrasonogram predict better developmental outcomes in childhood.
True
72
A fetal ultrasound is a reliable tool that can be used between the ___ to ___ weeks of gestation to demonstrate other associated central nervous system malformation and see any defects.
16th to 24th
73
TRUE OR FALSE: Open tube defects allow leakage of fetal CSF leading to elevated serum alpha fetoprotein (AFP) by 13th-15th post conceptual week, but this does not always occur.
True
73
Usual time of testing in maternal serum is between the ___ to ___ week of gestation
16th to 18th
Note: AFP can be seen in the maternal serum because it is in the amniotic fluid (absorbed by the mother’s body). If AFP still elevated by this time, it is probable that there is a neural tube defect.
74
TRUE OR FALSE: Amniocentesis may be done by the 16th to 18th week of gestation for confirmation by examining the amniotic fluid in the uterus.
True
75
The following are findings if L4 was spared, except:
A. Knee extensors are spared
B. Hip extensors and adductors remain weak
C. Coxa valga and acetabular dysplasia
D. Hip dislocation develops slowly
E. None of the above
B. Hip extensors and adductors remain weak
It should be hip extensors and aBductors
76
The following are findings if L5 was spared, except:
A. Knee flexion contracture is possible
B. Gluteal maximus, medius and hamstrings are spared
C. Foot is in calcaneus attitude
D. Less knee extension contracture; possible hip
E. None of the above
E. None of the above
77
The following are findings in a sacral lesion, except:
A. Pes cavus with clawing of toes
B. (+) Plantarflexion
C. Normal: starting from the trunk down to ankle DF
D. Weak intrinsic foot muscles
E. None of the above
E. None of the above
78
The following are findings in thoracic lesions, except:
A. Total paralysis of LE, difficulty with ambulation, bladder dysfunction
B. Spared UEs & abdomen
C. Kyphosis and kyphoscoliosis
D. Flail paralysis, contracture of hip & knee flexion, & ankle plantarflexion
E. None of the above
E. None of the above
Note: Legs are flaccid or may show signs of spasticity
79
Lesions at these thoracic levels leads to weakness of intercostals (late sitting), abdominals and back muscles varies
T6-T12
80
What are the postures and deformities seen in the LE in flail paralysis?
LE posture: hip external rotation and abduction, and ankle plantarflexion (due to gravity)
Foot in equinus (plantarflexed)
80
Orthopedic Treatment for the foot: Posterior transfer of tibialis anterior is performed at > 5 years of age for ____ deformity.
calcaneus foot deformity [calcaneal gait]
80
Calcaneus foot is characterized by strong (1)____ & weak (2)____.
1. dorsiflexors
2. plantarflexors
Note: The Tibialis Anterior will be transferred posteriorly for it to act as plantarflexors
81
TRUE OR FALSE: Rigid clubfoot is associated with thoracic or upper lumbar lesions. It is fairly common or 90% abnormalities/deformities. The goal is to
prevent pressure sores since there is no sensory function on the LE.
True
82
Sitting
1. Sits with some delay and increased lordosis
2. Child can sit normally
3. (+) trunk control
A. T12 lesions
B. Mid lumbar lesions
C. L4-L5 was spared
1. B
2. C
3. A
83
A patient with a thoracic lesion can roll by ___ mos. with compensatory strategies using arms.
18
84
TRUE OR FALSE: In rolling for patients with mid lumbar and L5 or sacral lesions, they get up on their hands and knees to crawl.
True
85
TRUE OR FALSE: Neonates with spina bifida are close to normal during 1st half year of life [1st 6 mos.] unless with complications, such as hydrocephalus & significant cognitive deficits.
True
86
TRUE OR FALSE: Delays in the motor function development are obvious in the 2nd half of the 1st year of life in babies with spina bifida.
True
87
Intellectual functioning correlates inversely with neurologic level of SC dysfunction. The higher the level of deficit, the higher the tendency of retardation and lower IQ.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
88
Functional Community / Ambulation
1. 95% of 15-31 y/o achieve functional community ambulation; 38% of <15 y/o functional community ambulation
2. Achieve some degree of community ambulation
3. All able to achieve functional community ambulation
4. Very low chance to have community ambulation
A. Thoracic lesion
B. High lumbar lesion
C. Low lumbar lesion
D. Sacral lesion
1. C
2. B
3. D
4. A
89
Clinical symptoms
1. Motor paralysis, sensory deficits, neurogenic bowel and bladder
2. No neurologic deficit, rarely associated with sacral Lipoma and tethered cord, therefore these children must be followed
3. In the absence of other underlying malformation, neurologic signs are normal, but children must be followed
A. Spina Bifida Occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
1. C
2. A
3. B
90
The prevalence of spina bifida according to race is in Western countries and is highest among whites compared to black. Asia has more rate of neural tube defect than western countries due to low economic status.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
91
Male sexual function is present in L5 lesions and sacral deficits, with reproductive potential related to lower and less severe lesions. Conception is possible in women, however, frequency of premature labor is increased.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
92
TRUE OR FALSE: The incidence of spina bifida in offspring with one affected parent is 4%.
True
93
Referral to preschool programs at age 3 years is legally mandated for children with disabilities. Most children with spina bifida can complete high school with 50% continuing to college or further education, and independent living is achieved by 30%–60% in the United States.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
94
Failure of one or more of the vertebral arches to meet and fuse in the 3rd month of development, but the spinal cord did not come out.
A. Spina Bifida Occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
A. Spina Bifida Occulta
Note: Sometimes it may be seen in an x-ray as failure, but the skin is closed or it can be represented by just a tuft of hair.
95
Refers to the dysplasia of the spinal cord and meninges. Abnormal growth of the cord and the tortuous pathway of neural elements make abnormal transmission of nervous impulses impossible resulting in loss of motor and sensory function below the lesion.
A. Spina Bifida Occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
C. Myelomeningocele
96
A renal ultrasound to define anatomy in infancy is done when the baby is ___ weeks old.
2
Additional: 15-20% reveal vesicoureteral reflux at birth (the urine goes back from bladder to kidney)
97
Presents with no neurologic signs, but may require neurosurgical excision and closure so that the spinal cord will not come out.
A. Spina Bifida Occulta
B. Meningocele
C. Myelomeningocele
D. Myelocele
B. Meningocele
98
The following are appropriate in the management of ambulation in thoracic lesions, except:
A. Gait pattern established from as low as drag to as high as swing through
B. Ambulation is a realistic goal
C. Require assistive devices for passive standing (braces), usually at 12-18 mos.
D. Parapodium, walker, swivel walker, braces (e.g. HKAFOs with spinal extensions), Lofstrand crutches
B. Ambulation is a realistic goal
99
Arnold Chiari Type II malformation is not associated with spina bifida occulta but is common in cystica especially in myelomeningocele. This condition is always associated with hydrocephalus and only 20% have brainstem dysfunction, presenting with CN deficit & respiratory problems.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: attention and concentration deficits are related to hydrocephalus.
100
TRUE OR FALSE: At the hips, bilateral dislocation without restriction of joint mobility is best left alone especially if the child will not stand up and this is common in upper lumbar lesion, or thoracic lesion that causes (B) hip dislocation.
True
Note: Unilateral dislocation or asymmetric contractures may be treated as these can lead to pelvic obliquity, difficulty sitting, decubiti (due to imbalance of the muscle), and pressure sores.
101
In motor function development, the provision of _____ for assisting in early motor milestone and exploratory behavior is important.
adaptive equipment
102
Alpha fetoprotein is normally excreted into fetal urine by babies and can be found in the amniotic fluid. AFP normally peaks at around 6-14 weeks and should decrease afterwards, and if it is still high, spina bifida is possible.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
103
The motor and sensory deficits vary according to level and extent of spinal cord anomaly. Motor paralysis is usually the LMN type, since lumbar is affected, and patients present with
a neurogenic bowel and bladder.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
104
The following are done in rehabilitation treatment of spina bifida, except:
A. Frequent turning to avoid contractures and pressure sores
B. PROM to all joints below level of paralysis with emphasis on joints with evident muscle imbalance
C. Strengthening exercises for partially innervated muscles
D. Management begins in the newborn if seen with spina bifida
E. None of the above
E. None of the above
105
TRUE OR FALSE: Studies show that children with prenatally diagnosed myelomeningocele suggest less severe ventriculomegaly.
True
106
TRUE OR FALSE: Fetal surgery can be done at 20 to 25 weeks age of gestation; this shows a 94% reversal in hindbrain herniation (Arnold Chiari malformation) and significant decrease in need for shunting of hydrocephalus and improvement of LE function.
True
107
The following are risk factors for spina bifida, except:
A. Women with pregestational and/or gestational diabetes
B. Maternal obesity
C. Hyperthermia / maternal febrile illness
D. Intrauterine exposure to antiepileptic drugs
E. None of the above
E. None of the above
Note: Hyperthermia / maternal febrile illness is NOT related to malignant hyperthermia
108
The following are risk factors for spina bifida, except:
A. Midspring conception
B. High folic acid intake
C. Low socioeconomic class
D. Drugs used to induce ovulation
E. Increase in maternal age
F. None of the above
B. High folic acid intake
109
Valproate and carbamazepine are antiepileptic ____ drugs.
teratogenic
Note: These two drugs are used for maintenance of seizures, so a pregnant woman must change her medication to antiepileptic drugs w/o teratogenic.
110
The following are clinical manifestations of spina bifida, except:
A. hydrocephalus
B. learning disability
C. motor loss
D. sensory loss, neurogenic bladder
E. none of the above
E. none of the above
111
Children with lower lumbar lesions walk at 2 y/o with Trendelenburg lurch (lurching gait) and _____.
gastrocnemius limp
112
The following are appropriate in the management of ambulation in lower thoracic and lumbar lesions, except:
A. Reciprocal gait orthosis (RGO) is used after 3 y/o
B. With low lumbar lesions, they can be pulled to stand and cruise near the expected age (10 mos)
C. For low lumbar lesions, functional community ambulation is realistic
D. None of the above
D. None of the above
113
In Lower Thoracic and Lumbar Lesions, if L3 was spared, what orthosis is appropriate to prescribe for ambulation?
AFO
114
The following are some symptoms associated with Arnold Chiari II malformation, except:
A. Ataxia, facial palsy, nystagmus
B. Seizures, hypotonia, swallowing difficulty
C. Tongue fasciculations, paralysis of vocal cords, poor feeding, bronchial aspiration
D. Stridor especially with inspiration
E. Apnea when crying or at night
F. None of the above
F. None of the above
Additional: A ventriculo peritoneal (VP) shunt is used so CSF will go to the abdominal area.
