Shared Flashcard Set

Details

2253 Hip and Spine
Phuong
191
Other
Not Applicable
05/01/2011

Additional Other Flashcards

 


 

Cards

Term
Abnormal relationship of femoral head to acetabulum is ___
Definition
DDH development dysplasia of hip
Term
Displacement of hip joint caused by femoral head moving___
Definition
out of the socket
Term
Dysplasia of hip include level
Definition
mild instability; sublaxation; and dislocation
Term
_____lead to temporary laxity of hip capsule in perinatal period?
Definition
Maternal estrogens and hormones
Term
The hip exam generally not performed ___
Definition
before 3-4 wks
Term
Ultrasound useful in first___
Definition
6months to 8 months
Term
Ossification may prevent US and femoral head ossifies by__
Definition
1 year
Term
This associated with hip laxity, possibly due to maternal hormones what is this ?
Definition
Hip instability
Term
Laxity is mean:
Definition
Slack/loose
Term
Femoral head is shallow in location; and incomplete displacement of femoral head from acetabulum during certain stress maneurvers of leg is called:
Definition
Subluxation
Term
Femoral head displaces from acetabulum during certain stress maneuvers of leg but returns to normal position once pressure is release this is:
Definition
Dislocatable hip
Term
2 most strongest Risk factor of DDH are:
Definition

Female neonate with frank breech presentation

Family hx of a parent and sibling with DDH

 

Term
Other risk factors of DDH are:
Definition

Oligohydramnios

1st born child

Torticollis (head tilt to 1 side due to abnormal control of muscles)

Lt hip more frequently affected than right 20% bilateral

Term
Which side of hip is more frequently has DDH?
Definition
Left
Term
Bilateral DDH is__
Definition
20%
Term
Patient is supine and knees flexed; affectted leg will have knee in lower position what is this sign?
Definition
Galeazzi sign
Term
If hip joint is dislocated a "click" is heard this is___
Definition
clicky hip
Term
Early signs of dislocation of right hip are:
Definition

Limitation of abduction

Asymmetry of skin folds prominence of trochanter

Shortening of femur

Term

-Patient lies supine with hip flexed 90 degrees and adducted

-Downward pressure is applied

-If hip is dislocated, examiner will feel femoral head move out of acetabulum this is called:

Definition
Barlow Maneuver
Term

-Pt lies supine with hip flexed 90 degrees and abducted

-Normally, should feel smooth

-If hip is dislocated examiner will feel a "clunk" as the femoral head returns to the acetabulum this is called:

Definition
Ortolani maneuver
Term
Ortolani maneuver when the examiner feel
Definition
A "clunk" as the femoral head returns to the acetabulum
Term
Barlow maneuver when the examiner feel
Definition
Femoral head move out of acetabulum
Term
Hip bones are fusion of 3 bones are:
Definition
Ilium, Ishium, and Pubis
Term
Ilium, Ischium, and pubis bones form the ___
Definition
Pelvic girdle
Term
Hip bones unites with ___
Definition
Sacral part of vertebral column
Term
2 hip bones join anteriorly form the__
Definition
Pubic symphysis
Term
The articulation of the head of femur with the acetabulum of the hip bone is called:
Definition
Hip joint
Term
Hip joint is ___
Definition
not directly palpable and surrounded by muscles of upper thigh
Term
Cup shaped cavity at junction of ilium, ischium, and pubis (body of acetabulum) in which ball shaped head of femur fits, this is called:
Definition
Acetabulum
Term
Body acetabulum is
Definition
juncture of ilium, ischium and pubis
Term
Extends over femoral head is
Definition
Cartilaginous acetabulum
Term
Round shaped femoral head fits into cup shaped acetabulum this is__
Definition
Ball and socket
Term
Bending forward is
Definition
Flexion (of knee joint)
Term
Bending backwards is
Definition
Extension (of knee joint)
Term
Moving sideways outwards and move extremity away from body is
Definition
Abduction (of hip joint)
Term
Moving sideways inwards; move extremity towards body is
Definition
Adduction (of hip joint)
Term
Sono exam of hip need:
Definition

ALARA

Use highest freg linear transducer to penetrate (5-10MHz)

Position infant in supine or lateral position

Relaxed infant/feed if needed

Exam both hips for comparision

Scan from lateral or posterolateral aspect of hip

Term
Which scan plan for hip exam?
Definition
2 orthogonal planes: coronal and transverse
Term
Coronal is ____
Definition
at rest in neutral position
Term
Transverse is __
Definition

Flexed hip with and without stress (Use Barlow and Ortolni type maneuver)

 

Term
___is determined through motion and application of stress
Definition
Stability of hip
Term
Always seated at rest with motion, and during application of stress is
Definition
normal hip
Term
Normal position at rest but abnormal movement with stress; this must remain within confines of acetabulum this is
Definition
Lax hip
Term
Displaced laterally at rest and is loose, but it is not dislocatable, it able to be pushed out of the joint this is__
Definition
Subluxable hip
Term
May be returned to acetabulum with traction and abduction this is __
Definition
Dislocated hip
Term
Treatment for DDH is
Definition
Pavlik harness
Term
Corrective harness that support hips in flexion and abduction without force and treat for 3 month and monitoring with US This is treatment of __
Definition
Pavlik harness for DDH
Term
The largest part of a vertebra and this is more or less cylindrical in shape what is this?
Definition
Body/centrum
Term
A circle of bone around the canal through which the spinal cord passes and this is composed of a floor at the back of the vertebra, walls (the pedicles), and a roof where two laminae join; posterior portion of vertebra this is:
Definition
Vertebral arch
Term
An opening between vertebrae through which nerves leave the spine and extend to other parts of the body this is___?
Definition
Intervertebral foramen/ neural foramen
Term
There are 2 short thick processes, which project dorsally one on either side from the superior part of the vertebral body at the junction of its posterior and lateral surfaces.  They connect the body of spinal vertebral to the arch what are they?
Definition
Pedicles
Term
A plate or layer. There are 2 broad plates, extending dorsally and medially from the pedicles fusing to complete the roof of the vertebral arch what is this?
Definition
laminae
Term
This is directed backward and downward from the junction of the laminae, and serves for the attachment of muscles and ligaments what is this?
Definition
Spinous process
Term
There are 2 and project one at either side from the point where the lamina joins the pedicle, they serve for the attachment of muscles and ligaments what are they?
Definition
Transverse processes or costal processes of the vertebra
Term
These 3 layers function to protect nourish and cushion the brain and spinal cord this is:
Definition
Meninges
Term
The meninges are connected to each other and the spinal cord by pair of ___which help stabilize the spinal cord and preventing side to side movement
Definition
Dentriculate ligaments
Term
The most external membrane, strong dense fibrous sheet closing spinal cord and cauda equina.  This is not attach to bony walls of vertebral column. Superiorly protecting the brain and inferiorly ends on the filum terminale this is_
Definition
Dura mater
Term
Superiorly continuous with ___protecting the brain and inferiorly ends on the ___
Definition
Dura mater-Filum terminale
Term
Dura mater
Definition
This membrane is not attached to bony walls of vetebral column
Term
Arachnoid mater
Definition
This is midle layer between the dura and pia,
Term
It is interposed between other meninges to cover brain and spinal cord what is this?
Definition
Arachnoid mater
Term
Arachnoid mater separated from dura mater by___
Definition
Subdural space
Term
Arachnoid mater separated from pia mater by the __
Definition
Subarachnoid space
Term
This layer membrane is closest to spinal cord, delicate innermost layer of the meninges this is:
Definition
Pia mater
Term
Pia mater superiorly continuous with ____and inferiorly fuses with___
Definition
Pia mater of brain-Filum terminale
Term
The area  between bony vertebrae and dural sheath that filled with fat (padding) and network of veins this is
Definition
Epidural space
Term
The subarachnoid space between the arachnoid mater and pia mater filled with__
Definition
Cerebrospinal fluid
Term
The point where spinal cord terminates taperinginto cone shaped structure this is__
Definition
Conus medullaris
Term
Conus medullaris is the ___
Definition
Terminal end of the spinal cord
Term
The collection of nerve roots at inferior end of vertebral canal this is __
Definition
Cauda equina
Term
Filum terminale is__
Definition
A threadlike structure which extends from the lower end of the spinal cord
Term
Fibrous extensions of pia mater extending inferiorly from conus medullaris to posterior surface of coccyx anchors spinal cord in place this is__
Definition
Filum terminate
Term
Sono appearance of normal conus position are___
Definition

Tip off the conus medullaris located at mid L3 vertebral body level or higher at birth

This position by beginning of the third trimester

Term
Clinical signs of tethered cord are
Definition

Fatty mass in mid lower back

Increase areas of pigmentation

Dimples on back

large collection of hari on back

Term
Tethered cord is
Definition
Fixation of spinal cord in abnormal caudal location, usually fixed eccentrically in spinal canal and decreased cord oscillations, suffer mechanical stretching,distortion and ischemia with daily activities growth and development
Term
As child grows, spinal cord not able grow due to abnormal structures holding on the cord, child could lose function of legs, bowel, bladder or have pain this is pathology of __
Definition
Tethered cord
Term
The dorsally concave curvature of the lumbar spinal column when seen from the side this is__
Definition
Lumbar lordosis or lumbar curvature
Term
Best position for infants scanning position is ___ if possible the lumbar lordosis to aid determination of vertebral body level and defining the lumbosacral junctions by elevating___
Definition
Prone-shoulders
Term

The spinal cord is relatively___ whereas the interfaces crreated by fanning nerve rootlets are___

 

Definition
Hypoechoic-echogenic
Term
The normal ___ should be clearly visible and mobile of csf pulsations, the center of the filum tends to be relatively ___ compared to its outer margins
Definition
Filum terminale-hypoechoic
Term
These should be considered a variant of normal development when there is no other suggestion of pathology what are they?
Definition
A terminal ventricle or filar cyst
Term
Which can help localize the epidural venous plexus, anterior spinal arteries, posterior spinal arteries?
Definition
Color Doppler ultrasound
Term
This is a normal variant should be considered unless other signs of abnormal mass
Definition

More prominent epidural fat

Terminal ventricle or filar cyst

Term
How to distinguish an abnormal mass within the vertebral canal from normal nerve rootlets or epidural fat?
Definition
Malposition, compression, distention of these vessels
Term
The method to determination of the position of the tip of the conus medularis include
Definition

Finding 12th rib and counting down from here

Defining the lumbosacral junction by accentuating the lumbar lordosis using as reference

Counting upward from the last ossified vertebral body

Term
Which vertebral body can be difficult ?
Definition
Ossification of the coccygeal vertebral bodies due to a great variability
Term

The sacral ossification centers take on a more____contour and ossified coccygeal vertebral bodies have ____

 

 

Definition
Square -Rounded central nucleus
Term
US finding of tethered cord are:
Definition

Abnormal caudally located conus;

Lack of nerve root pulsation

Term

Dys is "___" and raphe are "___" or "___"

 

 

 

Definition
Bad-Seam-Suture
Term
Any abnormality due to an error in embryologic processes of primary neurulation-Disjuntion-Canalization-Retrogressive differentiation of the caudal cell mass this is
Definition
Dysraphism
Term
Dysraphism due to error in embryologic processes of _
Definition

Primary neurulation

Disjunction

Canalization

Retrogressive differentiation of the caudal cell mass

 

Term
Dysraphism includes:__
Definition
Overt spinal dysraphism and occult spinal dysraphism
Term
The most case probably result of failure of neural tube to close or occur due to rupture of neural tube after it closes This is__
Definition
Spina bifida
Term
In spina bifida, most ___ occur as isolated malformation in chromosomally normal individual
Definition
Neural tube defects
Term
Spina bifida may occur as ___
Definition
part of syndrome
Term
For spinal bifida which increase risk of neural tube defects?
Definition
Folic acid deficiency
Term
Which is marker for neural tube defects during pregnancy and doesnot screen for occulta of spina bifida?
Definition
serum AFP (alpha fetoprotein)
Term
Spinal bifida most common among ____region?
Definition
Lumbar/sacral
Term
Spina bifida refers as ___fail to converge toward midline and splaying of the ____ over several vertebral levels
Definition
laminae-pedicles
Term
Overt spinal dysraphism, Spina bifida refers to ____of the posterior bony elements of the spine (it is open spine)
Definition
incomplete closure
Term
This is refers to the posterior protrusion of all or posterior body defect what is this?
Definition
Spina bifida aperta of overt spinal dysraphism
Term
Aperta mean:
Definition
open or uncovered
Term
Infants have flat neural palcode that is exposed to the environment  this is __
Definition
Myelocele
Term
This is refers to the protrusion that passes beyond the expected demarcations of the skin of the back what is this?
Definition
Spina bifida cystica of overt spinal dysraphism
Term
Spina bifida cystica of overt spinal dysraphism is
Definition
Cystlike mass can be seen expecially at Lumbosacral level
Term
This is more common and placode is further displaced posteriorly by expansion of the subarachnoid space what is this?
Definition
Myelomeningocele of overt spinal dysraphism
Term
Overt spinal dysraphism of spina bifida include these spina bifida___
Definition

-Incomplete closure of posterior bony elements of spine

-Fail to fuse dorsal ML/ fail to enclose the vert. canal

-Aperta: Posterior protrusion of all or part of the contents of vertebral canal through this posterior body defect

-Cystica: Cystlike mass can be seen at lumbosacral level

-Myelocele

-Myelomeningocele

 

Term
Myelomeningocele is more common than___ and associated with ___
Definition

Myelocele

Chiari II malformation

Term
Chiari II malformation highly asso with___
Definition
Spina bifida of overt spinal dysraphism (myelomeningocele) 97%
Term

Small posterior fossa

Displacement of cerebellum vermis 4th ventricle and medulla oblongata through the foramen magnum

Non visualization of cisterna magna

Banana sign

lemon sign

Dilation of lateral ventricle

All of these are associated with__

Definition
Chiari II malformation which asso with overt spinal dysraphism spina bifida
Term
Signs that is a deformation or compression of cerebellum shape called
Definition
banana sign
Term
sign that concave frontal bones, bitemporal narrowing of fetal skull is called:
Definition
lemon sign
Term
What is the most common mildest form of Dysraphism?
Definition
Spina bifida occulta
Term
An area of thickening in the embryonic epithelial layer from which some organ or structure later develops is ___
Definition
Placode
Term
The classically uncovered lesions of overt spinal dysraphsim include:
Definition
Myelocele and Myelomeningocele
Term
Newborn with myelocele and myelomeningocele generally are repaired on the ______without preoperative imaging
Definition
1st or 2nd days of life
Term
_____can provide great anatomic detail on with overt spinal dysraphism (myelocele or myelomeningocele)
Definition
Ultrasound
Term
Sono finding of overt spinal dysraphism are
Definition
Posterior fossa distortion in brain and anterior fontanelle and cranial cervical junction through the foramen magnum
Term
Relating to invoving or joining the two bones or the areas that they occupy called
Definition
 Bitemporal
Term
The vertebral arches of single vertebral fail to fuse underlying neural tube differentiates normally and does not protrude from the vertebral canal this is___
Definition
Spina bifida occulta
Term
The clinical signs of occult spinal dysraphism are
Definition
– Obvious skin-covered mass – A hairy tuft, – Appendage, – Discolored skin,
– Distorted spinal curvature, – Asymmetrical intergluteal cleft, – Deep dimple
Term

An out-pouching of the coverings of the spinal cord (spinal meninges) that results in a defect in the bone (vertebral column or foramina) and soft-tissue coverings of the back part of the spine.

this is called

Definition
Meningocele
Term
Meningocele is the sac that__
Definition
Filled with cerebrospinal fluid can lead to a bulging mass on the back.
Term
Meningocele are composed of___
Definition
A dorsal herniation of dura, arachnoid, and CSF into the subcutaneous tissue of the back and are skin cover
Term
Simple dorsal meningocele doesn't contain
Definition
Neural elements
Term
Complex dorsal meningocele is associated __-
Definition
Vertebral column
Term
The pia mater and arachnoid considered as one unit enveloping the brain and spinal cord is term as:
Definition
Leptomeninges/Pia-arachnoid
Term
The outermost of the three primitive germ layers of the embryo
Definition
Ectoderm
Term
Placode is__
Definition
A platelike structure, especially a thickened plate of ectoderm in the early embryo
Term
Filum terminale is__
Definition
A slender, threadlike prolongation of the spinal cord from the conus medullaris to the back of the coccyx
Term
The conus medullaris is __
Definition
The cone-shaped lower end of the spinal cord, at the level of the upper lumbar vertebrae
Term
Fatty masses that have a connection to the leptomeninges or spinal cord is ___
Definition
Spinal lipomas
Term
Origin of spinal lipoma is ___
Definition
Likely develop as a result of premature disjunction of neuroectoderm from cutaneous ectoderm.
Term
Types of Sacral Lipomas:
Definition

intradural lipomas

lipomyelocele

lipomyelomeningocele

fibrolipomas of the filium terminale

Term
Located in a subpial position in a dorsal cleft of the open spinal cord this is
Definition
Intradural lipoma
Term
Instead of an exposed neural placode, there is an overlying covering of attached lipoma and intact skin this analogous to the myelocele what is this?
Definition
Lipomyelocele
Term
Involves expansion of the subarachnoid space ventral to the neural placode this is__
Definition
Lipomyelomeningocele
Term
The fatty tissue expands the filum terminale beyond its usual diameter of 2mm this may present a variant of normal develoment this is___
Definition
Fibrolipoma of the filum terminale
Term
Sono finding of fibrolipoma of the filum terminaled are:
Definition
thickened, echogenic filum terminale; sometimes with an undulating contour
Term
Refers to a fibrolipoma of the filum terminale in the setting of an abnormally low positiion of the conus medullaris and this term should apply to the presence of a fibrolipoma of the filum terminale regarless of conus level this is term:___
Definition
Tight filum terminale or Tethered cord syndrome
Term
The origin of tight filum terminale or tethered cord syndrome refers ___
Definition
 Likely results from deficient retrogressive differentiation of caudal cell mass
Term
Occult spinal dysraphism of spinal lipoma describe as___
Definition
fatty masses associated with tethered cord
Term
Spinal lipoma can be continuous with ______and present clinically as _______
Definition

subcuataneous tissues

Fatty lump on lower back

Term
Ultrasound findind of spinal lipoma is
Definition
Echogenic mass
Term
Dilated cnetral canal of the spinal cord protrudes dorsally through a bony spina bifida is term:__
Definition
Myelocystocele
Term
Myelocystoceles can occur at the ____, ___, or _____ levels
Definition
Cervical, thoracic, lumbosacral
Term
Which is opposed to myelocystocele?
Definition
Myelomeningoceles (not covered by skin)
Term
Sono finding of myelocystocele are:__
Definition

low lying cord terminus ends in a cyst that in communication with the central canal of spinal cord

Expanded subarachanoid space tends to surround the distal cord and terminal cysts

Term
At the lumbosacral level they refers as ___ but is RARE and can mimic to ______or ______
Definition

Terminal myelocystocele

myelomeningocele

sacrococcygeal teratomas

Term
Which is not usually associated with chiari II syndrome?
Definition
Terminal Myolocystocele
Term
A regional thickening of cells through which gastrulating cells migrate anteriorly to form tissues in the future head and neck is ___
Definition
Henson's node
Term
The process in which the blastocyst differentiates into a trilaminar disk of ectoderm mesoderm and endoderm is ___
Definition
Gastrulation
Term
Each hemicord contains:
Definition
Central canal, single ventral horn, single dorsal horn
Term
Diastematomyelia is
Definition
likely caused by sagittal splitting of embryonic notochord due to an obstacle to cell migration from henson's node
Term
Cord is split at one or more sites by osseous, cartilaginous or fibrous septum this is ___
Definition
Diastematomyelia
Term
Diastematomyelia associated with___
Definition

Spina bifida cystica

Scoliosis

Lipomas

Dermal sinuses

Dermoids

Term
Sono finding of diastematomyelia are
Definition

Disorganized appearance of the vertebral column

Fusiform segment of vertebral canal widening

Visible dividing septum in the center of the widened segment

Term
Lateral curvature of the spine is called:
Definition
Scoliosis
Term
Exaggerated curvature of the spine in sagittal plane is called as:__
Definition
Kyphosis
Term
Which associated with spina bifida and abdominal wall defects?
Definition
Scoliosis and kyphosis
Term
Split notochord syndrome describe as:___
Definition

 

Extremely RARE_less than 40 cases in medical literature

Term
This included in the occult spinal dysraphism group not discovered with AFP screening what is this?
Definition
Split notochord syndrome
Term
Split notochord syndrome in complex group of anomalies are result of :
Definition

Incomplete closure of the neural tube during gastrulation

Clef or split of notochord to become spinal cord

Usually present in thoracic or lumbar regions

Involvement of other tissue usually GI

Term
Split notochord syndrome in malformations group include:
Definition

Dorsal enteric fistula

Cysts, sinus and diverticulum

 

Term
Dorsal enteric fistula  is:
Definition
An abnormal connection between the intestinal cavity that travels through the spinal cavity and exits the back
Term
Cysts, sinus (cavity) and diverticulum (outpouching) is:
Definition
Occurs along or within the vertebral canal where fistula becomes indistinct
Term
Split notochord syndrome associated with___
Definition
Urogenital and anorectal anomalies
Term
Split notochord syndrome assoiated with:
Definition

ectopic or low imperforate anus

high imperforate anus 30%

Cloacal malformatiion 50%

Cloacal exstrophy 100% most common

Term
The common passageway for feces, urine, and reproduction is called
Definition
Cloaca
Term
This is rare congenital defect, characterized by the absence of the sacrum and defects of variable portions of lumbar spine, associated with anomalies from the different systems this is___
Definition
Caudal regression
Term
Caudal regression is an
Definition

Abnormality of lower spine and limbs;

 

 

Term
Caudal regression associated with:__
Definition

Maternal diabetes mellitus (DM)

Imperforate anus

Bladder agenesis

Renal agenesis

Cord tethering

Term
This is rare disorder in which the legs are fused and the feet are deformed or absent this is__
Definition
Sirenomelia
Term
Sirenomelia has ___
Definition

Arterial blood flow bypasses the lower fetal body

and reduced or absent renal function

Term
Rarely positioned in and around the vertebral this is __
Definition
Spinal tumors
Term
This most likely dx in the neonatal period, calcify, extend into vertebral canal from retroperitoneum What is this?
Definition
Intraspinal neuroblastoma
Term
Clinical symptoms of intraspinal neuroblastoma are:
Definition

Palpable abdominal mass

Signs of spinal cord compression

 

Term
Differentiate dx of intraspinal neurblastoma are:
Definition

hemangioma

Rhabdoid tumor

Primary intramedullary neoplasms (gliofibroma)

 

Term
Sacrococcygeal teratomas that both large external and internal components this is ___
Definition
type II
Term
This most often present as a sacral mass tend to reur and heterogeneous What is this?
Definition
Sacrococcygeal teratomas
Term
2 types of sacrococcygeal teratomas are:
Definition
Mature and immature
Term
for helping in pre-surgical planning, the Altman's classification of the sacrococcygeal teratomas into____types?
Definition
4
Term
Sacrococcygeal teratomas that Bulk of mass is external is __
Definition
Type I
Term
Sacrococcygeal teratomas that a relatively small amount of the tumor is external this is type:
Definition
III
Term
Sacrococcygeal teratomas that no external mass, exclusively presacral this is type___
Definition
IV
Term
Sono finding of sacrococcygeal teratomas are
Definition

Heterogeneous

Solid and cystic components

Rarey enters vertebral canal

Term
Presacral mass are:
Definition
Teratoma, meningocele, enteric cyst
Term
Sacral agenesis are:
Definition
Assymetrical pattern (partial crescent shape)
Term
Currarino triad are:
Definition

DX in childhood

Screening may be done in infancy

Anorectal stenosis

Term
Sacrococcygeal teratomas with extreme hyperemia include:
Definition

Increase in the quantity of blood flow to body part

Fetal demise with high cardiac output failure

Newborn death with exsanguination (extensive blood loss) at delivery

Term
Different dx of sacrococcygeal teratomas are
Definition

Myelomeningocele

Feeding vessels and relative hyperemia with Doppler indicates of Sacrococcygeal teratoma

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