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Dysmorphology
Back
| Question | Answer |
|---|---|
| How many vertebrae are there? | 33 |
| How many cervical spine vertebrae are there? | 7 |
| How many thoracic vertebrae are there? | 12 |
| How many lumber? | 5 |
| How many sacral? | 5 |
| Vertebral anatomy | 1. Spinous Process 2. Transverse processes 3. Foramina 4. Body (Cancellous/spongy bone and cortical rim) |
| What do the three foramina do? | 2 on side are for nerves and the large on in the middle if for the spinal cord |
| What is the largest vertebrae? | C7 |
| Where does the spinal cord exit the brain? | At the foramen magnum at the base of the skull |
| Where does the spinal cord end? | At the conus medullaris (L3 in child and L1-L2 in adult |
| What lay between the vertebrae? | The cartilaginous disks |
| External landmarks of the back | 1. Spinous processes 2. Scapulae 3. Iliac crests 4. Sacrum 5. Coccyx |
| Examination technique- Inspection | 1. General configuration 2. Symmetry 3. Depressions, hair at midline, sacrum 4. Changes in skin texture, pigmentation 5. Curvature of the spine |
| Curvature of the spine: Kyphosis | Convex, normal is 30 degrees to 50 degrees |
| Curvature of the spine: Lordosis | concave curvature |
| Curvature of the spine: Scoliosis | Lateral curvature |
| Postural kyphosis | Usually presents in adolescence |
| Schuermann kyphosis | Usually presents in adolescence - Often familial -abn. growth of vertebrae - "wedge-shaped" -One side grows faster than the otther |
| Congenital kyphosis | Malformation of vertebrae |
| Paralytic disorders associated with kyphosis | MD, CP, etc. |
| Lordosis is often caused by... | 1. Achondroplasia 2. Benign 3. Spondylolisthesis (misalignment of the lumbar vertebrae, congenital (rare) |
| Scoliosis | 1. uneven shoulders and hips 2. unilateral rib hump 3. infantile scoliosos is a deformation caused neurologic DOs |
| Examination techniques- Palpation | For dimples, depressions of the spinal processes and sacrum |
| Minor variants/anomalies of the back | 1. Sacral dimples 2. Pigmentation 3. |
| Sacral dimples | 1. 2-3% of all newborns 2. Blind 3. Usually midline 4. Must be differentitated from spinal dysraphism |
| Minor anomaly: pigmentation | (Nevi, Mongolian spots, hematomas) -"Stork bites" "angel kisses" etc. -Evaluated for tethered cord, spina bifida occulta |
| Dysplasias of the back | 1. Gibbus 2. Platyspongyly 3. Winged scapulas |
| Malformations of the back | 1. Scoliosis 2. Scapular abnormalities 3. Hypoplastic scapulas 4. Pilonidal dimple/sinus/cysts 5. Arnold-Chiari malformation 6. Midline masses 7. Spinal dysraphism |
| Minor variants/anomalies | -Relative trunk length: height- Normal lumbar lordosis of toddlerhood- bifid spinous process-Sacral dimples and others mentioned above |
| Disruptions | None |
| Deformations of the back | 1. Scoliosis |
| Deformation scoliosis is due to | severe intrauterine constraint |
| Other deformations that present with scoliosis are (Joint contractures)... | Arthogryopsis multiplex congenital |
| What is a gibbus? | -Dysplasia- Severe kyphosis; humpback; curvature is not smooth |
| What is polyspondyly? | -Dysplasia-Flattening of vertebral body> shortened trunk |
| When does a Gibbus occur? (syndrome) | -Hunter syndrome |
| When does platyspondyly occur? | OI, MPS, skeletal dysplasias |
| What syndromes are associated with winged scapulas? | Muscular dystrophy, cleidocranial dysplasia, EDS |
| Describe scapular abnormalities | 1. Malformations2. Sprengel sequence3. Failure of normal scapula descent; hypoplastic |
| Scapular abnormalities are typically seen in what syndrome? | Klippel-Feil |
| What syndrome is hypoplastic scapulas (chondrodystrophies) typically seen in? | Campomelic dysplasia |
| Describe Pilonidal dimple/sinus/cyst | - Malformation of the back- Found in natal cleft- Often have hair, may drain fluid- Evaluate for tethered cord(1)Caudal end of spinal cord attached to bone by connective tissue (2) As spine grows, cord is stretched downward |
| Arnold-Chiari malformations | -Can be caused by tethered cord-Herniation of the cerebellum through the foramen magnum- Symptoms range from none to obstructive hydrocephalus |
| 2 types of midline masses (malformations) | (1) lipomas (2) sacrococcygeal teratoma |
| Lipomas | (1) can be irregulary shaped (2) move with the skin, firm (3) benign, fat cells (4) may signifiy underlying spina bifida(5) may extend into the spinal cord |
| Sacrococcygeal teratoma | (1) most common newborn tumor (2) 1:35,000-40,000 LBs (3) composed of many types of cells |
| 4 Types of spinal dysraphism (malformation) | (1) SB occulta (2) meningocele (3)myelomeingocele (4)Spinal rachischisis |
| Spina Bifida occulta | -Mildest form of Spinal dysraphism-Usually no clinical signs-Sometimes marked by lipomas, hemangioma, hairy patch |
| Meningocele | -Spinal membrance protrude through spinal canal-Usually lower lumbar or sacral-Usually no neurological sequelae |
| Myelomenigocele | -Most serious form of spina bifida-Spinal cord and meninges protrude-Problems with movement and sensation below the level of the defect |
| Spinal rachischisis | -Failure of fusion of a large part of neural tube-Incompatible with life-Most common in thoracic region-Anencephaly/inencephaly |
Created by:
KChatham
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