Spina Bifida: Occulta, Meningocele, Myelomeningocele & Rehab MCQs

Spina Bifida (Neural Tube Defects)

Spina Bifida is a failure of the posterior vertebral arches to fuse. It ranges from asymptomatic hidden defects to severe open lesions causing paralysis.

1. Classification

• Spina Bifida Occulta: Hidden defect. Arch is open but skin is intact. Often marked by a hairy patch or dimple. Usually asymptomatic.
• Spina Bifida Cystica:
  • Meningocele: Sac contains meninges + CSF (No nerves). Good prognosis.
  • Myelomeningocele: Sac contains meninges + CSF + Nerve roots/Cord. Severe deficits (paralysis, bladder bowel loss).

2. Associated Conditions

Key Associations:
- Hydrocephalus: (Water on brain) Associated with Arnold-Chiari Malformation II.
- Tethered Cord Syndrome: Cord gets stuck to scar tissue, causing traction during growth.
- Latex Allergy: Very common in these patients.

3. Management

• Prevention: Folic Acid supplementation in pregnancy.
• Surgery: Closure of the defect within 48 hours (to prevent infection). VP Shunt for hydrocephalus.
• Rehab: Bladder care (CIC), orthotics (AFOs/RGOs) for walking.

25 Practice MCQs

Q1. Which vitamin deficiency is strongly linked to Spina Bifida?

Answer: A). Supplements prevent up to 70% of NTDs.

Q2. Myelomeningocele contains:

Answer: A). Most severe form.

Q3. Spina Bifida Occulta typically presents with:

Answer: A). Often incidental finding.

Q4. Hydrocephalus is most commonly associated with:

Answer: A). Cerebellum herniates into spinal canal, blocking CSF flow.

Q5. Alpha-fetoprotein (AFP) levels in maternal blood are:

Answer: A). Screening test during pregnancy.

Q6. Tethered Cord Syndrome causes:

Answer: A). Cord is stuck distally and stretches.

Q7. Meningocele differs from Myelomeningocele because:

Answer: A). Better prognosis.

Q8. VP Shunt is used to treat:

Answer: A). Ventriculo-Peritoneal shunt drains CSF.

Q9. Allergy to what substance is common in spina bifida patients?

Answer: A). Due to multiple early surgeries/exposures.

Q10. Most common orthopedic deformity in Spina Bifida is:

Answer: A). Also Hip dislocation.

Q11. Surgery to close the back defect is ideally done within:

Answer: A). To prevent meningitis.

Q12. Neurogenic bladder in spina bifida usually requires:

Answer: A). Preserves kidney function.

Q13. Diastematomyelia is:

Answer: A). Causes tethering.

Q14. Which level of lesion allows good ambulation?

Answer: A). Higher levels usually require wheelchair use eventually.

Q15. "Rachischisis" means:

Answer: A). Most severe and fatal form.

Q16. The primary defect is failure of closure of the:

Answer: A). Cranial failure leads to Anencephaly.

Q17. RGO stands for:

Answer: A). Helps high-level patients walk (swivel motion).

Q18. Sensory loss in spina bifida leads to high risk of:

Answer: A). Daily skin checks are mandatory.

Q19. Is intelligence affected?

Answer: A). "Cocktail party personality" is sometimes described.

Q20. Lipomeningocele is:

Answer: A). A form of occult dysraphism.

Q21. Which hip muscle is often preserved in L3/4 lesions, leading to dislocation?

Answer: A). Muscle imbalance pops the hip out posterior-superiorly.

Q22. Fetal surgery involves:

Answer: A). Shown to improve outcomes (MOMS trial).

Q23. Charcot joints (Neuropathic arthropathy) can occur due to:

Answer: A). Insensate joints destroy themselves.

Q24. Scoliosis in Spina Bifida is:

Answer: A). Often requires fusion (Kyphectomy for severe kyphosis).

Q25. The "Lemon Sign" on ultrasound refers to:

Answer: A). "Banana sign" refers to the cerebellum.