In a child with myelomeningocele the sac contains one of the following:

IGNOU PB Bsc Entrance-2023

Child Health Nursing (Pediatrics)

Easy

Appeared in: IGNOU PB Bsc Entrance-2023

Explanation

Myelomeningocele is the most severe and common form of spina bifida, a type of neural tube defect.
It is characterized by the protrusion of a sac-like cyst through an opening in the developing spine.
This sac contains the meninges (the protective membranes covering the spinal cord), cerebrospinal fluid (CSF), and a portion of the spinal cord and nerve roots.
The term itself provides a clue: 'myelo-' refers to the spinal cord, 'meningo-' refers to the meninges, and '-cele' refers to a swelling or sac.
The exposure of neural tissue to the environment is what leads to significant and permanent neurological deficits.

Option A: A sac containing only spinal fluid is an incomplete description. In neural tube defects with a sac (spina bifida cystica), the meninges are also involved in forming the sac.
Option B: This is anatomically incorrect. The spinal cord is always covered by its protective meninges and bathed in cerebrospinal fluid; it would not protrude by itself.
Option C: A sac containing only the meninges and cerebrospinal fluid (but not the spinal cord) defines a meningocele, which is a different, less severe type of spina bifida.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology of Neural Tube Defects (Myelomeningocele) as background academic context rather than a clinical decision trigger.
The immediate post-natal nursing care for a newborn with myelomeningocele is critical to prevent life-threatening infection (meningitis) and further neurological damage. The nurse's primary role is to protect the exposed sac from injury, drying, and contamination.
Nurses must vigilantly monitor for signs of hydrocephalus (e.g., measuring head circumference daily, assessing fontanelle tension, observing for irritability or poor feeding), which is a very common comorbidity requiring surgical shunting.
Positioning the infant prone is a key safety measure to prevent pressure on the sac. This has implications for feeding, bonding, and respiratory monitoring.

How to Approach the Question

First, identify the key term in the question: 'myelomeningocele'.
Break down the medical term into its roots: 'myelo-' refers to the spinal cord, 'meningo-' refers to the meninges (the membranes covering the cord), and '-cele' means a sac or protrusion.
Combining the roots tells you that a myelomeningocele is a sac containing the spinal cord and meninges.
Recall that the central nervous system is bathed in cerebrospinal fluid (CSF), so the sac must also contain CSF.
Evaluate the options based on this complete definition. The only option that includes all three components—spinal cord, meninges, and spinal fluid—is the correct one.
Differentiate this from a 'meningocele', which would only contain meninges and CSF, to correctly eliminate the distractor.

Concept Tested & Keywords

Concept Tested: Pathophysiology of Neural Tube Defects (Myelomeningocele)
Stem keywords: myelomeningocele, sac contains, child
Lead-in keywords: BEST, MOST RELEVANT CLUE
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1368-1370