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Med Surg 2 > MIDTERMS: SCI > Flashcards

MIDTERMS: SCI Flashcards

1
Q

Epidemiology of SCI

A

Young men with a ratio of 4:1
Average age at injury is 30 years old
Traumatic SCI secondary to:
Vehicular accidents 37 %
Violence 28 %
Falls 21 %
Sports injuries 6 %

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2
Q

Anatomy: Spinal cord segments

A

Cervical 8, Thoracic 12, Lumbar 5, Sacral 5, Coccygeal 1

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3
Q

Injury: Cord hemisection
Characteristics:
Ipsilateral: Weakness, proprioceptive deficits
Contralateral: Loss of pain and thermal sensation caudal to 1-2 segments below the lesion

A

Brown-Sequard Syndrome

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3
Q

Blood supply: Anterior 2/3 of spinal cord
A) Posterior spinal arteries
B) Vertebral arteries
C) Anterior spinal arteries
D) Radicular arteries

A

C) Anterior spinal arteries

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3
Q

Blood supply: Posterior ⅓ of spinal cord
A) Posterior spinal arteries
B) Vertebral arteries
C) Anterior spinal arteries
D) Radicular arteries

A

A) Posterior spinal arteries

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4
Q

Spinal Tract: Proprioception and tactile discrimination
A) DCML
B) Spinothalamic
C) Spinocerebellar
D) Spinoreticular

A

A) DCML

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4
Q

Function of the spinal column: Anterior
A) Weight-bearing
B) Postural stability
C) Muscle attachments
D) Reflexes

A

A) Weight-bearing

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5
Q

Spinal Tract: Pain and temperature sensation

A

Spinothalamic

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5
Q

ASIA Impairment Scale: Complete, no motor or sensory function below S4-S5
A) A
B) B
C) C
D) D
E) E

A

A (Complete)

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5
Q

Spinal Tract: Proprioception to the cerebellum

A

Spinocerebellar

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6
Q

Injury: Hyperextension injuries with spondylosis
Characteristics: Weakness more severe in the arms, cruciate paralysis involving upper cervical spine

A

Central Cord Syndrome

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6
Q

ASIA Impairment Scale: Motor function is preserved below the neurological level with muscle grade > 3
A) A
B) B
C) C
D) D
E) E

A

D (Incomplete, muscle grade > 3)

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7
Q

Definition: Preservation or return of function of nerve roots near the level of the lesion
Potential: Recovery of some function

A

Root Escape

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7
Q

A Jefferson Fracture is a burst fracture involving the ___________ vertebra, typically caused by axial compression.

A

C1 (Atlas)

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7
Q

Injury: Flexion injury, anterior spinal artery damage
Characteristics: Pain sensation and motor weakness below injury level, preservation of proprioception, light touch, and deep pressure

A

Anterior Cord Syndrome

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8
Q

Injury: Damage to the conus medullaris
Characteristics: Bowel and bladder dysfunction, symmetrical sensory deficits in the saddle area, minor lower extremity deficit

A

Conus Medullaris Syndrome

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9
Q

Injury: LMN lesion, damage to the lumbosacral nerve roots
Characteristics: Asymmetrical deficits, areflexia, muscle atrophy, and atonia

A

Cauda Equina Syndrome

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9
Q

Common Locations: C5-C7, T12-L2
Injuries: Wedge fractures, burst fractures, teardrop fractures

A

Flexion

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10
Q

Common Locations: Fractures of posterior elements, avulsion fracture
Example: Hangman’s fracture from chin hitting the dashboard

A

Hyperextension

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10
Q

Injuries: Fractures of pedicles, articular facets, laminae
Example: Unstable if posterior longitudinal ligament (PLL) is affected

A

Flexion-Rotation

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10
Q

Injury: Horizontal force causing ligament disruption
Example: Fracture dislocations of thoracolumbar (TL) spine, Chance/lap belt fractures

A

Shearing

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10
Q

Injury: Least common mechanism
Cause: Whiplash, tensile force

A

Distraction

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10
Q

Injury: Fracture of C3-C7, axial compression
Stability: Stable, requires CT for evaluation

A

Burst Fracture

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11
Q

Injury: Burst fracture of atlas (C1), axial compression
Displacement: Lateral masses of C1 beyond the margins of C2

A

Jefferson Fracture

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11
Q

Injury: Anterior displacement of occipital condyles over C1

A

C1 - C2 Subluxation

11
Q

Which of the following describes a Clay Shoveler’s Fracture?

A) Avulsion fracture of the spinous process (C6-T1)
B) Burst fracture of C1
C) Spondylolisthesis of C2
D) Flexion teardrop fracture of C3-C7

A

A) Avulsion fracture of the spinous process (C6-T1)

11
Q

Injury: Bilateral C2 pars interarticularis fractures, hyperextension, and distraction
Stability: Unstable

A

Hangman’s Fracture

12
Q

Type I: Tip of odontoid, rare, potentially unstable
Type II: Most common, base of odontoid, unstable
Type III: Base of odontoid into the body of axis, best prognosis

A

Odontoid Fractures

12
Q

Name the fracture associated with hyperextension and distraction, commonly caused by hitting the dashboard during a motor vehicle accident.

A

Hangman’s Fracture

13
Q

T or F
A Chance Fracture typically occurs due to flexion-distraction and is associated with high intra-abdominal injury risk.

A

True

14
Q

Which of the following spinal cord syndromes is characterized by bowel and bladder dysfunction, with symmetrical sensory deficits in the saddle area?

A) Cauda Equina Syndrome
B) Anterior Cord Syndrome
C) Central Cord Syndrome
D) Conus Medullaris Syndrome

A

D) Conus Medullaris Syndrome

15
Q

The most common mechanism of injury for a Burst Fracture is ___________.

A

Axial compression

15
Q

Name the fracture that is characterized by a fracture of the odontoid process at its base and is the most common type of odontoid fracture.

A

Type II Odontoid Fracture

15
Q

What mechanism of injury is most commonly associated with a Flexion Teardrop Fracture?

A) Hyperflexion and compression
B) Hyperextension
C) Distraction
D) Shearing

A

A) Hyperflexion and compression

16
Q

In the ASIA Impairment Scale, Grade A represents _____________ injury, while Grade E represents _____________ motor and sensory function.

A

complete; normal

16
Q

The Motor Index Score (MIS) in the ASIA classification has a maximum score of _____________.

A

100

17
Q

The Beevor’s Sign indicates a lesion at which spinal level?

A) C2-C4
B) T10
C) L2
D) S4-S5

A

B) T10

17
Q

Which type of spinal cord injury (SCI) syndrome results in ipsilateral weakness and proprioceptive deficits with contralateral pain and temperature loss?

A) Brown-Sequard Syndrome
B) Central Cord Syndrome
C) Anterior Cord Syndrome
D) Conus Medullaris Syndrome

A

A) Brown-Sequard Syndrome

17
Q

T of F
A Clay Shoveler’s Fracture is a stable injury caused by hyperextension of the neck.

A

False (It is caused by hyperflexion)

17
Q

Which of the following is NOT a descending spinal tract?

A) Corticospinal Tract
B) Rubrospinal Tract
C) Spinothalamic Tract
D) Vestibulospinal Tract

A

C) Spinothalamic Tract

18
Q

T or F
The spinocerebellar tract conveys proprioceptive information to the ipsilateral cerebellum.

A

true

19
Q

Which type of injury results from horizontal force causing ligament disruption and is often associated with fracture dislocations of the thoracolumbar spine?

A

Shearing injury

20
Q

Which medication is not effective in penetrating SCI wounds?

A) Methylprednisolone
B) Gacyclidine
C) Naloxone
D) Neuro Ganglioside GM-1

A

A) Methylprednisolone

20
Q

T or F
A Chance Fracture occurs primarily in the cervical spine.

A

FASLE (It occurs in the upper lumbar spine)

20
Q

In a Burst Fracture, the empty vertebral body sign can be seen on a(n) _____________ radiograph.

A

AP (Anteroposterior)

21
Q

What is the clinical significance of preserved pin-prick sensation in SCI prognosis?

A

Better prognosis for ambulation recovery compared to preserved light touch sensation.

21
Q

True/False: Central Cord Syndrome has a better prognosis than Anterior Cord Syndrome.

A

True

22
Q

The majority of Brown-Sequard patients ambulate within _______ months of injury.

A

6 months

22
Q

What pharmacologic treatment is used for Venous Thromboembolism (VTE) in SCI patients?

A

Low Molecular Weight Heparin (e.g., Enoxaparin).

23
Q

Name a common respiratory complication in patients with C1-C4 SCI.

A

Pneumonia

24
Q

What is the recommended catheterization interval in an Intermittent Catheterization Program (ICP)?

A

4-6 hourss

25
Q

What is the key treatment for autonomic dysreflexia (AD)?

A

Sit the patient upright, identify and remove the noxious stimulus, treat hypertension with rapid-onset, short-duration antihypertensives like nifedipine.

26
Q

Name a common acute GI complication in SCI.

A

Ileus or fecal impaction.

27
Q

Which scoring system is used to evaluate motor and sensory functions in SCI patients?

A

ASIA motor/sensory scale.

28
Q

What are common associated fractures in SCI?

A

Chest, lower extremities (LE), upper extremities (UE), head, and pelvis.

29
Q

Which type of SCI leads to mechanical ventilatory support being necessary for patients?

A

Injuries at C4 or higher.

30
Q

What percentage of Brown-Sequard patients ambulate within 6 months post-injury?

A

90%.

31
Q

What medication is used within 8 hours of SCI for neuroprotection and its associated risks?

A

Methylprednisolone (MP); risks include increased infections, sepsis, respiratory complications, and GI hemorrhage.

32
Q

What is the first stage of spinal shock, and what are its features?

A

Stage 1 (0-24 hrs): Motor neuron hyperpolarization, hyporeflexia.

33
Q

What type of spinal cord injury (SCI) has the best prognosis for recovery?

A

Central cord syndrome and Brown-Sequard syndrome.

Med Surg 2 (12 decks)

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