Penetrating Spine Injuries and Long-Term Complications of Spine Injuries Flashcards
What are the indications for surgery in case of gunshot wound injury?
● A. Injury to cauda equina or neurologic deterioration
● B. Compression of a nerve root or CSF leak
● C. Spinal instability or to remove a copper jacket bullet
● D. Incomplete lesion or need for debridement or vascular injuries
● E. For late complications like migrant bullet, lead toxicity, or late spinal instability
● F. All of the above
F. All of the above
Penetrating injuries to neck are divided into three zones which are the following except?
● A. Zone 1 is inferior from the head of the clavicle to the thoracic outlet
● B. Zone 2 is from the clavicle to the angle of mandible
● C. Zone 3 is from angle of mandible to base of skull
● D. Zone 4 is from base of skull to the level of foramen of Monro
D. Zone 4 is from base of skull to the level of foramen of Monro
Penetrating injury of neck may cause which of the following?
● A. Shock or hypoxemia due to asphyxiation
● B. Cranial nerve injury
● C. Nerve root or brachial plexus involvement
● D. Spinal cord involvement with complete or incomplete spinal cord injury or spinal shock
● E. All of the above
E. All of the above
Extravasation of blood or intimal dissection of a vessel can be diagnosed with help of which of the following?
● A. Cervical X-ray
● B. Cervical CT with bone window
● C. MRI with MRV
● D. CT angiography of neck vessels
● E. DEXA scan
E. DEXA scan
Surgical exploration for neck injuries is indicated for which of the following?
● A. Penetrating injury piercing the platysma and anterior triangle of neck
● B. Penetrating injury in posterior triangle of neck
● C. Penetrating injury in lateral triangle of neck
● D. Penetrating injury below angle of mandible
● E. All of the above
E. All of the above
ICA ligation is recommended for injuries in which bleeding cannot be controlled, and it is associated with worse outcome. Endovascular technique is also suitable for select cases. Open carotid repair is recommended in which of the following patients?
● A. With major neurologic deficit
● B. With no or minor neurologic deficit
● C. With poor neurologic outcome patients
● D. In brain dead patients
● E. None of the above
B. With no or minor neurologic deficit
VA can be ligated in case of iatrogenic injury. In case of elective procedure, what is the prerequisite for VA ligation?
● A. Knowledge of the patency of contralateral VA
● B. Ability of fill of the ipsilateral PICA from retrograde flow from BA
● C. Knowledge of patency of ICA on both sides
● D. A and B
D. A and B
Delayed deterioration following spinal cord injury can occur because of which of the following?
● A. Post-traumatic syringomyelia or subacute ascending progressive myelopathy
● B. Unrecognized spinal instability or tethered spinal cord
● C. Delayed spinal epidural hematoma or apoptosis of neurons
● D. Glial scar formation
● E. All of the above
E. All of the above
Autonomic hyperreflexia can occur due to spinal cord injury which can lead to pounding headache, flushing, or diaphoresis above the lesion. It occurs only in patients with lesion above which of the following?
● A. T12
● B. T9
● C. T6
● D. T2
● E. Can occur at any level injury
C. T6
Treatment options for autonomic hyperreflexia include which of the following?
● A. Immediate HOB elevation
● B. Making sure that bladder is empty and that tight apparels are removed
● C. Control of hypertension
● D. IV diazepam
● E. All of the above
E. All of the above
Which of the following is a late complication of gunshot wound to spine causing anemia, encephalopathy, motor neuropathy, nephropathy, and abdominal colic?
● A. Cauda equina syndrome
● B. Lead toxicity
● C. Brown Sequard syndrome
● D. CSF fistula
● E. Catheter tip granuloma
B. Lead toxicity
Injury in the neck from the clavicle to the angle of the mandible is an injury of which zone?
● A. I
● B. II
● C. III
● D. IV
● E. V
B. II
Which of the following is the most commonly injured artery in penetrating neck trauma?
● A. ICA
● B. ECA
● C. CCA
● D. Vertebral artery
● E. Transverse cervical artery
C. CCA
A patient with penetrating spine injury had a delayed deterioration. There were signal changes extending to four levels above the original injury and was labeled as subacute progressive ascending myelopathy (SPAM). What is the median time of
occurrence post injury?
● A. 1 day
● B. 3 days
● C. 13 days
● D. 1 month
● E. 3 months
C. 13 days
In patients with spinal cord injury above T6, pounding headache, flushing, and diaphoresis above the lesion may occur due to autonomic hyperreflexia which is due to release of which of
the following?
● A. Epinephrine
● B. Norepinephrine
● C. Dopamine
● D. Serotonin
● E. Bradykinin
B. Norepinephrine
