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PM&R Recap > SCI > Flashcards

SCI Flashcards

1
Q

Most common etiology of SCIs?
Younger age groups vs. older age groups?

A

MVC most common overall (38%), falls 2nd (33%)
- MVC most common in younger age groups
- Falls = leading cause of SCI in pts > 65yo

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2
Q

Mean age of SCI?
Male : Female ratio?

A

Mean age 43 yo (up from 29 in the 1970s)
M:F ratio = roughly 4:1

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3
Q

Most common type of neurological injury? (tetra vs paraplegia, complete vs. incomplete?)

A

Incomplete tetraplegia
Incomplete paraplegia
Complete paraplegia
Complete tetraplegia

(tetra - para - para - tetra; incompletes come first)

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4
Q

Blood supply for spinal cord?

A

Anterior 2/3 = anterior spinal artery (derived from vertebral arteries)

Anterior distal 1/3 = artery of Adeamkiewicz (AKA great anterior radiculomedullary artery or arteria radicularis anterior magna); derived from descending aorta

Posterior cord = posterior spinal arteries

*Ischemia is more likely in watershed region b/t blood supplies (lower thoracic region)

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5
Q

What is a Jefferson Fracture? Typical treatment?

A

C1 burst fracture

due to high axial impact load -> burst fracture of anterior or posterior arches of C1 (Atlas) vertebra

Tx: cervical brace (Halo), or surgery if unstable

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6
Q

What type of dens/odontoid fracture is most common?

A

Type 2 - base of odontoid, typically requires surgery as is unstable

Dens fractures:
Type 1 = tip of dens (stable)
Type 2 = base of odontoid (typically unstable)
Type 3 = base of odontoid extending into C2 vertebrae (more stable, sometimes needs surgery)

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7
Q

What is a Hangman Fracture?

A

C2 burst fracture

Due to rapid deceleration injury of neck

Tx: cervical bracing vs. surgery if unstable

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8
Q

What type of SCI is usually due to hyperextension injury?

A

Central Cord Syndrome

E.g. elderly falling onto outstretched chin (cervical extension); inward bulging of ligamentum flavum into stenotic canal

Tx: often can treat w/ cervical collar

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9
Q

Most common level of cervical facet joint dislocations? (Jumped facets)

A

Unilateral = C5-C6

Bilateral = C5-C6

Tx: surgical stabilization often required

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10
Q

what is a chance fracture?

A

Fracture extends from spinous process through the vertebral body

Usually due to trauma/distraction injury

TX: often neurologically stable, may only require bracing (CASH/Jewett brace to limit flexion)

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11
Q

Criteria for ASIA B injury?

A

some sensory sparing below neurological level of injury w/ no motor function more than 3 levels below each motor level (S4-S5 or deep anal sensation is intact)

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12
Q

Criteria for ASIA C injury?

A

voluntary anal contraction OR some motor function is preserved below neurological level of injury

< 50% grade 3/5 strength or better

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13
Q

Criteria for ASIA D injury?

A

Voluntary anal contraction AND some motor function is preserved below neurological level of injury where > 50% of these muscles are 3/5 strength or better

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14
Q

Ambulation prognosis for posterior cord syndrome?

A

very poor

Posterior cord syndrome = rare, injury to dorsal columns, b/l impaired light touch, pressure, prioprioception

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15
Q

Better prognosis for recovery in Central Cord Syndrome?

A

Age < 50 = better prognosis

Central cord = most common incomplete SCI

UE > LE affected, distal > proximal weakness

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16
Q

Expected deficits in Brown Sequard Syndrome?

A

Ipsilateral loss of motor, coordination, light touch/proprioception

Contralateral loss of pain/temperature several levels below level of injury

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17
Q

Conus Medullaris Syndrom vs. Cauda Equina deficits?

A

Conus Medullaris = symmetric w/ variable bowel/bladder dysfunction; often NORMAL motor function (L1-L5 roots have already come off the cord, typically unaffected) -> UMN injury

Cauda Equina Syndrome = Asymmetric, variable myotome weakness and dermatome sensory loss -> LMN bowel/bladder; EMG can offer prognostic value

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18
Q

First reflexes to return after spinal shock?

A

Bulbocavernosus, anal wink, Babinski

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19
Q

SCI levels at risk for autonomic dysreflexia?

A

T6 and above

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20
Q

What is the cause of bradycardia in AD episodes?

A

Local vasoconstriction -> vagal nerve slows HR to compensate

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21
Q

Pharmacologic treatments for AD if SBP > 150?

A

Nifedipine 10mg
Clonidine 0.3mg
Nitroglycerin topical (above level of injury)

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22
Q

What amount of pressure leads to capillary ischemia and pressure injuries?

A

Pressure > 70 mmHg causes capillary ischemia to that area of skin

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23
Q

Most common site of pressure injury in adults?

A

sacrum

24
Q

Most common site of pressure injury in children?

A

occiput

25
Q

Pressure Injury stage?
Non-blanchable erythema

A

Stage 1

26
Q

Pressure Injury stage?
Skin breakthrough that extends into the dermis?

A

Stage 2

27
Q

Pressure Injury stage?
Extends through the dermis with subQ fat exposed

A

Stage 3

28
Q

Pressure Injury stage?
Muscle, tendon, or bone is exposed

A

Stage 4

29
Q

Vacuum-assisted closure is indicated for which stages of pressure injuries?

A

stage 3 and stage 4

30
Q

What type of wound care is indicated for stage 1 and stage 2 pressure injuries?

A

occlusive dressings - help to maintain a moist environment

31
Q

What is the role of the frontal lobe in normal bladder physiology?

A

Frontal lobe primary motor cortex allows voluntary contraction/relaxation of external urethral sphincter

Also inhibits the sacral micturition center (parasympathetic)

32
Q

What is the role of the pontine micturation center in normal bladder physiology?

A

coordinates detrusor contraction with internal sphincter relaxation

33
Q

What is the role of the sacral micturition center in normal bladder physiology?

A

allows parasympathetic micturition action

Parasympathetic Pee Pelvic

34
Q

Which nerve (and corresponding roots) allows for voluntary contraction of external sphincter?

A

Pudendal nerve (S2-S4)

Promotes bladder storage

35
Q

What is the action of the pelvic nerve on the bladder, and what receptors does it act on?

A

Pelvic nerve (S2-S4) = parasympathetic

Activates muscarinic ACh receptors in bladder wall to cause detrusor contraction -> causes bladder emptying

36
Q

What is the action of the hypogastric nerve on the bladder, and what receptors does it act on?

A

Hypogastric nerve (T11-L2) = sympathetic

Activates α-1 (internal urethral sphincter) and β-2 receptors (bladder wall) to promote urine storage

“Hypogastric nerve makes your bladder as big as a hippo”

37
Q

Most common bladder pathology in SCI?

A

detrusor-sphincter dyssynergia

Impaired coordination of sphincters and detrusor contraction -> high vesicular pressures, vesicoureteral reflux (VUR) = complication

38
Q

Goal UOP volumes for clean intermittent cathing?

A

< 500cc

39
Q

What are the motor and sensory plexuses for the bowel?

A

Myenteric (Auerbach) plexus = motor plexus

Submucosal (Meissner) plexus = sensory plexus

Coordinate peristalsis

40
Q

Normal bowel physiology (parasympathetic/sympathetic actions, somatic control of sphincters)?

A

Parsympathetic (vagus and pelvic nerves) action is to digest - peristalsis

Sympathetic (hypogastric nerve) action is to store (internal anal sphincter contraction) and shunt blood away from bowel

Somatic (pudendal nerve) control over external anal sphincter

41
Q

What is the gastrocolic reflex?

A

Presence of food in stomach causes reflex defecation (sit pt on commode 15-60min after meal for bowel program)

42
Q

What is the rectocolic reflex?

A

Rectal distension causes reflex defection

Utilize digital simulation in bowel program

43
Q

Female SCI - effects on fertility?

A

Fertility unaffected

Menstrual cycle returns to normal within 6-12 months after SCI

44
Q

Male SCI - effects on fertility?

A

Poor semen quality and impaired erections cause decreased male fertility after SCI

45
Q

Treatment of hypercalcemia in SCI?

A

IVF (normal saline) - increases urinary excretion of calcium

Pamidronate (bisphosphonate) - inhibits osteoclast-mediated resorption, reduces osteoclast viability; administered as single IV infusion, rapidly lowers serum calcium within 3 days

Furosemide increases urinary excretion of Ca (although not routinely used)

**Avoid thiazide diuretics - cause hypercalcemia

46
Q

Most common site of fracture in SCI? Typical treatment?

A

Distal femur, most fractures occur while doing ADLs

Tx: frequently treated non-operatively w/ soft padded splints

47
Q

Pulmonary function test patterns in SCI?

A

All lung volumes decreased except residual volume (restrictive lung pattern due to muscle weakness)

48
Q

DVT/PT ppx recommended after SCI?

A

SQ heparin or LMWH until discharge (incomplete injuries) or 8-12 weeks for complete SCI; compression garments

49
Q

Most common causes of death in SCI?

A

Respiratory complications
Acute = PE
Chronic = PNA

50
Q

Medication w/ FDA approval for neuropathic pain following SCI?

A

Pregabalin

51
Q

Most common MSK nociceptive pain in SCI patients?

A

Shoulder = most commonly affected joint, usually due to weight-bearing/overuse

52
Q

Highest level complete SCI level that can live independently without aid of an attendant?

A

C6 complete tetraplegia (highly motivated)
- feeding w/ universal cuff for utensils
- Transfers require stabilization of elbow extension w/ forces transmitted from shoulder
- bowel care w/ suppository inserter or other apparatus for digi stim

*C7 level is the usual level for achieving independence

53
Q

Insidious onset of ascending loss of reflexes, sensation, burning pain worse w/ sitting or valsalva in SCI patient is concerning for what complication?

A

Syrinx formation

MRI w/ contrast

54
Q

Completion of suicide is most common in paraplegics or tetraplegics?

A

paraplegics

Depression is very common in SCI, increased risk of suicide

55
Q

minimum strength needed for tendon transfer in SCI?

A

must have 4 or 5 strength in the tendon being transferred since you usually lose a grade postsurgery

PM&R Recap (10 decks)

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