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Medical Conditions > Spinal Cord > Flashcards

Spinal Cord Flashcards

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USMLE® Step 1 flashcards
1
Q

CNS

A

Sensory (afferent, ascending)
-gather info from PNS and transmits to CNS
Descending motor (efferent) information
-Originates from cortex and is transmitted by the spinal cord back to the PNS

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2
Q

Vertebral column; protects SC

A

 33 vertebrae
 7 cervical (C1-C7)
 12 thoracic (T1-T12)
 5 lumbar (L1-L5)
 5 sacral (S1-S5)
 4 coccygeal (fused)
* 31 pairs spinal nerves exit SC to form PNS
* Spinal nerves C1 – C7 exit above vertebrate
* Spinal nerves C8 – S5 exit below vertebrate
* Cauda equine (horse tail)
* Lumbar cistern
-The CSF-filled meningeal space between L2 and L4
-Site where r therapeutic punctures,

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3
Q

SC nerve tissue that make up the SC:

A

 Gray matter: located centrally, cell bodies / synapses
 resembles a butterfly
 White matter: contains ascending / descending pathways, periphery of SC
 most of the periphery of the cord and
contains the ascending and descending pathways.

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4
Q

Reflex arc; knee-jerk reflex

A

afferent nerve impulses also travel to
the brain almost instantaneously. This allows a, or “feeling,” of initial stimulation (knee tap) and subsequent response (knee jerk).

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5
Q

Cervical nerves (C1 through C8)

A

Carry afferent and efferent impulses for the head, neck, diaphragm, arms,
and hands

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6
Q

The thoracic spinal nerves (T1 through T12)

A

Serve the chest and upper abdominal musculature

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7
Q

The lumbar spinal nerves (L1 through L5)

A

Carry information to and from the legs and a portion of the foot

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8
Q

Sacral spinal nerves (S1 through S5)

A

Carry impulses for the remaining foot musculature, bowel, bladder, and
the muscles involved in sexual functioning

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9
Q

SCI Signs and Symptoms

A
  • Complete: complete transection of the cord, total loss below lev of
    injury
  • Incomplete: without total transection, some voluntary mvt / sensation below lev of injury
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10
Q

SCI Incidence and Prevalence

A
  • 12,000 new cases every yr
  • 80% SCI male; ~ age 34.7 yrs
  • 63% White vs 2% Asian
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11
Q

SCI Etiology

A
  • Motor vehicle accidents leading cause in US
  • Falls / acts of violence; gunshot wounds (3rd in US)
  • Sports-related; diving most common
  • Spina bifida (nontraumatic cause)
  • Bacterial / viral infections can damage SC tissue
  • Benign or malignant growths
  • Embolisms, thromboses, and hemorrhages
  • Radiation or vaccinations
  • Surgery
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12
Q

Upper motor neuron (UMN) injury

A
  • Intact below the level of injury but are no longer mediated by the brain.
  • Loss of voluntary function below the level of the injury, (b) spastic paralysis, (c) no muscle atrophy, and (d) hyperactive reflexes
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13
Q

Lower motor neuron (LMN) injury

A
  • Injuries involving spinal nerves after they exit the cord at any level are referred to as
    LMN injuries.
  • the reflex arc cannot occur, because impulses cannot enter the cord to synapse.
  • loss of voluntary function below the level of the injury, (b) flaccid paralysis, (c) muscle atrophy, and (d) absence of reflexes.
    UMN or LNN may be complete or incomplete
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14
Q

Anterior Cord Syndrome

A

Loss of motor function below the level of injury and loss of thermal, pain, and
tactile sensation below the level of injury. Light touch and proprioceptive
awareness are generally unaffected

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15
Q

Brown-Séquard’s Syndrome (damage to only 1 side of SC)

A
  • Often the result of a gunshot wound
  • Ipsilateral loss of motor function below the level of injury.
  • Ipsilateral reduction of deep touch and proprioceptive awareness.
  • Contralateral loss of pain, temperature, and touch.
  • Clinically, a major challenge
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16
Q

Central Cervical Cord Syndrome

A
  • UEs more impaired
  • Hyperextension of the neck, combined with a narrowing of the spinal canal
  • A potential for flaccid paralysis of the upper extremities
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17
Q

Cauda Equina injuries

A
  • Without injury to SC; injury to nerve roots / spinal nerves
  • Direct trauma most common cause
  • Loss of motor function and sensation below the level of injury.
  • Absence of a reflex arc
  • Motor paralysis is of the LMN type
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18
Q

Conus Medullaris injuries

A

Bowel and bladder incontinence and sexual dysfunction are typically more
severe than cauda equina injuries

19
Q

Complete Vs. Incomplete

A

 Quadriplegia (all extremities)
 Tetraplegia (arms, trunk, legs, pelvic organs)
 Paraplegia (LE’s / trunk)

20
Q

Recovery

A

-recovery must stress compensation.
* Always be truthful but must also be acutely aware of the impact of what the client is hearing
* Important not to take away HOPE

21
Q

Autonomic dysreflexia (Hyperreflexia)

A
  • An exaggerated response of the (ANS).
  • Impacts ANS; above T6
  • Signs to look for - a sudden, pounding headache, diaphoresis, flushing, goose
    bumps, and tachycardia followed by bradycardia
  • Autonomic dysreflexia is the body’s way of warning that something is wrong below the level of the injury.
22
Q

Respiratory Complications

A

-most common cause of death following SCI
 Respirator (complete above C4)
 Phrenic nerve stimulator
above level of T12

22
Q

Spinal shock (alt reflex activity)

A

 Period of altered reflex activity immediately after a traumatic SCI
 Flaccid paralysis of muscles below the level of injury and an absence
of reflexes
 Catheterization due to flaccid bladder muscles
 Increase in spasticity after shock is resolved
 Reflex arc “fires”

23
Q

Deep vein thrombosis and Edema

A

Reduced circulation caused by decreased tone, frequency of direct trauma to legs causing vascular damage

24
Q

Postural hypotension (orthostatic hypotension)

A

Blood tends to pool distally in the lower extremities as a result of reduced muscle
tone in the trunk and legs.
* Semi-reclined or reclined position should be maintained until the symptoms subside

25
Q

Thermal regulation;

A

problem maintaining appropriate body temp (above T6)

26
Q

Heterotopic ossification

A
  • Abnormal formation of bone deposits on muscles, joints, and tendons.
  • Most often in the hip and knee and less frequently in the shoulder and elbow
27
Q

Genitourinary complications (UTIs)

A

-LMN - Non-reflex or flaccid bladder due to no reflex arc, flaccid
-UMN - Reflex or spastic bladder.
* The bladder can contract and void reflexively

28
Q

Credé’s maneuver

A

The application of external pressure on the abdomen with their fists, starting at the umbilicus and pressing downward

29
Q

Valsalva maneuver

A

Closing the glottis and contracting the abdominal muscles, as if resisting a forceful exhalation

30
Q

Bowel Complications

A
  • Interferes with bowel function in much the same way as it impedes the bladder
  • Constipation / impaction common w/o regular elimination
  • Autonomic dysreflexia
  • Diarrhea
31
Q

Bowel Program Need

A
  • Use (not overuse) laxatives if prescribed
  • Eating a proper diet
  • Maintaining adequate hydration
  • Following a scheduled bowel program that reduces the chance of impaction
32
Q

Dermal complications (decubitus ulcer)

A
  • Mechanism of injury is continued pressure due to lack of movement.
  • Circulation is impaired because of the pressure, and capillary exchange is
    impeded. This can result rapidly in tissue necrosis.
  • Burns or frostbite
33
Q

Stage 1 of a pressure ulcer

A

Clinical signs are reddened or darkened skin. Damage is limited to more
superficial (epidermal and dermal) layers. At this stage, merely removing pressure until the skin returns to its normal color can halt tissue breakdown

34
Q

Stage 2 of a pressure ulcer

A

The skin now appears reddened and open. A blister or scab is present. The scab is not a sign of healing; rather, the tissue beneath it is necrotic. This involves the epidermal and dermal layers, as well as deeper adipose tissue. Wound dressings may be involved at
this stage, and it is imperative that pressure be kept off the site.

35
Q

Stage 3 of a pressure ulcer

A

The skin breakdown is deeper, and the wound is now draining. Muscle may be
visible through the open wound. An ulcer is developing in the necrotic tissue. In addition to wound dressings, surgical intervention may be indicated if more conservative treatment is unsuccessful

36
Q

Stage 4 of a pressure ulcer

A

All structures, from the superficial levels to the bone, are destroyed. Infection
and bone decay occur. Surgical intervention is likely, and the person with a decubitus ulcer at this stage often must spend weeks after a skin graft with pressure totally removed from the involved site (463)

37
Q

Mental health challenges (depression most common)

A
  • Disinterest and feelings of worthlessness
  • Fatigue
  • Weight and appetite changes
  • Suicidal ideations
38
Q

SCI Medical / Surgical Management

A

-brace
-imaging
-Surgery
* Spinal fusion
* Thoracolumbosacral orthosis (TLSO), “clamshell” =Thoracic injuries
* “halo” orthosis (most restrictive cervical device) =Fixed to skull
-drugs
-steroids
-Therapeutic hypothermia (New)
-Stem cells
* Epidural stimulation
* Functional electric stimulation
* Assisted movement
* Robotic-assisted therapy
* Brain-computer interfaces (BCI)

39
Q

SCI Impact on Occupational Performance

A

All

40
Q

Decubitus ulcers

A

as pressure ulcers, pressure sore

41
Q

Heterotopic ossification

A

bone tissue develops in your soft tissues

42
Q

Peristalsis

A

wave-like movement of muscles that moves food through your digestive system.

43
Q

Autonomic dysreflexia (hyperreflexia)

A

product of dysregulation of the autonomic system, leading to an uncoordinated response to a noxious stimulus below the level of a spinal cord injury.

Medical Conditions (12 decks)

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