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Comprehensive Exam #1 Study Guide > Spinal Cord Disorders > Flashcards

Spinal Cord Disorders Flashcards

1
Q

The mobility of the cervical spine makes it vulnerable to injury, especially _____ injury.
A. hyperflexion
B. hyperextension

A

B - hyperextension

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2
Q

How does acute spinal cord initially present?

A

A state of spinal shock that has flaccid muscle paralysis with loss of sensation below the level of injury

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3
Q

What is the difference between spinal shock and neurogenic shock?

A

Spinal shock - loss of neurogenic function
Neurogenic shock - reduction in BP

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4
Q

What is initial treatment for cervical fracture or dislocation?

A

Immediate immobilization to limit neck motion

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5
Q

Hard neck collars limit neck flexion and extension by ____%.

A

only 25%

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6
Q

What is the most effective in preventing cervical spine movement?

A

Immobilization and traction provided by halothoracic devices

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7
Q

What is manual in-line stabilization?

A

An assistant’s hands are placed on each side of the patient’s face, the head is grasped with fingertips resting on the mastoid process, and downward pressure is applied against a firm table surface to hold the head immobile in neutral position

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8
Q

For acute spinal cord injury, during DL what is recommended to minimize cervical spine flexion and extension?

A

Manual in-line stabilization

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9
Q

Cervical spine movement during DL is likely to be concentrated in what area?

A

the occipito-atlanto-axial area

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10
Q

What makes patients with cervical or high thoracic spinal cord injury vulnerable to dramatic decreases in BP following changes in body position, blood loss, or positive pressure ventilation?

A

The absence of compensatory SNS responses

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11
Q

What is poikilothermic?

A

Inability to maintain body temperature

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12
Q

Patients with acute spinal cord injury tend to become poikilothermic in dermatomes _____ the level of spinal cord lesion.

A

BELOW

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13
Q

T/F: Succinylcholine does not provoke excessive release of Potassium during the first few hours after spinal cord injury.

A

True

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14
Q

How long do you have to give Succinylcholine after spinal cord injury before it provokes the excessive release of Potassium?

A

24 hours

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15
Q

Injuries that occur more _____ along the spinal cord tend to have more significant systemic effects.

A

Rostrally (toward the top of the spinal cord/front of the brain)

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16
Q

With chronic spinal cord injury, where is nerve root pain located?

A

It is localized at or near the level of injury

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17
Q

How is visceral pain produced in chronic spinal cord injury?

A

By distention of the bladder or bowel

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18
Q

What medication is useful for treating spasticity in chronic spinal cord injury?

A

Baclofen

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19
Q

How does Baclofen work?

A

It potentiates the inhibitory effects of GABA

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20
Q

What can occur with abrupt cessation of Baclofen?

A

Withdrawal reactions including seizures

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21
Q

Spinal cord injury at or above the ___ cervical vertebra may result in apnea. Why?

A

5th; b/c of denervation of the diaphragm

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22
Q

The diaphragm’s innervation is from ___ – ____.

A

C3-C5

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23
Q

What is the main focus for anesthetic management in patients with chronic spinal cord injury?

A

Preventing autonomic hyperreflexia

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24
Q

For chronic spinal cord injury, succinylcholine may provoke ______, most commonly during the ______ after spinal cord injury.

A

hyperkalemia; initial 6 months

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25
Q

When does autonomic hyperreflexia appear?

A

Following spinal shock and in association w/ return of spinal cord reflexes

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26
Q

Autonomic hyperreflexia reflex response can be initiated by ____ or ____ stimulation above or below the spinal cord injury??

A

cutaneous or visceral stimulation BELOW the level

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27
Q

What are common stimuli for autonomic hyperreflexia?

A

surgery and distention of a hollow viscus (such as bladder or rectum)

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28
Q

Autonomic hyperreflexia: stimulation ____ the level of spinal cord injury initiates ____ impulses that enter the spinal cord.

A

below; afferent

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29
Q

Autonomic hyperreflexia, in the presence of a spinal cord lesion, splanchnic outflow is isolated from inhibitory impulses from above, so generalized _____ occurs below the level of spinal cord injury.

A

vasoconstriction

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30
Q

What are the hallmarks of autonomic hyperreflexia?

A

HTN and reflex bradycardia

31
Q

During autonomic reflexia, reflex cutaneous vasodilation occurs where?

A

Above the level of the spinal cord injury

32
Q

Approximately 85% of patients with spinal cord lesion injuries above ____ exhibit autonomic hyperreflexia reflex.

A

T6

33
Q

What should be readily available for patients with spinal cord injury in case autonomic hyperreflexia occurs intra-op?

A

Vasodilator drugs with a short half-life (Ex: sodium nitroprusside)

34
Q

What are the 2 categories of spinal cord tumors?

A

Intramedullary tumors and extramedullary tumors

35
Q

Where are intramedullary tumors located?

A

Within the spinal cord (Gliomas and ependymomas)

36
Q

Where do extramedullary tumors occur?

A

Either intradural (neurofibromas and meningiomas) or extradural

37
Q

Spinal cord tumors typically present with what symptoms?

A

Symptoms of cord compression

38
Q

Pain related to spinal cord tumors is aggravated by ___ or ____.

A

coughing or straining

39
Q

What is the technique of choice for spinal cord tumor diagnosis?

A

MRI

40
Q

What is a consideration with airway management of spinal cord tumors?

A

Significant motion of the cervical spine could lead to further cord compromise via compression and decrease cord perfusion

41
Q

What medication should be used in caution in spinal cord tumors?

A

Succinylcholine

42
Q

What is one of the most common causes of back pain?

A

Intervertebral disc disease

43
Q

What is a compression of a single nerve root called?

A

Radiculopathy

44
Q

What do patients usually complain of with compression of a single nerve root?

A

Pain in a single dermatomal distribution or localized muscle weakness

45
Q

In cervical spine procedures performed via an anterior approach, retraction of the airway structures to attain access to the cervical spine may result in injury to what?

A

Ipsilateral RLN

46
Q

What may injury to ipsilateral RLN cause?

A

Hoarseness, stridor, or airway compromise

47
Q

What are the 2 most common sites for lumbar disc protrusion?

A

L4-L5 and L5-S1

48
Q

What does lumbar disc protrusion at both L4-L5 and L5-S1 cause?

A

Low back pain that radiates down the posterior and lateral aspect of the thighs and calves (sciatica)

49
Q

What is spina bifida occulta?

A

Incomplete formation of a single lamina in the lumbosacral spine w/o other abnormalities; it is a congenital defect

50
Q

T/F: Spina bifida usually produces no symptoms and is often discovered as an incidental finding.

A

True

51
Q

During fetal development, closure of the ____ is required for normal formation of the brain, spinal cord, and their enclosing structures, the cranium and vertebral canal.

A

neural tube

52
Q

What causes neural tube defects?

A

Failure of the neural tube to appropriately close in the caudal segments

53
Q

What is herniation of contents of the spinal canal called?

A

Meningocele and myelomeningocele (only contains meninges and CSF)

54
Q

What is the most common severe congenital anomaly of the spine?

A

myelomeningocele

55
Q

What are increased risk factors for myelomeningocele?

A

Maternal folate deficiency, trisomy 13, trisomy 18, and type II chiari malformations

56
Q

Myelomeningocele results in ____ and ____ deficits.

A

motor and sensory

57
Q

What kind of allergy do patients with myelomeingocele often have?

A

Latex (d/t to frequent exposure since young age)

58
Q

What medication should be avoided for myelomeningocele?

A

Succinylcholine

59
Q

______ is a common acquired degenerative disorder that leads to osteophyte formation and degenerative disc disease.

A

Spondylosis

60
Q

Sponylosis is also known as what?

A

spinal stenosis

61
Q

When do symptoms of spondylosis typically develop?

A

After age 50

62
Q

What symptoms accompany cervical spondylosis?

A

neck pain and radicular pain in the arms and shoulders + sensory loss + muscle atrophy

63
Q

What is spondylolisthesis?

A

Anterior subluxation of one vertebral body on another

64
Q

Where does spondylolisthesis most commonly occur?

A

At the lumbosacral junction

65
Q

Amyotrophic lateral sclerosis (ALS) is a degenerative disease involves:
1. _____________
2. _____________

A
  1. the lower motor neurons in the anterior horn gray matter of the spinal cord
  2. the corticospinal tracts (i.e., the primary descending upper motor neurons)
66
Q

What gender is most commonly affected by ALS? What age?

A

Male; 40-60

67
Q

When ALS is degenerative process is limited to the motor cortex of the brain, the disease is called _____ lateral sclerosis.

A

primary

68
Q

What is pseudobulbar palsy?

A

Limitation to the brainstem nuclei

69
Q

What are the initial manifestations of ALS?

A

skeletal muscle atrophy, weakness, and fasciculations (

70
Q

Fasciculations of ALS frequently begin in the intrinsic muscles of the _____

A

hands

71
Q

GA in patients with ALS may be associated with what?

A

Exaggerated respiratory depression

72
Q

What medication should be avoided in ALS?

A

Succinylcholine

73
Q

What is the effect of ND NMBD on patients with ALS?

A

They may show prolonged responses

Comprehensive Exam #1 Study Guide (3 decks)

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