Spinal Cord Injury Flashcards

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1
Q

Where does the spinal cord begin and end?

1 - medulla oblongata to L1
2 - medulla oblongata to L4
3 - pons to L1
4 - pons to L4

A

1 - medulla oblongata to L1

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2
Q

What is the name given to the end of the spinal cord at L1?

1 - cauda equine
2 - caudate
3 - conus medullaris
4 - internal capsule

A

3 - conus medullaris

  • terminal end of the spinal cord
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3
Q

What is the most common site of the spine that has a major spinal injury?

1 - cervical
2 - thoracic
3 - lumbar
4 - sacral

A

1 - cervical

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4
Q

A spinal cord injury is defined as an injury that causes temporary or permanent changes in the spinal cords function. What % of spinal cord injuries are cervical?

1 - 5%
2 - 25%
3 - 50%
4 - >75%

A

3 - 50%

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5
Q

A spinal cord injury is defined as an injury that causes temporary or permanent changes in the spinal cords function. Spinal cord injuries have a bimodal distribution. Why is this?

1 - young and older patients have brittle bones
2 - diseases are more likely in older and younger patients
3 - young more likely for major trauma, and old more likely for minor and degenerative trauma

A

3 - young more likely for major trauma, and old more likely for minor and degenerative trauma

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6
Q

A traumatic spinal cord injury is a lesion of neural elements of the spinal cord that can result in any degree of sensory and motor deficit, and autonomic or bowel dysfunction. What does tetraplegia mean?

1 - loss of movement and sensation on one side of the body
2 - loss of movement and sensation in all limbs
3 - loss of movement and sensation in lower limbs
4 - loss of movement and sensation in upper limbs

A

2 - loss of movement and sensation in all limbs

  • tetraplegia =
  • tetra is greek for four
  • plegia = both halves
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7
Q

A traumatic spinal cord injury is a lesion of neural elements of the spinal cord that can result in any degree of sensory and motor deficit, and autonomic or bowel dysfunction. What does paraplegia mean?

1 - loss of movement and sensation on one side of the body
2 - loss of movement and sensation in all limbs
3 - loss of movement and sensation in lower limbs
4 - loss of movement and sensation in upper limbs

A

3 - loss of movement and sensation in lower limbs

  • paraplegia =
  • para - is greek for paralysed
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8
Q

A traumatic spinal cord injury is a lesion of neural elements of the spinal cord that can result in any degree of sensory and motor deficit, and autonomic or bowel dysfunction. What does hemiplegia mean?

1 - loss of movement and sensation of limbs on one side of the body
2 - loss of movement and sensation in all limbs
3 - loss of movement and sensation in lower limbs
4 - loss of movement and sensation in upper limbs

A

1 - loss of movement and sensation of limbs on one side of the body

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9
Q

When assessing a patient with a suspected spinal cord injury, which of the ABCDE is most important?

A
  • A for airway
  • if cervical spine is damaged airway can be compromised
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10
Q

if damaged which vertebrae can be life threatening?

1 - C3, 4 and 5
2 - C1 and C2
3 - C3, 4 and T1
4 - C7, 8 and T1

A

1 - C3, 4 and 5

  • the rhythm is C3, 4, 5 keeps the diaphragm alive
  • above C5 requires intubation
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11
Q

In the event of a trauma, should we always presume a spinal cord injury?

A
  • yes
  • until proven otherwise
  • use a rigid cervical collar
  • use firm spinal board with lateral support
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12
Q

In a spinal cord injury we need to be careful not to cause decubitus. What is this?

1 - new fractures due to transport
2 - blood born infection
3 - pressure ulcers

A

3 - pressure ulcers

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13
Q

In a spinal cord injury we need to be careful not to cause decubitus, which are pressure ulcers from remaining on the hard spinal support immobilised. How long before decubitus form?

1 - 1-6 minutes
2 - 15-20 minutes
3 - 30-60 minutes
4 - >2 hours

A

3 - 30-60 minutes

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14
Q

Patients with a spinal fracture often have a second one elsewhere. What % of patients does this occur in?

1 - 1-5%
2 - 10-15%
3 - 30-40%
5 - >50%

A

2 - 10-15%

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15
Q

When we assess a patient for risk of a cervical spine injury, we need to use which system?

1 - CURB score
2 - Wells score
3 - Canadian C-spine
4 - Modified Glasgow Score

A

3 - Canadian C-spine

  • Age - >65 high risk
  • Mechanism (e.g. wearing seatbelt v ejection from vehicle)
  • Abnormal neurological symptoms (paraesthesia or weakness or numbness)
  • Ambulation
  • Neck Pain
  • Neck range of movement (in low risk group – don’t move neck in high risk group!)
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16
Q

Spinal cord injuries can be separated into primary or secondary. Which of the following is the definition of a primary spinal cord injury?

1 - structural damage to the spine from trauma, compression or other injuries.
2 - arterial disruption, thrombosis or hypoperfusion due to shock

A

1 - structural damage to the spine from trauma, compression or other injuries.

17
Q

Spinal cord injuries can be separated into primary or secondary. Which of the following is the definition of a secondary spinal cord injury?

1 - structural damage to the spine from trauma, compression or other injuries.
2 - arterial disruption, thrombosis or hypoperfusion due to shock

A

2 - arterial disruption, thrombosis or hypoperfusion due to shock

  • normally occurs straight after the primary spinal cord injury
18
Q

Spinal cord injuries can be complete or incomplete. What is the distinguishing factor between these 2?

1 - volume of spinal cord damaged
2 - level of spinal cord damaged
3 - ability to communicate to and from the brain

A

3 - ability to communicate to and from the brain

  • complete means ability to communicate with the brain is lost below the damage
  • poor prognosis for complete spinal damage
19
Q

How many people in the UK suffer with a spinal cord injury per year?

1 - 10
2 - 100
3 - 1000
4 - 10,000

A

3 - 1000

20
Q

Which of the following is NOT a typical risk factor for a spinal cord injury?

1 - fall from waist height
2 - suggestive mechanism of injury
3 - spinal pain or neurological symptoms/signs
4 - consciousness
5 - malignancy, inflammation of the spinal cord, osteoporosis, rheumatoid arthritis, osteoarthritis, ankylosing spondylitis

A

1 - fall from waist heigh

  • major trauma - eg, motor vehicle accidents, violent assaults, gunshot wounds, falls, sports and recreation injuries are definitely a risk factor
21
Q

In primary care which 2 of the following are the most common issues patients with spinal cord injury present with?

1 - disability with pain
2 - bowel or bladder dysfunction
3 - paraesthesia (burning/prickling sensation)
4 - vision changes

A

3 - paraesthesia (burning/prickling sensation)

22
Q

If we suspect a patient has a spinal cord injury and they are conscious, what examination is most important?

1 - cardio
2 - respiratory
3 - neurological
4 - gastro

A

3 - neurological

23
Q

If we suspect a patient has a spinal cord injury, what is often the 1st line imaging?

1 - CT scan
2 - ultrasound
3 - X-ray
4 - MRI

A

3 - X-ray

  • lateral view is important
24
Q

According to the Advanced Trauma Life Support (ATLS). Which imaging modality should be used in a trauma setting?

1 - CT scan
2 - ultrasound
3 - X-ray
4 - MRI

A

1 - CT scan

  • X-ray should be available if CT cannot be performed
25
Q

If a patient is involved in trauma, is unconscious and we suspect a spinal cord injury what imaging is routinely performed?

1 - full body only MRI
2 - X-ray
3 - CT scan
4 - CT scan of brain and cervical vertebrae

A

4 - CT scan of brain and cervical vertebrae

  • patients with head trauma but are conscious, typically have just an X-ray
26
Q

Shock is defined as an inadequate delivery of O2 to organs. There are 4 main types of shock:

1 - hypovolemic
2 - cardiogenic
3 - obstructive
4 - distributive

Which of the following is neurogenic shock a subcategory of?

A

4 - distributive

  • disruption between brain and body caused by damage to the brain or spinal cord

-

27
Q

Shock is defined as an inadequate delivery of O2 to organs. There are 4 main types of shock:

1 - hypovolemic
2 - cardiogenic
3 - obstructive
4 - distributive

Neurogenic shock is a subcategory of distributive shock. In neurogenic shock is the para or sympathetic system typically affected?

A
  • sympathetic
  • descending pathways of cervical and upper thoracic cord
  • results in unopposed para-sympathetic activation
28
Q

Shock is defined as an inadequate delivery of O2 to organs. There are 4 main types of shock, hypovolemic, cardiogenic, obstructive and distributive. Neurogenic shock is a subcategory of distributive shock. In neurogenic shock which of the following would occur?

1 - vasodilation
2 - enlarged pupils
3 - bradycardia
4 - decreased urine output

A

1 - vasodilation
3 - bradycardia

  • both are due to lack of sympathetic activity
29
Q

In a patient with neurogenic shock should we continue to give them fluids if they are hypotensive?

A
  • no
  • hypotension is due to no sympathetic activity and not fluid loss
  • if lots of fluid are given it can cause fluid overload
30
Q

Spinal shock is a from of neurogenic shock (subcategory of distributive shock). Which of the following is NOT common in spinal shock?

1 - anaesthesia
2 - flaccidity
3 - areflexia
4 - paresthesia

A

4 - paresthesia

  • generally get loss of sensations and not burning or pins and needles