Spinal Cord Injury Flashcards
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
1 - medulla oblongata to L1
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
3 - conus medullaris
- terminal end of the spinal cord
What is the most common site of the spine that has a major spinal injury?
1 - cervical
2 - thoracic
3 - lumbar
4 - sacral
1 - cervical
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%
3 - 50%
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
3 - young more likely for major trauma, and old more likely for minor and degenerative trauma
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
2 - loss of movement and sensation in all limbs
- tetraplegia =
- tetra is greek for four
- plegia = both halves
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
3 - loss of movement and sensation in lower limbs
- paraplegia =
- para - is greek for paralysed
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
1 - loss of movement and sensation of limbs on one side of the body
When assessing a patient with a suspected spinal cord injury, which of the ABCDE is most important?
- A for airway
- if cervical spine is damaged airway can be compromised
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
1 - C3, 4 and 5
- the rhythm is C3, 4, 5 keeps the diaphragm alive
- above C5 requires intubation
In the event of a trauma, should we always presume a spinal cord injury?
- yes
- until proven otherwise
- use a rigid cervical collar
- use firm spinal board with lateral support
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
3 - pressure ulcers
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
3 - 30-60 minutes
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%
2 - 10-15%
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
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!)
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
1 - structural damage to the spine from trauma, compression or other injuries.
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
2 - arterial disruption, thrombosis or hypoperfusion due to shock
- normally occurs straight after the primary spinal cord injury
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
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
How many people in the UK suffer with a spinal cord injury per year?
1 - 10
2 - 100
3 - 1000
4 - 10,000
3 - 1000
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
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
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
3 - paraesthesia (burning/prickling sensation)
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
3 - neurological
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
3 - X-ray
- lateral view is important
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
1 - CT scan
- X-ray should be available if CT cannot be performed
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
4 - CT scan of brain and cervical vertebrae
- patients with head trauma but are conscious, typically have just an X-ray
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?
4 - distributive
- disruption between brain and body caused by damage to the brain or spinal cord
-
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?
- sympathetic
- descending pathways of cervical and upper thoracic cord
- results in unopposed para-sympathetic activation
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
1 - vasodilation
3 - bradycardia
- both are due to lack of sympathetic activity
In a patient with neurogenic shock should we continue to give them fluids if they are hypotensive?
- no
- hypotension is due to no sympathetic activity and not fluid loss
- if lots of fluid are given it can cause fluid overload
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
4 - paresthesia
- generally get loss of sensations and not burning or pins and needles
