Spinal cord injury Flashcards
pathophysiology
What is the most common cause of spinal cord injury (SCI)?
A) Falls
B) Motor vehicle accidents (MVA)
C) Sports injuries
D) Violence
Answer: B) Motor vehicle accidents (MVA)
A 22-year-old male presents with quadriplegia after a diving accident. Where is the likely spinal cord injury?
A) T6
B) L2
C) C5
D) T12
Answer: C) C5
A patient with an SCI at C3 has respiratory failure. What is the underlying cause?
A) Phrenic nerve paralysis
B) Autonomic dysreflexia
C) Spinal shock
D) Increased ICP
Answer: A) Phrenic nerve paralysis
Which diagnostic test is most appropriate for a suspected spinal cord injury?
A) X-ray spine
B) MRI spine
C) CT myelogram
D) Lumbar puncture
Answer: B) MRI spine
A patient with a suspected SCI has profound hypotension and bradycardia. What is the most likely cause?
A) Spinal shock
B) Hemorrhagic shock
C) Cardiogenic shock
D) Neurogenic shock
Answer: D) Neurogenic shock
A patient with an acute spinal cord injury is in the emergency room. What is the first step in management?
A) Immediate high-dose corticosteroids
B) Airway management with C-spine stabilization
C) Perform a lumbar puncture
D) Give IV fluids to increase blood pressure
Answer: B) Airway management with C-spine stabilization
A patient with SCI is at risk for autonomic dysreflexia. What is the most common trigger?
A) High blood glucose
B) Bladder distension or constipation
C) Hyperthermia
D) Seizures
Answer: B) Bladder distension or constipation
A patient with SCI has a BP of 210/110 mmHg, sweating, and a severe headache. What is the immediate intervention?
A) Administer IV labetalol
B) Sit the patient upright and remove any noxious stimuli
C) Give IV fluids
D) Give corticosteroids
Answer: B) Sit the patient upright and remove any noxious stimuli
A patient with SCI at T6 is at risk for which long-term complication?
A) Neurogenic shock
B) Autonomic dysreflexia
C) Increased ICP
D) Brainstem herniation
Answer: B) Autonomic dysreflexia
Why are corticosteroids contraindicated in SCI management?
A) Increased risk of hyperglycemia and infection
B) Increased risk of hemorrhage
C) Exacerbates neurogenic shock
D) Causes spinal edema
Answer: A) Increased risk of hyperglycemia and infection
complications
A patient with SCI at C5 is at greatest risk for which life-threatening complication?
A) Pulmonary failure due to diaphragmatic paralysis
B) Seizures
C) Increased ICP
D) Brain herniation
Answer: A) Pulmonary failure due to diaphragmatic paralysis
- A patient with a spinal cord injury at C4 is at greatest risk for which complication?
A) Paraplegia
B) Loss of bowel function
C) Respiratory failure
D) Autonomic dysreflexia
Answer: C) Respiratory failure
Rationale: A C4 injury can impair the diaphragm, requiring ventilatory support.
- A patient with a history of T6 spinal cord injury presents with severe hypertension, sweating, and bradycardia. What is the most likely cause?
A) Myasthenia gravis crisis
B) Autonomic dysreflexia
C) Neurogenic shock
D) Spinal shock
Answer: B) Autonomic dysreflexia
Rationale: Above T6, autonomic dysreflexia is triggered by noxious stimuli (e.g., full bladder) causing HTN, bradycardia, and sweating.
A patient with an SCI at C3 has respiratory distress. What is the most life-threatening concern?
A) Pulmonary embolism
B) Phrenic nerve dysfunction causing apnea
C) Neurogenic shock
D) Autonomic dysreflexia
Answer: B) Phrenic nerve dysfunction causing apnea
A patient with suspected SCI arrives at the ER with neck pain and weakness in all extremities. What is the first-line diagnostic test?
A) CT spine
B) MRI spine
C) X-ray spine
D) Lumbar puncture
Answer: A) CT spine
A patient with an SCI at C5 is at risk for which long-term complication?
A) Autonomic dysreflexia
B) Brainstem herniation
C) Intracranial hemorrhage
D) Spinal stenosis
Answer: A) Autonomic dysreflexia
A patient with an acute spinal cord injury is in neurogenic shock (bradycardia and hypotension). What is the first-line treatment?
A) Corticosteroids
B) IV fluids and vasopressors
C) Hypertonic saline
D) Lumbar puncture
Answer: B) IV fluids and vasopressors
A patient with a complete SCI at T4 develops autonomic dysreflexia. What is the most immediate intervention?
A) Administer IV antihypertensives
B) Sit the patient upright and remove noxious stimuli
C) Give IV fluids
D) Initiate a corticosteroid infusion
Answer: B) Sit the patient upright and remove noxious stimuli
Which of the following is most likely to kill a patient with high cervical SCI?
A) Respiratory failure
B) Sepsis
C) Autonomic dysreflexia
D) Deep vein thrombosis (DVT)
Answer: A) Respiratory failure
What is the most common cause of death in patients with chronic spinal cord injury?
A) Sepsis
B) Pulmonary complications (pneumonia, PE)
C) Myocardial infarction
D) Autonomic dysreflexia
Answer: B) Pulmonary complications (pneumonia, PE)
A 35-year-old sustains a severe spinal injury in a motor vehicle accident. Initial imaging confirms a complete transection at T2. Which of the following best characterizes this injury?
A. Partial motor deficits but intact sensory function
B. Complete loss of motor and sensory function below T2
C. High cervical injury leading to diaphragmatic paralysis
D. Normal lower extremity reflexes due to the upper thoracic level
- B – Complete loss of motor/sensory function below T2
In SCI, secondary injury refers to:
A. Immediate mechanical disruption of the spinal cord at impact
B. Prolonged nerve regeneration over months
C. Preventable ischemia, inflammation, and edema occurring after the initial trauma
D. Genetic predisposition to cord compression
- C – Secondary injury = ischemia, inflammation, edema post-trauma
A 40-year-old with a suspected SCI reports loss of vibration and proprioception in both legs but preserved pain and temperature sensation. Which incomplete spinal cord syndrome is most likely?
A. Anterior cord syndrome
B. Posterior cord syndrome
C. Central cord syndrome
D. Brown-Séquard syndrome
- B – Posterior cord syndrome (loss of vibration/proprioception, preserved pain/temperature)
A patient arrives after a diving accident with weakness in all four extremities (more pronounced in the upper limbs) and some preserved sensation in the lower limbs. Imaging shows a cervical cord injury with no complete transection. This presentation is most consistent with:
A. Central cord syndrome
B. Anterior cord syndrome
C. Posterior cord syndrome
D. Brown-Séquard syndrome
- A – Central cord syndrome (greater motor weakness in upper limbs)
A 28-year-old with a penetrating spinal trauma experiences ipsilateral paralysis and loss of proprioception, but contralateral loss of pain and temperature below the level of injury. This classic presentation describes:
A. Brown-Séquard syndrome
B. Anterior cord syndrome
C. Central cord syndrome
D. Posterior cord syndrome
- A – Brown-Séquard (ipsilateral motor/proprioception loss, contralateral pain/temp loss)
A 24-year-old with a C4 spinal cord injury arrives in the trauma bay. He has shallow respirations and is becoming hypoxic. Which intervention best addresses the primary concern in acute SCI management?
A. Give IV corticosteroids immediately
B. Apply abdominal binders to improve venous return
C. Perform endotracheal intubation to protect the airway and support breathing
D. Check serum potassium to rule out electrolyte imbalances
- C –
- Perform endotracheal intubation to protect the airway and support breathing
Rationale: Secure the airway (C4 injury → diaphragmatic compromise)
A patient with an acute SCI at T3 shows bradycardia and hypotension unresponsive to fluid boluses. This is most likely:
A. Septic shock
B. Neurogenic shock
C. Spinal shock
D. Autonomic dysreflexia
- B – Neurogenic shock (bradycardia/hypotension unresponsive to fluids)
Rationale: Neurogenic shock” typically presents with hypotension and bradycardia; “spinal shock” refers to loss of reflexes and flaccidity below the injur
During the acute phase of SCI, corticosteroids are:
A. Recommended to reduce inflammation in all SCI patients
B. No longer routinely recommended due to lack of proven benefit and increased complications
C. Administered only if the patient also has a brain injury
D. Needed to treat neurogenic shock
- B – Corticosteroids are no longer routinely recommended in acute SCI
A 32-year-old with a T5 spinal cord injury experiences a sudden rise in blood pressure, pounding headache, and sweating above the level of injury. He states his bladder feels very full. Which life-threatening complication is this most consistent with?
A. Neurogenic shock
B. Autonomic dysreflexia
C. Spinal shock
D. Orthostatic hypotension
- B – Autonomic dysreflexia (high-level SCI, severe hypertension, headache)
Rationale: Autonomic dysreflexia typically occurs in injuries above T6.
A common concern for SCI patients who are immobile includes:
A. Portal vein thrombosis
B. Immune-mediated vasculitis
C. Deep vein thrombosis (DVT) and pressure ulcers
D. Chronic hyperthermia due to overstimulation
- C – DVT and pressure ulcers are common immobility complications
What will kill your patient with SCI
(ABCs, respiratory compromise, severe shock)
What will harm your patient sci
complications like autonomic dysreflexia, DVT, pressure ulcers
What is really common
infections, spasticity, incomplete syndromes, bowel/bladder issues
A 60-year-old patient arrives with a hyperextension injury to the cervical spine. Neurological findings include loss of motor function primarily in the upper extremities but relative sparing in the lower limbs. Sensory deficits are patchy, and the patient maintains some sensation below the level of injury. Which incomplete spinal cord syndrome does this presentation most closely suggest?
A. Anterior cord syndrome
B. Posterior cord syndrome
C. Central cord syndrome
D. Brown-Séquard syndrome
- C – Central cord syndrome
Rationale: commonly from hyperextension injury, with upper > lower extremity involvement)
A 45-year-old with a T4 SCI develops profound hypotension and bradycardia shortly after arrival, despite adequate fluid resuscitation. Which initial pharmacologic intervention is typically needed to manage this form of neurogenic shock?
A. IV methylprednisolone
B. IV vasopressor (e.g., norepinephrine)
C. Subcutaneous epinephrine
D. High-dose fentanyl
- B – IV vasopressor (e.g., norepinephrine) to address hypotension and bradycardia in neurogenic shock
Rationale: (Recall that neurogenic shock is characterized by hypotension + bradycardia, often requiring vasopressors.)
A patient with a T8 SCI is in the ICU. The care plan includes frequent turning, specialty mattresses, and careful skin assessment. What complication is being actively prevented with these measures?
A. Spasticity
B. Autonomic dysreflexia
C. Pressure ulcers
D. Neurogenic shock
- C – Pressure ulcers (frequent turning, specialty mattress)
Complications: Autonomic Dysreflexia vs. Spinal Shock
Which of the following describes spinal shock rather than autonomic dysreflexia?
A. Severe hypertension and pounding headache
B. Temporary loss of reflexes, flaccid paralysis, and absent sensation below injury
C. Sudden flushing of the skin above the level of injury
D. Nasal congestion and sweating triggered by a full bladder
- B – Spinal shock presents with a temporary loss of reflexes and flaccidity below the injuryabsent sensation
A 38-year-old with a C6 SCI is in a rehabilitation facility. He notices that he’s unable to regulate his body temperature in cold environments, often feeling much colder than others. This phenomenon, where the patient adopts the ambient temperature, is best described as:
A. Autonomic dysreflexia
B. Poikilothermia
C. Hyperthermia crisis
D. Orthostatic hypotension
- B – Poikilothermia (loss of autonomic temperature regulation)
(especially central cord)
Incomplete cord syndromes
neurogenic shock
Immediate management for
Common phenomenon
poikilothermia in SCI patients
what kills
(shock)
what harms
(pressure ulcers)
what’s common
(poikilothermia, incomplete syndromes)
Definition and Impact types of injuries
(primary vs. secondary)
Mechanisms of Injury
(flexion, hyperextension, etc.)
Neurologic Tracts Affected
(spinothalamic, corticospinal, dorsal columns)
Levels of Injury
(cervical vs. thoracic/lumbar)
Complete vs. Incomplete Injuries
(central cord, anterior cord, posterior cord, Brown-Sequard)
Which statement best describes the impact of a spinal cord injury (SCI)?
A. Motor function is lost, but sensory function remains intact
B. Injury to the spinal cord can disrupt motor and/or sensory function below the level of injury
C. SCIs only occur from non-traumatic causes, such as infections
D. SCIs are always temporary
- B – Injury to the spinal cord can disrupt motor and/or sensory function below the level of injury
A 28-year-old experiences a severe spinal cord contusion in a car accident. The primary injury is best described as:
A. The immediate and irreversible damage to axons at the moment of trauma
B. Inflammatory swelling that occurs days after the accident
C. Ischemia and edema that could be prevented with quick intervention
D. Regeneration of spinal axons over time
- A – Primary injury = immediate, irreversible axonal damage at the moment of trauma
Which process is considered a secondary spinal cord injury?
A. Direct mechanical disruption of neural tissue at the time of impact
B. A stable fracture that spares the spinal cord
C. Preventable damage from ischemia, inflammation, and edema post-injury
D. Congenital malformation of the spine
- C – Secondary injury = preventable ischemia, edema, inflammation
Which of the following is not a typical cause of SCI listed in the study guide?
A. Fracture from hyperflexion
B. Chronic respiratory illness
C. Non-traumatic tumor compression
D. Infection leading to spinal cord damage
- B – Chronic respiratory illness is not listed as a typical SCI cause
Question 5 (Scenario-Based)
A 40-year-old patient falls off a ladder and lands on his feet, experiencing a vertical force that compresses the spinal column. This mechanism is described as:
A. Flexion
B. Extension-Rotation
C. Compression
D. Hyperextension
- C – Compression (vertical force)
Which mechanism involves forward bending of the neck or body beyond normal limits?
A. Flexion
B. Hyperextension
C. Compression
D. Lateral bending
- A – Flexion = forward bending of neck/body
A driver in a rear-end collision experiences a violent backward motion of the neck. Which mechanism of injury does this scenario suggest?
A. Flexion
B. Flexion-Rotation
C. Hyperextension
D. Compression
- C – Hyperextension = backward motion
In a diving accident, the patient’s head strikes the bottom of a pool, exerting vertical force on the spine. This scenario most closely aligns with which mechanism?
A. Extension-Rotation
B. Compression
C. Hyperextension
D. Flexion-Rotation
- B – Compression (e.g., diving accidents)
Flexion-Rotation injuries combine forward motion with twisting. Which best characterizes the outcome of such injuries?
A. They generally spare the spinal cord
B. They rarely cause fracture-dislocation
C. They can produce severe ligamentous damage and potential cord injury
D. They only affect the thoracic region
- C – Flexion-Rotation can cause severe ligamentous damage and cord injury
The spinothalamic tract is responsible for:
A. Motor control of the ipsilateral limbs
B. Tactile discrimination and proprioception
C. Pain and temperature sensation
D. Reflex arcs only
- C – Spinothalamic tract = pain & temperature
A patient with a unilateral spinal cord lesion loses pain and temperature sensation on the opposite side of the body below the level of injury but retains motor function on that side. This pattern suggests involvement of the:
A. Ipsilateral dorsal columns
B. Contralateral spinothalamic tract
C. Ipsilateral corticospinal tract
D. Bilateral dorsal columns
- B – Contralateral spinothalamic involvement
Which tract carries motor signals from the brain to the ipsilateral side of the body, typically crossing over in the medulla?
A. Spinothalamic
B. Corticospinal
C. Dorsal columns
D. Sympathetic chain
- B – Corticospinal tract = ipsilateral motor signals (crosses in medulla)
A lesion affecting the dorsal columns of the spinal cord would most likely present with loss of:
A. Pain and temperature
B. Proprioception and vibratory sense
C. Motor control
D. Autonomic functions (e.g., heart rate control)
- B – Dorsal columns = proprioception and vibration sense
level of injury
Question 14
Which level of the spinal cord, if injured, most commonly results in quadriplegia?
A. T2–T4
B. C7 and above
C. L3–L5
D. T1 and below
- B – Cervical (C7 and above) → quadriplegia
A patient with an SCI at T4 can move his arms well but has no motor function in the legs. This presentation aligns with:
A. Quadriplegia
B. Hemiplegia
C. Paraplegia
D. Monoplegia
- C – T4 injury → paraplegia
- Which statement regarding higher spinal injuries is correct?
A. They cause less functional loss than lower injuries
B. They lead to motor deficits in only one extremity
C. They typically result in more extensive deficits, including respiratory compromise if cervical
D. They affect primarily the sacral segments
- C – Higher (cervical) injuries cause greater functional loss, possibly affecting respiration
Complete vs. Incomplete Injuries
Question 17
A complete SCI is defined by:
A. Mixed motor and sensory deficits below the level of injury
B. Total loss of motor and sensory function below the level of injury
C. Ability to recover some function with rehabilitation
D. Preserved reflex arcs and partial sensation
- B – Complete = total loss of motor/sensory below level
A patient has partial motor loss and some preserved sensation below the level of injury. MRI confirms spinal cord trauma but not a transection. Which conclusion is most accurate?
A. This is a complete injury and no recovery is possible
B. This is an incomplete injury with potential for some recovery
C. This indicates no actual SCI
D. This is simply a contusion with no functional loss
- B – Incomplete = partial loss with some function preserved
Common Incomplete Syndromes
Question 19
In central cord syndrome, which deficit pattern is most characteristic?
A. Greater motor loss in the lower extremities
B. Greater motor loss in the upper extremities
C. Total loss of pain and temperature
D. Ipsilateral motor and proprioceptive loss
- B – Central cord = greater motor loss in upper extremities
Which syndrome involves loss of pain, temperature, and motor function below the level of injury, but preservation of vibration and proprioception?
A. Posterior cord syndrome
B. Brown-Séquard syndrome
C. Anterior cord syndrome
D. Central cord syndrome
- C – Anterior cord = loss of pain, temp, motor; preserves vibration/position
A patient with an SCI experiences loss of proprioception and vibration sense below the injury but retains pain and temperature sensation. This finding is consistent with:
A. Anterior cord syndrome
B. Brown-Séquard syndrome
C. Posterior cord syndrome
D. Central cord syndrome
- C – Posterior cord = lost proprioception/vibration, preserves pain/temp
A patient presents with ipsilateral loss of motor function and dorsal column sensations, but contralateral loss of pain and temperature below the level of injury. Which incomplete SCI syndrome matches this description?
A. Central cord syndrome
B. Brown-Séquard syndrome
C. Anterior cord syndrome
D. Posterior cord syndrome
- B – Brown-Séquard = ipsilateral motor/dorsal column, contralateral pain/temp
A 30-year-old with a flexion-rotation lumbar spine injury from a motorcycle accident has minimal motor function loss but significant pain and temperature sensation changes. Based on pathophysiology, which tract is most likely affected?
A. Corticospinal (ipsilateral motor)
B. Dorsal columns (proprioception/vibration)
C. Spinothalamic (pain/temperature)
D. Lateral corticospinal + dorsal columns
- C – Spinothalamic tract is responsible for pain/temp sensation
Why is secondary injury often considered preventable?
A. It occurs only with non-traumatic lesions
B. It involves processes (ischemia, edema, inflammation) that can be mitigated with timely interventions
C. It is caused by genetic predispositions
D. It has no significant impact on recovery
- B – Secondary injury is mitigable with timely care
A diver suffers a cervical spine fracture. The immediate mechanical damage to neural tissue is substantial. However, within hours, edema and ischemia worsen the neurologic deficits. This progression emphasizes the difference between:
A. Complete vs. incomplete injury
B. Primary vs. secondary injury
C. Hyperflexion vs. hyperextension injuries
D. Compression vs. rotation injuries
- B – Primary vs. secondary injury progression
(central cord, anterior cord, posterior cord, Brown-Séquard).
complete vs. incomplete syndromes
(X-ray/CT for bony abnormalities, MRI for cord compression/edema)
SCI Imaging Studies
ASIA Impairment Scale (AIS)
(classifications from A to E)
A 32-year-old was in a motor vehicle accident and now complains of numbness in both legs, weakness in both arms, and urinary retention. Vital signs show normal respiratory rate and oxygenation. These deficits most likely suggest an injury:
A. Above C3–C5, causing diaphragmatic compromise
B. In the lower lumbar spine, solely affecting the legs
C. In the cervical or upper thoracic region, affecting multiple motor and sensory pathways
D. Below L5, primarily affecting the sciatic nerve
- C – Indicates injury in the cervical/upper thoracic region affecting multiple limbs and autonomic pathways.
A 56-year-old with a suspected high cervical injury (around C4) should be monitored primarily for:
A. Hypertension from kidney disease
B. Respiratory failure due to diaphragmatic paralysis
C. Excessive sweating in the lower extremities
D. Pain and temperature deficits below L1
- B – C4 level can compromise the diaphragm, leading to respiratory failure.
A patient with a T6 spinal cord injury experiences both motor weakness in the legs and episodes of dizziness upon standing. Which additional symptom or sign would best confirm autonomic dysfunction?
A. Elevated muscle tone (spasticity) in lower limbs
B. Normal blood pressure variations
C. Marked bradycardia and hypotension when sitting up
D. Preserved bowel and bladder control
- C – Marked bradycardia and hypotension on sitting (orthostatic/ autonomic issues).
In a C5 spinal cord injury, which of the following clinical presentations is most expected?
A. Full normal strength in upper extremities
B. No respiratory involvement at all
C. Impaired diaphragm function due to partial phrenic nerve involvement
D. Complete voluntary control over bowel and bladder
- C – Partial phrenic nerve involvement at C5 can impair diaphragmatic function.
Question 5
Which imaging study is typically used first to identify bony abnormalities or fractures in an acute SCI?
A. MRI of the spine
B. PET scan
C. Plain X-ray or CT scan
D. Ultrasound of the spine
- C – X-ray or CT is standard initial imaging for bony injuries.
A patient with a thoracic spine fracture on X-ray has ongoing neurological deficits (weakness, sensory loss) despite the fracture appearing stable. Which imaging test is most sensitive for detecting spinal cord compression or edema?
A. CT myelogram
B. Repeat X-ray in one week
C. MRI of the spine
D. Nerve conduction study
- C – MRI is most sensitive for spinal cord compression and edema
Which statement best explains why MRI is crucial in assessing prognosis in spinal cord injury?
A. MRI is rarely used due to low sensitivity
B. MRI reveals cord edema, hemorrhages, or compression that can guide treatment outcomes
C. MRI only detects ligamentous injuries, not cord damage
D. MRI is solely used for follow-up months later
- B – MRI findings (edema, compression) guide prognosis/treatment
Question 8
According to the ASIA Impairment Scale, a patient with complete loss of motor and sensory function below the level of injury is classified as:
A. ASIA A
B. ASIA B
C. ASIA C
D. ASIA D
- A – ASIA A = complete loss of motor/sensory below injury level.
A 45-year-old SCI patient retains sensation below the injury level but has no voluntary motor function. This pattern corresponds to which ASIA classification?
A. ASIA A
B. ASIA B
C. ASIA C
D. ASIA E
- B – ASIA B = sensory preserved, no motor below injury.
An SCI patient who has motor function preserved, but muscle strength below 50% in at least half the muscles, would be classified as:
A. ASIA B
B. ASIA C
C. ASIA D
D. ASIA E
- B – ASIA C = motor function preserved, but muscle strength <50%
Clinical presentation
SCI levels (high cervical, thoracic)
with emphasis on respiratory and autonomic dysfunction
Imaging modalities for SCI
(X-ray/CT for bones, MRI for cord pathology)
ASIA scale classifications (A–E)
to differentiate complete vs. partial preservation of motor/sensory function
A 46-year-old sustains a suspected C4 spinal cord injury after a diving accident. Which immediate concern is most critical, given the clinical presentation typically associated with this level?
A. Loss of hand grip strength
B. Complete control of the diaphragm
C. Respiratory compromise due to partial diaphragmatic paralysis
D. Leg weakness with no effect on breathing
- C – A high cervical (C4) injury commonly jeopardizes diaphragmatic function
A 52-year-old with a T10 spinal injury complains of burning pain across both legs and bladder incontinence. Motor testing shows moderate weakness in the lower limbs. Which feature would most strongly suggest autonomic dysfunction associated with this level of injury?
A. Inability to sense light touch on the thighs
B. Marked bradycardia or hypotension
C. Preserved sexual function
D. Hyperreflexia in the upper limbs
- B – T10 injuries can affect sympathetic outflow, causing bradycardia/hypotension (autonomic dysfunction).
Imaging
A patient with a stable compression fracture on CT scan continues to have persistent numbness in a specific dermatomal pattern. Which imaging modality is most indicated to evaluate possible spinal cord edema or soft tissue compromise?
A. Repeat CT scan of the spine
B. Ultrasound of the spinal column
C. MRI of the spine
D. Plain film X-ray in flexion-extension
- C – MRI is indicated for assessing cord edema or compression beyond bony injury
A patient retains full sensation below the level of injury but shows mild to moderate weakness in key muscle groups. Strength testing reveals at least 3/5 strength (i.e., can move against gravity but not full resistance) in more than half of these muscles. According to the ASIA scale, this presentation is most consistent with:
A. ASIA B
B. ASIA C
C. ASIA D
D. ASIA E
- C – ASIA D: Motor function preserved >50%, mild-to-moderate weakness
A 30-year-old SCI patient demonstrates no voluntary motor function but intact pain and light touch sensation below the injury. Which ASIA classification is most likely?
A. ASIA A
B. ASIA B
C. ASIA C
D. ASIA D
- B – ASIA B: Sensory intact but no voluntary motor function below injury.
(C3–C5) High Cervical Injuries
risk phrenic nerve compromise → respiratory issues.
in thoracic injuries can manifest as bradycardia/hypotension or incontinence.
Autonomic Dysfunction
MRI ins SCi
is superior for soft tissue and cord pathology
ASIA D
indicates motor preservation with strength ≥3/5 in more than half of key muscles;
ASIA B indicates
sensory preservation only, with no motor function below the level of injury
SCI acute management
A 30-year-old patient presents with a C4 spinal cord injury after a diving accident. They are struggling to maintain effective ventilation. According to best practices in the acute phase, what is the most critical next step to protect their airway?
A. Administer high-dose corticosteroids
B. Intubate with cervical spine precautions
C. Give broad-spectrum antibiotics
D. Start a bowel regimen immediately
- B – Intubate with cervical spine precautions (C4–C5 injury threatening airway)
A T2 spinal cord injury patient is hypotensive (BP 85/50 mmHg) and bradycardic (HR 48 bpm). Fluid boluses have minimal effect. Which intervention aligns with the guidelines for neurogenic shock management?
A. Increase sedation to lower intracranial pressure
B. Give intravenous vasopressors like norepinephrine
C. Restrict fluids to avoid fluid overload
D. Initiate high-dose steroids to improve vasomotor tone
- B – IV vasopressors (e.g., norepinephrine) for neurogenic shock
A 52-year-old with a thoracic spine fracture and neurological deficits is evaluated. According to the acute management protocol, which imaging study is most likely to guide surgical decisions on decompression?
A. Plain X-ray of the thoracic spine
B. CT scan of the lumbar spine
C. MRI of the thoracic spine
D. Ultrasound of the vertebral column
- C – MRI of the thoracic spine to assess cord compression and surgical needs
In the acute phase of SCI, rapid imaging and classification of the injury is essential primarily to:
A. Determine the patient’s baseline blood pressure
B. Justify the use of corticosteroids
C. Identify fractures, cord compression, or hematomas needing urgent intervention
D. Rule out benign tumors
- C – Identify fractures or compressions needing urgent intervention
A 40-year-old with a C6 SCI is in the ICU. The attending physician recommends no corticosteroids despite complete motor loss below the arms. Which explanation aligns with current guidelines?
A. Steroids are always harmful in any neurologic injury
B. There is no proven benefit of steroids in acute SCI, and they increase complication risk
C. Steroids are given only if the patient is also septic
D. Steroids worsen osteopenia, which is the main concern
- B – Steroids offer** no proven benefit in acute SCI and pose higher complication risk
An acute SCI patient is at high risk for deep vein thrombosis (DVT). According to the study guide, when is DVT prophylaxis typically initiated?
A. Only after the patient starts ambulating
B. Immediately with no regard for bleeding risk
C. Once bleeding risk is deemed acceptable, using low-molecular-weight heparin
D. Only if the patient is not sedated
- C – Start DVT prophylaxis (LMWH) once bleeding risk is acceptable
A patient with a T10 SCI from a traumatic accident also has multiple rib fractures and is receiving analgesics. He hasn’t had a bowel movement in 4 days. Which pharmacologic measure is most appropriate to prevent constipation?
A. High-dose opioid infusions
B. Regular administration of a bowel regimen (e.g., stool softeners, laxatives)
C. Intravenous mannitol to reduce intracranial pressure
D. No pharmacologic agent is needed
- B – Regular bowel regimen is important to prevent constipation
Which primary indication justifies surgical decompression in the acute phase of SCI?
A. Ischemic stroke on CT
B. Significant cord compression or unstable fracture requiring stabilization
C. Mild low back pain
D. Presence of intact motor function
- B – Decompression indicated for unstable fracture or cord compression
A patient with a cervical fracture and incomplete SCI is taken urgently for decompression and stabilization. Which key rationale supports this intervention?
A. It permanently reverses motor deficits
B. It prevents secondary injury by relieving pressure on the spinal cord
C. It allows immediate full neurologic recovery
D. It replaces the need for ventilation
- B – Decompression helps prevent secondary injury by relieving pressure
Which nonpharmacologic measure is crucial in the acute setting to prevent further neurologic damage (secondary injury)?
A. Strict bedrest without spinal alignment
B. Early ambulation regardless of fracture stability
C. Maintaining proper spinal alignment and stabilization
D. Regular deep-tissue massage on the fractured site
- C – Proper stabilization/alignment to prevent further trauma
In SCI (especially with high cervical injuries) is paramount.
In SCI Stabilizing ABCs
In SCI
**No corticosteroids **
are routinely recommended
In SCI * DVT prophylaxis and a bowel regimen
are crucial supportive measures
- Surgical decompression can prevent
further cord damage (secondary injury)
In SCI What Will Kill Your Patient?
(Respiratory failure, neurogenic shock)
in SCI 2. What Will Harm Your Patient?
(Autonomic dysreflexia, pressure ulcers, DVT, constipation/urinary retention)
In SCI What Is Really Common?
(Poikilothermia, infections, chronic pain, spasticity)
In SCI Long-term Care and Rehabilitation
(interdisciplinary approach, prevention measures, enhancing quality of life)
A 28-year-old with a C3 spinal cord injury is at highest risk of death from:
A. Hypertensive crisis
B. Respiratory failure due to diaphragmatic paralysis
C. Deep vein thrombosis
D. Urinary retention
- B – High cervical (C3) → risk of respiratory failure
despite IV fluids. This is characteristic of:
A. Septic shock from infection
B. Neurogenic shock requiring vasopressors
C. Hypervolemic state
D. Autonomic dysreflexia
- B – Neurogenic shock (bradycardia, hypotension unresponsive to fluids)
Autonomic dysreflexia is a life-threatening hypertensive crisis typically seen in injuries:
A. Below L2
B. Below T10
C. Above T6
D. Below T1
- C – Autonomic dysreflexia typically above T6
A 35-year-old with a T4 SCI complains of a sudden pounding headache, sweating, and has a BP of 200/110 mmHg. On checking, you find a distended bladder. The best initial management step is:
A. Discontinue all antihypertensive meds
B. Sit the patient upright and relieve the noxious stimulus (e.g., empty the bladder)
C. Give high-dose corticosteroids
D. Lower the head of the bed to increase venous return
- B – Sit patient up and correct the triggering stimulus (e.g., distended bladder)
Immobility in SCI increases the risk for pressure ulcers primarily because:
A. Spinal cord injuries lead to hyperactive movement below the lesion
B. Reduced sensation and inability to shift weight compromise skin integrity
C. SCI patients typically spend more time walking
D. All SCI patients have severe malnutrition
- B – Reduced sensation/mobility = skin breakdown risk
A patient with paraplegia is admitted. Frequent turning and a pressure-relieving mattress are used. What key goal do these measures serve?
A. Avoid autonomic dysreflexia
B. Prevent pressure ulcer formation
C. Maintain fluid balance
D. Enhance spasticity
B. Prevent pressure ulcer formation
A patient with a high thoracic SCI has no ankle pumps (muscle contractions) during bed rest. Which key prophylactic measure reduces the risk of DVT?
A. Maintain supine position only
B. Use of low-molecular-weight heparin and mechanical compression devices
C. High-dose steroids
D. Minimize fluid intake
– Use LMWH and compression devices
Question 7
Why are spinal cord injury patients at a high risk for DVT?
A. Excessive ambulatory activities
B. Increased muscle mass in the lower limbs
C. Prolonged immobility and reduced muscle pumping
D. They have constant vasoconstriction
C. Prolonged immobility and reduced muscle pumping
Urinary retention is common in SCI because:
A. Autonomic control of the bladder can be disrupted
B. All SCI patients have kidney failure
C. Fluid intake is severely limited in SCI
D. There is always a direct injury to the bladder
- A – Disrupted autonomic control of bladder
A 40-year-old with T8 paraplegia experiences chronic constipation despite a normal diet. Which intervention best addresses this complication?
A. High-dose antibiotics
B. Bowel regimen with stool softeners and scheduled evacuation
C. No intervention is needed
D. Intravenous diuretics
B. Bowel regimen with stool softeners and scheduled evacuation
Poikilothermia in SCI refers to:
A. Extreme fever due to hypothalamic injury
B. Loss of normal temperature regulation, adopting ambient temperature
C. Chronic hypothermia below the level of injury
D. Heat stroke induced by vasodilation
- B – Poikilothermia = inability to regulate body temperature
Question 13
Chronic pain is commonly seen in incomplete injuries because:
A. Complete injuries cause no pain
B. Partial nerve pathways may transmit aberrant pain signals
C. Bone fractures always accompany incomplete SCIs
D. Infections are more frequent in incomplete SCIs
- B – Partially damaged nerve pathways can transmit abnormal pain signals
A 50-year-old with paraplegia is prone to frequent UTIs. Which factor most contributes to recurrent urinary tract infections in SCI patients?
A. Increased mobility
B. Poor catheter care or incomplete bladder emptying
C. Heightened immune response
D. High-intensity exercise
- B – Poor catheter hygiene/incomplete emptying → UTIs
A 29-year-old with an incomplete SCI develops spasticity in the legs. This is typically managed by:
A. Total bedrest to avoid muscle use
B. Physical therapy and possibly muscle relaxants
C. High-dose antibiotics to reduce inflammation
D. Exclusively surgical interventions
- B – Spasticity managed via PT and muscle relaxants
A patient with a T6 SCI is ready for discharge. The care team includes physicians, nurses, physical therapists, occupational therapists, social workers, and psychologists. Which statement best describes the reason for this interdisciplinary approach?
A. One discipline can manage all aspects of SCI alone
B. Financial and legal matters are not relevant to SCI
C. SCI affects multiple domains (physical, psychological, social), requiring coordinated care
D. All SCI patients require only medical support
- C – Interdisciplinary care needed for physical, psychosocial, and financial aspects
Which is a primary method to prevent pressure ulcers in long-term SCI care?
A. Frequent repositioning and skin checks
B. Daily steroid injections
C. No need for special bedding
D. Complete fasting
A. Frequent repositioning and skin checks
Which measure is most effective to prevent recurrent UTIs in SCI patients who use chronic catheterization?
A. Prophylactic steroids
B. Routine prophylactic antibiotics for life
C. Proper catheter care and scheduled bladder emptying
D. Daily high-dose diuretics
C. Proper catheter care and scheduled bladder emptying
Question 18 (Scenario-Based)
A 50-year-old with a T8 SCI has ongoing bowel incontinence. The rehab team emphasizes bowel training programs. Why is this crucial for SCI patients?
A. It eliminates the risk of pressure ulcers
B. It allows normal muscle function to return immediately
C. It helps establish a routine to minimize accidents and complications
D. It cures the SCI
C. It helps establish a routine to minimize accidents and complications
Early DVT prophylaxis, pressure sore prevention, and bowel regimen in SCI primarily aim to:
A. Improve immediate surgical outcomes
B. Prevent secondary complications that can harm or prolong recovery
C. Eliminate all future infections
D. Ensure full motor recovery
B. Prevent secondary complications that can harm or prolong recovery
Which long-term management principle best reflects the key takeaway for incomplete SCIs?
A. They have no potential for functional recovery
B. They often regain some function with aggressive rehabilitation
C. They have identical outcomes to complete SCIs
D. They never develop spasticity
B – Incomplete SCIs often show partial recovery with rehab
35-year-old sustains a severe spinal injury in a motor vehicle accident. Initial imaging confirms a complete transection at T2. Which of the following best characterizes this injury?
A. Partial motor deficits but intact sensory function
B. Complete loss of motor and sensory function below T2
C. High cervical injury leading to diaphragmatic paralysis
D. Normal lower extremity reflexes due to the upper thoracic level
- B – Complete loss of motor/sensory function below T2
In SCI, secondary injury refers to:
A. Immediate mechanical disruption of the spinal cord at impact
B. Prolonged nerve regeneration over months
C. Preventable ischemia, inflammation, and edema occurring after the initial trauma
D. Genetic predisposition to cord compression
- C – Secondary injury = ischemia, inflammation, edema post-trauma
A 40-year-old with a suspected SCI reports loss of vibration and proprioception in both legs but preserved pain and temperature sensation. Which incomplete spinal cord syndrome is most likely?
A. Anterior cord syndrome
B. Posterior cord syndrome
C. Central cord syndrome
D. Brown-Séquard syndrome
- B – Posterior cord syndrome (loss of vibration/proprioception, preserved pain/temperature)
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A patient arrives after a diving accident with weakness in all four extremities (more pronounced in the upper limbs) and some preserved sensation in the lower limbs. Imaging shows a cervical cord injury with no complete transection. This presentation is most consistent with:
A. Central cord syndrome
B. Anterior cord syndrome
C. Posterior cord syndrome
D. Brown-Séquard syndrome
- A – Central cord syndrome (greater motor weakness in upper limbs)
A 28-year-old with a penetrating spinal trauma experiences ipsilateral paralysis and loss of proprioception, but contralateral loss of pain and temperature below the level of injury. This classic presentation describes:
A. Brown-Séquard syndrome
B. Anterior cord syndrome
C. Central cord syndrome
D. Posterior cord syndrome
- A – Brown-Séquard (ipsilateral motor/proprioception loss, contralateral pain/temp loss)
Question 6 (Scenario-Based)
A 24-year-old with a C4 spinal cord injury arrives in the trauma bay. He has shallow respirations and is becoming hypoxic. Which intervention best addresses the primary concern in acute SCI management?
A. Give IV corticosteroids immediately
B. Apply abdominal binders to improve venous return
C. Perform endotracheal intubation to protect the airway and support breathing
D. Check serum potassium to rule out electrolyte imbalances
- C – Secure the airway (C4 injury → diaphragmatic compromise)
A patient with an acute SCI at T3 shows bradycardia and hypotension unresponsive to fluid boluses. This is most likely:
A. Septic shock
B. Neurogenic shock
C. Spinal shock
D. Autonomic dysreflexia
(Note: “Neurogenic shock” typically presents with hypotension and bradycardia; “spinal shock” refers to loss of reflexes and flaccidity below the injury.)
- B – Neurogenic shock (bradycardia/hypotension unresponsive to fluids)
