Spinal cord trauma/Parkinson's dz/drug abuse

Question 1

injury of c4 or above

Answer 1

quad. may require mechanical ventilation

Question 2

c4-c5

Answer 2

quad. can control head, neck, shoulder, trap and elbow flexion

Question 3

c5-6

Answer 3

quad; some extension of wrist, index finger and thumb

Question 4

c6-7

Answer 4

elbow extension, capable of feeding, dressing

Question 5

c7-T1

Answer 5

hand movement

Question 6

T1-T2

Answer 6

paraplegia; upper extremity control but no trunk control

Question 7

T3-8

Answer 7

some trunk control

Question 8

T9-10

Answer 8

bowel and bladder reflex, moves trunk and upper thigh

Question 9

T11-L1

Answer 9

most leg and some foot movement; ambulation possible

Question 10

L1-L2

Answer 10

lower legs, feet and perineum; continued bowel, bladder and sexual dysfunction if s2-s4 spinal nerves involved

Question 11

4/5 strength

Answer 11

full ROM against moderate resistance and gravity

Question 12

3/5 strength

Answer 12

full ROM against gravity, not against resistance

Question 13

2/5 strength

Answer 13

extremity can move but not against gravity (can roll but not lift)

Question 14

1/5 strength

Answer 14

muscle contracts but extremity cannot move

Question 15

management of spinal lesion

Answer 15

• methylprednisolone bolus followed by infusion of 5.4mg/kg/hr for 23 hours. improves neurologic recover when giving within 8 hours of injury
• controversial

Question 16

complication in T4-T6 injury

Answer 16

may lead to autonomic dysreflexia. an emergency clinical condition

Question 17

autonomic dysreflexia in t4-6 injury caused by:

Answer 17

exaggerated autonomic response to a stimulus (bladder or bowel distention, or or cold stimulus, restirctive clothing etc)

Question 18

symptoms of autonomic dysreflexia in T4-6 injury include:

Answer 18

diaphoresis and flushing above the level of injury

• chills and severe vasoconstriction below the level of injury
• HTN, bradycardia
• headache, nausea

Question 19

Tx for autonomic dysreflexia

Answer 19

antihypertensives and stimulus removal

Question 20

What may occur with t6 or above injury?

Answer 20

Neurogenic shock

Question 21

what happens in neurogenic shock

Answer 21

disruption of transmission of sympathetic impulses causes unopposed parasympathetic stimulation which leads to loss of vasomotor tone, inducing massive vasodilation

Question 22

What results from neurogenic shock and what is used for treatment?

Answer 22

hypovolemia, decreased venous return, and decreased cardiac output result.

sympathomimetic vasopressors are used to maintain blood pressure.

Question 23

S/S of Parkinson’s

Answer 23

• tremor**: slow, most conspicuous at rest, may be enhanced by stress
• rigidity***
• bradykinesia**
• wooden facies
• impaired swallowing
• drooling
• decreased blinking
• myerson’s sign (repetitive tapping over the bridge of the nose produces a sustained blink response

Question 24

Mngt Parkinson’s

Answer 24

-increasing available dopamine (Carbidopa-Levodopa, amantadine, tolcapone, pramipexole, ropinirole

Question 25

What medications help relieve tremor and rigidity

Answer 25

Venztropine and trihexyphenydyl (artane)

Question 26

What is the leading cause of death for men < 35 years of age

Answer 26

head trauma

Question 27

workup of head trauma

Answer 27

was there a lucid interval? imp because suggest expanding hematoma.
epidural hematoma a/w lucid interval

Question 28

decompensating patients. what do they show

Answer 28

signs of bushings triad
widening pulse pressure, decreased RR and decreased HR

Battle’s sign: bruising behind ear at mastoid process
-otorrhea or rhinorrhea

Question 29

Thoracic injuries involve:

Answer 29

trunk

paraplegia

Question 30

cervical injuries are about:

Answer 30

hands and arms-variability in use depending on lesion

quadraplegic

Question 31

major complications of spinal cord injuries

Answer 31

c4 and above: respiratory compromise

T4-6 autonomic dysreflexia

T6 or above: neurogenic shock

Question 32

what is the triad of Parkinson’s?

Answer 32

tremor
rigidity
bradykinesia (very slow movement)

Question 33

Parkinson’s patient usually die from what?

Answer 33

pulmonary problem

Question 34

c/o feet sticking to the floor

vs my tremor is worse treatment differences.

Answer 34

feet: need more dopamine
tremor: need anticholinergic

Question 35

cervical injuries. what are you assessing to see if they can move

Answer 35

hands and arms. may be svaed