Spinal Cord Injury

Question 1

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

Answer 1

1 - medulla oblongata to L1

Question 2

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

Answer 2

3 - conus medullaris

• terminal end of the spinal cord

Question 3

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

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

Answer 3

1 - cervical

Question 4

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%

Answer 4

3 - 50%

Question 5

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

Answer 5

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

Question 6

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

Answer 6

2 - loss of movement and sensation in all limbs

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

Question 7

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

Answer 7

3 - loss of movement and sensation in lower limbs

• paraplegia =
• para - is greek for paralysed

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

1 - C3, 4 and 5

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

Question 11

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

Answer 11

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

Question 12

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

Answer 12

3 - pressure ulcers

Question 13

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

Answer 13

3 - 30-60 minutes

Question 14

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%

Answer 14

2 - 10-15%

Question 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

Answer 15

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!)

Question 16

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

Answer 16

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

Question 17

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

Answer 17

2 - arterial disruption, thrombosis or hypoperfusion due to shock

• normally occurs straight after the primary spinal cord injury

Question 18

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

Answer 18

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

Question 19

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

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

Answer 19

3 - 1000

Question 20

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

Answer 20

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

Question 21

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

Answer 21

3 - paraesthesia (burning/prickling sensation)

Question 22

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

Answer 22

3 - neurological

Question 23

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

Answer 23

3 - X-ray

• lateral view is important

Question 24

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

Answer 24

1 - CT scan

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

Question 25

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

Answer 25

4 - CT scan of brain and cervical vertebrae

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

Question 26

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?

Answer 26

4 - distributive

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

-

Question 27

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?

Answer 27

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

Question 28

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

Answer 28

1 - vasodilation
3 - bradycardia

• both are due to lack of sympathetic activity

Question 29

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

Answer 29

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

Question 30

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

Answer 30

4 - paresthesia

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