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Test your basic knowledge |
Emergency Medicine: Spinal Trauma
Start Test
Study First
Subjects
:
health-sciences
,
emergency-medicine
Instructions:
Answer 44 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. Hyperextension injuries - disruption of blood flow to the spinal cord - cervical spinal stenosis - Quadriparesis (Upper > Lower) - Some loss of pain / temp - Good prognosis
Thoraco-lumbar Junction
TLS Flexion-distraction
Central Cord Injury
S2 - S4
2. Most damaging of all injuries - Compression - flexion - distraction - rotation - shearing forces -> failure of ALL 3 columns - Causes subluxation or dislocation - Grossly unstable spine T11 -> L2
PE Findings: Priapism
TLS fracture-dislocation
Compression Fracture
L2 - L4
3. Any injury above C5 -> Intubation - Hypotension due to neurogenic/spinal shock - blood loss - cardiac injury - Blood loss should be presumed to be the caUse of hypotension until proven otherwise
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4. Triceps (Elbow extension)
C7 - C8
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
L1 - L3
Cervical Burst Fracture
5. Hamstrings (Knee flexion)
Myelopathy
L4 - S2
Cervical Burst Fracture
Hangman's Fracture
6. Caused by intense flexion against a contracted posterior erector spinal muscle - Avulsion fx of the lower cervical spinous processes (C7 especially)
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7. NEXUS C-Spine Criteria (5)
Thoraco-lumbar Junction
C-Spine Xrays NOT needed if all 5 met: 1. Absence of midline cervical tenderness 2. Normal level of alertness and consciousness 3. No evidence of intoxication 4. Absence of focal neurologic deficit 5. Absence of painful distracting injury
L2 - L4
Anterior cord injury
8. Chest Muscles
TLS Flexion-distraction
MVA
Clay-Shoveler's Fracture
T2 - T7
9. Deltoid (Arm Abduction) Biceps (Elbow Flexion)
C5 - C6
L4 - S2
Neurogenic shock
Thoraco-lumbar Junction
10. Caused by a direct axial blow - Vertebral fragments displaced in all directions
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Central Cord Injury
Myelopathy
Cervical Burst Fracture
11. Direct _____ compression - flexion of the cervical spine - Thrombosis of anterior spinal artery. - Complete paralysis below the lesion - loss of pain / temp sensation - Preservation of proprioception and vibratory function - Poor prognosis
Anterior cord injury
L2 - L4
L4 - L5
Clay-Shoveler's Fracture
12. Canadian C-Spine Criteria (3)
Hangman's Fracture
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
C-Spine Xrays NOT needed if all 3 met:1. No high risk factors mandating x-rays (>65 years - dangerous MOI - presence of parasthesias) 2. Low risk factors allowing a safe assessment of ROM (simple rear-end MVC - patient able to sit up in ED - patient
L4 - S2
13. Functional disturbance and/or pathological change in the spinal cord - Due to a spinal cord lesion - stenosis - or compression
Spinal Shock
Clay-Shoveler's Fracture
Indications for C-Spine Xrays
Myelopathy
14. Abdominal Muscles
Cauda Equina Syndrome
PE Findings: Priapism
T9 - T12
C1 Fx - Atlas
15. Complete neurologic lesion as the absence of sensory and motor function below the level of injury - Minimal chance of recovery
Brown Sequard Injury
Complete Cord Injury
Spinal Shock
C5 - C6
16. Gastrocnemius (Ankle plantar flexion)
L5 - S1
L4 - L5
S1 - S2
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
17. Serious spinal cord damage and disruption of tracts w/o a fx - Most common in children - Flexion - hyperextension - longitudinal distraction - and ischemia causing complete - severe - or partial cord lesions
Thoraco-lumbar Junction
Compression Fracture
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
PE Findings: Respiratory Dysfunction
18. Extensor Carpi Radialis (Wrist extension)
Spinal Shock
C6 - C7
L1 - L3
MVA
19. Bladder
S2 - S4
C-Spine Xrays NOT needed if all 3 met:1. No high risk factors mandating x-rays (>65 years - dangerous MOI - presence of parasthesias) 2. Low risk factors allowing a safe assessment of ROM (simple rear-end MVC - patient able to sit up in ED - patient
TLS Axial burst fracture
Cervical Burst Fracture
20. roots of phrenic nerve (supplying diaphragm) emerges at C3-C5 - Intubate any injury above C5
PE Findings: Respiratory Dysfunction
S1 - S2
Hangman's Fracture
L4 - S2
21. Peripheral nerve injury - Variable motor and sensory loss in the lower extremites - sciatica - bowel/bladder dysfunction - 'saddle anesthesia' - Good prognosis
L1 - L3
Radiculopathy
PE Findings: Sacral Sparing
Cauda Equina Syndrome
22. Caused by axial loading and flexion - with subsequent failure of the anterior column - Middle column remains intact - Stable unless > 50% decrease in vertebral height - unlikely to be directly responsible for neuro damage
L5 - S1
Hangman's Fracture
Compression Fracture
L4 - L5
23. Indicates spinal cord injury or nerve severing - No Bueno
L4 - L5
T9 - T12
Radiculopathy
PE Findings: Areflexia
24. Caused by failure of the vertebral body under axial load - Both the anterior and middle columns fail - Retropulsion of bone/disc into canal -> Neuro damage - Unstable
TLS Axial burst fracture
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Thoraco-lumbar Junction
C2 Fx - Axis
25. Caused by significant external forces - frequently involve other C-spine injuries - Dens projection
S2 - S4
Hangman's Fracture
C2 Fx - Axis
Central Cord Injury
26. High speed MVC (>35 mph)- Fatal MVC- Ped vs Auto- Fall from >10 ft- Significant or serious closed head injury - Neuro signs/symptoms referable to C-Spine - Pelvic of multiple extremity injuries - ICH seen on CT
C7 - C8
C5 - C6
Hangman's Fracture
Indications for C-Spine Xrays
27. Persistent irrection - Implies a complete spinal cord injury
PE Findings: Priapism
L4 - L5
PE Findings: Areflexia
Importance of ABDCE's in SCIs
28. Fx of both pedicles of C2 - Body of C2 displaces anteriorly on C3
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29. Test anogenital reflexes -> ______ with preservation o fthe reflexes denotes an incomplete spinal cord level - even if patient has complete sensory/motor loss
S2 - S4
L4 - L5
L4 - S2
PE Findings: Sacral Sparing
30. Hand intrinsics (Finger Abduction) Flexor Digitorum Profundus (Hand Grasp)
Clay-Shoveler's Fracture
C8 - T1
L4 - L5
L1 - L3
31. Caused by direct blow to top of head - Outward displacement of lateral masses of ___
L4 - S2
C1 Fx - Atlas
TLS Flexion-distraction
Cauda Equina Syndrome
32. Pain seeming to radiate from the spine to extend outward - Due to a single spinal nerve root irritation
Spinal Cord Injuries
Neurogenic shock
Clay-Shoveler's Fracture
Radiculopathy
33. Injury to C/T spinal cord -> Peripheral sympathetic denervation - Patients are warm - peripherally vasodilated - hypotensive - relative bradycardia
Neurogenic shock
Cervical Burst Fracture
TLS Axial burst fracture
L4 - S2
34. Extensor hallucis longus (Big toe extension)
L5 - S1
C1 Fx - Atlas
Anterior cord injury
Complete Cord Injury
35. Most susceptable spinal region in MVA and falls from a height injuries
C5 - C6
Complete Cord Injury
Thoraco-lumbar Junction
C-Spine Xrays NOT needed if all 3 met:1. No high risk factors mandating x-rays (>65 years - dangerous MOI - presence of parasthesias) 2. Low risk factors allowing a safe assessment of ROM (simple rear-end MVC - patient able to sit up in ED - patient
36. Transverse hemisection of the spinal cord - unilateral cord compression - Ipsilateral spastic paresis - loss of prorioception / vibratory senation - Contralateral loss of pain / temp sensations - Good prognosis
MVA
Brown Sequard Injury
C8 - T1
Neurogenic shock
37. Illiopsoas (Hip Flexion)
C6 - C7
Indications for C-Spine Xrays
TLS Flexion-distraction
L1 - L3
38. Men:Women = 4:1 - Mean age 40 years - Occurs on weekends / holidays
Cervical Burst Fracture
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Spinal Cord Injuries
MVA
39. 45% of Spinal Cord Injuries due to this
C5 - C6
Cauda Equina Syndrome
MVA
TLS Flexion-distraction
40. Controversial - ______ infusion with acute blunt SCI can improve both motor/sensory function if started right away
Anal Sphincter (voluntary rectal tone) Corticosteroid use
C8 - T1
PE Findings: Sacral Sparing
C1 Fx - Atlas
41. Caused by seat belt-type injuries (particularly lap belt only) - Middle and Posterior column failure - Increased height and/or fx of posterior vertebral body - posterior opening of disc space - Chance fx - Unstable
Indications for C-Spine Xrays
TLS Flexion-distraction
Spinal Shock
Compression Fracture
42. Quadriceps (Knee extension)
L2 - L4
Central Cord Injury
C-Spine Xrays NOT needed if all 5 met: 1. Absence of midline cervical tenderness 2. Normal level of alertness and consciousness 3. No evidence of intoxication 4. Absence of focal neurologic deficit 5. Absence of painful distracting injury
S1 - S2
43. The temporary loss or depression of spinal reflex activity that occurs below a complete or incomplete spinal cord injury - Loss of neuro function w/ this can cause an incomplete spinal cord injury to mimic a complete cord injury - Duration of days ->
Importance of ABDCE's in SCIs
Spinal Shock
Anterior cord injury
C-Spine Xrays NOT needed if all 3 met:1. No high risk factors mandating x-rays (>65 years - dangerous MOI - presence of parasthesias) 2. Low risk factors allowing a safe assessment of ROM (simple rear-end MVC - patient able to sit up in ED - patient
44. Tibialis Anterior (Ankle dorsiflexion)
C6 - C7
PE Findings: Priapism
Hangman's Fracture
L4 - L5