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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. Quadriceps (Knee extension)
L1 - L3
Anal Sphincter (voluntary rectal tone) Corticosteroid use
T2 - T7
L2 - L4
2. Complete neurologic lesion as the absence of sensory and motor function below the level of injury - Minimal chance of recovery
Spinal Shock
Compression Fracture
Complete Cord Injury
Brown Sequard Injury
3. Functional disturbance and/or pathological change in the spinal cord - Due to a spinal cord lesion - stenosis - or compression
Myelopathy
TLS Flexion-distraction
Neurogenic shock
L1 - L3
4. Deltoid (Arm Abduction) Biceps (Elbow Flexion)
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Cauda Equina Syndrome
C8 - T1
C5 - C6
5. Persistent irrection - Implies a complete spinal cord injury
L2 - L4
Spinal Shock
Neurogenic shock
PE Findings: Priapism
6. 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
7. 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
Brown Sequard Injury
T9 - T12
TLS Flexion-distraction
Spinal Shock
8. Caused by significant external forces - frequently involve other C-spine injuries - Dens projection
Cauda Equina Syndrome
L4 - L5
C2 Fx - Axis
Compression Fracture
9. 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
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Compression Fracture
Anal Sphincter (voluntary rectal tone) Corticosteroid use
T9 - T12
10. Extensor Carpi Radialis (Wrist extension)
PE Findings: Priapism
C6 - C7
L1 - L3
Anal Sphincter (voluntary rectal tone) Corticosteroid use
11. Canadian C-Spine Criteria (3)
C8 - T1
Spinal Cord Injuries
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
C6 - C7
12. Abdominal Muscles
C6 - C7
C2 Fx - Axis
T9 - T12
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
13. Gastrocnemius (Ankle plantar flexion)
Anal Sphincter (voluntary rectal tone) Corticosteroid use
S1 - S2
Neurogenic shock
Myelopathy
14. 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
Compression Fracture
T9 - T12
PE Findings: Priapism
Cauda Equina Syndrome
15. 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
Cervical Burst Fracture
L4 - S2
Anterior cord injury
C8 - T1
16. Hyperextension injuries - disruption of blood flow to the spinal cord - cervical spinal stenosis - Quadriparesis (Upper > Lower) - Some loss of pain / temp - Good prognosis
L2 - L4
C2 Fx - Axis
Neurogenic shock
Central Cord Injury
17. Pain seeming to radiate from the spine to extend outward - Due to a single spinal nerve root irritation
Importance of ABDCE's in SCIs
Myelopathy
Cervical Burst Fracture
Radiculopathy
18. Peripheral nerve injury - Variable motor and sensory loss in the lower extremites - sciatica - bowel/bladder dysfunction - 'saddle anesthesia' - Good prognosis
Cauda Equina Syndrome
PE Findings: Areflexia
S1 - S2
Neurogenic shock
19. 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
TLS fracture-dislocation
Brown Sequard Injury
L4 - S2
S1 - S2
20. Caused by a direct axial blow - Vertebral fragments displaced in all directions
Cervical Burst Fracture
Clay-Shoveler's Fracture
PE Findings: Priapism
Brown Sequard Injury
21. Bladder
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
S2 - S4
Importance of ABDCE's in SCIs
22. 45% of Spinal Cord Injuries due to this
PE Findings: Respiratory Dysfunction
MVA
TLS Flexion-distraction
Importance of ABDCE's in SCIs
23. Hamstrings (Knee flexion)
PE Findings: Areflexia
Anterior cord injury
L4 - S2
TLS Axial burst fracture
24. Illiopsoas (Hip Flexion)
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
Hangman's Fracture
L1 - L3
C8 - T1
25. Men:Women = 4:1 - Mean age 40 years - Occurs on weekends / holidays
L4 - L5
C8 - T1
Spinal Cord Injuries
TLS fracture-dislocation
26. Test anogenital reflexes -> ______ with preservation o fthe reflexes denotes an incomplete spinal cord level - even if patient has complete sensory/motor loss
L4 - S2
PE Findings: Sacral Sparing
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
C8 - T1
27. Extensor hallucis longus (Big toe extension)
T2 - T7
MVA
PE Findings: Sacral Sparing
L5 - S1
28. Tibialis Anterior (Ankle dorsiflexion)
L4 - L5
PE Findings: Sacral Sparing
Anterior cord injury
Complete Cord Injury
29. Triceps (Elbow extension)
C7 - C8
Radiculopathy
Compression Fracture
C6 - C7
30. Most susceptable spinal region in MVA and falls from a height injuries
TLS Flexion-distraction
Cervical Burst Fracture
C2 Fx - Axis
Thoraco-lumbar Junction
31. 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
Complete Cord Injury
TLS Flexion-distraction
Indications for C-Spine Xrays
Anterior cord injury
32. NEXUS C-Spine Criteria (5)
C7 - C8
Clay-Shoveler's Fracture
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
33. Hand intrinsics (Finger Abduction) Flexor Digitorum Profundus (Hand Grasp)
Cervical Burst Fracture
C8 - T1
TLS Flexion-distraction
Anal Sphincter (voluntary rectal tone) Corticosteroid use
34. roots of phrenic nerve (supplying diaphragm) emerges at C3-C5 - Intubate any injury above C5
PE Findings: Respiratory Dysfunction
TLS fracture-dislocation
Brown Sequard Injury
MVA
35. Indicates spinal cord injury or nerve severing - No Bueno
TLS Axial burst fracture
Hangman's Fracture
L1 - L3
PE Findings: Areflexia
36. Caused by intense flexion against a contracted posterior erector spinal muscle - Avulsion fx of the lower cervical spinous processes (C7 especially)
37. Fx of both pedicles of C2 - Body of C2 displaces anteriorly on C3
38. Injury to C/T spinal cord -> Peripheral sympathetic denervation - Patients are warm - peripherally vasodilated - hypotensive - relative bradycardia
Central Cord Injury
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Neurogenic shock
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
39. 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
TLS Flexion-distraction
C8 - T1
Myelopathy
TLS Axial burst fracture
40. Controversial - ______ infusion with acute blunt SCI can improve both motor/sensory function if started right away
Spinal Shock
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
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Anal Sphincter (voluntary rectal tone) Corticosteroid use
41. Chest Muscles
Compression Fracture
Brown Sequard Injury
T2 - T7
C5 - C6
42. 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 ->
Central Cord Injury
Spinal Shock
Hangman's Fracture
Importance of ABDCE's in SCIs
43. Caused by direct blow to top of head - Outward displacement of lateral masses of ___
C1 Fx - Atlas
Hangman's Fracture
C6 - C7
Cervical Burst Fracture
44. 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
C1 Fx - Atlas
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
C2 Fx - Axis