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