- Ventilator independent- Has biceps, deltoid, and can flex elbow, but lacks wrist extension and supination needed to feed oneself- Independent ADL’s; electric wheelchair with hand control, minimal manual wheelchair function
- Various return of B/B and sexual function- Walking with minimal or no assistance
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A 26-year-old arena football player is seen in the emergency room after he was injured playing football. On physical exam the patient has 4/5 strength in his deltoid, and 0/5 strength in the remainder of his extremities. He has no perianal sensation or rectal tone, but his bulbocavernosus reflex is intact. He has no other injuries except for those seen in Figures A and B. Which of the following is true?
The patient has a complete injury, so early decompression (< 24 hours) will not increase the liklihood of neurologic recovery compared to delayed treatment
The patient has an incomplete injury, and he should be taken to the OR for early decompression (< 24 hours) to improve neurologic recovery
The patient has a complete injury, but early decompression (< 24 hours) will increase the likelihood of neurologic recovery
The patient has a complete injury, and early decompression (< 24 hours) will increase risk of mortality within 30 days of the injury
The patient has a complete injury, and early decompression (< 24 hours) will increase the peri-operative complications
Select Answer to see Preferred Response
An 17-year-old football player is brought to the emergency room following a tackling injury 90 minutes prior. On arrival to the emergency room he is alert and oriented. On physical exam he has tenderness in his posterior midline cervical spine. He reports intact sensation in his upper and lower extremities. He motor exam shows he has some motion in his arms and legs, but is unable to lift his legs or arms against gravity. His bulbocavernosus reflex is absent. Which of the following statements is true regarding the administering a dose of Methylprednisolone 30 mg/kg bolus followed by a 5.4 mg/kg/hr infusion x 24 hours?
It is not supported by current literature - recent studies have shown that while there are no associated complications, there is not significant benefit.
It is not supported by current literature - recent studies have shown an increased risk of complications with no clear evidence of benefits
It is supported by current literature - recent studies have demonstrated few harmful side effects, which are outweighed by the large potential benefits
It is supported by current literature - recent studies have shown only a mild benefit, but due to the high safety profile, the benefits still outweigh the risks
There is no clear evidence to recommend for or against the administration of Methylprednisolone
Which of the following scenarios would be most appropriate for posterior deltoid-to-triceps transfers?
Axillary nerve injury
C6 ASIA A Spinal Cord Injury with 5/5 biceps and 4/5 brachioradialis
Erb's palsy with waiters tip deformity
C5 ASIA C Spinal Cord Injury with 3/5 deltoid and 2/5 biceps
C5 ASIA D Spinal Cord Injury with 4/5 deltoid and 4/5 biceps
A 49-year-old male fell from a height of 10 feet while cleaning his roof. He sustained the isolated injury shown in Figures A and B. Upon transfer from the outside hospital 10 hours later, he has 0/5 motor strength in bilateral lower extremities, no sensation distal to umbilicus, and an intact bulbocavernosous reflex. He has no perianal sensation or rectal tone. He received no medical management at the outside hospital. Which of the following is the most appropriate use of methylprednisolone in this patient.?
Initiate high-dose methylprednisolone with a loading dose of 30mg/kg and a drip of 5.4 mg/kg/hr
Initiate high-dose methylprednisolone, without a loading dose, at 5.4 mg/kg/hr
Do not initiate treatment with methylprednisolone
Initiate high-dose methyprednisolone if his neurologic status does not improve over the next 14 hours
Administer a one-time dose of methylprednisolone at a dose of 30 mg/kg
A 32-year-old man is brought to the Emergency Department after cervical spine trauma. Physical examination has classified his injury as ASIA B at the C6 level. All of the following exam findings are expected in this patient EXCEPT?
Sensation intact in the long finger
Sensation intact over the medial aspect of the forearm
5/5 strength in deltoid function
2/5 strength in triceps function
0/5 strength in the instrinic hand muscles
Functional electrical stimulation is used in the rehabilitation of patients with spinal cord injuries. This rehabiliation method has the greatest functional effect on which of the following?
Dorsal root ganglion
A 2-year-old child falls down a flight of stairs and is found to have spinal cord injury without radiographic abnormality (SCIWORA). What is the most important predictor of her neurologic outcome?
Mechanism of injury
Severity of initial neurologic injury
Injury pattern of fracture or dislocation
Location of spinal cord injury
Age of patient
All of the following are attributed to the loss of supraspinal control of the sympathetic nervous system that commonly occurs in patients with spinal cord lesions at T-6 or higher EXCEPT
A 52-year-old male is involved in an altercation where his neck was twisted and extended with force. Upon presentation he complains of neck pain, and loss of ability to stand or ambulate. On physical exam, he has Grade 3 motor strength in the majority of his muscles groups in his upper and lower extremities. His sensory is intact in all four extremities, and his bulbocavernosus reflex is intact. Sagittal and coronal computed tomography are shown in Figure A and B respectively. The patient's neurologic condition is best classified as?
An 18-year-old male is evaluated for a suspected spinal cord injury. His neurological exam shows diminished sensation below the T7 level. His bulbocavernosus reflex is intact. Which physical finding of motor function, below the affected neurological level, would classify this injury as an ASIA B according to the American Spinal Injury Association impairment scale?
More than half of the major muscles demonstrate palpable or visible muscle contraction
At least half of key muscles have a muscle grade of 5.
More than half of key muscles have a muscle grade less than 3.
At least half of key muscles have a muscle grade of 3 or more.
No motor function preserved below affected neurological level
What percentage of patients with a spinal cord injury suffer from Major Depressive Disorder?
Less than 5%
5 to 20%
20 to 50%
50 to 75%
Greater than 75%
A 36-year-old male involved in a high speed motor vehicle accident is found on exam to have Grade 2 of 5 motor strength in 80% of his key muscle groups in his lower extremity. His perianal sensation and rectal tone are intact. A bulbocavernosus reflex is present. His sensation is decreased from a point at the intersection of the mid-clavicular line and the 4th intercostal space at the level of the nipples distally. Based on the American Spinal Injury Association (ASIA) classification system, what ASIA grade is he?
Following an acute spinal cord injury a patient presents with systemic hypotension and relative bradycardia. His bulbocavernosus reflex is present. This is characteristic of what type of response in acute spinal cord injuries?
A 16-year-old male is involved in a diving accident six months ago that leads to a spinal cord injury. On physical exam he has 5 out of 5 deltoid and biceps strength. He has good brachioradialis muscle tone and 5 out of 5 bilateral wrist extension. He has 0 out of 5 wrist flexion and triceps strength. He has no anal sphincter tone, absent perianal sensation, absent lower extremity sensation, and an intact bulbocavernosus reflex. He has no motor tone in his lower extremities. How would you define this patients neurologic deficit.
Incomplete C5 spinal cord injury (ASIA A)
Complete C5 spinal cord injury (ASIA E)
Complete C6 spinal cord injury (ASIA A)
Complete C7 spinal cord injury (ASIA A)
Incomplete C7 spinal cord injury (ASIA B)
A 30-year-old male is involved in a motor vehicle accident and sustains a fracture-dislocation of the cervical spine. On physical exam he has absent distal motor function, absent sensation, absent rectal tone, and an intact bulbocavernosus reflex. Which term best describes this spinal cord injury pattern?
Central cord syndrome
Incomplete spinal cord injury
Complete spinal cord injury
Which of the following best describes a patient's functional level with a complete C5 spinal cord injury?
Electric wheelchair with only head or chin control
Electric wheelchair with hand control
Limited use of manual wheelchair, can drive car with manual controls
Long-distance use of a manual wheelchair
Fully independent transfers
A 23-year-old man falls down a flight of stairs while intoxicated and is brought to the emergency room the following morning. On physical exam he has no motor function in his upper and lower extremities. Sensory exam shows diminished but present sensation in the perianal area and in the lower extremities. Reflex exam shows his bulbocavernosus reflex is intact. The inital CT and MRI are seen in Figures A and B. According to the American Spinal Injury Association (ASIA), how would this injury be classified?