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A 27-year-old male is involved in a motorcycle accident and presents with severe neck pain, loss of sensation of his entire body, and no motor function in his upper and lower extremities. The patient is respiring without difficulty. Figures A and B are the sagittal and axial at C6 CT slices of the cervical spine. Figures C and D are the T2 and STIR weighted sagittal MRI images, respectively. What is the most appropriate treatment at this time?
Early surgical decompression and stabilization, IV steroids, and systemic hypothermia treatment
Early surgical decompression and stabilization and IV steroids
Early surgical decompression and stabilization and systemic hypothermia treatment
Early surgical decompression and stabilization
Early surgical decompression and stabilization, IV steroids, and regional hypothermia treatment
Select Answer to see Preferred Response
A 50-year-old T3 paraplegic is taken to the emergency department by his caretaker with chest pain, bradycardia, hypertension, headache, shivering, agitation, and diaphoresis. He is poorly supervised and recently his caretaker noticed increased swelling isolated to his right thigh. He is otherwise afebrile. A diagnosis of autonomic dysreflexia is suspected. Which of the following is the most likely potential cause?
Suprapubic urinary catheter
Recent viral illness
A 28-year-old male is involved in a high-speed motor vehicle collision. Upon arrival in the trauma bay, ATLS protocol and aggressive fluid resuscitation is started for hypotension and bradycardia. On exam, he cannot move either lower extremity and lacks sensation below the umbilicus, but no deficits are noted in the upper extremities. There is no rectal tone when the foley catheter is tensioned. How would you classify his injury based on the ASIA classification?
Cannot determine at this time
A 21-year old previously healthy male presents to the trauma bay 8 hours after a helicopter evacuation from a national park with a suspected cervical spine injury. He reports he dove into a lake without understanding the depth and hit a rock. On primary exam he has a 5 cm laceration over the parietal region of his skull with no other aparent injuries in his extremities or abdomen. His heart rate is 57 and blood pressure is 92/70 despite resuscitation efforts with fluids. He is unable to move his arms or his legs and denies peri-anal sensation. He has absent patellar reflexes. When performing a rectal exam, no anal sphincter contraction occurs when the indwelling catheter is pulled. His abdomen is soft and painless. A CT scan of the chest, abdomen, and pelvis is negative except for the cervical spine injury shown in Figure A. Which of the following most accurately describes his American Spinal Injury Association (ASIA) Impairment Scale level:
Unable to determine ASIA Impairment Score
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
A 25-year-old male is involved In a motor vehicle accident. He is awake and alert and able to follow commands. He is unable to move his extremities, but has intact perianal sensation and an intact bulbocavernosus reflex. Representative injury CT scan sequences are shown in Figures A, B and C What is his most likely ASIA score at this point in time?
Complete ASIA A
Incomplete ASIA A
Complete ASIA B
Incomplete ASIA B
Complete ASIA C
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
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 more than 3 levels below the level of neurologic injury
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
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?
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 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?
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?
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%
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
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 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
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)
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?
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 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
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