Epidemiology Incidence 11,000 new cases/year in US 34% incomplete tetraplegia central cord syndrome most common 25% complete paraplegia 22% complete tetraplegia 17% incomplete paraplegia Demographics bimodal distribution young individuals with significant trauma older individuals that have minor trauma compounded by degenerative spinal canal narrowing Anatomic location 50% in cervical spine Etiology Mechanism MVA causes 50% falls GSW iatrogenic it is estimated that 3-25% of all spinal cord injuries occur after initial traumatic episode due to improper immobilization and transport. Pathophysiology primary injury damage to neural tissue due to direct trauma irreversible secondary injury injury to adjacent tissue due to decreased perfusion lipid peroxidation free radical / cytokines cell apoptosis methylprednisone used to prevent secondary injury by improving perfusion, inhibiting lipid peroxidation, and decreasing the release of free radicals Associated conditions acute phase conditions (see below) spinal shock neurogenic shock associated injuries closed head injuries noncontiguous spinal fractures vertebral artery injury risk factors for vertebral artery injury include atlas fractures facet dislocations most people with unilateral injury remain asymptomatic imaging magnetic resonance angiography is least invasive method treatment stenting only if patient is symptomatic from basilar arterial insufficiency Relevant Anatomy See Spinal Cord Anatomy Classification Descriptive tetraplegia injury to the cervical spinal cord leading to impairment of function in the arms, trunk, legs, and pelvic organs paraplegia injury to the thoracic, lumbar or sacral segments leading to impairment of function in the trunk, legs, and pelvic organs depending on the level of injury. Arm function is preserved complete injury an injury with no spared motor or sensory function below the affected level. patients must have recovered from spinal shock (bulbocavernosus reflex is intact) before an injury can be determined as complete classified as an ASIA A incomplete injury an injury with some preserved motor or sensory function below the injury level incomplete spinal cord injuries include anterior cord syndrome Brown-Sequard syndrome central cord syndrome posterior cord syndrome conus medullaris syndromes cauda equina syndrome ASIA Classification ASIA Impairment Scale Motor Sensory A Complete No motor function Complete deficit B Incomplete No motor function Incomplete deficit C Incomplete Motor function partially preserved: more than half of key muscles below the neurological level have a muscle grade less than 3. Incomplete deficit D Incomplete Motor function is partially preserved - at least half of key muscles below the neurological level have a muscle grade of 3 or more. Incomplete deficit E Normal Normal motor Normal sensory Acute Phase Conditions Neurogenic shock characterized by hypotension & relative bradycardia in patient with an acute spinal cord injury potentially fatal mechanism circulatory collapse from loss of sympathetic tone disruption of autonomic pathway within the spinal cord leads to lack of sympathetic tone decreased systemic vascular resistance pooling of blood in extremities hypotension treatment Swan-Ganz monitoring for careful fluid management pressors to treat hypotension Spinal shock defined as temporary loss of spinal cord function and reflex activity below the level of a spinal cord injury. characterized by flaccid areflexic paralysis bradycardia & hypotension (due to loss of sympathetic tone) absent bulbocavernosus reflex reflex characterized by anal sphincter contraction in response to squeezing the glans penis or tugging on an indwelling Foley catheter timing variable but usually resolves within 48 hours at its conclusion spasticity, hyperreflexia, and clonus slowly progress over days to weeks mechanism neurophysiologic in nature neurons become hyperpolarized and unresponsive to stimuli from brain evaluation important because one cannot evaluate neurologic deficit until spinal shock phase has resolved end of spinal shock indicated by return of the bulbocavernous reflex conus or cauda equina injuries may lead to permanent loss of the bulbocavernous reflex ruled out when bulbocavernous reflex present 48 hours has elapsed from time of injury stages of spinal shock Phase 1 - hyporeflexic 0 to 48 hours areflexia/hyporeflexic Phase 2 - initial reflex return 1-2 days polysynaptic reflexes return (bulbocavernous reflex) monosynaptic (patellar) remain absent Phase 3 - initial hyperreflexia 1-4 weeks Phase 4 - spasticity 1 to 12 months characterized by altered skeletal performance Spinal vs. Neurogenic vs. Hypovolemic Shock Spinal shock Neurogenic shock Hypovolemic shock BP Hypotension Hypotension Hypotension Pulse Bradycardia Bradycardia Tachycardia Reflexes / Bulbocavernosus Reflex Absent Variable/independent Variable/independent Motor Flaccid Paralysis Variable/independent Variable/independent Time ~48-72 hours immediately after spinal cord injury ~48-72 hours immediately after spinal cord injury Following excessive blood loss Mechanism Peripheral neurons become temporarily unresponsive to brain stimuli. Disruption of autonomic pathway leads to loss of sympathetic tone and decreased systemic vascular resistance. Decreased preload leads to decreased cardiac output. Evaluation Field treatment treatment of potential spinal cord injuries begins at the accident scene with proper spinal immobilization immobilization immobilization should include a rigid cervical collar and transport on a firm spine board with lateral support devices patient should be rolled with standard log roll techniques with control of cervical spine spine boards should be used for transport only and patients should be removed when clinically safe decubitus ulcers can occur after only 30-60 mintues on a backboard athletes in the setting of sports-related injuries helmets and shoulder pads should be left on until arrival at the hospital OR until experienced personnel can perform simultaneous removal of helmet and shoulder pads in a controlled situation Initial evaluation primary survey airway breathing SCI above C5 likely to require intubation circulation initial survey to inspect for obvious injuries of head and spine visual and manual inspection of entire spine should be performed seat belt sign (abdominal ecchymoses) should raise suspicion for flexion distraction injuries of thoracolumbar spine secondary survey cervical spine exam remove immobilization collar examine face and scalp for evidence of direct trauma inspect for angular or rotational deformities in the holding position of the patient's head rotational deformity may indicate a unilateral facet dislocation palpate posterior cervical spine looking for tenderness along the midline or paraspinal tissues absence of posterior midline tenderness in the awake, alert patient predicts low probability of significant cervical injury log roll patient to inspect and palpate entire spinal axis perform careful neurologic exam cervical spine clearance Initial Medical Treatment Medical / Prevention DVT prophlaxis indications most patients contraindications include coagulopathy hemorrhage modalities low-molecular weight heparin rotating bed pneumatic compression stocking cardiopulmonary management careful hemodynamic monitoring and stabilization is critical in early treatment hypotension should be avoided implement immediate aggressive pulmonary protocols decubitus ulcer prevention Steroids high dose methylprednisone indications current indications current literature and available guidelines recommend against administration due to lack of clear clinical benefit risk of complications historical indications nonpenetrating SCI within 8 hours of injury recommended by NASCIS III historical contraindications include GSW pregnancy under 13 years > 8 hours after injury brachial plexus injuries (peripheral nerve injuries) technique load 30 mg/kg over 1st hour (2 grams for 70kg man) drip 5.4 mg/kg/hr drip for 23 hours if started < 3 hrs after injury for 47 hours if started 3-8 hours after injury outcomes may leads to improved root function at level of injury associated with significant complications monosialotetrahexosylganglioside (GM-1) indications remains controversial large multicenter RCT did not show long term benefit some evidence of faster recovery Reduction acute closed reduction with axial traction indications alert and oriented patient with neurologic deficits and compression due to fracture/dislocation bilateral facet dislocation with spinal cord injury in alert and oriented patient is most common reason to perform acute reduction with axial traction technique reasons to abort overdistraction worsening neurologic exam failure to obtain reduction Hypothermia systemic and local evidence is weak and limited currently not recommended due to increased complications coagulopathy sepsis pneumonia rebound hypertension arrhythmias Definitive Treatment Nonoperative bracing and observation indications most GSWs exceptions listed below Operative surgical decompression and stabilization indications most incomplete SCI (except GSW) decompress when patient hits neurologic plateau or if worsening neurologically decompression may facilitate nerve root function return at level of injury (may recover 1-2 levels) most complete SCI (except GSW) stabilize spine to facilitate rehab and minimize need for halo or orthosis decompression may facilitate nerve root function return at level of injury (may recover 1-2 levels) consider for tendon transfers e.g. Deltoid to triceps transfer for C5 or C6 SCI GSW with progressive neurological deterioration with retained bullet within the spinal canal cauda equina syndrome (considered a peripheral nerve) retained bullet fragment within the thecal sac CSF leads to the breakdown of lead products that may lead to lead poisoning Rehabilitation Goals goal is to assess and identify mechanisms for reintegration into community based on functional level and daily needs patients learn transfer techniques, self care retraining, mobility skills Restoring hand function hand function is often limiting factor for many patients tendon transfers can be used to restore function to paralyzed arms and hands by giving working muscles different jobs Modalities functional electrical stimulation is a technique that uses electrical currents to stimulate and activate muscles affected by paralysis Spinal cord injury level and Function Level Patient Function C1-C3 Ventilator-dependent with limited talking. Electric wheelchair with head or chin control C3-C4 Initially ventilator-dependent, but can become independent Electric wheelchair with head or chin control C5 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 C6 C6 has much better function than C5 due to ability to bring the hand to mouth and feed oneself (wrist extension and supination intact) Independent living; manual wheelchair with sliding board transfers, can drive a car with manual controls C7 Improved triceps strength Daily use of a manual wheelchair with independent transfers C8-T1 Improved hand and finger strength and dexterity Fully independent transfers T2-T6 Normal UE function Improved trunk control Wheelchair-dependent T7-T12 Increased abdominal muscle control Able to perform unsupported seated activities; with extensive bracing walking may be possible L1-L5 Variable LE and B/B function Assist devices and bracing may be needed S1-S5 Various return of B/B and sexual function Walking with minimal or no assistance Prognosis Complete Injuries improvement of one nerve root level can be expected in 80% of patients improvement of two nerve root levels can be expected in 20% of patients only 1% have complete recovery at time of hospital diagnosis ASIA A injuries have the least chance for marked recovery and the highest lifetime healthcare costs Incomplete Injuries trends of improvement include the greater the sparring, the greater the recovery patients that show more rapid recovery have a better prognosis when recovery pleateus, it rarely resumes improvement Conus medullaris syndrome has a better prognosis for recovery than more proximal lesions Complications Skin problems treatment is prevention start in ER do not leave on back board start log rolling early proper bedding Venous Thromboembolism prevent with immediate DVT prophylaxis Urosepsis common cause of death strict aseptic technique when placing catheter don't let bladder become overly distended Sinus bradycardia most common cardiac arrhythmia in acute stage following SCI Orthostatic hypotension occurs as a result of lack of sympathetic tone Autonomic dysreflexia potentially fatal presents with headache, agitation, hypertension caused by unchecked visceral stimulation check foley disimpact patient radiographs of lower extremity if there is concern for undiagnosed fracture Major depressive disorder ~11% of patients with spinal cord injuries suffer from MDD MDD in spinal cord injury patients is highly associated with suicidal ideation in both the acute and chronic phase. Prognosis Only 1% have complete recovery at time of hospital diagnosis conus medullaris syndrome has a better prognosis for recovery than more proximal lesions
QUESTIONS 1 of 43 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ18.228) 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? QID: 213124 FIGURES: A B C D Type & Select Correct Answer 1 Early surgical decompression and stabilization, IV steroids, and systemic hypothermia treatment 7% (183/2583) 2 Early surgical decompression and stabilization and IV steroids 11% (293/2583) 3 Early surgical decompression and stabilization and systemic hypothermia treatment 7% (190/2583) 4 Early surgical decompression and stabilization 71% (1831/2583) 5 Early surgical decompression and stabilization, IV steroids, and regional hypothermia treatment 2% (57/2583) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ18.189) 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? QID: 213085 Type & Select Correct Answer 1 Sarcoma 3% (62/2045) 2 Pulmonary embolism 12% (242/2045) 3 Occult fracture 68% (1384/2045) 4 Suprapubic urinary catheter 13% (256/2045) 5 Recent viral illness 4% (83/2045) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (SBQ18SP.31) 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? QID: 211443 Type & Select Correct Answer 1 ASIA A 10% (247/2457) 2 ASIA E 1% (26/2457) 3 ASIA D 3% (84/2457) 4 Cannot determine at this time 83% (2030/2457) 5 ASIA B 2% (52/2457) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ17.83) 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: QID: 210170 FIGURES: A Type & Select Correct Answer 1 ASIA A 17% (383/2311) 2 ASIA B 2% (42/2311) 3 ASIA C 2% (47/2311) 4 ASIA D 2% (52/2311) 5 Unable to determine ASIA Impairment Score 76% (1767/2311) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ14.45) 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? QID: 5455 Type & Select Correct Answer 1 Sensation intact in the long finger 14% (672/4811) 2 Sensation intact over the medial aspect of the forearm 13% (629/4811) 3 5/5 strength in deltoid function 10% (497/4811) 4 2/5 strength in triceps function 53% (2559/4811) 5 0/5 strength in the instrinic hand muscles 9% (422/4811) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.237) 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? QID: 4872 FIGURES: A B C D Type & Select Correct Answer 1 Complete ASIA A 12% (421/3622) 2 Incomplete ASIA A 15% (535/3622) 3 Complete ASIA B 15% (531/3622) 4 Incomplete ASIA B 56% (2020/3622) 5 Complete ASIA C 2% (84/3622) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ13.19) 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? QID: 4654 FIGURES: A B Type & Select Correct Answer 1 The patient has a complete injury, so early decompression (< 24 hours) will not increase the liklihood of neurologic recovery compared to delayed treatment 21% (1040/4873) 2 The patient has an incomplete injury, and he should be taken to the OR for early decompression (< 24 hours) to improve neurologic recovery 13% (617/4873) 3 The patient has a complete injury, but early decompression (< 24 hours) will increase the likelihood of neurologic recovery 63% (3051/4873) 4 The patient has a complete injury, and early decompression (< 24 hours) will increase risk of mortality within 30 days of the injury 1% (33/4873) 5 The patient has a complete injury, and early decompression (< 24 hours) will increase the peri-operative complications 2% (88/4873) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ12SP.15) 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? QID: 3713 Type & Select Correct Answer 1 More than half of the major muscles demonstrate palpable or visible muscle contraction 4% (235/5515) 2 At least half of key muscles have a muscle grade of 5. 2% (134/5515) 3 More than half of key muscles have a muscle grade less than 3. 19% (1059/5515) 4 At least half of key muscles have a muscle grade of 3 or more. 11% (590/5515) 5 No motor function preserved more than 3 levels below the level of neurologic injury 63% (3459/5515) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ12.55) 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? QID: 4415 Type & Select Correct Answer 1 It is not supported by current literature - recent studies have shown that while there are no associated complications, there is not significant benefit. 14% (1152/8372) 2 It is not supported by current literature - recent studies have shown an increased risk of complications with no clear evidence of benefits 61% (5116/8372) 3 It is supported by current literature - recent studies have demonstrated few harmful side effects, which are outweighed by the large potential benefits 5% (447/8372) 4 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 10% (847/8372) 5 There is no clear evidence to recommend for or against the administration of Methylprednisolone 9% (761/8372) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ12.184) 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? QID: 4544 Type & Select Correct Answer 1 ASIA A 1% (35/3779) 2 ASIA B 18% (667/3779) 3 ASIA C 73% (2763/3779) 4 ASIA D 7% (280/3779) 5 ASIA E 0% (12/3779) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.225) 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.? QID: 3648 FIGURES: A B Type & Select Correct Answer 1 Initiate high-dose methylprednisolone with a loading dose of 30mg/kg and a drip of 5.4 mg/kg/hr 15% (546/3699) 2 Initiate high-dose methylprednisolone, without a loading dose, at 5.4 mg/kg/hr 3% (98/3699) 3 Do not initiate treatment with methylprednisolone 79% (2939/3699) 4 Initiate high-dose methyprednisolone if his neurologic status does not improve over the next 14 hours 1% (19/3699) 5 Administer a one-time dose of methylprednisolone at a dose of 30 mg/kg 2% (80/3699) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.9) 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? QID: 3432 FIGURES: A B Type & Select Correct Answer 1 ASIA A 5% (300/5579) 2 ASIA B 84% (4668/5579) 3 ASIA C 4% (239/5579) 4 ASIA D 5% (290/5579) 5 ASIA E 1% (58/5579) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ10.35) 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? QID: 3123 FIGURES: A B Type & Select Correct Answer 1 ASIA E 2% (81/4964) 2 ASIA D 66% (3266/4964) 3 ASIA C 24% (1207/4964) 4 ASIA B 7% (349/4964) 5 ASIA A 0% (22/4964) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ10.44) What percentage of patients with a spinal cord injury suffer from Major Depressive Disorder? QID: 3132 Type & Select Correct Answer 1 Less than 5% 1% (25/3371) 2 5 to 20% 36% (1219/3371) 3 20 to 50% 24% (807/3371) 4 50 to 75% 23% (789/3371) 5 Greater than 75% 15% (519/3371) L 4 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ09.43) 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 QID: 2856 Type & Select Correct Answer 1 Supine hypotension 17% (431/2604) 2 Orthostatic hypotension 7% (193/2604) 3 Spasticity 50% (1299/2604) 4 Autonomic dysreflexia 5% (134/2604) 5 Cardiac arrhythmias 21% (534/2604) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ09.154) 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? QID: 2967 Type & Select Correct Answer 1 Sensory nerves 7% (200/2695) 2 Motor nerves 16% (438/2695) 3 Skeletal muscle 70% (1891/2695) 4 Motor cortex 2% (50/2695) 5 Dorsal root ganglion 4% (108/2695) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ09.170) 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? QID: 2983 Type & Select Correct Answer 1 Central cord syndrome 1% (31/3646) 2 Incomplete spinal cord injury 6% (203/3646) 3 Complete spinal cord injury 85% (3107/3646) 4 Neurogenic shock 1% (51/3646) 5 Spinal shock 7% (240/3646) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.17) 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. QID: 403 Type & Select Correct Answer 1 Incomplete C5 spinal cord injury (ASIA A) 1% (57/3937) 2 Complete C5 spinal cord injury (ASIA E) 2% (63/3937) 3 Complete C6 spinal cord injury (ASIA A) 65% (2559/3937) 4 Complete C7 spinal cord injury (ASIA A) 25% (999/3937) 5 Incomplete C7 spinal cord injury (ASIA B) 6% (236/3937) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.87) 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? QID: 473 Type & Select Correct Answer 1 Spinal shock 11% (364/3400) 2 Cardiac shock 1% (31/3400) 3 Neurogenic shock 88% (2979/3400) 4 Septic shock 0% (6/3400) 5 Hypovolemic shock 0% (11/3400) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ08.82) Which of the following best describes a patient's functional level with a complete C5 spinal cord injury? QID: 468 Type & Select Correct Answer 1 Electric wheelchair with only head or chin control 50% (1777/3542) 2 Electric wheelchair with hand control 44% (1550/3542) 3 Limited use of manual wheelchair, can drive car with manual controls 4% (142/3542) 4 Long-distance use of a manual wheelchair 1% (30/3542) 5 Fully independent transfers 1% (25/3542) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ05.12) 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? QID: 49 Type & Select Correct Answer 1 Mechanism of injury 2% (30/1941) 2 Severity of initial neurologic injury 75% (1452/1941) 3 Injury pattern of fracture or dislocation 2% (31/1941) 4 Location of spinal cord injury 7% (135/1941) 5 Age of patient 14% (281/1941) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ04.154) Which of the following scenarios would be most appropriate for posterior deltoid-to-triceps transfers? QID: 1259 Type & Select Correct Answer 1 Axillary nerve injury 8% (490/5994) 2 C6 ASIA A Spinal Cord Injury with 5/5 biceps and 4/5 brachioradialis 67% (4043/5994) 3 Erb's palsy with waiters tip deformity 6% (361/5994) 4 C5 ASIA C Spinal Cord Injury with 3/5 deltoid and 2/5 biceps 4% (252/5994) 5 C5 ASIA D Spinal Cord Injury with 4/5 deltoid and 4/5 biceps 13% (807/5994) L 3 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic
All Videos (4) Podcasts (2) 2019 FORE/AANA World Series of Live Surgery (Prev. CHI Sports) Hip - Spine Syndrome Work Up - Sanjeev Bhatia, MD Sanjeev Bhatia Spine - Spinal Cord Injuries 8/24/2022 514 views 0.0 (0) Login to View Community Videos Login to View Community Videos 2019 Orthopaedic Summit Evolving Techniques Decision Making: Vancomycin Powder, Obesity And Tobacco Affects On Fusions - Derek Moore, MD Derek W. Moore Spine - Spinal Cord Injuries D 12/10/2020 59 views 0.0 (0) Login to View Community Videos Login to View Community Videos 2019 Orthopaedic Summit Evolving Techniques Honored Professor Lecture: Spine Trauma & Spinal Cord Injuries- Where Are We Going - Alexander Vaccaro, MD Alexander R Vaccaro Spine - Spinal Cord Injuries C 12/2/2020 162 views 3.0 (1) Spine | Spinal Cord Injuries Spine - Spinal Cord Injuries Listen Now 26:53 min 10/15/2019 1545 plays 4.7 (15) Question Session⎪Spinal Cord Injuries Orthobullets Team Spine - Spinal Cord Injuries Listen Now 18:47 min 11/8/2019 125 plays 0.0 (0) See More See Less
Gun Shot Wound in Spinal Canal (C2272) Gio Sabal Spine - Spinal Cord Injuries E 6/30/2015 545 0 6 bilateral heterotopic ossification in tetraplegic patient (C2174) Kleanthis Ziogas Spine - Spinal Cord Injuries E 3/13/2015 116 0 1 Asia B (Incomplete) Spinal Cord Injury due to C3/4 HNP. Odontoid fracture. (C1066) Spine - Spinal Cord Injuries E 9/28/2011 154 0 4