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74 Cards in this Set
- Front
- Back
Define radiculopathy
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disorder of the spinal nerve roots
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Define myelopathy
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disorder of the spinal cord
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Define pathologic fracture
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fx occurring at a site of weakened preexisting disease; especially neoplasm or necrosis of the bone
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Discuss the epidemiology of spinal cord injury in terms of age, sex, when it is most likely to occur and the etiology of over 90% of all cases
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90% due to blunt trauma (MVC, assaults, GSW, falls, sport accidents). C-spine most common 61%, thoracolumbar jct 19%, thoracic spine 16%, lubosacral 4%
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Describe the 4 categories of major spinal injuries
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Compression (wedge), burst, flexion-distraction (seatbelt type injuries), fracture/dislocations
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Define compression (wedge) fractures
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result from axial loading and flexion. Failure of anterior column, middle column remains intact. Usually stable
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Define burst fractures
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follow failure of vertebral body under axial load both anterior and middle columns fail. Retropulsion of bone and disk fragments into canal and may cause spinal cord compression
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Define felxion-distraction fractures (seatbelt type injuries)
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seatbelt serves as axis of rotation during distraction, failure of posterior and middle columns, intact anteror column prevents subluxation
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Define fracture / dislocations
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most damaging of injuries; compression, flexion and distraction, rotation or shearing forces lead to failure of all 3 columns
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Identify the area of the spine most likely to be affected in motor vehicle injuries and in falls from a height
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cervical spine
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Describe the corticospinal tract and what happens when it is damaged in a SCI
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Damage results in ipsilateral clinical findings such as muscle weakness, spasticity, increased deep tendon relfexes and babinski sign.
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What pathway is the corticospinal tract
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descending motor pathway
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Briefly discuss etiology, symptoms and prognosis of anterior cord
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Direct injury to anterior cord. Loss of motor function, px & temp sensation distal to lesion. Only vibratory, position and crude touch okay. poor prognosis for recovery of fx
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Briefly discuss etiology, symptoms and prognosis of Central cord
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hyperextension injury which disrups blood flow to cord, c-spine stenosis. Quadriparesis greater in upper ext. than lower. Some px, temp loss sensation, greater in upper ext. Prog. good
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Briefly discuss etiology, symptoms and prognosis of Brown Sequard
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transverse hemisection of spinal cord, unilateral cord compression. Ipsilateral spastic paresis, loss of proprioception and vibratory and contralateral loss px, temp. sensation. Prog good
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Briefly discuss etiology, symptoms and prognosis of Cauda equine
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peripheral nerve injury. Variable motor and sensory loss in lower ext., sciatica, bowel / bladder dysfx and saddle anesthesia. Prog. good
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Briefly discuss etiology, symptoms and prognosis of Incomplete cord
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partial or complete injury usually at T6 or above. Areflexia, loss of sensation, flaccid bladder, rectal tone; bradycardia, hypoTN. Prog. some degree of recovery
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Briefly discuss etiology, symptoms and prognosis of Complete cord
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partial or complete injury usually at T6 or above. Areflexia, loss of sensation, flaccid bladder, rectal tone; bradycardia, hypoTN. Prog. poor
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Define Anterior cord injury
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damage to the corticospinal and spinothalamic pathways
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Define central cord injuries
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involves the central portion of the cord more than the peripheral. Seen in older pt's with pre-existing cervical spondylosis who sustain hyperextension injury
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Define Brow-Sequard injury
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hemisection of the cord
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Define Cauda Equine injury
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Composed entirely of lumbar, sacral and coccygeal nerve roots and produces a peripheral nerve injury rather than direct injury to cord
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Expain why airway concerns nad hypTN are paramount in the acute SCI pt
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phrenic nerve roots at C3,4,5 supply diaphragm. Loss of a-adrenergic tone and dilation of arterial and venous vessels lead on decreased systemic vascular resistance
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What spinal cord injury pt's should be intubated
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Any injury above C5.
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What injuries cause sympathetic denervation
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injuries at level of cervical or thoracic regions.
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What does sacral sparing indicate
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incomplete spinal cord level
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What does areflexia indicate
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spinal shock with partial or complete injury usually at T6 and above
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What type of SCI would cause spasticity
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Brown-sequard
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What type of SCI would cause flaccidity
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spinal shock from partial or complete injury usually at T6 or above
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Define presentation, etiology, and prognosis of spinal shock
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Blood loss presumed to be cause of hypotension until proven. PE partial/complete usually T6-above. Prog: complete poor, partial some recovery
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Define presentation, etiology, and prognosis of neurogenic shock
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warm, peripherally vasodilated and bradycardic, tolerate hypoTN well.
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Know when corticosteroids might be indicated for treatment of SCI
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high-dose methylprednisole standard for blunt SCI; shown improvement of motor and sensory fx in pt's with complete/incomplete neurologic lesion. Not effective in penetrating SPI
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What are benefits and disadvantages of plain radiography in cervical spinal injuries
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Good visualization of prevertebral swelling and spinous process. Gold standard for bony c-spine injuries with 3 views. Poor for imaging C1-2
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If ordering plain radiograph of C-spine what would they be
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AP, lateral and odontoid
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What are benefits and disadvantages of CT in cervical spinal injuries
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can visualize entire c-spine but may not identify pt's with ligamentous injuries
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What are benefits and disadvantages of MRI in cervical spinal injuries
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unreliable pt's or those with sig MOI or risk factor like age should have MRI although rarely indicated as part of initial investigation
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Identify the 5 views obtained for cervical trauma series.
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lateral, AP, odontoid, swimmer's view (thru axilla to attempt imaging lower c-spine) and oblique
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What radiographic view is most sensitive
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laeral c-spine will identify 90% of injuries to bone and ligaments
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Know how to evaluate cervical spine alignment, fracture and soft tissue spaces on plain films
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look for presence or absence of prevertebral swelling. Prevertebral space anterior to C3 should be less than 5mm. Predental space <3mm
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Identify the most common causes of cervical spine injuries
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MVC, assaults, blunt trauma, GSW, falls, sporting accidents
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Identify the factors that lower the risk for cervical spine injury
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spinal immobilization helps prevent secondary injury, athletes who wear helmets and other protective equipment, etc.
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Describe the 5 NEXUS criteria utilized to clear cervical spine
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Pt must meet all criteria in order to omit radiography: no posterior midline c-spine tenderness, no intoxication, normal level alertness, no focal neurologic deficit, no px distracting factors
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Discuss the indications for obtaining cervical spine radkographs
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often initial screening for injuries and should be performed for all pt's with suspicion of spinal injury
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Define Jefferson fracture and what vertebrea involved
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direct blow to top of head; C1
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Define transverse ligament disruption and what vertevae involved
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anteriorally on inside of ring of C1 to posterior surface of dens. Crucial to maintaining stability of 1st and 2nd vertebrae. Direct blow to occiput like in old person who falls
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Define avulsion fracture and what vertevae involved
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hyperextension injury may avulse the inferior pole of the anterior tubercle of C1; involves entire anterior arch is UNSTABLE
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Define hangman's fracture and what vertevae involved
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traumatic spondylolithesis or axis; pedicles of C2 with displacing C2 anteriorly on C3. Extension MOI like judicial hangings; not suicidal hangings. Also MVC, diving. UNSTABLE
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Define clay-shoveler's fracture and what vertevae involved
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avulsion of the spinous process of lower cervical vertebrae, classically C7. STABLE
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Define simple wedge fracture and what vertevae involved
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caused by compression between 2 vertebrae. Posterior element disruption makes injury STABLE
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Define flexion teardrop fracture and what vertevae involved
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extreme flexion associated with anterior cord syndrome due to impingment of spinal cord by fx hyperkyphosis. UNSTABLE
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Define pillar fracture and what vertevae involved
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extension and rotation causing impaction of superior vertebra on articular mass. STABLE
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Define burst fracture and what vertevae involved
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direct axial load causing vertebra to burst with fragments displacing in all directions. UNSTABLE
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Define extension teardrop and what vertevae involved
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hyperextension causing anterior longitudinal ligament to avulse inferior portion of anterior vertebral body at insertion. More common in old pt's with osteoporosis. UNSTABLE
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Define Laminar fracture and what vertevae involved
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hyperextension. CT required to define extent of spinal cord involvement
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Identify where most thoracic spine injuries occur
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thorocolumbar junction
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How would you manage a thorocolumbar junction fracture
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pt should remain in spinal immobilization unti ldefinitive diagnosis and evaluation of CT and MRI are made by spinal surgeon
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List Hx and PE that might suggest a traumatic injury to lumbar or sacral spine
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associated with fractures of pelvis; bowel or bladder dysfunction, anal sphincter tone and bulbocavernousus reflex diminished
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Identify lumbar spine cases when referral to a neurologist or neurosurgeon is indicated
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suspicion of cauda equina injury
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How would you classify a compression fracture
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major, unstable until evaluation is complete
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How would you classify an axial burst fracture
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major, unstable, CT define extent of injury
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How would you classify a flexion-distraction fracture
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major, unstable, CT and specialist consultation
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How would you classify a transverse fracture
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minor
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Spinal Trauma
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Spinal Trauma
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What associated neurological exam problems might you see with a C5-6 level SCI
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arm adbduction, elbow flexion
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What associated neurological exam problems might you see with a C6-7-8 level SCI
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wrist, elbow extension
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What associated neurological exam problems might you see with a C8-T1 level SCI
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finger abduction, hand grasp
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What associated neurological exam problems might you see with a T2-7 level SCI
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chest muscles
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What associated neurological exam problems might you see with a T9-12 level SCI
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abdominal muscles
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What associated neurological exam problems might you see with a L1-3 level SCI
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iliopsoas, hip flexion
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What associated neurological exam problems might you see with a L2-4 level SCI
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quadriceps, knee extension
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What associated neurological exam problems might you see with a L4-5 level SCI
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ankle dorsiflexion
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What associated neurological exam problems might you see with a L5-S1 level SCI
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extensor hallucis longus, great toe extension
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What associated neurological exam problems might you see with a S1-2 level SCI
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gastrocnemius, ankle plantar flexion
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What associated neurological exam problems might you see with a S2-4 level SCI
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bladder, anal sphincter, voluntary rectal tone
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