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Common spinal trauma exam questions for medical finals, OSCEs and MRCP PACES

 

Question 1.

List four causes of spinal trauma.

  • Falls
  • Assault
  • RTCs
  • Sport

 

Question 2.

What are the different types and number of vertebrae that make up the vertebral column?

  • Seven cervical vertebrae
  • Twelve thoracic vertebrae
  • Five lumbar vertebrae
  •  Sacrum
  •  Coccyx

 

Question 3.

At what level does the spinal cord begin?

  • The spinal cord begins at the caudal medulla oblongata at the level of the foramen magnum

 

Question 4.

At what level does the spinal cord terminate?

  • The spinal cord terminates as the conus medullaris at the level of the L1 vertebra

 

Question 5.

What are the three tracts of the spinal cord that can be assessed clinically? Give their location and function.

  • Corticospinal tract
    • Location: posterolateral cord
    • Function: motor innervation
  • Dorsal columns
    • Location: posteromedial cord
    • Function: light touch and proprioception innervation
  • Spinothalamic tract
    • Location: anterolateral cord
    • Function: pain and temperature innervation

 

Question 6.

What is neurogenic shock?

  • A form of shock that is caused by damage to descending sympathetic pathways in the cervical and upper thoracic spinal cord resulting in loss of vasomotor tone and cardiac sympathetic innervation.

 

Question 7.

What is spinal shock?

  • Refers to flaccidity and areflexia seen after spinal cord injury

 

Question 8.

What is the MRC grading of power?

  • 5 = normal power
  • 4 = weak
  • 3 = movement against gravity
  • 2 = movement with gravity eliminated
  • 1 = flicker of movement
  • 0 = complete paralysis

 

Question 9.

What are three contraindications to use of the Canadian C-spine rules?

  • Glasgow coma scale (GCS) <15
  • Presence of distracting injuries
  • Intoxication

 

Question 10.

What are three high-risk factors that mandate radiography in the Canadian C-spine rules?

  • Age >65 years
  • Dangerous mechanism
  • Paraesthesia in extremities

 

Question 11.

Give five low-risk factors, any one of which allow for clinical assessment of the cervical spine.

  • Simple rearend MVC
  • Sitting in Emergency Department
  • Ambulatory at any time since
  • Delayed onset of neck pain
  • Absence of midline cervical spine tenderness

 

Question 12.

What are seven indications for requesting a CT cervical spine as opposed to the standard 3-view plain radiographs?

  • Elderly patients
  • Patients with known or presumed cervical spine degenerative disease
  • GCS <13
  • Intubated patients
  • Inadequate plain film series
  • Suspicion or certainty of abnormality on plain film series
  • Patients being scanned for head trauma and/or multi-region trauma as well

 

Question 13.

What are two methods of protecting the cervical spine?

  • MILS (manual inline stabilisation)
  • Triple immobilisation (collar, blocks, tape)

 

Question 14.

If required, what airway manoeuvre would you use in a patient with suspected spinal trauma?

  • Jaw thrust; head-tilt and chin-lift are contraindicated