Spinal Rehabilitation — MCQs

10 questions

Hypotension in acute spinal injury is due to:

In a diving accident that severed the spinal cord below the sixth cervical vertebra, which of the following muscles would be affected?

In an accident involving potential cervical spine damage, the first line of management is:

What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT

Investigation of choice for lumbar prolapsed disc -

What is the first step to be taken in the management of a cervical spine injury?

A 50-year-old male with a history of chronic low back pain presents with new-onset bowel and bladder incontinence. What is the next best step in management?

A patient prescribed crutches for residual paralysis in poliomyelitis is a type of -

In below-elbow amputation the length of stump should be

Q10

The shown apparatus is used for

Spinal Rehabilitation Indian Medical PG Practice Questions and MCQs

Question 1: Hypotension in acute spinal injury is due to:

A. Loss of sympathetic tone (Correct Answer)
B. Loss of parasympathetic tone
C. Orthostatic hypotension
D. Vasovagal attack

Explanation: ***Loss of sympathetic tone*** - **Acute spinal cord injury** above T6 can interrupt the sympathetic outflow from the central nervous system. - This leads to unopposed **parasympathetic activity**, causing **vasodilation**, **bradycardia**, and resultant **hypotension**. *Loss of parasympathetic tone* - Loss of parasympathetic tone would typically result in **tachycardia** and potentially **hypertension**, as sympathetic activity would be unopposed. - This is not the primary mechanism for hypotension observed in acute spinal injury. *Orthostatic hypotension* - While patients with spinal cord injury can experience orthostatic hypotension, the initial acute hypotension is due to the fundamental physiological disruption of **autonomic control**. - **Orthostatic hypotension** specifically refers to a drop in blood pressure upon standing, which is a symptom that can persist, but not the direct cause of acute neurogenic shock. *Vasovagal attack* - A **vasovagal attack** is typically triggered by emotional stress or pain, leading to temporary reflex-mediated bradycardia and vasodilation. - It is not the underlying cause of sustained hypotension in the setting of acute spinal cord injury.

Question 2: In a diving accident that severed the spinal cord below the sixth cervical vertebra, which of the following muscles would be affected?

A. Deltoid
B. Infraspinatus
C. Levator Scapulae
D. Latissimus Dorsi (Correct Answer)

Explanation: ***Latissimus Dorsi*** - The **latissimus dorsi muscle** is primarily innervated by the **thoracodorsal nerve**, which arises from the **C6, C7, and C8** nerve roots (with C7 and C8 being the predominant contributors) [1]. - A spinal cord injury below the sixth cervical vertebra would affect the C7 and C8 segments, thereby disrupting the nerve supply to the latissimus dorsi, leading to weakness or paralysis. - This muscle is responsible for adduction, extension, and internal rotation of the shoulder. *Deltoid* - The **deltoid muscle** is innervated by the **axillary nerve**, which arises predominantly from the **C5 and C6** nerve roots. - Since the injury is below the C6 vertebra, the upper cervical segments (C5 and C6) would remain intact above the level of injury. - Therefore, deltoid function would be preserved. *Infraspinatus* - The **infraspinatus muscle** is innervated by the **suprascapular nerve**, which arises from the **C5 and C6** nerve roots. - Similar to the deltoid, its innervation originates above the level of the spinal cord injury and would be spared. *Levator Scapulae* - The **levator scapulae muscle** receives innervation from the **C3, C4, and C5** spinal nerves, as well as contributions from the dorsal scapular nerve (predominantly C5). - All of these nerve roots originate well above the level of injury, so this muscle would not be affected.

Question 3: In an accident involving potential cervical spine damage, the first line of management is:

A. x-ray
B. turn head to side
C. maintain airway (Correct Answer)
D. stabilize the cervical spine

Explanation: ***Correct: Maintain airway*** - In trauma management, the **ATLS protocol** follows the **A-B-C-D-E** approach where **Airway is the first priority** - In suspected cervical spine injury, airway management is performed **with concurrent cervical spine protection** (using jaw thrust maneuver instead of head tilt-chin lift) - A compromised airway leads to death within minutes, making it the **immediate first-line intervention** - **Cervical spine stabilization is performed simultaneously** during airway assessment and management, not as a separate preceding step - The correct approach: **"Airway with cervical spine protection"** - both are done together, but airway assessment/management takes priority *Incorrect: Stabilize the cervical spine* - While **cervical spine stabilization** is critical and must be maintained throughout trauma management, it is **not performed before airway assessment** - Manual inline stabilization and cervical collar application are done **during** airway management, not before it - ATLS teaches that C-spine protection is **integrated into** airway management, not a separate first step *Incorrect: X-ray* - **X-ray** is a diagnostic tool performed after initial stabilization and resuscitation - Imaging is part of the **secondary survey**, not primary trauma management - Never delay life-saving interventions for diagnostic studies *Incorrect: Turn head to side* - **Turning the head** is absolutely contraindicated in suspected cervical spine injury - Any movement can convert an unstable fracture into a **complete spinal cord injury** - If airway management is needed, use **jaw thrust** or **chin lift without head tilt**

Question 4: What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT

A. 2,1,4,3
B. 1,3,2,4
C. 2,1,3,4
D. 1,2,3,4 (Correct Answer)

Explanation: ***1,2,3,4*** - This sequence follows the **ATLS (Advanced Trauma Life Support)** protocol, prioritizing immediate life threats in order. - **Cervical spine stabilization** is the **first action upon patient contact** to prevent secondary neurological injury in any trauma patient. - **Airway management (intubation)** is then performed **with maintained in-line c-spine stabilization** - these occur nearly simultaneously but c-spine protection is instituted first. - **IV cannulation (circulation)** follows to establish vascular access for resuscitation and medications. - **CECT (imaging)** is performed last, once the patient is stabilized after addressing immediate life threats. - This follows the **ATLS Primary Survey: Airway (with c-spine protection) → Breathing → Circulation → Disability → Exposure**. *2,1,4,3* - This incorrectly places intubation **before** cervical spine stabilization is initiated. - In ATLS, **c-spine protection must be applied immediately upon patient contact** before any airway manipulation. - Delaying IV cannulation until after CECT is inappropriate as circulatory access is critical for early resuscitation. *1,3,2,4* - While this correctly starts with cervical spine stabilization, it incorrectly places **IV cannulation before intubation**. - In the ATLS primary survey, **Airway comes before Circulation** - securing the airway takes priority over establishing IV access. - This sequence could delay critical airway management in a patient with respiratory compromise. *2,1,3,4* - This sequence places **intubation before cervical spine stabilization**, which violates ATLS principles. - **C-spine stabilization must be the first action** upon approaching any trauma patient to prevent secondary spinal cord injury. - While intubation with in-line stabilization is possible, the c-spine protection must be instituted first, not after beginning airway manipulation.

Question 5: Investigation of choice for lumbar prolapsed disc -

A. CT Scan
B. Myelogram
C. X-ray
D. MRI (Correct Answer)

Explanation: ***MRI*** - An **MRI** provides the best visualization of **soft tissues**, including the intervertebral discs, spinal cord, and nerve roots, making it the **gold standard** for diagnosing lumbar prolapsed disc. - It can accurately show the **degree of disc herniation**, its impact on neural structures, and associated edema, which are crucial for treatment planning. *CT Scan* - While a **CT scan** provides good bony detail and can show disc herniation, its ability to visualize soft tissues is inferior to MRI for this specific condition. - It involves **ionizing radiation** and may miss subtle nerve root compression or spinal cord abnormalities apparent on MRI. *Myelogram* - A **myelogram** involves injecting contrast dye into the spinal canal and then performing X-rays or CT scans to outline the spinal cord and nerve roots. - Though effective in showing **nerve compression**, it is an **invasive procedure** with potential complications and has largely been replaced by MRI as a first-line diagnostic investigation. *X-ray* - **X-rays** primarily visualize **bony structures** and are useful for detecting fractures, spinal alignment issues, or severe degenerative changes. - They **cannot directly visualize intervertebral discs** or nerve compression, making them unsuitable for diagnosing a prolapsed disc.

Question 6: What is the first step to be taken in the management of a cervical spine injury?

A. Turn head
B. None of the options
C. Maintain airway
D. Immobilization of spine (Correct Answer)

Explanation: ***Immobilization of spine*** - In the context of **isolated cervical spine injury management**, **spinal immobilization** is the primary intervention to prevent further neurological damage. - This is typically achieved using a **cervical collar** and **backboard** to maintain in-line spinal stabilization. - **Note**: In actual trauma scenarios following **ATLS protocols**, airway management and cervical spine immobilization occur **simultaneously** as the first priority (Airway with C-spine protection). *Turn head* - **Turning the head** is absolutely contraindicated as it can exacerbate a cervical spine injury, leading to further compression or damage to the **spinal cord**. - Maintaining a **neutral, in-line position** is critical to avoid neurological deterioration. *Maintain airway* - In comprehensive trauma management per **ATLS guidelines**, **airway management with simultaneous cervical spine protection** is the first priority in the ABC sequence. - Airway is maintained using methods that do not compromise spinal stability, such as a **jaw thrust maneuver** or **endotracheal intubation with manual in-line stabilization**. - The distinction here is that this question focuses on the specific step for **spinal injury management** rather than overall trauma priorities. *None of the options* - This option is incorrect because **immobilization of the spine** is a definitive priority in managing a suspected cervical spine injury. - Both spinal immobilization and airway management are critical interventions that should occur together in actual practice.

Question 7: A 50-year-old male with a history of chronic low back pain presents with new-onset bowel and bladder incontinence. What is the next best step in management?

A. Conservative management with NSAIDs
B. Bed rest
C. Urgent MRI of the spine (Correct Answer)
D. Physical therapy

Explanation: ***Urgent MRI of the spine*** - The new onset of **bowel and bladder incontinence** in a patient with chronic low back pain is highly suggestive of **cauda equina syndrome**. This is a surgical emergency. - An **urgent MRI** is crucial to confirm the diagnosis and identify the level of compression, guiding immediate surgical decompression to prevent permanent neurological deficits. *Conservative management with NSAIDs* - This approach is appropriate for routine, uncomplicated low back pain, but it is entirely inadequate for a **neurological emergency** like potential cauda equina syndrome. - Delaying definitive diagnosis and treatment in such cases can lead to irreversible neurological damage, including chronic incontinence and paralysis. *Bed rest* - While bed rest might be recommended for acute exacerbations of certain types of back pain, it is not a primary treatment for neurologic emergencies and will not resolve the underlying compression causing **cauda equina syndrome**. - Prolonged bed rest can also lead to complications like deconditioning and venous thromboembolism, and it would waste critical time for diagnosis and intervention. *Physical therapy* - Physical therapy is a cornerstone of management for chronic low back pain and for rehabilitation after an acute event once stability is achieved. - However, in cases of suspected **cauda equina syndrome**, physical therapy is contraindicated as an initial step because it does not address the acute spinal cord or nerve root compression and may worsen the condition or delay necessary surgical intervention.

Question 8: A patient prescribed crutches for residual paralysis in poliomyelitis is a type of -

A. Disability limitation
B. Primordial prevention
C. Primary prevention
D. Rehabilitation (Correct Answer)

Explanation: ***Rehabilitation*** - Rehabilitation is a component of **tertiary prevention** that aims to restore maximum functional ability after permanent damage has occurred from disease. - Providing crutches to a polio patient with **residual (established) paralysis** helps restore mobility and independence, allowing the patient to adapt to their permanent disability. - This intervention occurs **after the disease has run its course** and permanent sequelae have developed, which is the hallmark of rehabilitation. *Disability limitation* - Disability limitation is another component of **tertiary prevention** but focuses on **preventing progression or complications** of an already established disease. - It applies during the **disease active phase** to minimize further damage (e.g., physiotherapy during acute polio to prevent contractures, or strict glycemic control in diabetes to prevent complications). - In this case, the paralysis is **residual (fixed)**, not active, so we are beyond the disability limitation phase. *Primordial prevention* - Primordial prevention targets the underlying environmental and social determinants to prevent the emergence of risk factors at the population level. - This occurs **before any risk factors** for disease have developed (e.g., policies to prevent emergence of sedentary lifestyles). - Not applicable to a patient with established disease. *Primary prevention* - Primary prevention aims to prevent disease occurrence by reducing risk factors or increasing resistance (e.g., polio vaccination, health education). - This intervention is applied **before the disease occurs**, which is not the case for a patient with established paralysis from poliomyelitis.

Question 9: In below-elbow amputation the length of stump should be

A. 15 - 20 cm (Correct Answer)
B. 5 - 10 cm
C. 20 - 25 cm
D. 10-15 cm

Explanation: ***15 - 20 cm*** - For a **below-elbow amputation** to be functional, the **stump length** should be approximately **15 to 20 cm** from the olecranon to allow for optimal prosthetic fitting and control. - This length provides sufficient leverage and preserves enough forearm musculature for effective **prosthetic operation**. *5 - 10 cm* - A stump length of **5-10 cm** from the olecranon would be considered too short for a below-elbow amputation, making it difficult to achieve **adequate prosthetic suspension** and control of the artificial limb. - Such a short stump might be classified as a **very short below-elbow amputation**, which often requires specialized prosthetic designs and can limit functionality. *20 - 25 cm* - A stump length of **20-25 cm** from the olecranon would be considered too long for a below-elbow amputation, encroaching on the wrist and hand area. - An excessively long stump can make it challenging to fit a standard **transradial prosthesis** comfortably and effectively, and might even be classified as a **wrist disarticulation** if extending too far distally. *10 -15 cm* - While **10-15 cm** from the olecranon can sometimes be functional, it is often considered on the shorter end of the ideal range for a below-elbow amputation, potentially limiting the effectiveness of certain **prosthetic designs** and control mechanisms. - A stump in this range might work, but the **15-20 cm range** generally offers superior functional outcomes and easier prosthetic fitting.

Question 10: The shown apparatus is used for

A. Ankle knee stabilizer
B. Thomas splint
C. Knee brace
D. Patella tendon bearing brace (Correct Answer)

Explanation: ***Patella tendon bearing brace*** - This orthotic device is designed to **transfer weight-bearing load through the patella tendon**, reducing stress on the lower extremity during ambulation. - It features a **molded cuff** that fits snugly below the patella and distributes weight through the **patellar tendon bearing area**, commonly used in **prosthetic applications** and **below-knee amputees**. *Ankle knee stabilizer* - This device provides **combined support to both ankle and knee joints** simultaneously, typically used for **multi-joint injuries** or instability. - It features **dual bracing systems** with straps and supports extending from ankle to knee, unlike the focused patellar tendon bearing design. *Thomas splint* - A **rigid metal-framed splint** used primarily for **femur fracture stabilization** and maintaining **skeletal traction** in emergency situations. - It consists of a **ring that fits around the upper thigh** with extending metal bars, designed for **fracture immobilization** rather than weight distribution. *Knee brace* - A general **knee joint support device** used for **ligament injuries**, **post-surgical recovery**, or **osteoarthritis management**. - Available in various forms (**sleeve, hinged, or wraparound designs**) but lacks the specific **weight-bearing transfer mechanism** of a patella tendon bearing brace.

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