Spinal Trauma — MCQs
Hypotension in acute spinal injury is due to:
A 40-year-old male sustains spinal injury after an accident. His lower limb power is greater than that of upper limb and sacral sensations are present. Type of spinal cord lesion is:
The clinical manifestations of cauda equina lesion include the following EXCEPT:
All of the following are true about Brown-Sequard syndrome, except which of the following?
Burst fracture of spine is a type of:
Which of the following is not a component of Brown-Sequard syndrome?
A moving vehicle hits a pedestrian on his lateral aspect of the knee and causes a fracture. The fracture line is passing through the intercondylar eminence. Which of the following structures will most likely be injured
All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:
A patient fell off a bicycle and now complains of pain around the hip, with shortening of the affected limb. The hip is held in a position of flexion, adduction, and internal rotation. What is the most likely diagnosis?
Pilon fracture is
Spinal Trauma 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: A 40-year-old male sustains spinal injury after an accident. His lower limb power is greater than that of upper limb and sacral sensations are present. Type of spinal cord lesion is:
- A. Complete spinal cord injury.
- B. Central cord syndrome (Correct Answer)
- C. Posterior cord syndrome
- D. Anterior cord syndrome
Explanation: ***Central cord syndrome*** - This syndrome is characterized by **greater motor weakness** in the **upper extremities** than in the lower extremities, along with varying degrees of sensory loss. **Sacral sparing** (preserved perineal sensation and voluntary anal contraction) is also a classic feature. - It often results from **hyperextension injuries** of the cervical spine, leading to damage predominantly in the central gray matter and surrounding white matter. *Complete spinal cord injury* - This involves a total loss of **motor and sensory function** below the level of the injury, including the sacral segments. - The presence of **sacral sensations** in the patient rules out a complete spinal cord injury. *Posterior cord syndrome* - This syndrome affects the **dorsal columns**, resulting in a loss of **proprioception**, **vibration sense**, and **fine touch** below the level of injury. - Motor function and pain/temperature sensation are typically preserved, which does not match the described motor weakness. *Anterior cord syndrome* - This involves damage to the **anterior two-thirds of the spinal cord**, leading to a loss of **motor function** (corticospinal tracts) and **pain and temperature sensation** (spinothalamic tracts) below the injury. - However, **proprioception** and **vibration sense** (dorsal columns) are typically preserved, and sacral sparing of sensation is not a characteristic feature, nor is greater lower limb power. [1]
Question 3: The clinical manifestations of cauda equina lesion include the following EXCEPT:
- A. Saddle anesthesia
- B. Radicular pain
- C. Urinary retention
- D. Extensor plantar reflexes (Correct Answer)
Explanation: ***Extensor plantar reflexes*** - Extensor plantar reflexes (Babinski sign) are indicative of an **upper motor neuron lesion**, typically affecting the **corticospinal tract**, not the cauda equina [4]. - The cauda equina comprises **lower motor neurons**; therefore, a lesion here would more likely result in absent or diminished deep tendon reflexes, and a flexor plantar response or no response [4]. *Saddle anesthesia* - This is a classic symptom of cauda equina syndrome, involving numbness or sensory loss in the **perineal and gluteal regions** due to compression of sacral nerve roots. - It results from damage to the **sensory fibers** of the cauda equina innervating these areas [1]. *Radicular pain* - Cauda equina syndrome often causes severe **low back pain** radiating down the legs, similar to sciatica, due to compression or irritation of the **nerve roots** [1]. - This pain can be bilateral and is a significant symptom, reflecting the involvement of multiple nerve roots [3]. *Urinary retention* - **Bladder dysfunction**, particularly urinary retention, is a critical red flag for cauda equina syndrome, caused by damage to the **sacral nerve roots** responsible for bladder control [2], [3]. - It signifies significant neurological compromise affecting **autonomic function** [2].
Question 4: All of the following are true about Brown-Sequard syndrome, except which of the following?
- A. Ipsilateral Pyramidal Tract Features
- B. Contralateral Spinothalamic Tract Features
- C. Ipsilateral Plantar Extensor
- D. Contralateral Posterior Column Features (Correct Answer)
Explanation: ***Contralateral Posterior Column Features*** - This statement is incorrect because **posterior column** (dorsal column-medial lemniscus pathway) involvement in Brown-Séquard syndrome would manifest as **ipsilateral** loss of proprioception, vibration, and fine touch, as these fibers decussate in the medulla, not the spinal cord [1]. - Therefore, the hallmark of Brown-Séquard syndrome concerning posterior column deficits is **ipsilateral** to the lesion, not contralateral [1]. *Ipsilateral Pyramidal Tract Features* - The **pyramidal tract** (corticospinal tract) controls voluntary motor function, and its fibers decussate in the medulla [1]. - In Brown-Séquard syndrome, damage to this tract will result in **ipsilateral** motor weakness or paralysis below the level of the lesion [1]. *Contralateral Spinothalamic Tract Features* - The **spinothalamic tract** carries pain and temperature sensations, and its fibers decussate within one or two spinal cord segments of their entry [1]. - Therefore, a lesion on one side of the spinal cord will cause a loss of pain and temperature sensation on the **contralateral** side, typically one to two dermatomes below the lesion [1]. *Ipsilateral Plantar Extensor* - This refers to a **Babinski sign**, which is an abnormal reflex indicating upper motor neuron damage. - Given that the **pyramidal tract** is involved **ipsilaterally**, an ipsilateral plantar extensor response (upward movement of the big toe and fanning of the other toes) is expected below the level of the lesion.
Question 5: Burst fracture of spine is a type of:
- A. Extension injury
- B. Rotation injury
- C. Flexion injury
- D. Compression injury (Correct Answer)
Explanation: ***Compression injury*** - A **burst fracture** occurs due to a high-energy axial load or significant compression force impacting the spine. - This force causes the vertebral body to **shatter or "burst"** outwards, often into the spinal canal. *Extension injury* - **Extension injuries** typically result from hyperextension of the spine, such as in whiplash. - This mechanism often leads to **posterior element fractures** or disc injuries, not the bursting of the vertebral body. *Rotation injury* - **Rotational injuries** involve twisting forces on the spine, which generally result in **facet joint dislocations** or **fracture-dislocations**. - While they can cause instability, they do not primarily manifest as the compressive shattering seen in a burst fracture. *Flexion injury* - **Flexion injuries** are caused by forward bending forces, leading to **wedge fractures** or **flexion-distraction injuries**. - These typically spare the posterior vertebral wall from bursting into the spinal canal, unlike burst fractures.
Question 6: Which of the following is not a component of Brown-Sequard syndrome?
- A. Contralateral loss of pain and temperature sensation
- B. Contralateral posterior column involvement (Correct Answer)
- C. Ipsilateral extensor plantar response
- D. Ipsilateral loss of proprioception
Explanation: ***Contralateral posterior column involvement*** - **Brown-Séquard syndrome** is caused by hemisection of the spinal cord, affecting pathways as they ascend or descend. [1] - The **posterior columns** (involved in proprioception, vibration, and fine touch) transmit sensory information **ipsilaterally**, meaning symptoms would be on the same side as the lesion, not contralateral. [1] *Ipsilateral extensor plantar response* - This is a feature of **upper motor neuron (UMN) damage** affecting the corticospinal tract, which descends ipsilaterally before crossing in the medulla. - In Brown-Séquard syndrome, the **ipsilateral corticospinal tract** is damaged, leading to UMN signs below the lesion. [1] *Ipsilateral loss of proprioception* - **Proprioception** is carried by the posterior columns, which ascend **ipsilaterally** in the spinal cord. [2] - Damage to the posterior column on one side of the spinal cord (as in a hemisection) results in **ipsilateral loss** of proprioception, vibration, and discriminative touch. [1] *Contralateral loss of pain and temperature sensation* - The **spinothalamic tracts** carry pain and temperature sensations and cross within one or two spinal cord segments after entering. [2] - Therefore, a lesion on one side of the spinal cord will result in **contralateral loss** of pain and temperature sensation, typically a few segments below the level of the lesion. [1]
Question 7: A moving vehicle hits a pedestrian on his lateral aspect of the knee and causes a fracture. The fracture line is passing through the intercondylar eminence. Which of the following structures will most likely be injured
- A. Medial collateral ligament
- B. Medial meniscus
- C. Anterior cruciate ligament (Correct Answer)
- D. Lateral collateral ligament
Explanation: ***Anterior cruciate ligament*** - A fracture of the **intercondylar eminence** typically involves the avulsion of the **tibial attachment** of the anterior cruciate ligament (ACL). - The ACL's fibers attach to the **tibial intercondylar area**, making it highly susceptible to injury with a fracture in this region. *Medial collateral ligament* - The **medial collateral ligament** (MCL) originates from the medial femoral epicondyle and attaches to the medial tibia, primarily resisting valgus forces. - While knee trauma can affect the MCL, a fracture of the intercondylar eminence specifically points to an injury involving a structure attached to that area. *Medial meniscus* - The **medial meniscus** is a C-shaped cartilage in the knee joint and can be injured by rotational forces or compression. - Its injury is not directly linked to an intercondylar eminence fracture, although severe trauma can injure multiple structures. *Lateral collateral ligament* - The **lateral collateral ligament** (LCL) originates from the lateral femoral epicondyle and attaches to the fibular head, resisting varus forces. - An injury to the LCL is less likely with an intercondylar eminence fracture, as the LCL does not attach to this specific tibial region.
Question 8: All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:
- A. Multiple trauma
- B. Stable closed fracture (Correct Answer)
- C. Compound fracture
- D. Intra-articular fracture
Explanation: ***Stable closed fracture*** - A **stable closed fracture** typically does not require surgical intervention with ORIF as it can usually be managed non-surgically with casting or bracing. - The goal of ORIF is to achieve **anatomic reduction and rigid fixation**, which is not necessary for stable fractures that maintain alignment. *Multiple trauma* - In patients with **multiple trauma**, early stabilization of long bone fractures using ORIF can help reduce pain, prevent further injury, and facilitate patient mobilization. - This approach aims to reduce the risk of complications such as **ARDS (acute respiratory distress syndrome)** and fat embolism for critically ill patients. *Compound fracture* - **Compound (open) fractures** involve a break in the skin, exposing the bone to the external environment, and are a classic indication for surgical management. - ORIF in these cases helps to achieve **stabilization** after debridement, crucial for preventing infection and promoting bone healing. *Intra-articular fracture* - **Intra-articular fractures** involve the joint surface, and accurate anatomical reduction is critical to prevent post-traumatic arthritis and preserve joint function. - ORIF provides the precise reduction and stable fixation needed to restore the **joint congruity**.
Question 9: A patient fell off a bicycle and now complains of pain around the hip, with shortening of the affected limb. The hip is held in a position of flexion, adduction, and internal rotation. What is the most likely diagnosis?
- A. Intertrochanteric fracture (IT fracture)
- B. Transcervical fracture
- C. Posterior dislocation (Correct Answer)
- D. Anterior dislocation
Explanation: **Posterior dislocation** - **Posterior hip dislocations** typically occur after high-energy trauma (e.g., falls from height, motor vehicle accidents) and present with the affected limb in a classic position of **flexion, adduction, and internal rotation**. - **Shortening of the limb** is also a hallmark sign, often due to the femoral head displacing posteriorly and superiorly. *Intertrochanteric fracture (IT fracture)* - **Intertrochanteric fractures** usually present with the affected limb in **external rotation** and shortening, which is contrary to the internal rotation described in the case. - While pain is present, the specific rotational deformity helps differentiate it from a hip dislocation. *Transcervical fracture* - **Transcervical fractures** (femoral neck fractures) also typically present with the leg in **external rotation** and shortening. - These fractures are common in older adults and often associated with less severe trauma or falls. *Anterior dislocation* - **Anterior hip dislocations** are less common and typically present with the affected limb in a position of **flexion, abduction, and external rotation**. - This presentation is directly opposite to the adduction and internal rotation described in the question.
Question 10: Pilon fracture is
- A. Bimalleolar fracture
- B. Trimalleolar fracture
- C. Distal tibia Intraarticular fracture (Correct Answer)
- D. Proximal tibia fracture
Explanation: ***Distal tibia Intraarticular fracture*** - A **pilon fracture** specifically refers to an **intra-articular fracture of the distal tibia**, involving the weight-bearing surface of the **ankle joint**. - These fractures typically result from high-energy axial loading mechanisms, driving the talus into the plafond and causing extensive articular damage. *Bimalleolar fracture* - A **bimalleolar fracture** involves fractures of both the **medial malleolus** (distal tibia) and the **lateral malleolus** (distal fibula). - While it involves the ankle, it does not necessarily involve the **tibial plafond** articular surface in the same destructive manner as a pilon fracture. *Trimalleolar fracture* - A **trimalleolar fracture** includes fractures of the medial, lateral, and **posterior malleolus** (a portion of the distal tibia). - Like bimalleolar fractures, it primarily describes the involvement of the malleoli rather than the intra-articular surface load-bearing portion of the distal tibia. *Proximal tibia fracture* - This term refers to a fracture occurring in the **upper part of the tibia**, near the knee joint. - It does not involve the **distal end of the tibia** or the ankle joint, which is characteristic of a pilon fracture.
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