NCS Spinal Cord Injury 3 — Questions and Answers
Question 1: Autonomic dysreflexia (AD) most commonly occurs in individuals with spinal cord injuries at or above which neurological level?
- L2
- T10
- T6 (Correct answer)
- C8
Correct answer: T6
Autonomic dysreflexia occurs at T6 or above because injuries at this level disrupt supraspinal control of the splanchnic sympathetic outflow.
Question 2: The FIRST intervention when a patient with tetraplegia presents with sudden severe hypertension and pounding headache suggestive of autonomic dysreflexia is to:
- Administer sublingual nifedipine immediately
- Sit the patient upright and lower the legs to reduce blood pressure (Correct answer)
- Perform immediate bladder catheterization
- Apply ice to the posterior neck
Correct answer: Sit the patient upright and lower the legs to reduce blood pressure
Sitting the patient upright uses orthostatic hypotension reflexively to lower blood pressure while the noxious stimulus source is identified.
Question 3: Which of the following is the MOST common trigger for autonomic dysreflexia?
- Pressure injury below the level of injury
- Bladder distension or urinary retention (Correct answer)
- Heterotopic ossification
- Deep vein thrombosis
Correct answer: Bladder distension or urinary retention
Bladder distension from urinary retention or a blocked catheter is the most frequent precipitating cause of autonomic dysreflexia.
Question 4: How does neurogenic shock differ from hypovolemic shock in acute spinal cord injury?
- Neurogenic shock features tachycardia and vasoconstriction; hypovolemic features bradycardia
- Neurogenic shock features bradycardia and vasodilation; hypovolemic features tachycardia and vasoconstriction (Correct answer)
- Neurogenic shock is caused by fluid loss; hypovolemic is caused by loss of sympathetic tone
- Both present identically and can only be differentiated with imaging
Correct answer: Neurogenic shock features bradycardia and vasodilation; hypovolemic features tachycardia and vasoconstriction
Neurogenic shock results from loss of sympathetic tone causing vasodilation and bradycardia, while hypovolemic shock causes compensatory tachycardia and vasoconstriction.
Question 5: Spinal shock following acute SCI is best characterized by:
- Hypertension and spasticity below the injury level
- Transient areflexia, flaccidity, and loss of autonomic function below the injury (Correct answer)
- Permanent loss of all reflex activity and motor function
- Hyperreflexia and autonomic instability in the acute phase
Correct answer: Transient areflexia, flaccidity, and loss of autonomic function below the injury
Spinal shock is a transient physiological depression of spinal cord function presenting with flaccidity, areflexia, and autonomic dysfunction below the injury level.
Question 6: A patient with a complete C4 SCI will most likely require which level of respiratory support?
- No support; the diaphragm is fully functional at C4
- Supplemental oxygen via nasal cannula only
- Mechanical ventilation due to compromised diaphragmatic function (Correct answer)
- Non-invasive BiPAP support during sleep only
Correct answer: Mechanical ventilation due to compromised diaphragmatic function
The phrenic nerve originates at C3-C5; a complete C4 injury frequently disrupts diaphragmatic function sufficiently to require mechanical ventilation.
Question 7: The most appropriate initial management for orthostatic hypotension in a patient with T4 complete paraplegia during early rehabilitation is:
- Oral midodrine 10 mg three times daily as first-line therapy
- Abdominal binder and compression stockings with gradual head-of-bed elevation (Correct answer)
- Immediate IV fluid bolus to restore blood pressure
- Restricting upright positioning to less than 15 minutes per session
Correct answer: Abdominal binder and compression stockings with gradual head-of-bed elevation
Abdominal binders, compression stockings, and gradual tilt-table or recliner progression are first-line non-pharmacological strategies for orthostatic hypotension in SCI.
NCS Spinal Cord Injury 3
Autonomic dysreflexia (AD) most commonly occurs in individuals with spinal cord injuries at or above which neurological level?