ATLS - Advanced Trauma Life Support Spine and Spinal Cord Trauma Questions and Answers

Question 1

A 28-year-old is involved in a motorcycle crash and presents with a blood pressure of 85/45 mmHg, a heart rate of 55 bpm, and warm, dry extremities. There is no obvious external hemorrhage. Which type of shock is most likely responsible for this clinical picture?

Accepted Answer

Neurogenic shock

Answer

The patient's presentation of hypotension with paradoxical bradycardia and peripheral vasodilation (warm, dry skin) is the classic triad for neurogenic shock. This results from the loss of sympathetic tone due to a spinal cord injury, typically above T6. Hemorrhagic shock would typically present with hypotension and tachycardia, with cool, clammy skin.

Question 2

A patient with a flexion injury to the cervical spine demonstrates complete paralysis and loss of pain and temperature sensation below the level of the injury. However, their sense of vibration and proprioception remains intact. Which incomplete spinal cord syndrome do these findings represent?

Accepted Answer

Anterior cord syndrome

Answer

Anterior cord syndrome results from damage to the anterior two-thirds of the spinal cord, affecting the corticospinal tracts (motor function) and spinothalamic tracts (pain and temperature). The posterior columns, which carry vibration and proprioception signals, are spared.

Question 3

A 30-year-old trauma patient is alert (GCS 15), not intoxicated, and has no focal neurological deficits. According to the NEXUS low-risk criteria for clinical clearance of the cervical spine, which of the following findings would mandate radiographic imaging?

Accepted Answer

Presence of a painful wrist fracture

Answer

The NEXUS criteria require five conditions to be met for clinical clearance: no posterior midline cervical tenderness, no evidence of intoxication, a normal level of alertness, no focal neurologic deficit, and no painful distracting injury. A painful wrist fracture is considered a distracting injury that could mask the pain from a significant cervical spine injury, thus requiring imaging.

Question 4

During the secondary survey of a patient with paraplegia following a severe fall, the examiner assesses for sacral sparing. Which of the following findings indicates an incomplete spinal cord injury?

Accepted Answer

Voluntary anal contraction

Answer

Sacral sparing refers to the preservation of sensory or motor function in the lowest sacral segments (S4-S5). Evidence of this, such as voluntary anal contraction, perianal sensation, or great toe flexion, indicates that the spinal cord injury is incomplete and carries a better prognosis for recovery. The other options are signs associated with spinal shock or a complete injury.

Question 5

A patient suffers a penetrating stab wound to the right side of the neck, resulting in a Brown-Séquard syndrome at the C7 level. Which pattern of neurological deficits would be expected below the injury?

Accepted Answer

Paralysis and loss of proprioception on the right; loss of pain and temperature on the left

Answer

Brown-Séquard syndrome is caused by hemisection of the spinal cord. This damages the ipsilateral (same side) corticospinal tracts (motor) and posterior columns (proprioception/vibration). It also damages the spinothalamic tracts, which cross over; therefore, the loss of pain and temperature sensation occurs on the contralateral (opposite) side.

ATLS - Advanced Trauma Life Support Practice Test

ATLS - Advanced Trauma Life Support Practice Test

ATLS - Advanced Trauma Life Support Spine and Spinal Cord Trauma Questions and Answers