TCRN Neurological Trauma 2 — Questions and Answers
Question 1: A patient with a C5 spinal cord injury is most likely to experience which respiratory complication?
- No respiratory compromise because diaphragm function is preserved
- Diaphragmatic breathing only with impaired intercostal and accessory muscle function, requiring close monitoring (Correct answer)
- Complete apnea requiring immediate intubation regardless of other findings
- Paradoxical breathing from intercostal spasticity
Correct answer: Diaphragmatic breathing only with impaired intercostal and accessory muscle function, requiring close monitoring
C5 injuries spare the diaphragm (C3-C5) but impair intercostal and accessory muscles, leaving patients at high risk for respiratory fatigue.
Question 2: Neurogenic shock following spinal cord injury is characterized by which hemodynamic pattern?
- Hypotension with tachycardia and vasoconstriction
- Hypotension with bradycardia and warm, vasodilated extremities (Correct answer)
- Hypertension with reflex bradycardia
- Normal blood pressure with tachycardia
Correct answer: Hypotension with bradycardia and warm, vasodilated extremities
Loss of sympathetic tone in neurogenic shock produces vasodilation and bradycardia, distinguishing it from hypovolemic shock.
Question 3: Autonomic dysreflexia in a patient with a spinal cord injury above T6 is most commonly triggered by which cause?
- Pain from a minor abrasion
- A distended bladder or bowel (Correct answer)
- Hypoglycemia
- Hyponatremia
Correct answer: A distended bladder or bowel
Bladder distension is the most common trigger of autonomic dysreflexia, causing massive sympathetic stimulation below the injury level.
Question 4: Which intervention is the priority when a spinal cord injury patient develops autonomic dysreflexia with BP 220/130 mmHg?
- Administer IV morphine for pain
- Sit the patient upright and identify and remove the triggering stimulus immediately (Correct answer)
- Lay the patient flat and apply a cooling blanket
- Administer IV normal saline 500 mL bolus
Correct answer: Sit the patient upright and identify and remove the triggering stimulus immediately
Sitting the patient upright uses gravity to lower BP while rapid identification and removal of the offending stimulus is the definitive treatment.
Question 5: Diffuse axonal injury (DAI) is best diagnosed by which imaging modality?
- Plain skull X-ray
- CT scan of the head without contrast
- MRI of the brain (Correct answer)
- Cerebral angiography
Correct answer: MRI of the brain
MRI is far superior to CT for detecting the small axonal shearing injuries characteristic of DAI, especially in white matter.
Question 6: Secondary brain injury after TBI is primarily caused by which mechanism?
- The initial kinetic energy transfer from impact
- Hypoxia, hypotension, cerebral edema, and elevated ICP occurring after the primary injury (Correct answer)
- Genetic predisposition to neuronal death
- Inflammatory response that only begins 72 hours post-injury
Correct answer: Hypoxia, hypotension, cerebral edema, and elevated ICP occurring after the primary injury
Secondary brain injury results from systemic and intracranial processes after the initial insult—all of which are potentially preventable.
TCRN Neurological Trauma 2
A patient with a C5 spinal cord injury is most likely to experience which respiratory complication?