Traumatic Paraplegia: Spinal Shock, Bladder Care & Rehab MCQs

Traumatic Paraplegia & Quadriplegia

Spinal Cord Injury (SCI) is a life-altering event. Management involves stabilizing the spine, preventing secondary complications (bedsores, contractures), and rehabilitation for independence.

1. Spinal Shock vs Neurogenic Shock

• Spinal Shock: Temporary physiological loss of all spinal reflexes below the lesion. Flaccid paralysis. Ends when the Bulbocavernosus Reflex returns (usually 24-48 hrs).
• Neurogenic Shock: Hemodynamic instability (Low BP + Bradycardia) due to loss of sympathetic tone. Seen in injuries above T6.

2. ASIA Impairment Scale

• A (Complete): No motor or sensory function in S4-S5.
• B (Incomplete): Sensory preserved, No motor below level.
• C (Incomplete): Motor preserved (Muscle grade < 3).
• D (Incomplete): Motor preserved (Muscle grade ≥ 3).
• E: Normal.

3. Critical Complications

Autonomic Dysreflexia:
In injuries above T6, a noxious stimulus (full bladder, tight clothes) causes unchecked sympathetic discharge: High BP, Pounding Headache, Bradycardia, Sweating.
Treatment: Sit patient up, loosen clothes, check catheter immediately. Medical emergency!

4. Bladder Management

• Automatic (Spastic) Bladder: Injury above S2. Reflex intact but no control.
• Autonomous (Flaccid) Bladder: Injury at S2-S4 (Cauda Equina). No reflex.
• Management: Clean Intermittent Catheterization (CIC) is the gold standard.

25 Practice MCQs

Q1. Spinal Shock is characterized by:

Answer: A). Spasticity develops only after spinal shock resolves.

Q2. The return of which reflex signals the end of spinal shock?

Answer: A). Contraction of anal sphincter upon squeezing glans/clitoris.

Q3. Autonomic Dysreflexia occurs in injuries above which level?

Answer: A). Due to splanchnic outflow involvement.

Q4. Neurogenic Shock presents with:

Answer: A). Loss of sympathetic tone causes vasodilation but heart cannot speed up.

Q5. ASIA "A" indicates:

Answer: A). Sacral sparing is the key differentiator.

Q6. Which bladder type occurs in Cauda Equina injury (S2-S4)?

Answer: B). The reflex arc is destroyed. Bladder fills and overflows.

Q7. First line treatment for Autonomic Dysreflexia is:

Answer: A). Sitting up lowers BP orthostatically. Remove the noxious stimulus.

Q8. Heterotopic Ossification (HO) is:

Answer: A). Common complication in SCI.

Q9. Brown-Sequard Syndrome involves:

Answer: A). Hemi-section of the cord.

Q10. Central Cord Syndrome is common in:

Answer: A). "Walking Quad" - arms are weak, legs are strong.

Q11. Pressure ulcers (bedsores) are best prevented by:

Answer: A). Most preventable complication.

Q12. C4 injury results in:

Answer: A). High cervical injury.

Q13. Tenodesis grip utilizes:

Answer: A). Do NOT stretch finger flexors in C6 tetraplegics; let them tighten for functional grip.

Q14. Anterior Cord Syndrome has poor prognosis for:

Answer: A). Dorsal columns (proprioception) are spared.

Q15. Clean Intermittent Catheterization (CIC) reduces risk of:

Answer: A). Gold standard.

Q16. Which dermatome corresponds to the nipple line?

Answer: A). T10 is umbilicus.

Q17. Deep Vein Thrombosis (DVT) prophylaxis is:

Answer: A). High risk in acute phase.

Q18. Can sexual function (erection) occur in SCI?

Answer: A). UMN lesions often allow reflex erections.

Q19. Spasticity is treated with:

Answer: A). Spasms can be painful but also functional (for transfers).

Q20. Orthostatic Hypotension in SCI patients is due to:

Answer: A). Use abdominal binder and tilt table.

Q21. Zone of Partial Preservation (ZPP) refers to:

Answer: A). Used only for ASIA A.

Q22. Conus Medullaris Syndrome vs Cauda Equina Syndrome:

Answer: A). Conus is the tip of the cord.

Q23. Functional potential of C6 tetraplegia:

Answer: A). Wrist extensors are intact.

Q24. Syrinx (Post-traumatic Syringomyelia) causes:

Answer: A). Cyst formation in the cord.

Q25. Methylprednisolone (Steroids) in acute SCI:

Answer: A). Risks (infection, GI bleed) often outweigh small benefits.