2002 SAE-P: Spinal Cord Injury Medicine MicheUe S. Gittler, M D Clinical Activity 1.1 1. The American Spinal Injury Association (ASIA) Impairment Scale was recently revised in 2000. Which statement regarding the 2000 revisions is TRUE? (a) The zone of partial preservation is to be documented by the most rostral segment with sensory function. (b) Three new FIM T M instrument categories were added to the standards. (c) ASIA class C or D motor incomplete was defined as voluntary anal sphincter contraction, or sensory sacral sparing with some motor function more than 3 levels below the motor level. (d) The sensory exam was expanded to a 5-point scale to include sharp and dull, temperature, proprioception, and vibration.
Ref" American Spinal Injury Association. International standards for neurological classification of spinal cord injury. Chicago: ASIA; 2000.
(a) (b) (c) (d)
cervical spine x-ray. spiral computerized tomography. magnetic resonance imaging. contrast myelogram.
Ref" Educational Activity 1.4 Clinical Activity 2.1 6. In order to achieve pressure relief with a tilt-in-space wheelchair, the user must (a) change position every 2 hours. (b) achieve more than 45 ° of tilt. (c) use a low air loss cushion. (d) reestablish pelvic positioning with each position change.
Ref" Partsch H, Blatler W. Compression and walking versus bed rest in the treatment of proximal deep vein thrombosis with low molecular weight heparin. J Vasc Surg 2000;32:861-9. Clinical Activity 2.2
Clinical Activity 1.2 2. In the treatment of acute spinal cord injury, which mechanism of action is NOT characteristic of methylprednisolone? (a) Preventing lipid peroxidation (b) Improving blood flow to the spinal cord (c) Scavenging free radicals (d) Promoting nerve regrowth
Ref" Bracken MB, Shepard M J, Holford TR, et aL Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury: results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA. 1997;277:1597-604. Clinical Activity 1.2 3. In which case could closed traction be considered an appropriate treatment? (a) Associated thoracic and lumbar fracture (b) Atlanto-axial dislocation (c) Comminuted skull fracture (d) Extensive scalp lacerations
Ref" Amar A, Levy M. Surgical controversies in the management of spinal cord injury. J Am Coil Surg 1999;18:550-66. Clinical Activity 1.3 4. Compared with traumatic spinal cord injury (SCI), nontraumatic SCI (a) accounts for two thirds of all SCI costs. (b) can be predicted by familial inheritance patterns. (c) is more likely to occur in older, female, and married persons. (d) is more likely to result in tetraplegia.
7. You are listing the advantages of using low molecular weight heparin for treatment of deep vein thrombosis. Which characteristic should NOT be included on the list? (a) Low cost (b) Ease of use (c) Decreased risk factors (d) Reduced delay of therapy
Ref" Clinical Activity 2.2 Clinical Activity 2.2 8. Adequate treatment for newly diagnosed deep vein thrombosis on a rehabilitation unit (a) should include 3 days of bedrest. (b) should also include a vena cava filter. (c) requires 5 days of low molecular weight heparin prior to initiating warfarin. (d) requires weight-adjusted doses of low molecular weight heparin.
Ref: Laposata M, Green D, VanCott EM, Barrowcliffe TW, Goodnight SH, Soslik RC. College of American Pathologists Conference XXX1 on laboratory monitoring of anticoagulant therapy: the clinical use and laboratory monitoring of lowmolecular-weight heparin, danaparoid, hirudin and related compounds, and argatroban. Arch Pathol Lab Med 1998;122: 799-807. Clinical Activity 2.2 9. Treatment of lower limb long bone fractures in persons with spinal cord injury is best accomplished by (a) open reduction and internal fixation. (b) circumferential casting. (c) electric bone stimulation. (d) soft removable splint.
Ref" Clinical Activity 1.3
Ref" Freehafer AA. Limb fractures in patients with spinal cord injury. Arch Phys Med Rehabil 1995;76:823-7.
Educational Activity 1.4
Clinical Activity 2.3
5. The best test to diagnose a suspected posttraumatic syrinx in the cervical cord is Arch Phys Med Rehabil Vol 83, Suppl 1, March 2002
10. The goal of injecting botulinum toxin into the external sphincter is to increase
(a) (b) (c) (d)
intravesicular pressure. urethral compliance. the rate of urinary outflow. bladder capacity.
Ref" Clinical Activity 2.3 Clinical Activity 2.3 11. When counseling individuals regarding the use of intrathecal baclofen for treatment of their spasticity, correct statements include: (a) It is only FDA approved for spasticity of cerebral etiology. (b) It is indicated for patients who do not wish to take oral medications. (c) Its use can result in significant improvements in Ashworth scores. (d) Overdoses can lead to renal failure.
Ref" Penn RD. Intrathecal baclofen for spasticity of spinal origin: seven years of experience. J Neurosurg 1992;77:23640. Clinical Activity 2.4 12. In a person experiencing autonomic dysreflexia, compensatory reflexes occurring in response to an increase in sympathetic inhibitory outflow cause (a) flushing. (b) bradycardia. (c) hypotension. (d) tetany.
Ref" Consortium for Spinal Cord Medicine. Acute management of autonomic dysreflexia: individuals with spinal cord injury presenting to health care facilities. Washington (DC): Paralyzed Veterans of America; 1997. Educational Activity 2.5 13. Which medication would NOT be a reasonable first choice to alleviate neuropathic pain in an individual with a spinal cord injury? (a) Carbamazepine (b) Gabapentin (c) Amitriptyline (d) Methadone
Ref" (a) McQuay 14, Carroll D, Jadad A, Wiffen P, Moore A. Anticonvulsant drugs for management of pain: a systematic review. Br Med J 1995;311:1047-52. (b) Bryce TN, Ragnarsson KT. Pain after spinal cord injury. Phys Med Rehabil Clin North Am 2000;11:157-68.
Ref" (a) Glenn WW, Phelps ML. Diaphragmatic pacing by electrical stimulation of the phrenic nerve. Neurosurgery 1985; 17.'974-84. (b) DiMarco A. Diaphragm pacing in patients with spinal cord injury. Top Spinal Cord bTj Rehabil 1999;5:1:6-20. Educational Activity 3.4 16. Which treatment is NOT appropriate for a man who has erectile dysfunction as a result of his spinal cord injury? (a) Sildenafil (b) Intraurethral alprostadil (c) Intracavernosal papaverine (d) Testosterone
Ref" Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WE, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Group. N Engl J Med 1998;338:1397404. Clinical Activity 3.5 17. Management of a person with a T8 metastatic spinal lesion resulting in spinal cord compression secondary to lung cancer must include (a) a rigid thoracic lumbar sacral orthosis for stabilization. (b) independence with an intermittent catheterization program. (c) pain control with opiates and nonopiates. (d) referral to a hospice.
Ref" Clinical Activity 3.5 Educational Activity 4.1 18. The proper width of a doorway to allow transit of a power wheelchair without turning is at least (a) 26 inches. (b) 34 inches. (c) 36 inches. (d) 40 inches.
Ref" Eberhardt K. Home modifications for persons with spinal cord injury. OT Practice 1998;Nov:24-7. Educational Activity 4.1 19. The ideal accessible bathroom includes all of the following EXCEPT (a) wall mounted sink. (b) under sink cabinets. (c) standard height toilet. (d) roll-in shower.
Ref" Eberhardt K. Home modifications for persons with spinal cord injurs'. OT Practice 1998,Nov:24-7.
Clinical Activity 2.6 14. Which symptom is NOT indicative of hypercalcemia? (a) Nausea (b) Diarrhea (c) Anorexia (d) Lethargy
Clinical Activity 4.2
Ref" Clinical Activity 2.6
20. The possible benefits of participation in sporting activities for disabled participants include (a) higher maximal work rate. (b) improved maximal oxygen uptake in tetraplegics. (c) longer life expectancy.. (d) improved oxygen saturation.
Educational Activity 3.3
Ref" Clinical Activi~.' 4.2
15. Benefits conferred by use of a phrenic pacemaker in a tetraplegic patient include (a) elimination of ventilatory support. (b) improved speech. (c) improved hearing acuity. (d) longer life expectancy.
21. Which statement is TRUE regarding to injuries incurred while participating in wheelchair sports? (a) The injuries are primarily traumatic. (b) Fewer than 20% of athletes are affected.
Clinical Activity 4.2
Arch Phys Med Rehabil Vol 83, Suppl 1, March 2002
(c) Lower extremities are more prone to injury. (d) Neck and spine injuries account for 18% of injury.
Ref: Taylor D, Williams T. Sports injuries in athletes with disabilities: wheelchair racing. Paraplegia 1995;33:296-9.
Educational Activity 4.3
(a) the perspective of the attending physician. (b) the viewpoint of the patient as an insider experiencing disablement. (c) the combined viewpoints of the interdisciplinary team. (d) the perspective of the hospital ethics committee.
Ref" Clinical Activity 4.5
22. An important component to consider in formulating a life care plan is that (a) general disability and impairment needs should be addressed. (b) plan formulation should start immediately at the onset of disability. (c) complications and changing needs with age should be anticipated. (d) medical and rehabilitation needs should be separate from the financial plan.
Ref" Clinical Activity 5.1
Ref" Educational Activity 4.3
Clinical Activity 5.2
Clinical Activity 4.4 23. Which mechanism is NOT a likely cause of male infertility after spinal cord injury? (a) Anejaculation (b) Hypomotile sperm (c) Inadequate number of sperm (d) Decreased scrotal temperature
Ref" Rutkowski SB, Geraghty TJ, Hagen DL, Bowers DM, Craven M, Middleton JW. A comprehensive approach to the management of male infertility following spinal cord injury. Spinal Cord 1999;37:508-14.
Clinical Activity 4.4 24. A favorable prognostic indicator for ejaculation with vibratory stimulation after spinal cord injury is (a) duration of injury less than 6 months. (b) lesion cephalic to T10. (c) incomplete injury. (d) absence of spasticity.
Clinical Activity 5.1 27. The risk of having a child with myelomeningocele is reduced most by the pregnant woman (a) getting regular exercise. (b) avoiding anemia. (c) taking folic acid and prenatal vitamins. (d) avoiding the use of hot tubs.
28. In order to be a candidate for a bladder electric stimulation system, a person must have a/an (a) continent, catheterizable pouch. (b) detrusor myomectomy. (c) continent stoma. (d) intact sacral reflex arc.
Ref" Clinical Activi~ 5.2
Clinical Activity 5.3 29. The risk of which type of cancer is heightened after spinal cord injury? (a) Bladder (b) Colon (c) Lung (d) Prostate
Ref" Clinical Activi~., 4.4
Ref" Groah SL, Weitzenkamp DA, Lammertse DP, Whiteneck GG, Lezotte D, Hammon RF. Excess risk of bladder cancer in spinal cord injury: evidence for an association between indwelling catheter use and bladder cancer. Arch Phys Med Rehabil. 2002;83:346-51.
Clinical Activity 4.5
Clinical Activity 5.3
25. A patient with C2 ASIA class A spinal cord injury wishes to be removed from his ventilator. Important considerations for this patient include all of the following EXCEPT (a) adequate pain management. (b) presence of depression. (c) caregiver assessment of quality of life. (d) opportunities for productive work options.
30. Compared with able-bodied counterparts, individuals with spinal cord injuries have (a) a higher risk of cardiovascular disease. (b) a lower risk of cardiovascular disease. (c) an equal risk of cardiovascular disease. (d) an unknown risk of cardiovascular disease.
Ref" Clinical Activi~ 4.5
Clinical Activity 4.5 26. "Quality of life" as a construct for guiding intervention is best measured from
Arch Phys Med Rehabil Vol 83, Suppl 1, March 2002
Ref" (a) DeVivo N J, Kruse JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil 1999;80:1411-9. (b) Groah SL, Weitzenkamp DA, Sett P, Soni B, Savic G. The relationship between neurologic level of injury and symptomatic cardiovascular disease risk and the aging spinal injured. Spinal Cord 2001;39:310-7.