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Introduction to Reading and Clearing Cervical Spines for Advanced Practice Nurses, Part II: C-spine Injuries—Causes, Cases, and Treatments (Including CT Scan)

doi: 10.1097/01.TME.0000359614.94307.1f
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General Purpose: To provide the professional registered advanced nurse practitioner with an overview of the diagnosis and current treatment of common C-spine injuries.

Learning Objectives: After reading this article and taking the test, you should be able to:

  1. Identify the causes and presentation of common C-spine injuries.
  2. Illustrate the diagnosis and current management of common C-spine injuries.

1. Which statement about the cervical spine and its injuries is true?

a. Less than one half of spinal cord injuries result from cervical spine fractures.

b. The upper cervical spine isdefined as extending from C1 through C3.

c. Seventy-five percent (75%) of cervical spine injuries occur in the upper cervical spine.

d. The most common area of cervical injury is C3 to C7.

2. Which statement best reflects current thinking about imaging studies for cervical spine evaluation?

a. Radiographic films should always be performed initially.

b. Computed tomography (CT) scans should always be first-line studies.

c. There is controversy whether radiography or CT scan should be performed first.

d. Magnetic resonance imaging (MRI) is not needed to examine cervical spine injuries.

3. The teardrop fracture

a. is a stable fracture.

b. involves disruption of all 3 spinal columns.

c. results from forceful flexion with compression.

d. is difficult to visualize on plain radiographs.

4. Management of a flexion teardrop fracture involves all of the following except

a. nonoperative management with a halo vest and steroids.

b. strict C-spine immobilization.

c. spinal cord decompression.

d. eventual spinal fusion.

5. Bilateral fracture of the pars inter-articularis of C2 is termed a

a. burst fracture.

b. teardrop fracture.

c. Hangman's fracture.

d. odontoid fracture.

6. A Hangman's fracture

a. is unstable and requires immediate referral if associated with a C2 facet dislocation.

b. is often associated with spinal cord injury.

c. commonly results from diving accidents.

d. is managed with traction and hyperextension of the cervical spine.

7. A cervical burst fracture causes compression of the vertebral body with

a. a fracture line through the superior and inferior articular facets.

b. loss of anterior vertebral body height only.

c. loss of anterior and posterior vertebral body height.

d. fracture of the dens.

8. Proper diagnostic evaluation of a burst fracture requires

a. a history and physical examination only.

b. plain radiographic films only.

c. axial CT scan or MRI.

d. exploratory surgery.

9. Burst fractures with neurologic deficits are initially managed with

a. traction with cervical tongs.

b. bedrest and a rigid cervical collar.

c. steroids and halo vest immobilization.

d. immediate surgical spinal fusion.

10. A Jefferson burst fracture occurs most frequently by

a. diving into shallow water.

b. falling on one's head.

c. being thrown against the roof of a car.

d. a heavy object falling on the head.

11. Which type of injury causes a Jefferson burst fracture?

a. flexion-compression

b. axial compression

c. hyperextension

d. flexion and axial rotation

12. Whichisthe best radiographic view to identify a Jefferson burst fracture?

a. lateral

b. anteroposterior

c. oblique

d. open mouth odontoid

13. Which statement about odontoid fractures is true?

a. They are fractures of C1.

b. They can result from either flexion or extension.

c. The least stable is type I.

d. Nonunion occurs frequently in type III.

14. Management of a type I dens fracture typically requires

a. external immobilization with a halo vest for up to 12 weeks.

b. urgent surgical management for repair of the transverse ligament.

c. a rigid cervical collar for up to 72 hours followed by surgical management.

d. soft cervical collar for 7–10 days followed by surgery if needed.

15. When the posterior elements remain intact, an anterior wedge fracture would be considered stable with

a. 25% compression and 50% angulation.

b. 35% compression and 40% angulation.

c. 40% compression and 25% angulation.

d. 55% compression and 20% angulation.

16. Management of anterior wedge compression fractures includes all except

a. placement in a rigid cervical collar.

b. flexion and reduction with traction.

c. bedrest.

d. hyperextension of the vertebral body.

17. The clinical presentation of a Clay-Shoveler's fracture consists of

a. neck pain and a C3or C4 nondisplaced spinal process fracture noted on the plain film.

b. neck pain and displacement of the lateral aspects of C5 on a plain film.

c. escalating neck pain after an injury involving forced extension of the cervical spine.

d. sudden sharp neck pain and shoulder and arm pain, usually at the level of C7.

18. When evaluating the cervical spine, it is important to do all of the following except

a. clear the cervical spine in the emergency department.

b. recognize any unstable bony injury.

c. recognize any ligamentous injury.

d. identify a spinal cord injury.



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