- Which statement best describes paraplegia?
A. Paralysis of all four limbs
B. Paralysis of one side of the body
C. Paralysis of the lower limbs
D. Inability to speak due to motor cortex damage
Answer: C - Which spinal cord segments are most commonly associated with paraplegia?
A. Cervical segments C1–C4
B. Thoracic, lumbar, or sacral segments below T1
C. Only lumbar segments L1–L5
D. Only sacral segments S1–S5
Answer: B - One of the most frequent causes of non-traumatic paraplegia worldwide is:
A. Poliomyelitis
B. Diabetes mellitus
C. Spinal tuberculosis (Pott’s disease)
D. Cerebrovascular accident (stroke)
Answer: C - Which is a primary clinical feature of acute paraplegia due to spinal cord injury?
A. Gradual onset of lower limb weakness over months
B. Immediate loss of motor function below the level of injury
C. Normal bowel and bladder control
D. Hyperactive reflexes on the day of injury
Answer: B - An upper motor neuron (UMN) lesion in the thoracic spinal cord typically presents with:
A. Flaccid paralysis in the legs
B. Hyperreflexia and spasticity in the legs
C. Decreased muscle tone in the arms
D. No change in bowel and bladder function
Answer: B - A lower motor neuron (LMN) lesion at the level of the cauda equina commonly leads to:
A. Spastic paralysis in the lower limbs
B. Positive Babinski sign
C. Flaccid paralysis and reduced or absent reflexes
D. Hyperreflexia of the lower limbs
Answer: C - In spinal shock following an acute spinal cord injury, which finding is expected initially?
A. Hypertonia below the level of injury
B. Spasticity and exaggerated deep tendon reflexes
C. Flaccidity and absent deep tendon reflexes
D. Automatic bladder emptying
Answer: C - Which imaging modality is most useful for an initial assessment of suspected spinal cord injury?
A. Ultrasound scan
B. X-ray of the spine
C. CT angiography
D. MRI of the brain
Answer: B - Which imaging study is best for detailed visualization of spinal cord pathology?
A. CT scan of the spine
B. Electromyography (EMG)
C. MRI of the spine
D. Plain X-ray of the thorax
Answer: C - In the context of paraplegia, “complete spinal cord injury” implies:
A. Partial loss of motor function
B. Preservation of sensory function below the level of injury
C. Total loss of motor and sensory function below the level of injury
D. Only sensory deficits
Answer: C - Which spinal cord syndrome can result in paraplegia with dissociated sensory loss (loss of pain and temperature sensation, preserved proprioception)?
A. Central cord syndrome
B. Anterior cord syndrome
C. Brown-Séquard syndrome
D. Conus medullaris syndrome
Answer: B - The sudden onset of paraplegia in a patient with a known abdominal aortic aneurysm might suggest:
A. Spinal cord compression by tumor
B. Anterior spinal artery infarction
C. Guillain-Barré syndrome
D. Multiple sclerosis
Answer: B - Which of the following is NOT a common complication of paraplegia?
A. Pressure ulcers
B. Urinary tract infections
C. Hyperthyroidism
D. Deep vein thrombosis (DVT)
Answer: C - Spastic bladder in paraplegic patients is primarily due to:
A. A lesion in the sacral micturition center (S2–S4)
B. UMN lesion above the conus medullaris
C. Lesion of the peripheral nerves in the lower limbs
D. A direct lesion of the frontal micturition center
Answer: B - Which dietary recommendation is often crucial for patients with paraplegia to reduce complications?
A. High-fiber diet to prevent constipation
B. Strict vegan diet only
C. Excessive sodium intake to raise blood pressure
D. High simple sugars to provide quick energy
Answer: A - Which of the following is most characteristic of the rehabilitation process in paraplegia?
A. Avoidance of any physical therapy to protect the spinal cord
B. Short-term therapy lasting only a few days
C. Intensive, multidisciplinary approach tailored to individual needs
D. Exclusive use of speech therapy
Answer: C - When assessing muscle strength in the lower limbs of a paraplegic patient, the standard grading scale used is the:
A. Modified Ashworth Scale
B. Glasgow Coma Scale
C. Medical Research Council (MRC) scale
D. Barthel Index
Answer: C - The phenomenon of “autonomic dysreflexia” in paraplegic patients is typically triggered by:
A. Hot weather exposure
B. Sympathetic overactivity due to a noxious stimulus (e.g., bladder distension)
C. High-altitude conditions
D. Upper respiratory infections
Answer: B - A patient with T12 paraplegia is likely to have:
A. Full function of both upper and lower limbs
B. Arm weakness but normal leg function
C. Motor and sensory deficits in the lower limbs with normal upper limb function
D. Complete paralysis of all four limbs
Answer: C - Which complication is particularly related to prolonged immobility in paraplegic patients?
A. Diplopia
B. Deep vein thrombosis and pulmonary embolism
C. Migraine headaches
D. Chronic sinusitis
Answer: B - Frequent urinary tract infections in paraplegic patients often result from:
A. Complete voluntary bladder control
B. Proper intermittent catheterization technique
C. Neurogenic bladder dysfunction leading to incomplete emptying
D. Excessive fluid intake
Answer: C - Which physical examination finding suggests an UMN lesion in the lower limbs?
A. Decreased tone and absent reflexes
B. Marked muscle atrophy in the acute phase
C. Clonus and a positive Babinski sign
D. Fasciculations in the calf muscles
Answer: C - Which factor contributes to pressure ulcer formation in paraplegia?
A. Constant repositioning
B. Immobility and decreased sensation
C. Strict skin care regimen
D. Use of specialized pressure-relief mattresses
Answer: B - Which medical specialty is primarily involved in the long-term management of paraplegic patients?
A. Cardiology
B. Rehabilitation medicine (physiatry)
C. Endocrinology
D. Ophthalmology
Answer: B - In evaluating paraplegia, electrophysiological studies such as nerve conduction studies (NCS) and EMG are most helpful in:
A. Identifying bladder stones
B. Differentiating upper motor neuron from lower motor neuron lesions
C. Visualizing vertebral fractures
D. Diagnosing meningitis
Answer: B - Which surgical procedure might be indicated for certain cases of paraplegia due to traumatic spinal injury?
A. Craniotomy and burr hole drainage
B. Spinal decompression and stabilization
C. Hysterectomy
D. Carotid endarterectomy
Answer: B - Which of the following best describes the conus medullaris syndrome?
A. Primarily upper motor neuron signs in the upper limbs
B. Flaccid paralysis and areflexic bladder if the lesion is at or below L1/L2
C. Intact sexual function
D. Preservation of motor function with loss of sensation only
Answer: B - Brown-Séquard syndrome can lead to paraplegia if:
A. Both sides of the spinal cord are hemisectioned
B. Only the dorsal columns are affected
C. The lesion spares the corticospinal tract
D. There is minimal damage to the spinal cord
Answer: A - Which reflex is commonly assessed to evaluate spinal cord integrity in paraplegic patients?
A. Gag reflex
B. Pupillary light reflex
C. Patellar tendon (knee jerk) reflex
D. Corneal reflex
Answer: C - Spastic paraplegia in hereditary spastic paraplegia is primarily due to:
A. Peripheral nerve demyelination
B. Cerebellar degeneration
C. Degeneration of the corticospinal tracts
D. Anterior horn cell destruction
Answer: C - Which medication class is frequently used to manage spasticity in paraplegic patients?
A. Antipsychotics
B. Benzodiazepines (e.g., diazepam)
C. Proton pump inhibitors
D. Antibiotics
Answer: B - Baclofen is a commonly prescribed medication in paraplegia. Its primary action is:
A. Enhancing muscle contraction
B. Blocking acetylcholine receptors
C. Acting as a GABA_B receptor agonist to reduce spasticity
D. Raising blood pressure by vasoconstriction
Answer: C - Which muscle group is most essential for paraplegic patients to strengthen for wheelchair propulsion?
A. Quadriceps
B. Upper limb muscles, particularly triceps and shoulder girdle
C. Abdominal and pelvic muscles only
D. Facial muscles
Answer: B - Early mobilization and physiotherapy in paraplegia can help prevent:
A. Pressure sores, joint contractures, and osteoporosis
B. Mild muscle hypertrophy
C. Hearing loss
D. Cognitive decline
Answer: A - The Bobath approach in neurological rehabilitation focuses on:
A. Prescription of high-dose steroids
B. Use of acupuncture for pain control
C. Neurodevelopmental treatment for improving movement patterns
D. Herbal remedies for spasticity
Answer: C - Which factor most directly influences the prognosis of paraplegia after spinal cord injury?
A. Patient’s hair color
B. Promptness and quality of initial management, including decompression
C. Geographic region of the hospital
D. Type of footwear used during recovery
Answer: B - In the acute phase of paraplegia from traumatic injury, high-dose steroids:
A. Have never shown any potential benefit
B. Are universally administered for one year
C. May be considered to limit secondary spinal cord damage
D. Are no longer used in any clinical setting
Answer: C - In paraplegic patients, contracture prevention includes:
A. Leaving limbs immobile to avoid pain
B. Regular passive and active range-of-motion exercises
C. Restricting fluid intake
D. Avoiding any weight-bearing efforts
Answer: B - “Neurogenic shock” typically occurs in:
A. Cervical or high thoracic spinal cord injuries
B. Lower lumbar fractures
C. Migraine headache
D. Brainstem infarcts only
Answer: A - Which approach is most suitable for bowel management in paraplegic patients?
A. Complete neglect of bowel function
B. Random use of laxatives and enemas
C. A structured program with scheduled bowel emptying and appropriate medications
D. No fiber intake in the diet
Answer: C - The term “diplegia” often refers to:
A. Paralysis of just one limb
B. Paralysis involving identical body regions on both sides, commonly the legs (seen in cerebral palsy)
C. Quadriplegia with normal trunk function
D. Hemiplegia combined with partial paraplegia
Answer: B - In cases of paraplegia, a frequent recommendation for skin care is:
A. Daily vigorous scrubbing with abrasive cloths
B. Complete avoidance of bathing to keep skin dry
C. Regular inspections and gentle cleansing, with an emphasis on pressure-relieving surfaces
D. Soaking in extremely hot water for long periods
Answer: C - Paraplegic patients can sometimes use standing frames. The primary benefit includes:
A. Worsening pressure on the spine
B. Increasing bone density and improving circulation
C. Exacerbation of spasticity
D. Permanent cure of paralysis
Answer: B - Which device is used for assisted ambulation in some paraplegic patients?
A. Prosthetic arms
B. Knee braces with pacemakers
C. Orthoses (e.g., knee-ankle-foot orthosis)
D. Intracranial stents
Answer: C - A crucial psychosocial aspect in paraplegia management involves:
A. Denying any form of counseling
B. Providing psychological support, counseling, and peer support groups
C. Forbidding social interaction to avoid infection
D. Avoiding discussions about independence
Answer: B - In paraplegic patients, heterotopic ossification (HO) refers to:
A. Formation of bone in non-osseous tissue, typically around joints
B. Normal bone growth in the femur and tibia
C. Disappearance of bones on imaging
D. Fractures caused by minor traumas
Answer: A - A significant risk factor for osteoporosis in paraplegia is:
A. Weight-bearing exercises performed daily
B. Prolonged immobilization and reduced mechanical loading of bones
C. High calcium diet
D. Smoking cessation
Answer: B - Gabapentin or pregabalin in paraplegic patients is often prescribed to manage:
A. Spasticity
B. Pressure ulcers
C. Neuropathic pain
D. Urinary infections
Answer: C - Which is true regarding partial paraplegia?
A. No recovery of any motor function
B. Some motor and/or sensory preservation below the lesion
C. Inability to breathe independently
D. No need for rehabilitation
Answer: B - Long-term goals of paraplegia management commonly include:
A. Maximizing independence and quality of life
B. Encouraging complete bed rest indefinitely
C. Avoiding any social interaction
D. Neglecting psychological well-being
Answer: A