Spine: autonomic dysreflexia: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: autonomic dysreflexia

Sample item

A 28-year-old with a complete T4 spinal cord injury has a sudden pounding headache and flushing above the lesion. BP is 200/120 mmHg, pulse 48 per minute, and his urinary catheter has stopped draining. What is the first step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Sit him upright, loosen clothing and relieve the catheter blockage

Autonomic dysreflexia occurs in cord lesions above about T6 when a noxious stimulus below the level, usually a full bladder or bowel, causes unopposed sympathetic discharge. Initial management is to sit the patient up to lower BP, remove tight clothing and find and relieve the trigger. Antihypertensives are used only if BP stays high.

Option by option

  • A. Sit him upright, loosen clothing and relieve the catheter blockage (correct)

    Correct. Upright posture and removal of the trigger such as a blocked catheter treat the cause.

  • B. Arrange an urgent CT scan of the head

    The headache is due to the dysreflexia, and a CT delays treatment of an easily reversible cause.

  • C. Give intravenous atropine for the bradycardia

    The bradycardia is a reflex response to hypertension, so atropine does not address the cause.

  • D. Lay him flat with his legs raised

    Lying flat or raising the legs would increase blood pressure further.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Sit him upright, loosen clothing and relieve the catheter blockage. Autonomic dysreflexia occurs in cord lesions above about T6 when a noxious stimulus below the level, usually a full bladder or bowel, causes unopposed sympathetic discharge.

Why is "Arrange an urgent CT scan of the head" not the answer?

The headache is due to the dysreflexia, and a CT delays treatment of an easily reversible cause.

Why is "Give intravenous atropine for the bradycardia" not the answer?

The bradycardia is a reflex response to hypertension, so atropine does not address the cause.

Why is "Lay him flat with his legs raised" not the answer?

Lying flat or raising the legs would increase blood pressure further.

What concept does this question test?

It tests Spine: autonomic dysreflexia in Orthopaedics. Initial management is to sit the patient up to lower BP, remove tight clothing and find and relieve the trigger. Antihypertensives are used only if BP stays high.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: autonomic dysreflexia?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.