Trauma Nurse Core Course (TNCC) Practice Exam

What finding raises suspicion of complete spinal cord injury?

1. Weakness in the lower extremities

2. Priapism

3. Voluntary anal sphincter tone

4. Intact reflexes distal to the injury

The correct answer is: Priapism

Priapism, which is a prolonged and painful erection, can be a significant finding in cases of complete spinal cord injury. This occurs due to disruption of autonomic pathways that control blood flow to the genital region, often as a result of spinal cord damage. In a complete spinal cord injury, there is an absence of sensory and motor function below the level of the injury; this includes autonomic control, which affects erectile function. When priapism is present, it suggests that there has been a loss of neurologic function that affects regulation of blood flow, indicating complete injury to the spinal cord. In contrast, weakness in lower extremities, voluntary anal sphincter tone, or intact reflexes distal to the injury imply some degree of preserved function or incomplete injury, reflecting ongoing neurological activity and responses below the injury site. Therefore, the presence of priapism is a marker of severe disruption in the autonomic nervous system and supports the diagnosis of a complete spinal cord injury.