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Time Completed: 01:42:54

Final Score 86%

154

Reference Ranges

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Anatomy

Head and Neck

Question 98 of 180

A 28 year old male was brought into ED by the police following a drunken brawl. He has been punched on his mandible, resulting in subluxation of the atlanto-axial joint. Which of the following movements is most likely to be affected by this movement:

x ✓ Flexion 11%
x ✓ Extension 12%
x ✓ Rotation 66%
x ✓ Lateral flexion 9%
x ✓ Abduction 2%

Answer:

The atlanto-axial joints allow the head to rotate from side to side.

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Atlas and Axis

Atlas

Vertebra C1 (the atlas) is distinguished by its lack of vertebral body, essentially being composed of two lateral masses interconnected by an anterior and posterior arch. Each lateral mass articulates above with an occipital condyle of the skull and below with the superior articular facet of vertebra C2 (the axis). The posterior surface of the anterior arch has an articular facet for the dens of the axis.

The atlanto-occipital joints allow the head to nod up and down on the vertebral column.

Axis

The axis is characterised by the large dens, which extends superiorly from its vertebral body to articulate with the anterior arch of the atlas, and by its bifid spinous process. The dens is held in position by the strong transverse ligament of atlas posterior to it and spanning the distance between the lateral masses of the atlas.

The atlanto-axial joints allow the head to rotate from side to side.

Structure of the Cervical Vertebrae. (Image by OpenStax College [CC BY 3.0], via Wikimedia Commons)

Biochemistry
Blood Gases
Haematology

Biochemistry	Normal Value
Sodium	135 – 145 mmol/l
Potassium	3.0 – 4.5 mmol/l
Urea	2.5 – 7.5 mmol/l
Glucose	3.5 – 5.0 mmol/l
Creatinine	35 – 135 μmol/l
Alanine Aminotransferase (ALT)	5 – 35 U/l
Gamma-glutamyl Transferase (GGT)	< 65 U/l
Alkaline Phosphatase (ALP)	30 – 135 U/l
Aspartate Aminotransferase (AST)	< 40 U/l
Total Protein	60 – 80 g/l
Albumin	35 – 50 g/l
Globulin	2.4 – 3.5 g/dl
Amylase	< 70 U/l
Total Bilirubin	3 – 17 μmol/l
Calcium	2.1 – 2.5 mmol/l
Chloride	95 – 105 mmol/l
Phosphate	0.8 – 1.4 mmol/l

Haematology	Normal Value
Haemoglobin	11.5 – 16.6 g/dl
White Blood Cells	4.0 – 11.0 x 10⁹/l
Platelets	150 – 450 x 10⁹/l
MCV	80 – 96 fl
MCHC	32 – 36 g/dl
Neutrophils	2.0 – 7.5 x 10⁹/l
Lymphocytes	1.5 – 4.0 x 10⁹/l
Monocytes	0.3 – 1.0 x 10⁹/l
Eosinophils	0.1 – 0.5 x 10⁹/l
Basophils	< 0.2 x 10⁹/l
Reticulocytes	< 2%
Haematocrit	0.35 – 0.49
Red Cell Distribution Width	11 – 15%

Blood Gases	Normal Value
pH	7.35 – 7.45
pO2	11 – 14 kPa
pCO2	4.5 – 6.0 kPa
Base Excess	-2 – +2 mmol/l
Bicarbonate	24 – 30 mmol/l
Lactate	< 2 mmol/l

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Time Completed: 01:42:54

Final Score 86%

Reference Ranges

Questions

Anatomy

Head and Neck

Answer:

Atlas and Axis

Anatomy / Head and Neck / Vertebral Column

Last Updated: 11th April 2019

Atlas

Axis

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