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Time Completed: 01:29:15

Final Score 79%

142

Reference Ranges

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Anatomy

Central Nervous System

Question 23 of 180

A 68 year old lady was involved in a road traffic accident and describes a whiplash type injury. She has pain and tenderness in the cervical region and imaging shows a herniated disc in this region. The patient is complaining of weakness of elbow extension and loss of sensation over the middle finger. Which of the following spinal nerves is most likely affected:

x ✓ C5 6%
x ✓ C6 12%
x ✓ C7 74%
x ✓ C8 7%
x ✓ C9 0%

Answer:

Elbow extension is a predominant function of the C7 spinal nerve root, which also supplies sensation to skin over the middle of the hand. The important myotomes are shown below.

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Myotomes and Reflexes

Upper Limb

Table: Myotomes of the Upper Limb

Myotome	Most Strongly Associated Movement
C5	Elbow flexion (also shoulder abduction and external rotation)
C6	Wrist extension
C7	Elbow extension (also wrist flexion)
C8	Finger flexion (also thumb extension)
T1	Finger abduction

Lower Limb

Table: Myotomes of the Lower Limb

Myotome	Most Strongly Associated Movement
L2	Hip flexion
L3	Knee extension
L4	Ankle dorsiflexion
L5	Great toe extension
S1	Ankle plantarflexion
S2	Knee flexion

Reflexes

Table: Reflexes of the Upper and Lower Limb

Reflex	Root	Muscle
Biceps	C5 – C6	Biceps brachii
Supinator	C6 – C7	Brachioradialis
Triceps	C7 – C8	Triceps brachii
Knee	L3 – L4	Quadriceps
Ankle	S1	Gastrocnemius

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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