{"id":822,"date":"2023-04-26T15:05:00","date_gmt":"2023-04-26T15:05:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=822"},"modified":"2025-10-01T11:39:36","modified_gmt":"2025-10-01T19:39:36","slug":"usmle-step-2-ck-question-of-the-day-spinal-cord-injury","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day: Spinal cord injury"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury\/#A_T7\" >A. T7<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury\/#B_T4\" >B. T4<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury\/#C_C2\" >C. C2<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury\/#D_C4\" >D. C4<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury\/#E_T10\" >E. T10<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Here&#8217;s another USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 32-year-old man who fell from a building. He did not suffer loss of consciousness. The patient has 2+ triceps and brachioradialis reflexes and 5\/5 strength of the upper extremities bilaterally. The patient is unable to move the bilateral lower extremities. Which of the following reflects the most likely level of spinal injury? Can you figure it out?<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 32-year-old man is brought to the emergency department after falling two stories while washing windows on scaffolding. Per paramedics, the patient fell directly on his back, was helmeted, and did not suffer the loss of consciousness. On arrival, temperature is 98.6\u00b0F (37\u00b0C), pulse is 45\/min, respirations are 22\/min, blood pressure is 178\/65 mmHg, and O2&nbsp;saturation is 95% on room air. The patient\u2019s primary survey is intact. The patient&#8217;s secondary survey is notable for bruising and tenderness over the cervical and thoracic spine. A neurological examination demonstrates loss of sensation starting below the xiphoid process. The patient has 2+ triceps and brachioradialis reflexes and 5\/5 strength of the upper extremities bilaterally. The patient is unable to move the bilateral lower extremities. Which of the following reflects the most likely level of spinal injury?<br><strong>A. T7<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. T4<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. C2<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. C4<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. T10<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span><strong>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_T7\"><\/span><strong>A. T7<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Before we get to the Main Explanation, let&#8217;s see why the answer wasn&#8217;t B, C, D, or E. Skip to the bottom if you want to see the correct answer right away!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_T4\"><\/span>B. T4<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;A spinal lesion at T4 would present with loss of sensation below the nipple line; this patient has preserved sensation at this dermatome.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_C2\"><\/span>C. C2<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>A spinal lesion at C2 would result in loss of sensation below the posterior half of the skull; injuries to this spinal level are often lethal due to damage to brainstem structures.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_C4\"><\/span>D. C4<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Injury to the C4 level would result in loss of sensation below the collar line and possible diaphragmatic dysfunction since this spinal cord level helps innervate the diaphragm.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_T10\"><\/span>E. T10<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;A spinal cord lesion at T10 would result in loss of sensation starting at the level of the umbilicus.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents for trauma evaluation after sustaining an injury to the spine. The neurologic examination is consistent with preserved sensation and motor strength above the level of T7, which is best approximated at the xiphoid process level.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pathologies that affect the spinal cord are diverse and include trauma, ischemia, infection, autoimmune conditions, neoplasm, and hereditary-degenerative diseases. Compressive etiologies (e.g. those resulting in direct physical impingement on the spinal cord) include tumors, spinal epidural abscesses, hematomas, herniated disks, or bony disease. Spinal cord transection can also result from direct trauma such as stab wounds, gunshot wounds, or extreme shearing forces. Ischemia, particularly from the anterior or posterior spinal arteries, may also result in injury to the spinal cord.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Regardless of the etiology, the level of injury can be determined via a focused neurological assessment, including sensation testing, motor function testing, and reflex testing. The absence of sensation below a particular dermatome in conjunction with correlating motor and reflex deficits can indicate the level of a lesion.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"848\" height=\"926\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/dermatomal-distribution.png\" alt=\"illustration of dermatomal distribution\" class=\"wp-image-823\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/dermatomal-distribution.png 848w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/dermatomal-distribution.png?resize=275,300 275w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/dermatomal-distribution.png?resize=768,839 768w\" sizes=\"auto, (max-width: 848px) 100vw, 848px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Pathologies that affect the spinal cord are diverse and include trauma, ischemia, infection, autoimmune conditions, neoplasm, and hereditary-degenerative diseases. A detailed neurologic examination can often elucidate the level of spinal injury.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Kaplan AI, Krishnan C, Deshpande DM, et al. Diagnosis and management of acute myelopathies. Neurologist 2005; 11:2.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">McDonald JW, Sadowsky C. Spinal-cord injury. Lancet. 2002 Feb 2;359(9304):417-25. doi: 10.1016\/S0140-6736(02)07603-1. PMID: 11844532.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>__________________________<\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"http:\/\/osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/83.png?w=700\" alt=\"Osmosis ad\" class=\"wp-image-651\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/83.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/83.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>____________________________<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong><em>Try Osmosis today! Access your&nbsp;<\/em><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><em>free<\/em><em>&nbsp;<\/em><em>trial<\/em><\/a><em>&nbsp;and find out why millions of clinicians and caregivers love learning with us.<\/em><\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Here&#8217;s another USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 32-year-old man who fell from a building. He did not suffer loss of consciousness. The patient has 2+ triceps and brachioradialis reflexes and 5\/5 strength of the upper extremities bilaterally. The patient is unable to move the bilateral lower extremities. Which of [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":824,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,45],"tags":[],"class_list":["post-822","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day: Spinal cord injury - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-spinal-cord-injury\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day: Spinal cord injury - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Here&#8217;s another USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 32-year-old man who fell from a building. He did not suffer loss of consciousness. The patient has 2+ triceps and brachioradialis reflexes and 5\/5 strength of the upper extremities bilaterally. The patient is unable to move the bilateral lower extremities. 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