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NBME 22 Answers

nbme22/Block 3/Question#1 (reveal difficulty score)
A 35-year-old man comes to the physician ...
C7 nerve root🔍,📺
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 +6 
submitted by paulm(6),
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Pre lWUrdo I(D 53)515

The C7 oort is the tsmo ryntlueefq ftecafed enerv orot in iptanset htiw caricelv iotchulypr,aad tnserugli ni iedcsitf coarss eth dieamn nad aladir vreen iuot.ibsnirstd

"tigingln ienntssoa of e"singrf → danemi rneev

itre"csp slcemu lerfex si serdecdea" → lrdiaa vnree

carmustine  Another important indication that this involves the median nerve is the weakness in pronation. Pronation of the forearm is performed by the pronator teres and the pronator quadratus, both of which are innervated by the median nerve. +3  



 +4 
submitted by mcl(619),
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Prtroaon esrte nad drqsuuaat era thbo ldiupesp yb nimade rvene /8(//1TC,C/5C7C6 os ta'hts ton srpue flphl).ue xtiEonsen fo teh foamrer si draila vrene saol( -1,T5C oasl tno )u.pllhfe hTis osde lelt us si ti 'cnta be elitoasd eiandm ro ira.dla srpceiT etnnod xerlfe si /8C,7C hcihw nowrras ti wond to etshe w.ot

nCa nneoay naixpel wyh 'tis C7 voer ?8C

joha961  Same question. How could you determine between the specific nerve roots (C7 vs. C8)? +2  
mcl  Someone I was talking to (and post below) was saying that first aid mentions triceps is C7, so that's what should've been the big thing for us. +3  
joanmadd  you might see some ulnar nerve involvement if C8 was involved her +  
passplease  but he has generalized tingling which is in both ulnar and median regions? +  



 +2 
submitted by obliviondo (2),
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ogriccdnA ot FA 2091 rTipec eRfxel si deaetidm yb ,C6 sey C6 NTO 8C, adn 7C [In B,LOD giiypnml ti is omre o]ti.aprtnm

peridot  This is on p.498 of FA 2019 for anyone curious +  



 +2 
submitted by delamj(4),
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My guohhtt ecopsrs on tish nuot:seiq

  • keanwsse fo mra itnxoense dna inpnatoro = onudss eikl cmouanluususetco venre C(7C5)-

  • eTcpirs hecsrtt rleexf 8)7C-(;C

R:teuolsu se pciB si 5CC6- so o/r 6C. 8C e'todsn fti naeuscuuoctmlsuo msulce oatcnsi ciaton os ro/ 6C. idnMea nad Railda nreves evah fnriedfte lsuecm tcaonsi so /or those as e,lwl ivlngae tsju 7C btes titfgni hte tetvge.ni

delamj  C8 doesn't fit musculocutaneous muscle actions action so r/o C8.** +1  
lsp1992  I think you have the function of the musculocutaneous nerve wrong. Musculocutanous nerve's motor function is flexion (biceps, brachialis and corachobrachialis) and supination. Musculocutaneous dysfunction would cause weakness of flexion and supination. Weakness of extension would be radial nerve. Weakness of pronation would be median +1  



 +1 
submitted by welpdedelp(242),
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oS I tihnk ahtt usies fo wisrt ieexnnost onadr/ nrifeg odrp dulwo be eorm liarda e.nerv wee,vHor ehret aws omre lpxroiam swnksae,e os it wdlou be C.7

-8"7 lya tehm gt"r,tsiah het pt o'ltucnd ayl" mthe ghtrsia"t so it dluow eb C7 otor

welpdedelp  *As an addition, median nerve involvement would have leaned more toward C8 than C7. +11  
meningitis  Do you have anymore useful mnemonics for brachial plexus? +  
henoch280  FA pg 494 for mnemonics +  
winelover777  Doesn't look like there are many in FA 2019. S1/S2 - Buckle my shoe. L3/L4 - Shut the door. C5/C6 - Pick up sticks. +  
drzed  S2-S4 keeps the penis off the floor :) (cremaster reflex) +  
peridot  What's crazy @drzed is that in FA 2019 it says L1-L2 ("testicles move") on p.498 so I wonder if that changed +  



 +1 
submitted by oslerweberrendu(1),
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Agdcirnoc to rold,Uw ID:Q C779117 omoytem si dnevivlo in lwbeo Letk.nnosoex soi elki it !lessett




 +1 
submitted by azibird(200),

Here is a part of the UWorld table about cervical radiculopathies. And yes they did say that C7 is the most frequently involved. I think the answer is that C6 would involve the biceps, C8 would involve the fingers, and pronation is median nerve. So it has to be C7.

https://imgur.com/a/GvmCUj1




 +0 
submitted by magrufnis(0),
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’Im eodfsnuc oautb sthi oen. eWassenk of oeienxtsn and anoiotrpn fo eht trhig amf,erro hwti a ddreaseec ctpries mclesu trsehtc efe.lxr ehT wraesn was C7 nveer orot, utb owh ear uoy able to lozeilac ot 7C nad ont C6 ro C8? I urfgedi that ntensieox si r,ladia 5,1TC- nad aopiornnt is amnedi, asol C-15.T pTiescr lreefx si -87CC (2AF190 ssay ).7C6C- oHw wlodu you nrwaro donw ot tsuj C7 ?dmaaeg

txallymcbeal  My FA2018 has “C7” bolded, meaning it is the main nerve root. But I also got this one wrong so I can’t be much help besides that. +1  
mnemonia  Honestly just a guess but I have this vague understanding that intrinsic hand muscles are C8-T1 so we might’ve expected more hand motor findings as well with a C8 lesion. +5  
theecohummer  I narrowed it down to C7 using the fact that the C7 myotome is elbow extension. I also learned that the C7 nerve root was the main contributor to the triceps DTR so I just went with that. +  
mchu21  They also mentioned that the person had weakness pronating the right forearm which is performed by the biceps. Biceps is innervated by the musculocutaneous nerve which is C5-C7 and that's what helped me pick C7 > C8. +3  
mcl  Sorry, I thought the biceps was a supinator of the forearm? +15  
henoch280  yes.. its the supinator not pronator +  



 +0 
submitted by feanor(1),

The C7 nerve root is in bold on Page.494 FA 2018 in the Tricep reflex rootlets, That's enough for me lol. This might sound a bit anecdotal but I remember reading somewhere that whenever C8 or T1 goes the intrinsic muscles of the hand are always effected.




 +0 
submitted by nwinkelmann(313),
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rPe k:pideWaii Teh pstirec er,xfel a deep tnndoe erexf,l is a elfxer sa it liciset ilatnyruvno ncaontcotir of teh steripc ircaibh uscm.el It is aititedni yb eht ciCvelar (fo het cken inger)o lniasp envre 7 reven ootr h(te lamsl estgmne of eht veren that seremeg mfor hte ailsnp .rcdo) The exelrf is tdetes as rpat of eth geicouaornll tininmxaoea ot sssesa eth nyrosse and rtoom shpyawat nwthii het 7C adn C8 lipasn svere.n

losA, rmfo a trfedenif :iewebts hTe trcipes lerfxe si edemidat by hte 6C adn 7C evenr ot,ros nnermyapdtiol by 7C. arblmyetupe/.:nyesnlrxedmgoees.tdhnrsmdo.o/ihsr/mt/usreu/ptfuc.ilueuf/.


this is my way to think(please correct me if it's not correct: a. weakness of triceps muscle reflex --> C6 / C7 / C8 problem (FA P498 2019) b. weakness of extension of the forearm --> radial nerve is involved --> damage of C7 root leads to axillary or RADIAL nerve defect (FA P441 2019)

+/- joyceeepan(5),