Mr. Mohan developed quadriplegia following a diving accident. The most likely cause is?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2020

Medical Surgical Nursing

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2020

Explanation

Quadriplegia, also known as tetraplegia, is the paralysis of all four limbs (arms and legs) and the torso.
This condition results from an injury high up on the spinal cord, specifically in the cervical (neck) region, which contains vertebrae C1 through C7.
A C4 injury damages the spinal cord at a level that affects nerve signals to both the upper and lower extremities.
Diving into shallow water is a common mechanism of injury that causes hyperflexion or compression fractures of the cervical spine.

Option B: An injury to the thoracic spine (T-spine) results in paraplegia, which is paralysis of the lower half of the body. Arm and hand function remain normal.
Option C: An injury to the lumbar spine (L-spine) also results in paraplegia, affecting the legs and pelvic region. Upper body function is unaffected.
Option D: Similar to a T3 injury, a T6 injury causes paraplegia. Injuries at or above the T6 level are particularly associated with autonomic dysreflexia.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Spinal Cord Injury Levels and Associated Deficits as background academic context rather than a clinical decision trigger.
Immediate management of a suspected spinal cord injury from a diving accident involves strict spinal immobilization (e.g., cervical collar, backboard) to prevent further neurological damage.
For a C4 injury, the priority nursing assessment is respiratory function. The phrenic nerve, which innervates the diaphragm, originates from C3-C5. An injury at this level can cause respiratory arrest, requiring immediate ventilatory support.
What if? If the patient had developed paraplegia instead of quadriplegia, the injury would most likely be in the thoracic or lumbar spine (e.g., T6 or L3). The immediate concern would shift from respiratory failure to risks like neurogenic shock and autonomic dysreflexia (for injuries at T6 and above).

How to Approach the Question

First, identify the key clinical finding in the question stem: the patient has "quadriplegia".
Recall the definition of quadriplegia: paralysis affecting all four limbs (arms and legs).
Next, relate the type of paralysis to the anatomical level of the spinal cord injury. Remember the general rule: the higher the injury on the spinal cord, the more extensive the paralysis.
Specifically, recall that injuries to the cervical spine (C-spine) cause quadriplegia, while injuries to the thoracic (T-spine) or lumbar (L-spine) spine cause paraplegia (paralysis of the lower body).
Evaluate the given options: C4 is a cervical injury. T3, L3, and T6 are thoracic or lumbar injuries.
Based on this, conclude that a C4 injury is the only option that would result in quadriplegia.

Concept Tested & Keywords

Concept Tested: Spinal Cord Injury Levels and Associated Deficits
Stem keywords: quadriplegia, diving accident, spinal cord injury
Lead-in keywords: most likely cause
Clinical cues: The patient developed quadriplegia, which is the key diagnostic sign pointing to a cervical spine injury.

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