Neonatology: Klumpke palsy: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Neonatology: Klumpke palsy

Sample item

After a difficult breech delivery, a newborn has a weak hand grip, paralysed wrist and finger flexors, and a claw hand. The same side shows ptosis and a small pupil. Which nerve roots are injured?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. C8 and T1

Klumpke paralysis follows traction on the lower plexus, injuring C8 and T1. It causes intrinsic hand weakness and, when the T1 sympathetic fibres are involved, an ipsilateral Horner syndrome, which indicates a poorer prognosis.

Option by option

  • A. C8 and T1 (correct)

    Correct. Lower plexus injury paralyses the hand, and T1 involvement causes Horner syndrome.

  • B. C4 and C5

    These roots supply the diaphragm and shoulder; injury causes respiratory involvement, not claw hand.

  • C. C5 and C6

    These upper roots give Erb palsy, with the arm adducted and internally rotated and hand function preserved.

  • D. C6 and C7

    These middle roots give wrist drop and triceps weakness, not a claw hand with Horner syndrome.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, C8 and T1. Klumpke paralysis follows traction on the lower plexus, injuring C8 and T1.

Why is "C4 and C5" not the answer?

These roots supply the diaphragm and shoulder; injury causes respiratory involvement, not claw hand.

Why is "C5 and C6" not the answer?

These upper roots give Erb palsy, with the arm adducted and internally rotated and hand function preserved.

Why is "C6 and C7" not the answer?

These middle roots give wrist drop and triceps weakness, not a claw hand with Horner syndrome.

What concept does this question test?

It tests Neonatology: Klumpke palsy in Pediatrics. It causes intrinsic hand weakness and, when the T1 sympathetic fibres are involved, an ipsilateral Horner syndrome, which indicates a poorer prognosis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neonatology: Klumpke palsy?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.