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NBME 20 Answers

nbme20/Block 1/Question#14 (45.7 difficulty score)
A 28-year-old man who is a migrant worker ...
Psoas major🔍,📺
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 +9 
submitted by studentdo(10),
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hTe mrajo inmoto of sPaos moraj si lnieofx fo p.ih Tshi nepttai is lehd ni irg"di ex"stnen,oi ceneh he esod ton anwt to exfl. sasPo si hte onyl clumes on isth tisl taht nncstcoe teh rasbulm ot wlore erixymtte "dolhs sih rtghi eolrw mxrttieye"

myoclonictonicbionic  The qstem said "lower extremity in rigid extension" which made it sound like extension at the knee joint rather than at the hip. Confusing wording +2  
j44n  if you lay on your back and kick your leg straight up this is lower extremity extension, hes doing that to prevent any weight being placed on his psoas, I know because ive had psoas problems before and you will do ANYTHING to keep your hip from flexing (like doing a sit up or pulling your knees toward your chest) getting in and out of a car was a nightmare +  



 +4 
submitted by aj32803(4),
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Urwold afcillypsiec says atth oPssa saecsbs msnae eht petatni lliw rerpfe lxfnieo ot advio ishrncgett teh u.cselm 'Tsaht wyh sPsoa did not make nsese ot em ncsie het tpitena frederrep it,xnsnoee ciwhh duwlo be istngcehtr tuo eht ecumsl.

nO teh ohter hnda 'tis hgitr on eht earvertb dna its' csoetsiaad tihw BT.

adong  it's confusing but i think b/c psoas acts to flex at the hip, staying completely flat would keep the muscle from being contracted. uworld is talking about the psoas test which would end up hyperextending the psoas muscle which would elicit pain (psoas test can also be done with active flexion against pressure which would explain the not wanting to flex). +2  
kamilia20  First ideal to my mind is that:patient is a TB, TB prefer psoas +  



 +0 
submitted by andremosq(6),

Psoas muscle is located in the lower lumbar region of the spine and extends through the pelvis to the femur. This muscle works by flexing the hip joint and lifting the upper leg towards the body. The patient pain is when he flexes his leg and difficulty/pain when trying to stand in a fully upright posture...also, the question says the infection spread from the lumbar spine ... only flexor in the answer choices is the psoas muscle.

https://my.clevelandclinic.org/health/diseases/15721-psoas-syndrome




 -1 
submitted by pfebo(5),

Psoas sign - pain with hip extension

It can also present in adute appendicitis

djeffs1  but this is the opposite of psoas sign. Pt prefers hip extension +  



 -3 
submitted by hayayah(1101),
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Of all eht ,osnipto aposs omjar si eht noly oen atht si erlayl acosesitda twhi het mbraul .bteeraver

.Q mrmoLubu inoselvv eht netsevrras oercssp of L1 btu Psaso raoMj iortiaegsn mofr 5L-1L

imnotarobotbut  QL is connected to L1-L5 vertebrae as well (https://en.wikipedia.org/wiki/Quadratus_lumborum_muscle) +