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NBME 20 Answers

nbme20/Block 2/Question#31 (39.3 difficulty score)
A 25-year-old man comes to the physician 8 ...
Rupture of an intervertebral discπŸ”,πŸ“Ί

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submitted by chandlerbas(100),
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ton uesr if ouy lla heav nees the owlrdu chrta dDx rof bcka iapn but i unfdo ti lealry plhleu.f lil amuzimrse ti r:eeh niicdootn ek(y gvttrei)erd :uafenaee ietroossthriat p(aisonoilt ledeveri htwi )r,ste ucpthadlraioy - sicd toeiiea(adsitharnrn ot teh elg kaa glseaue ngs)i, pnlasi poan(etsinssi wthi nigas)tdn, teyrnyp(lsaloperieodhvd itwh irxc,eees nda idanotmdn at ,srt)e sainlp smssottncsat(enitaa ,npia ewors at n,hgti not lieverde by itosnilpao n,hesa)cg vlebrrtae tooaslmilfcsy(etoei ndeet,rnsse atuce bcak n,iap adn e)e,rfv acotri dsctniosei eev(ers nrtrsesroleta anpi, irtaaignd to eth ca)bk

cbreland  What page in FA is this? +  

submitted by usmle11a(77),
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ok here is woh i ekrob ti w:don )a nwgro acbuese toms assec duwlo hvae emos isrk cafrto "ldo emfela ..b" ). "lo ice)dt"d reund euprsser it acn tsurb nad krfnlya it si detoniemn in AF as a yrev mcomon cs) Da.ue i tinhk ti ulwdo ndee ginhestom eilk a oiseprrto dlsaciinoot fo .pe)ih wolud pbbrysol otn sacue rnoeu S S$

submitted by stepbystep(1),
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edso smeo mndi axinigplne hwy tish t'nis a ater ni eht iactcis e?evnr

sugaplum  It is a very thick nerve, so I think it is hard to tear without physically cutting it. Also if it tore you would have tibial and common fibular nerve symptoms as well. You would see sensory numbness and tingling along the dermatome also the mechanism of injury is focused on spine so a disc rupture is more likely +1  
zevvyt  I got this question wrong but I really like because it helped me get past a confusion I hadon this subject. If it were a tear, you'd see the loss of motor function that sugaplum was taling about(FA 444 2019). But if it's a herniation, like in this case, you see Radiculopathy/Sciatica symptoms that are on 446. +2  

submitted by waterloo(77),

Golijan had a good point about this in CNS lecture (near the end of the first one). Your CSF has tremendous pressure, and if someone tries to lift a ton of weight without breathing, that's basically like doing a major valsalva. That valsalva reduces preload right...and that pressure backs up - up the jugular vein to the sinuses to the CSF --> rupture intervertebral disc. Apparently that can happen cause the pressure can be so severe. I never thought I'd see a question on it though.

submitted by kentuckyfan(43),
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ncieS eht pian si l,arurdica a sidc iiheaontnr is stom lekyi.l

charcot_bouchard  Why it cant be a lumbar vertebra fracture +  
whoissaad  @charcot The patient is young and doesn't have any risk factors for weak bones. Also, disc herniation is a common problem in the young. The disc gets fibrosed and stiff in the elderly so they have less chance for disc herniation. So basically age was the key to answering this question. +3  
lovebug  you are genius! thank you! :) +  

submitted by victor_abdullatif(2),

Quick and dirty way to get this: patient has sciatica (low back pain that radiates down to leg) β†’ 2 etiologies β†’ (1) posterior hip dislocation or (2) intervertebral disc rupture

submitted by step1soon(48),
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caciStai si a ttniibaidelg oitndinco ni hwihc eth tienpat epeisexecrn apin orad/n ipheesrtasas ni teh oibsuiindrtt fo eht iaiscct erven ro an oasdaictse uslamclbaro enrve oro.t nO,etf a omnomc tikaems si errfniger to yan olw kacb napi or rciadular gel nipa as iaa.cicst aiacitcS si pcfiisce to the napi ttha is a crited elruts of siticca erven ro sitaicc vnere ootr .yotlhoagp Teh tisaicc rneve is dmae pu fo eth L4 rghuoht S2 evrne tsoor hcwih laeccseo at eth visple to rfmo teh stccaii .veenr tA up ot 2 cm in aedr,mite hte stcciia erven si aleiys hte eatlrsg eenvr in het ob.yd iccSatai nipa entfo si rdwonsee htwi eolnxif of eht bumral ien,ps tiswtgin, igdb,nne ro oghnc.uig ehT ctciais enerv isveopdr ceditr otmro icotunnf ot het mtsgihra,ns worle exteytrim aocs,urdtd nad crtndiei rtomo cnntfiou ot the lafc escs,uml irnartoe lower egl semul,cs nda osme trsiiicnn foto .slucmse o,Asl linticedyr ghthour tsi itlmenra b,resahnc hte csticia rneev epidsrov sneionsat ot the oertopsri dna rtaleal rolwe gel sa llew sa teh pantlar tfoo.

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