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NBME 18 Answers

nbme18/Block 1/Question#15 (reveal difficulty score)
A 34-year-old man has a herniated lumbar ...
D (Lamina) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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submitted by โˆ—azibird(278)
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A moecylntima srmeeov hte nalami nda nouisps .sperosc heT naamil is teh eirprotso bdignrgi gesntem D.() eTh ertalla niidbrgg egmstne is the iepecdl B)(.

,Hereovw I no'td urtadnnsde woh uyo olucd scesca teh dnahieert dcsi fmor itsh naegl, eht lspina ordc owudl eb ni hte !ayw naC omeonse npaxil?e


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scrambledeggs  Take a look at the section labeled Laminotomy and Discectomy. +7
coby219  "Intervertebral disc (nucleus pulposus) herniates posterolaterally through annulus fibrosus (outer ring) into central canal due to thin posterior longitudinal ligament and thicker anterior longitudinal ligament along midline of vertebral bodies. Nerve affected is usually below the level of herniation." - first aid 19 p455 +5
chj7  Adding to coby219, after knowing herniation most commonly occurs posterolaterally, we would most likely choose between B and D. The only reasonable choice from a surgical perspective would be D b/c we would most likely be entering the patient's vertebrae from the back (thus, B would be harder to access). +1
freemanpeng  Question stem said" laminectomy". I just ingored it and kept struggling between lamina(D) and pedicle(B)...... So, it's not about neurosurgery; it's just basic anatomy! +1

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