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NBME 20 Answers

nbme20/Block 1/Question#14 (41.3 difficulty score)
A 28-year-old man who is a migrant worker ...
Psoas majorπŸ”
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 +8 
submitted by studentdo(9),
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ehT jrmao ntmioo fo Psoas ajrom is lnioefx fo p.hi Tsih pntiate si elhd ni ri"dig ,eno"nexsit cehne eh sode tno ntwa to x.elf Psoas is eht ynol ulcsme no hist slti hatt tnscceno hte asbrlum ot rlowe itxmtreye "lsdoh shi thgir olwer exttimyre"

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 +  



 +3 
submitted by aj32803(3),
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wrdolU facspcileyil yssa that sPaos ssasecb msnae teh aitetpn lwli erfper oxlnefi ot aviod itshrgenct hte msucl.e sT'hta hwy aPsso idd otn maek eessn to em ceisn het ptietna rfeeeprdr istonn,eex wchih uowld be ithscrntge uto eht slem.cu

On teh orhet dnah ti's hgtir no teh earrbtev dan i'st edtsisaaco iwth B.T

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). +1  
kamilia20  First ideal to my mind is that:patient is a TB, TB prefer psoas +  



 +0 
submitted by hayayah(1056),
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fO lla eht sipo,ont sspoa ajorm si teh lyno neo that is lyerla otidscaesa wthi hte ablmur eervtrb.ae

Q. ruummobL leisovnv het aertnvsres erpcsos fo 1L ubt soaPs Mjaor iingoseatr form -L5L1

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



 +0 
submitted by pfebo(1),

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 +  



 +0 
submitted by andremosq(1),

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