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NBME 20 Answers

nbme20/Block 2/Question#31 (36.9 difficulty score)
A 25-year-old man comes to the physician 8 ...
Rupture of an intervertebral discπŸ”

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submitted by chandlerbas(95),
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not rseu fi uyo lal have enes het rduwlo htarc xDd rof acbk niap tbu i oufdn it rlelya hlpf.ule lil miuzesram it :eehr coiotinnd ey(k e eru:grfe)tenadvitea trosirittesoha ootsiln(pia eveledri twhi et,rs) hducripyaltao - sicd eadsoarneaiit(trinh to eth gel aak lgeaues i),gns pnails esstpsaonn(ii wthi gnsadit)n, lys(vdioapledretnyeorhp wthi eixcsr,ee nad nanomddit at esrt), plasin tamstaoatnnssei(cst ,iapn eorws at nh,tgi not eevelidr by lasioitonp )c,sgahne avertrebl syeoief(lmscoloitat tnsnes,rede caetu kacb na,ip and rev),fe iactor ciisnoetsd ee(rsve atnorrrlesset i,nap atgriiadn to hte ak)bc

cbreland  What page in FA is this? +  

submitted by usmle11a(73),
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ok hree is woh i erokb it wond: a) ngrow becseua tsmo acsse wdoul vhea emso skir ofctra lo"d fmelae b.").. d" olitc"d)e renud rssuerep it anc tubrs adn lkafnry it si nneedotmi in FA as a yevr monmco )e.Dusac i htkni ti lwoud dnee nietosmgh eilk a roirstope acidoniostl fo pei h.) wudlo prbylsbo otn casue nureo S S$

submitted by stepbystep(1),
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esdo omse mndi ngipeaixln why shti nist' a trae in the stcacii neev?r

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(71),

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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ciSen teh naip si al,arirudc a dcsi oaitienhnr si otsm

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(0),

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(45),
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