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NBME 20 Answers

nbme20/Block 2/Question#31

A 25-year-old man comes to the physician 8 hours ...

Rupture of an intervertebral disc

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 +1  upvote downvote
submitted by usmle11a(2),

ok here is how i broke it down: a) wrong because most cases would have some risk factor "old female ..." b) "deltoid" c) under pressure it can burst and frankly it is mentioned in FA as a very common cause. D) i think it would need something like a posterior dislocation of hip. e) would probsbly not cause neruo S $S

 +0  upvote downvote
submitted by stepbystep(0),

does some mind explaining why this isn't a tear in the sciatic nerve?

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 +  

 +0  upvote downvote
submitted by kentuckyfan(13),

Since the pain is radicular, a disc herniation is most likely.

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. +