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NBME Step 2 CK Free 120 Answers

step2ck_free120/Block 3/Question#120 (reveal difficulty score)
A 47-year-old woman comes to the office ...
S1 radiculopathy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: MSK inc

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 +5  upvote downvote
submitted by โˆ—mmizell(26)

So I was between L4 and S1 radiculopathies on this one and couldn't remember the sensory/motor/reflex losses that differentiated the two. Here's a summary (including L5 for completeness)

L4 Radiculopathy:

  • sensory loss: distal lateral thigh over patella to medial calf
  • motor loss: knee extension, tibialis anterior (foot dorsiflexion) โ†’ difficulty heel walking
  • reflex loss: patellar reflex

L5 Radiculopathy:

  • sensory loss: Dorsolateral thigh, lateral side of the knee, anterolateral lower leg, dorsum of foot, big toe
  • motor loss: Extensor hallucis longus muscle (first toe dorsiflexion) โ†’ difficulty heel walking (foot drop)

S1 Radiculopathy:

  • sensory loss: Lateral foot
  • motor loss: Peroneus longus and brevis muscle (foot eversion) and gastrocnemius muscle (foot plantarflexion) โ†’ difficulty toe walking
  • reflex loss: Achilles

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 -2  upvote downvote
submitted by โˆ—bwdc(697)

Sciatica. (Comments must be between 40 and 1,925 characters!)

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mmizell  She had decreased DTR in the achilles reflex of the affected limb and decreased sensation to light tough over the lateral and inferior aspect of the foot --> S1 radiculopathy. She has sciatica, but the sciatic nerve encompasses roots from L4-S3, so that doesn't really help narrow down the answer.,single%20nerve%20in%20the%20body. +
nbmehelp  what is the point of even commenting "sciatica" without further elaborating? how is that helpful? +

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