On physical examination, the physician notes that - jcbc

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A 62-year-old man is seen in an emergency department because of severe pain
in his lower back, Ieft buttock and the posterolateral aspect
of his left leg. The pain began acutely after he lifted his 8-year-old granddaughter
into the back of a truck, and he describes it as "shooting" in
nature. When examined by the physician, he has curled into a fetal position,
which he says relieves the pain. Attempts to extend the man's
spine cause a marked exacerbation of the pain.

1. On physical examination, the physician notes that spasm is occurring in the large
muscles on the posterior aspect of the thigh. Which of the
following muscles is most likely involved?
/ A. Adductor longus
/ B. Biceps femoris
/ C. Gastrocnemius
/ D. Sartorius
/ E. Soleus


2. More detailed examination demonstrates foot drop with weakness of the anterior
tibiaI, posterior tibiaI, and peroneal muscles. Sensory loss
is demonstrated over the anterior shin and dorsal foot. These findings suggest a
radiculopathy at which of the following cord levels?
/ A. C-7
/ B. L-5
/ C. S-3
/ D. T-9
/ E. T-12


3. PIain spinal x-ray films show disk space narrowing in the involved area of the
spine, and herniation with protrusion of the nucleus pulposus of
one disk is demonstrated by CT scan. The normal location of the disk is between
which of the following?
/ A. The body of the superior vertebrae and the body of the inferior vertebrae
/ B. The inferior articular process of the superior vertebrae and the superior
articular process of the inferior vertebrae
/ C. The pedicle of the superior vertebrae and the pedicle of the inferior
vertebrae
/ D. The superior articular process of the superior vertebrae and the inferior
articular process of the inferior vertebrae
/ E. The vertebral canal of the superior vertebrae and the vertebral canal of the
inferior vertebrae




4.The nucleus pulposus is composed of which of the following?
/ A. Cancellous bone
/ B. Compact bone
/ C. EIastic fibrocartilage
/ D. Hyaline cartilage
/ E. White fibrocartilage



5. A principal component of the intervertebral disk is collagen. Cross-Iinking of
collagen to form a more stable structure requires the use of a
vitamin C-dependent enzyme that can hydroxylate which of the following amino
acids in procollagen?
/ A. Asparagine
/ B. Cysteine
/ C. Proline
/ D. Serine
/ E. Valine