On physical examination, the physician notes that - jcbc

[ArchivalUser]

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

[ArchivalUser]

B
B
A
E
C

[ArchivalUser]

Hey jcbc, where are you and wats the follow up to your question? Answers of course, so i;m waiting.

[ArchivalUser]

Explanation - Q: 1.1
The correct answer is B. The biceps femoris is the only muscle listed that is
in the posterior compartment of the thigh.
The adductor longus (choice A) and the sartorius (choice D) are in the
anterior compartment of the thigh.
The gastrocnemius (choice C) and the soleus (choice E) are in the posterior
compartment of the leg below the knee.


Explanation - Q: 1.2
The correct answer is B. The findings are typical for involvement at the L-5
level. Most ruptured disks involve either the lumbar area (L-5 and S-1 most
common) or the cervical area (C-6 and C-7 most commonly). Compression
by a disk of the cervical cord can produce a spastic paresis of the lower
limbs; compression of the cauda equina can cause urine retention or
incontinence.
C-7 (choice A) supplies the back of the shoulders, down the back of the
arm, past the elbow, to the back of the second and third fingers.
S-3 (choice C) supplies a small area on the buttocks.
T-9 (choice D) supplies a band on the abdomen and back that passes above
the umbilicus.

Explanation - Q: 1.3
The correct answer is A. The disk lies between the bodies of the vertebrae,
cushioning the bones to allow for smooth motion. When too much pressure is
placed on the spine, a disk can bulge or rupture (herniated disk). The pain of
disk herniation may begin abruptly after an obvious inciting event (as in this
case) or may be insidious in onset. In many patients, the pain is worsened by
Valsalva maneuver, coughing, laughing, or straining at stool. Patients without
symptoms of spinal cord compression, cauda equina compression, or severe
neurologic deficits related to peripheral nerve root involvement are often
treated conservatively, since up to 95% recover without surgery. Surgical
repair is used in symptomatic patients, or those with more severe or
persistent cases.
The superior and inferior articular processes (choices B and D) form the
surfaces for the joints between the posterior aspects of the vertebrae.
The vertebral canal (choice E) contains the spinal cord, and the pedicle
(choice C) contributes to its posterior margin.


Explanation - Q: 1.4
The correct answer is E. The disk contains a soft, centrally located nucleus
pulposus, surrounded by the protective shell of the annulus fibrosis. The
nucleus pulposus is composed of white fibrocartilage.
The disk contains no bone (choices A and B).
Elastic fibrocartilage (choice C) is found in the larynx, epiglottis, and ear.
The disk has a thin outer layer of hyaline cartilage (choice D), but this does
not involve the nucleus pulposus.



Explanation - Q: 1.5
The correct answer is C. The amino acids proline and lysine in collagen are
hydroxylated by two vitamin C-dependent enzymes, prolyl- and lysyl
hydroxylase, respectively. Hydroxyproline plays an essential role in stable
triple helix formation. Cysteine residues form disulfide bonds also important
for a stable collagen structure, but hydroxylation plays no role in this process.
The other amino acids listed are not hydroxylated in the process of collagen
cross-linking.

[ArchivalUser]

Thanks, just saw your posted answers.