A medical student offered to move a grand piano for his landlady. He had just finished his final examinations in anatomy and was in poor physical shape. He struggled with the antique monstrosity and suddenly experienced an acute pain in the back, which extended down the back and outer side of his left leg. On examination in the emergency department, he was found to have a slight scoliosis with the convexity on the right side. The deep muscles of the back in the left lumbar region felt firmer than normal. No evidence of muscle weakness was present, but the left ankle jerk was diminished.
-The symptoms and signs of this patient strongly suggest a diagnosis of prolapsed intervertebral disc except which?
A) The pain was the worst over the left lumbar region opposite the fifth lumbar spine.
B) The pain was accentuated by coughing.
C) With the patient supine, flexing the left hip joint with the knee extended caused a marked increase in the pain.
D) A lateral radiograph of the lumbar vertebral column revealed nothing abnormal.
E) A magnetic resonance imaging study revealed the presence of small fragments of the nucleus pulposus that had herniated outside the anulus in the disc between the fifth lumbar vertebra and the sacrum.
F) The pain occurred in the dermatomes of the third and fourth lumbar segments on the left side.
Correct Answer:
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