1. Step 6
1.1. Review session 1
1.1.1. Summary of step 5
1.2. Report new knowledge
1.2.1. Anatomy of the lower back
1.2.1.1. Sacral and lumber vertebral column
1.2.1.2. Lumber and sacral plexuses
1.2.2. Common injuries in labors
1.2.3. Mechanism and diagnosis of disk herniation
1.2.3.1. how can it cause sciatic nerve injury
1.2.3.1.1. picture
2. Step 7
2.1. Inquiry plan and info gathering
2.1.1. Chief complaint
2.1.1.1. Male working in lifting came to the hospital limping because of a back pain after lifting a box, the pain is radiated to the leg and foot.
2.1.1.2. age?
2.1.1.2.1. middle age man
2.1.2. History of presenting complain
2.1.2.1. SOCRATES
2.1.2.1.1. Site
2.1.2.1.2. Onset
2.1.2.1.3. Characteristic
2.1.2.1.4. Radiation
2.1.2.1.5. Associated symptoms
2.1.2.1.6. Timing
2.1.2.1.7. Exacerbation / alleviation
2.1.2.1.8. Severity
2.1.3. Previous medical / surgical history
2.1.3.1. a bit of bad back as long as he remembers
2.1.3.2. no previous surgeries
2.1.3.3. no cancer
2.1.3.4. twisting and stumbling to one side while unloading a truck
2.1.4. Drug history / allergy
2.1.4.1. took pain killers "parasitamol"
2.1.4.2. not allergic to drugs
2.1.5. Family history
2.1.5.1. no chronic dieseases in the family
2.1.6. Social / occupational history
2.1.6.1. been working for many years
2.1.6.2. has a distress , not satisfide with work
2.1.6.3. no drug abuse
2.1.6.4. no smoking or drinking
2.1.7. Systemic review
2.1.7.1. No problems in urinating
2.1.7.2. No wight loss
2.1.7.3. No fever
2.1.7.4. No morning stiffness
2.1.8. Physical examination
2.1.8.1. vital signs are normal
2.1.8.2. BMI is not known
2.1.8.3. Looks depresses
2.1.8.4. inspection
2.1.8.4.1. loss of lumber lordosis
2.1.8.4.2. no swellings
2.1.8.4.3. no redness
2.1.8.4.4. no atrophy
2.1.8.4.5. no scars
2.1.8.4.6. gait
2.1.8.5. palpation
2.1.8.5.1. mild tenderness
2.1.8.5.2. wormth
2.1.8.6. Range of motion
2.1.8.6.1. in the lumberspine
2.1.8.6.2. Knee and hip are normal
2.1.8.7. Special tests
2.1.8.7.1. straight leg
2.1.8.8. neurological examination
2.1.8.8.1. L5
2.1.8.8.2. S1
2.1.9. tests results
2.1.9.1. MRI
2.1.9.1.1. Sagittal
2.1.9.1.2. Axial
2.1.9.1.3. Coronal
3. Step 8
3.1. Diagnostic decision
3.1.1. large L5 / S1 disc prolapse (disk herniation)
3.2. Mechanism
3.2.1. nature of the work
3.2.2. herniation that irritates the nerve roots
3.2.3. depressing
3.2.4. aging
3.2.5. long duration of work
3.2.6. the twisting
3.3. Presentation
3.3.1. Back pain
3.3.2. pain in the posterior thigh, shooting threw the leg (sciatica)
3.3.3. loss of sensation of lateral foot
3.3.4. limping
3.4. Supporting data
3.4.1. MRI shows strong herniation
3.4.2. positive straight leg test