<prompt> Disc prolapse involving L4 nerve root typically presents with: RepeatWeakness of hip flexionAbsent ankle jerkWeakness of hip extensionAbsent knee jerk  <response>: Ans: D Absent ankle jerk Ref: Harrisons Principles of Internal Medicine, 18th ed.Explanation:Lumbosacral Radiculopathy--Neurologic Features Sec Table 16Neurologic ExaminationDeep Tendon ReflexesL4 Nerve Root L3-4 disc: Patellar Reflex or Knee jerkSI Nerve Root L5-SI disc: Achilles Reflex or Ankle jerkMotor ExamL4 Nerve Root L3-4 disc: Ankle dorsiflexionL5 Nerve Root L4-5 disc : Great toe dorsiflexion extensor haihicis longusS1 Nerve Root L5-S l disc: Ankle plantar flexion gastrocnemius-soleus complexSensory ExamL4 Nerve Root L3-4 disc: Medial malleolusL5 Nerve Root L4-5 disc: Dorsal third metatarsophalangeal jointSI Nerve Root L5-S1 disc: Lateral heelRadicular patterns by disc herniation typeCentral Disk herniationNerve root affected is ABOVE the discExample: Central L3 di.,c herniation causes findings above the L2-3 Nerve rootParacentral disk herniationNerve root affected is AT the discExample: Paracentral disc herniation causes findings at the L2-3 Nerve rootLateral disk herniationNerve root affected is BELOW the disc foraminal effects Table 16Examination FindingsLumbosacral Nerve RootsReflex AbsentSensoryMotorPain DistributionL2--Upper anterior thighPsoas hip flexionAnterior thighL3--Lower anterior thigh Anterior KneePsoas hip flexion Quadriceps knee extension Thigh adductionAnterior thigh, kneeL4Quadriceps Knee reflexMedial calfQuadriceps knee extension Thigh adduction Tibialis anterior foot dorsiflexionKnee medial calf Anterolateral thighL5 Dorsal surface- foot Lateral calfPeroneii foot eversion Tibialis anterior foot dorsiflexion Gluteus medius hip Auction Tne dorsiflexorsLateral calf dorsal foot, teral thigh,buttocksS1Gastrocnemiussoleus Ankle reflexPlantar surface-- foot Lateral aspect -footGastrocnemiussoleus foot plantar flexion Abductor hallucis toe flexors Gluteus maximus hip extensionBottom foot, posterior calf, posterior thigh, buttocksExample: Lateral L3 disc herniation causes findings at the L3-4 Nerve root 