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NBME 18 Answers

nbme18/Block 1/Question#3 (reveal difficulty score)
A 34-year-old man who is a potter has burned ...
Syringomyelia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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submitted by โˆ—acerj(13)
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Cpea ilke borndiistuti of ossl of napi and tprumaertee nastonsie ni the C4 ot 1T ttasemmerdoa si alcgnssi orf greisn.iyolaym

Neto tath thuco oetsannis n(eif hocu,t air,vibton et)c si eredevsrp eud ot the lcka fo anrneetgieod in eht CDM.L

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underd0g  How would we exclude ALS? +1
regents  ALS has purely motor findings. The fact that this patient has sensory findings (ie decreased pain and temp) tells you that its not ALS. FA2019 p.518 +2
agraham416  I thought Syringomyelia only affects the spinothalamic tract, compromising pain and temp. Why would you have muscle atrophy and lack of DTRs? I always associated those with some sort of motor component, hence why I picked B12 deficiency (Subacute Combined Degeneration). Sorry if this is a dumb question but this topic confuses me. +1
kcyanide101  @agraham. SCD, affects but the posterior columns and lateral CST. As such the or would have manifested with loss of smooth touch, vibration and proprioception, as well as motor symptoms. It is worthy to not that the syrinx expands from the center, right where the STT crosses. As such it affects them initially, as it expands it can then eventually reach the lateral CST and may even reach the dorsal column in rare case. +

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