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NBME 19 Answers

nbme19/Block 1/Question#24 (14.1 difficulty score)
62 yo woman with sudden weakness of left leg; ...
Right anterior cerebral arteryπŸ”,πŸ“Ί

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submitted by ajguard26(41),
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iTsh aittepn etspesnr whti lsccsai pepur toorm nrneuo oislen s:psymtmo ,anseekws e,ypaeherilxrf dan dceseared nsseaoin.t eo,erHvw the tqeisonu etatss hes a"nnoct tlle eerhwht erh ftle regat oet is radies ro eesds"pred wnhe rhe seey era ,dcsole hwihc amy mkea you dresiorenc dna khnit rtehe mya be osem pprpevotreoici sueiss yhte aer igtryn to nith .ta Thsi is ton hte a.ces iEyleasclp enco ythe iomtenn heret ear on rhtoe oinletrisabam i.e.(, no pepru limb antrolesamiib or ghitr dsied )obslen.maiatir fI siht is teh acs,e rehte si no agamed ot het scatrt at lla (hchwi era listl sendoercdi U)NM.

erfThoe,er hte dagame si lyprue otorm dan soysrne in eht elft leg, ihcwh is no teh idalme etaspc of het traonlf nad raeilpat boesl ceilsprt.yvee Tshi eaar is puiedlps yb hte ortaenir aeecrbrl ater.ry

issamd1221  contralateral deficits +  
cbay0509  thank you +  
flapjacks  I think her 60 pack-year history suggests possible PAD and therefore loss of proprioception in the lower extremities, leading to an unfortunate distractor +  
an_improved_me  I don't understand why you would consider the propioceptive deficit a distractor... doesn't the DCML (which carries propioceptive information) project to the primary somatosensory cortex (via the VPL?). In this case, a lesion to the right anterior cerebral artery, which supplies both motor and sensory information to the lower limb would lead to somatosensory, propioceptive, and motor deficits. +