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NBME 19 Answers

nbme19/Block 1/Question#24 (14.0 difficulty score)
62 yo woman with sudden weakness of left leg; ...
Right anterior cerebral arteryπŸ”,πŸ“Ί

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submitted by ajguard26(40),
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Tshi napiett tssperen with alscisc rppeu morot nunreo ioseln mtyss:pom ,nasewkes rxyiere,alehpf adn edaderecs .nosaistne wo,eerHv the eutinsoq setats hes nac"otn lelt ehtwreh ehr etlf tgrae ote si eaidsr or speedr"dse hwen rhe seye ear deso,cl ihcwh yma emak yuo cseoirednr dan khtin teher mya eb esom ieprocpepirovt sessui yhte rea nrtiyg to tnih at. iTsh si nto het .scea plyEsilcae nceo htye omiennt hetre ear no ehrot neiarlsaibotm .,.ie( on uperp lbim iteisnabalrom or gthir edisd a)ali.mtniberso If ihts is the easc, eehrt is no geamda to het rtcast ta all (cwhhi era itlls dcrnidesoe NU)M.

rerf,eeoTh the amdgea is lryepu omort dna nrsyseo in eht tfel ,leg hhcwi is on hte aemldi satecp fo the atrfnol nda atraipel sebol pyterc.evelsi ihTs eara si splipedu yb eht notierar arleberc yater.r

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. +