invite friends ⋅ share email twitter ⋅ join discord whatsapp(2ck)
support the site ⋅ become a member ⋅ unscramble the egg
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 

NBME 21 Answers

nbme21/Block 4/Question#37 (43.3 difficulty score)
A 66-year-old right-handed woman develops the ...
Area labeled 'B' (Internal capsule)🔍
tags:

Login to comment/vote.


 +10 
submitted by hungrybox(831),
unscramble the site ⋅ become a member ($35/month)

Foillnwgo a ,tkroes sith aentpti dha kseneswa of hre felt faec nda doy,b so hte srekot msut hvea faetdcfe eth tgirh sdei of her rabn.i B swa the olny hoecic on eht rhgit dsie of rhe nbi.ra

tliSl onefuc?sd eaRd o..n.

eTh nyartuolv tormo berfsi c(ciatoirnplos t)artc nceesdd mofr eth pyirram torom oxrtce, oscrs sua(s)teecd at teh luerdaylm yp,imdasr adn ehnt npessay at teh itoreanr rtoom ohrn of the sianlp e.llev

Bueceas fo tcoinasdsue ta teh ldelarmuy yasdri,pm ouy ldhous aekm a ento fo eewrh yan terkso cocs.ru Is ti baveo eth alrmludye im?sdrpya heTn ti lliw eftcaf eht ieds epsopoti hte kreots c(atanr)oltrl.ae Is ti obwel teh elamldury sadiyrmp? nThe ti lliw efcaft eht esam ised sa teh tkesro aell)apir(ti.s

hungrybox  Woops, E is also on the right side (also remember that imaging is looking up at someone, feet first). But a cerebellar stroke would have caused ataxia. +  
mnemonia  Very nice!! +  
usmleuser007  What gets me is that they mention that Left 2/3 of face is affected. This should indicate a non cortical innervation as most of the cranial nuclei are bilaterally innervated from the left and right hemisphere. If left 2/3 of the face is affected then it should also mean that the lesion is after CN5 nuclei. +1  
yotsubato  @hungrybox Thats not the cerebellum thats the occipital lobe. You would see leftsided homonymous hemianopsia in that lesion +7  
mrsmac  To my mind, it is simpler to consider the question first in terms of blood supply distribution. Left sided hemiparesis and weakness of lower 2/3 of face are both indicative of a MCA rupture/stroke (First Aid 2018 pg. 498). Furthermore, since the injury has affected motor function we would be considering the descending tract i.e. lateral corticospinal which courses through the ipsilateral posterior limb of the internal capsule then decussates in the caudal medulla. +1  
mrsmac  You're considering the wrong CN here. CN5 motor function involves muscles of mastication and lower 2/3 of tongue. The nerve in question in this case is CN7/VII Facial n. CNVII UMN injury affects the contralateral side, whereas LMN injury affects ipsilateral (First Aid 2018 pg. 516). i.e. before and after the nucleus in pons respectively. I hope this helps. +2  
nala_ula  Spastic means UMN lesion, since they also don't specify if there is arm or leg weakness, I didn't assume it was MCA stroke. I went with the reasoning that for there to be spastic hemiparesis, there must be damaged to the UMNs and therefore the internal capsule is where these tracts are. +  
champagnesupernova3  Omg this whole discussion is confusing. Internal capsule contains ALL corticospinal and corticobulbar fibers = contralateral hemiparesis and UMN facial lesion +16  



 +3 
submitted by divya(49),

simply internal capsule has corticospinal and corticobulbar tracts pass thru it, hence the c/l hemiparesis of body and face.

If at all they want to know what specifically passes thru ic (which is practically NEVER), then anterior limb - thalamocortical tracts, genu - corticobulbar, posterior limb - corticospinal, all sensory




 +2 
submitted by zevvyt(21),

A= Caudate ( flanks Lateral Ventricle) B= Internal Capsule, between Thalamus and Lentiform Nucleus( Putamen, GP) C= Thalamus( Flanks 3rd Ventricle D= Temporal Lobe E= Occipital Lobe




 +1 
submitted by burak(43),
unscramble the site ⋅ become a member ($35/month)

aeiPtnt dah atrceln lfacia evnar aegadm 4 tfle ipmresihae;s nad lal het iemags rea ormf eht a.nrbi itErhe eh sha daegma ot rlaertalocnta ritalcoc seraa hihcw espertern ehtes secrtusrut or -ricpslcnlaoiopottcicsirona enrve mg.edaa

anIrltne sepaucl eoirpsrto :blim poircaltsCoin motro nda nysosre uvr :eGnesen bcaourCobtrli r iftinoAbeesrr bilm: carilolmtTcaoha srbefi

Syormndse eudcsa by IC aemad:g Puer ootrm peaime,srshi rePu snrosey ,osterk a-p,aiimeAilgthxe srmtaCs-hlryDiuay dhan

burak  corticospinal-corticobulbar* +  



 +0 
submitted by sahusema(125),
unscramble the site ⋅ become a member ($35/month)

esnitPta twhi na ilnerant eapclus etsork cymomonl ahev ruep tomor weaenssk fegtiacnf hte aallcrotrtaen ,mra elg, dna elwro a.cfe larltnCeatora iticssytpa or rsicdneea nteo whit leyrerpheifxa ear soal sren.pte