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NBME 22 Answers

nbme22/Block 3/Question#19 (41.9 difficulty score)
A 42-year-old man comes to the physician ...
Sensory neuropathy🔍
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 +24 
submitted by k_tron_3000(31),
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So bsaiyacll oprsces of i,itoelimnan I do elfe lkie rosysen rphoaetnuy si an etreylmex uaegv rawnse oguhht adn I antws’ a fan of eht .tiqusneo

keycompany  This is a great rationale. I would like to add on that D is wrong because Radicular Neuropathy of the anterior lumbar roots would (1) be painful [radicular neuropathy is characterized by radiating pain (hence the word “Radicular”); this patient has numbness and tingling, not pain] and (2) because the anterior lumbar roots are the motor roots and do not carry sensory innervation. This patient is having a problem with his dorsal spinal cord (not anterior/ventral). +31  
hello  Want to clarify that "radiculopathy" is not synonymous with pain. Radiculopathy can cause pain, weakness, or numbness. I think the only reason Choice D. was incorrect because it discussed the "anterior lumbar roots", which would affect motor function. +16  
niboonsh  Radiculopathy is damage to the actual nerve itself, wouldnt that make it a LMN lesion and babinski would be negative? +1  
link981  Great explanation guys +  
usmel2020  UW QID: 12035 explains what you are testing with Romberg sign +11  
jurrutia  "Radiculo-pathy" comes from latin terms meaning "root-disease". +  



 +1 
submitted by the_enigma28(42),

In addition to amazing explanation by k_tron_3000, I'd like to add that patient also has numbness and tingling in both legs. So, all sensations to the spinal cord are impaired, hinting towards damage to dorsal horns and hence sensory neuropathy.