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NBME 23 Answers

nbme23/Block 1/Question#28 (46.3 difficulty score)
An otherwise healthy 82-year-old man is ...
Posterior cord syndromeπŸ”
tags: neuro 

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submitted by sajaqua1(518),
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tsoeirrPo droc nmysdroe uscorc eud ot otianricnf fo hte ioeporrst lhfa of hte lispan dr,oc from lnsoiccuo fo eth rrtosipoe npsila Our eiptnat tsnsrepe htiw ecdseaerd nantsesoi ot ipickrpn lboew teh vlele fo eth nesek as ewll sa lwaking whit a w-deeasbid gi,ta kllyei indnacgiti olss of roercnpo.oipipt Teh ittneap si laos ecianm hiwt esdr-eetnpegmyh pior.ulnhset

metpdregeyesHn unrltoehpis rae ilycatlpy aduesc by an biiyntila ot kmae ngehuo DNA, cedaus by a lack fo ecsysaenr prrucosres dan vainmsit inldcnugi B9 )otel(fa nad 2B1 (bc)ailoman. fI the iaepntt si tolfea int,fdceie ew see taeveedl iscomeyhneto ecciifenyd. fI het epitatn si B21 niftiec,de ew ese eadveetl oteiylmacnlmh adic nda yihoectsnmoe ee.lvls nhtsiyHpyoereecmaoim nac rseenica hsrm.ibstoo Tsrboisomh ni teh trespoiro aipnsl ertayr can ucsea ooiretrps rcod omed.synr nI itia,nddo lcak fo imtavni 12B airpism eyilnm mtrnooiaf and asled to tebaSuuc Cnomdebi gatrneDe,neio ciwhh tffesac hte aSnlmiphtcoai cartt ungcntocia( orf ecedsreda irnpkcpi atesns,o)in nCtooaipisrcl cT,tar nad lroasD l-laminodCMue sicmsLneu aTtrc cant(ocuign rfo eth eudedrc opo.cntprepiiro

A) irnoreAt rdoc ny-smerdo lsso fo oormt momcnda, sa ewll as aitreball lsos fo heta dna ,npai het tpneita has nto oslt toomr ionunft,c os ti oactnn be )B rnaClte codr dmnyo-esr eprstsne sa a nmoioiacbtn of otomr adn nosesry l,sos yaluslu iwth rdldbea con.sdunifty hiTs naeptit esdo not aplidsy toomr sslo ro ddalrbe otidfnyu.nsc C) demoHrci eyd-morsn Aols alldce nwrBodea-Sq,ur shit si cetemopl nryjiu ot ehiter eht eftl ro ghrti iesd fo the npisal rdoc. tI sneperst tihw motro tfidsunnoyc nad elexfr sfuconynitd erlltiaailpsy ta teh llvee of eth nlo;sei slos fo pruep tomor omndcma olbew the nilose iepytrllailas scptais( esp)ias;r slos of asdolr rauoemcndc-ilr ssanenito ytlripleaslai at and blweo hte s;onlie dna slso fo nipa dna tpaeeetmrru inntosesa ctearaloytnrall 2 to 3 vetrarbe blweo teh l.osein E) reSntamyge seod-nrmy a altioecngn lueafir ot doeelpv rpat fo hte spnial o.drc ehT new oenst fo ysmomspt at 28 aeyrs ldo aemsk htsi an ylileknu ,i.gadosnis

yb_26  amazing, thank you! +  
aisel1787  great explanation +  
rockodude  sensation to pinprick is DCML tract. SCD affects spinocerebellar (not spinothalamic), corticospinal, and DCML. otherwise good explanation. +1  
azibird  Sensation to pinprick is not dorsal column-medial lemniscal tract, it's spinothalamic tract. So this patient has a lesion of the dorsal columns, spinothalamic tract hypersegmented neutrophils, and anemia. What the hell is going on? How is this just posterior cord syndrome? Spinothalamic is not posterior cord. +4  

submitted by seagull(1391),
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12B iecifenycd ledas to atilidnnyoem fo eth LDCM adn LSA pshwyata (i..e rpsoetori drco d)nymeors.

submitted by amarousis(22),
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tuB sontde' esuatbcu bmidceon eernieogtand dela to ieamnmitrp in C,LMD lnelracesribeop adn iotccipnoarls ?crtta I get teh iaatcx tiga - sDnoeile/ec.rlLparbCM uBt eht snnostaie ot p,nikcrip uwodtn'l tath be het shicnmltapaoi ta?trc Ttah si ton allsuyu afefectd in stbeucua mbidnceo eotiarnngee.d

krewfoo99  It would affect the dorsal column tract and the spinothalamic tract. It wont affect the spinocerebellar tract (Thus Rombergs sign in B12 deficiency will be positive) All three of the tracts are affected in Friedrichs Ataxia +  
krewfoo99  Sorry. Just checked on FA. It will also affect the spinocerebellar tract +  
spow  Sensation to pinprick is DCML +  
meli  UWORLD ID:65 "many patients develop neurologic manifestations due to: axonal degeneration of the peripheral nerves, leading to numbness, paresthesia, and depressed motor reflexes." So, I think the sensation to pinprick was describing the paresthesia! +  

submitted by titanesxvi(77),
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Heer is a ogdo erroecus


submitted by masonkingcobra(313),
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alsrlePyon ym esius itwh tsih tsqieuno is tath I thguho B21 euscas dyonnaltiemei ni bhot eht TLSC nad eht LDMC CS)D( tub thye aer iegsttn teh caeshimmn hree lleyar twih hte heolw lmhtnmaociey adic tib adn eth ameiipdr emliyn estsynhis

fI ouer'y iusrocu


submitted by krewfoo99(88),
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Cna mseooen lxnpeia thwa hte reucpit si uspdoesp ot ?shwo Is it epdusspo ot be nmegedtse e?hrpoisnult

titanesxvi  yes do to B12 deficiency +