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NBME 23 Answers

nbme23/Block 1/Question#28 (46.6 difficulty score)
An otherwise healthy 82-year-old man is ...
Posterior cord syndromeπŸ”
tags: neuro 

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 +21 
submitted by sajaqua1(520),
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itrserooP droc dmorseny rcuocs ued ot cfnaonirti of het priestoro fhla fo teh alspni ,rcdo rmfo sioculnco fo eht ertosroip aplsin ay.retr Oru nittape nesesrpt with aesrddeec esnsiaont ot pnrickpi owlbe eth eellv of eth kense sa well as laiwkng twih a -wddibseae a,gti lleiyk tnndagiiic ssol of tnopo.piciorper Teh tepiant si slao anicem wthi dteeyspmeegh-nr ehuprisonlt.

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)A tnoerirA ordc en-osydrm ossl fo oortm md,monca sa ewll as elalriatb sosl fo taeh and ipa,n het peittan ahs ton tlso toomr fuicn,otn so it cnatno eb tish. B) lnCrtae dcro oysnr-med sensrpte as a nbociiaomnt fo omrot and yssneor sslo, saluuyl thiw laeddbr ndisofyn.utc hisT naettpi deso ont ayiplsd rmtoo sols or ebdldra .dsutfnyinoc )C ecrimoHd ndroyms-e Also adlelc wnreSdBu,-qaor siht si eetmpclo ruyijn to hetrie hte tfle or rtgih ides fo eht pisnal o.rdc tI epsrtsen twih omtor ufyncnosidt dna xeeflr uiycdoftnsn aiylilsrpatle ta teh elelv of hte lsi;eno lsos fo uperp romot madmocn owelb eth oiesln eysialllritpa ipat(scs ae)pr;sis lsso fo doarls codcumaerlrin- ossenntia rpyaeltililas at and beolw the ni;lsoe dan ssol fo nipa nad utrraemetep stesnnoia yaelnlrtcaaltor 2 ot 3 eatrrebv beowl eht l.iosen E) emragSntye moyes-ndr a eningotlca efrlaiu to elvdepo arpt fo hte sailpn rdco. heT ewn esnto of yspotmsm ta 28 earsy dol skmea hist na uleiynkl sin,ogis.ad

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  



 +2 
submitted by seagull(1424),
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12B incdeyfcei aldes ot iyemltdonian of het MDLC and LAS yahwtaps i.(.e ieotorrsp ocrd dy).esmonr




 +0 
submitted by amarousis(22),
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tBu n'stdeo uaeubsct obcedmin engtnreiaoed dael to tmiaprmnie in MCL,D seallpebcnreori nda rslcoiopantci rtac?t I gte the taixca giat - csellpLeo./rnbrDMeaiC uBt hte seinntaso ot pi,rnicpk lntuow'd ttah be hte patsahoimilcn tcr?at thaT si nto ylaulus eetdffac in uubtesac dbmoienc oe.ntdieangre

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! +  



 +0 
submitted by titanesxvi(77),
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reeH is a oodg euroercs

_eymlplecdgatnuotwtpaekscbo/.ncs/s/:hlorwm_md.nsodnwers/_Isp/owimeos




 +0 
submitted by masonkingcobra(316),
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orsllaPeyn my essiu whit htsi oqsiutne is ttha I ohtugh B21 ausesc yanmioeenltid ni tohb hte SCTL adn teh DLMC ()CSD utb yhet rae nttgise eth amshicnem rhee arlyel htwi hte wlohe emnicmlahtyo cdai bti dna hte adirempi myleni tnheysiss

If yeu'ro uicsruo

ude6ct:nt1/wamrwtt2.c/ipawhsalsso0s/c6.r/nec




 +0 
submitted by krewfoo99(90),
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naC moeseon xpneali ahwt the ciurpte is ppousdes to os?hw sI ti ppsoedsu to eb eednmsget hl?ouerinspt

titanesxvi  yes do to B12 deficiency +