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NBME 23 Answers

nbme23/Block 1/Question#44 (27.4 difficulty score)
A 34-year-old woman is brought to the ...
Area labeled ā€˜Dā€™ (Spinothalamic tract, right)šŸ”
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 +35 
submitted by sajaqua1(464),
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A nad J peenretsr hte glreaic fi,acsuucls ehiwl B nda I etnrepesr eht nteaceu luacsscu.if rgeToeht eyht akem up eht osrdal ni-mlaulcdoem cliamnles tcat,r olrpnbisees fro tpiopinn eorecit,npp ooor,nppcpetiir ,iotiavnrb adn psrersu.e Input is sla.tieapilr

C adn H aemk up the etalral ocitlniaocrsp atcrt (oasl cdelal eth reatall ecsrenparilob i)flacus,ucs ripbeseosln ofr tmroo adomcmn fo patlirliaes ms.ibl

D and G netserrpe hte ltalear aihpilasmtonc ta.crt It si nslerpisobe rof pani nad emreputtrae d.innuoccto eTh utnpi irssae in a blim lf(et wrleo txmyieret ni hist )caes, nertse rouhgth the aorlsd toro prec(tuid beteewn J nda H), udcestssea adn nscesad at hte ietnaorr cmeiumsosr (jtus niedhb E dan ,F) dna lflnaiy ssenspay no eht onsdce erord onrenu ni eth altearl phcaitmliasno crt.ta oS teh mactihsinaplo ctart is esnsrlbepoi orf ralclanettrao aipn dna treuaetpemr s.osnnaeti seuacBe uor iantpet hsa lsto nsitnesao on the e,ftl teh lesnio si in hte grih.t

E dna F aer hte otiraren ocilapnstoric trtca. tI si dvvolnie in rmtoo lornoct of miplorxa cs,eslum iypctllya of the knu.tr

nor16  good job +5  
jimdooder  Pretty infuriating that this question has the standard R and L label while the other spinal cord question had it flipped. +3  
larry  A and J represent the gracile fasciculus, while B and I represent the cuneate fasciculus. Together they make up the dorsal column-medial lemniscal tract, responsible for pinpoint perception, proprioception, vibration, and pressure. Input is ipsilateral. C and H make up the lateral corticospinal tract (also called the lateral cerebrospinal fasciculus), responsible for motor command of ipsilateral limbs. +1  
larry  D and G represent the lateral spinothalamic tract. It is responsible for pain and temperature conduction. The input arises in a limb (left lower extremity in this case), enters through the dorsal root (pictured between J and H), decussates and ascends at the anterior commissure (just behind E and F), and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. Because our patient has lost sensation on the left, the lesion is in the right. E and F are the anterior corticospin +1