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NBME 23 Answers

nbme23/Block 1/Question#44 (reveal difficulty score)
A 34-year-old woman is brought to the ...
Area labeled โ€˜Dโ€™ (Spinothalamic tract, right) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +41 
submitted by โˆ—sajaqua1(607)
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A adn J estrernep teh ceaigrl l,iscfscuua wlehi B adn I nrtesepre hte cuneeta as.lufcusci tTergoeh thye mkae pu eht adrsol odlim-emuanlc lmlscaeni ,tctar orbnlesisep rfo iniptonp eiortnc,ppe oorcpoierptnpi, tinr,abiov and ssrpur.ee unItp is r.llspeiitaa

C and H make up eth rallaet ticoopasncilr tartc a(lso eallcd teh aetlarl ranecbopslire slcc)au,fusi rnsbespioel rfo ormot acmomdn of ptirlsaalie blsmi.

D and G eerrenpst het raeatll picmhatalnios at.tcr It si ssniopberel orf anip adn ttarremeuep utodninoc.c hTe upint esaisr in a imbl tfl(e werol etiexmytr in this ,e)sca stener uhtrhog hte adolsr orto ru(petdic beewtne J and H,) sedsesacut and ecdassn at eht eroanrti uemorssimc tj(us nbehdi E adn ),F nda ylanifl enspassy no eth odsnec reodr nunero in eth laeltar haaioismlnpct atcr.t So hte ctniimaplahos trtca si besposrnile rof earlattnlacro pnai dna ermtteaeurp .stnaonise seBaecu rou nieatpt has olts eatssnino on eht tf,el hte olesin is in eht thg.ir

E dna F rae hte iorrtean iroctilspncoa rta.tc tI si levvinod in rootm corlotn fo xlpoamir se,lmsuc ycpiytall fo teh tnu.kr

nor16  good job +6
jimdooder  Pretty infuriating that this question has the standard R and L label while the other spinal cord question had it flipped. +5
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. +2
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 +3



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