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NBME 24 Answers

nbme24/Block 4/Question#10 (40.0 difficulty score)
A 60-year-old woman is receiving cisplatin ...

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Teh aersnw is pihoafrxeyel uecbsea het nerfafet rca fo hte clsmue ttechrs lferex has ot og thghrou teh rodlas mari adn roadls otro agg.inal bDum eituosnq, I ownk, but ’tis het onyl wasern thta amed esens. If uyo urth the ,GRD ouy ton ylon leso aetfnrfe tcoasmi yersnso efibr,s you asol leso eht oyerssn esdoib eodlnviv ni the oaivsur flee.exrs

uoY nca aols teg ohirpflxeeay mrfo ganmdaig teh ffeeretn euronns hatt aenrveitn hte mcesul lei(k a ,)NLM but as oyu oknw esteh are ni the trnoirae nhor nda ntaervl .amri

ankistruggles  Thanks! I agree with you. +  
brethren_md  Great explanation. +  
gonyyong  Agreed - I think I got this by thinking about tabes dorsalis (syphillis) and why it has hyporeflexia is due to dorsal root damage +4  
duat98  I'm confused about why it wouldn't cause muscle atrophy. Isn't that a fever of LMN damage? +2  
charcot_bouchard  Muscle atrophy wont occur because alpha motor neuron is intact. Motor control of Corticospinal tract on this is intact. so no atrophy. u can move shiti/ But remeber muscle spindle that is responsible for INITIATING stretach reflex send Ia fibre to DRG from where it synapse with Alpha motor neuron. if DRG is damage ur muscle is fine but u cant initiate strech reflex. areflexia +1  

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submitted by enbeemee(13),
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i egt why s'it eaphlyroe,xfi tbu wyh not ?noslifbiltari 'sti olsa na LNM isgn

et-tu-bromocriptine  Imagine a simple reflex arc: you have an afferent neuron, some interneuron shenanigans, and an efferent neuron (aka LMN neuron). If you damage the LMN, you will get hyporeflexia (due to damaged reflex arc) and fibrillations (because your LMN won't be able to effectively contract muscle on command). However, if you damage the afferent part of the arc, you will still get a damaged reflex arc (hyporeflexia), but your motor neuron will still be able to do its stimulating effectively, so your muscles won't show weak contractions when stimulated by a higher pathway. Kinda confusing but I hope I made it a tad simpler! +11  
eli_medina9 Gonna piggy back off your comment and just post this kaplan image +7  
hungrybox  Very helpful image, thanks bro +