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Comments ...

 +1  (nbme18#10)
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aRnle gaemad ofmr DKP anc temllityau asceu ciohnrc enarl iscfyfiecunni. Tsih imaspir eht libaiyt fo hte edinky to etrexec ssporpuhho nda obarresb C3HO. tdveleEa hhtpsoape vslele ni eht olbod sritgrge eaelres fo FG-3F2 ofrm on,be ihcwh loresw miavtni D nridcutoop adn rsdeeseca ucilacm pntooiarsb in hte .niestntie Teh ruilentgs myhoaleccpai nda pparyhmotshehipae ilwl dela to an icernase in eth scetrnioe of H.PT


 +2  (nbme18#36)
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heT eitntap has alaimngtn ty,rahpeirhem na sdreave tenve ecdsaotsai htwi eosm hniaestaes gsdru i(e snci).eulcionyhcl Teh OCD fro nttraieg gnanaltmi riehryaptmhe si lnnteo,Daer hihcw esgaoaznnit hte yrnieanod teercopr dna sresltu in rdceadese terlclrluiana cumcai.l


 +6  (nbme23#37)
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Teh opirtoser nclsuom ccFsi(suaul ctuiuusun/Faelaccss igc)rlasi yrrac iamrninfoto ot het arinb agerndgri opi,ppcretioonr i,atnorvbi iirncestadiivm uhcot nad esu.rsepr yPscaihl xema fnisdign setusgg a olines here te(h aatmschlpinoi tacrt errasic kicnaiprppn/i nad puea,rttemre dna teseh erew n.mo)rla Sceni hte anteitp sah bralonma infidgsn in eht lerow xreei,etitsm nda mnalor nifsgnid in teh erpup iitsxereetm, hte wnreas si ssuuciaclF cilria.gs shiT si bcsauee tinriafnmoo omrf body sarae olwbe hte evlle fo T6 is rcaerid by clrigasi dna nftoiarnimo romf doyb araes oaveb eht leevl of 6T is aecdrir yb unactseu.

kai  kick Goals (gracilis) with your feet Cook and eat (cuneatus) with your hands +3
temmy  i remember gracilis is for legs by saying i have graciously long legs and they are inside while arms can spread out to remember their orientation on the spinal cord +4
jess123  I remember it as gracilis = grass so feet haha +4
link981  Just to add found on page 492 on FA 2018. +
charcot_bouchard  Hey Temmy, I can spread my legs too :) +
maxillarythirdmolar  I can't feel GRACIE's ~fine touch~ as she ~vibrates~ my balls. +3
cat5280  Could someone please explain why you were able to eliminate the spinocerebellar tracts? +1
drzed  Lmao I remember gracilis because of the gracilis muscle in the legs! +3
alexxxx30  cat5280...so spinocerebellar tract does 4 things to know 1. proprioception in the Romberg test 2. intention tremor if damaged 3. shin to knee test 4. dysdiadochokinesia (being able to rapidly pronate/supinate the upper extremity) yes the patient has proprioception issues, but the other symptom of vibration loss points us more to a fasciculus gracilis issue. If the patient had presented with proprioception and and intention tremor then we would think spinocerebellar +2
alexxxx30  adding to my comment^ I would commit these 4 things to memory as I have gotten several questions concerning this topic (there were 2 questions on this exam where spinocerebellar tracts are involved). Memorize them and it might get you 1-2 extra points! +
solidshake  Just to clarify a point, Spinocerebellar tracts are not tested by the Romberg Test. Romberg tests conscious proprioception that is done by the dorsal columns. Spinocerebellar tracts are used for Unconscious proprioception. Look up tabes dorsalis in First Aid. One of the positive indicators is a positive romberg test, which shows that the dorsal columns have been damaged thus affecting conscious proprioception and thus impaired balanced on standing with the eyes closed +




Subcomments ...

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hWy is ti 9%9 nad tno %59? tI askde rof nteos fo desesai at slse hatn 9 aeyrs fo ae.g mI' cryalle nssmigi heomsgint ereh

cbrodo  @fulminant_life because the mean age is 3.8 with a standard deviation of 1.8. An age of onset of 9 years is nearly 3 standard deviations above the mean. Therefore, since we know +/- 2 SD covers 95% of the bell curve, it must be higher than that. The only option higher than 95% is 99%. +10  
charcot_bouchard  Yes 9.2 was the upper limit for 99% CI. I picked 95 first because i thought 2.5% would be out of this range. But changed ans because it should be less than 2.5% because 9.2 is so close to 9. Also they are asking CLOSEST to which of the following? +4  
aakb  I see what you are saying but you have to remember to add the things on the right side to include all the values under 9. So even if you go with the 2 standard deviations for 95%, youd have to add 2.5% that's on the left. which would be 97.5 and you know you would still add more on the left to get to 9 years of age so it would have to be closer to 99% than to 95%. hope that helps +  


submitted by sakbarh(5),
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mousie  The Boards and Beyond video of SC strokes was really helpful at explaining this if you are a video kind of person! +1  
yotsubato  What pushed me away from pons was "dysarthric speech" which implied she still could speak to some degree.... which made me pick medulla. +3  
mimi21  I think FA may be misleading. Primarily it will effect the Pons because that is where the majority of the Basilar Artery is located. and I guess it could effect the other locations? but everywhere I have looked Locked-in syndrome is an issue with the Pons. But someone please continue to clarify, cause I was a bit tripped up at first with this question +  
cbrodo  Although FA says it can be pons, medulla, or lower midbrain, "locked-in" syndrome generally arises from BL pons lesions. Another way you can rule out medulla and midbrain in this question is the ocular movement findings. Since the patient has impaired horizontal gaze BL, you can conclude that the Abducens nuclei are involved on both sides. The abducens nuclei are located in the pons. +42  
gh889  USMLE secrets also states that it is most commonly in the pons Bates states that locked-in syndrome preserves consciousness but these patients have limited speaking ability +1