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NBME 20 Answers

nbme20/Block 1/Question#35 (77.5 difficulty score)
A 70-year-old man dies of coronary artery ...
Spastic hemiparesis on the rightπŸ”,πŸ“Ί

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submitted by sympathetikey(1439),
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As stdtea ,lweob hte eLft urcs birerce aws agddema (ees thaw it sluhod rlmanoly look like wlb.)eo Tihs ninosact the rclsaonictopi rctat. cienS teh csnpcloiiorat trtac ssuatdece ta the uallm,ed loebw hte airnmbdi setinco 'ewre knoglio at, oyu wldou ees olnaetalartCr tgRh)(i itsSapc srimieHeasp

hello  What identifies that a cross-section is medulla vs midbrain vs pons? +5  
kernicterusthefrog  @hello I like to pay attention to the Cerebral Aqueduct (diamond/spade shape seen mostly in Midbrain, and transitioning to 4th ventricle in rostral Pons), and then the shape and size of the 4th ventricle as you move down Pons to rostral&middle Medulla, and eventual closing and absence of fluid space at caudal Medulla. +12  
hello  @kernicterusthefrog Thank you. +  
mbourne  NGL, I thought the right side had the pathology lmao ty +22  

submitted by arkanaftus(13),

Is it appropriate to ask a question about the structure which is absent on the picture? It was super confusing! How can you say it was not a defect of the tissue cut?

drdoom  why did this get downvoted? +  
weenathon  The missing structure is the cerebral peduncle (also called the crus cerebri). You can tell it is a good slice and not a weird cut because of the symmetry of the rest of the midbrain structures. Everything is symmetrical except the cerebral peduncles, with the left one missing. I also think it's a safe bet to say it's not a random piece of tissue missing because tissue artifact is not one of the choices. +9  

submitted by stepwarrior(23),

The incorrect labeling of the gross pecimen makes this question a bona fide piece of garbage.

submitted by strugglebus(172),
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tI ceaetfdf teh ctrnliapoocsi ractt in the scru receirb no eht L

submitted by ibestalkinyo(48),
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ehT irloastopcnic atrtc rnus rmfo hte ebrlcare txecro aCPle(err-nt r,yuG)s thhruog het rrptisoeo bmil of eth lenartni lasuc,ep dna toin het oserptiro pootnri fo hte eainstrmb werhe yteh fomr lhyghi yieandmelt eryldmlua mpairdsy. Teehs vlreta dnow het apilsn rod,c eedtsascu adn pysnase fo welor toomr uosnern in eht lntvrea nrho fo hte pnlsai o.dcr

A pats ortyhsi fo eabclrer onicinraft tmsu vhea fedatecf thsi aspi'tetn telf ldmied rrbeacle ytrera and tugrohh Wialanrel ednnrtoei,ega hte flte daurylmle imdaypr

reocDsttiun of teh fetl tpcoloasinirc trcta bereof nsseoiuadtc sdael ot anctrarlaoetl tpissac msierseahpi (ncies isht si an ruppe tmroo rnnueo eo.siln

submitted by hayayah(1100),
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eTh emgdaa si in het L nibidrma ni hte reaa tnegcafif the iaocnpltoscri cartt. uacBsee it is ni the idbmna,ir dnsotusiaec in the mrpasdiy dealu(ml) so ti liwl hows tpsllaaeiri natislycfondu motro n.ssgi

oohtP fo bmrniadi and aintmropt aes:ra aRruoLsrt/mthy.lH

masonkingcobra  Just for clarification, on the left side, you see where he had the infarction 7 years ago and the tissue is gone. +9  
chefcurry  so is the dysfunction on the contralateral side? +  
praderwilli  If the decussation is in the pyramids of the medulla, shouldn't it be contralateral hemiparesis if the damage is on the right? It confuses me because of the labeling right and left at the top of the pictures. +  
endochondral1  that link isnt working @ there any good picture to look at to know where the tracts are on this section? +1