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NBME 23 Answers

nbme23/Block 1/Question#37

A 47-year-old woman with multiple sclerosis is ...

Fasciculus gracilis

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 +3  upvote downvote
submitted by cbrodo(17),

The posterior columns (Fasciculus cuneatus/Fasciculus gracilis) carry information to the brain regarding proprioception, vibration, discriminative touch and pressure. Physical exam findings suggest a lesion here (the spinothalamic tract carries pinprick/pain and temperature, and these were normal). Since the patient has abnormal findings in the lower extremities, and normal findings in the upper extremities, the answer is Fasciculus gracilis. This is because information from body areas below the level of T6 is carried by gracilis and information from body areas above the level of T6 is carried by cuneatus.

kai  kick Goals (gracilis) with your feet Cook and eat (cuneatus) with your hands +2  
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 +  
jess123  I remember it as gracilis = grass so feet haha +1  
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. +  
cat5280  Could someone please explain why you were able to eliminate the spinocerebellar tracts? +  

 +1  upvote downvote
submitted by cat5280(1),

Could someone please explain why you were able to eliminate the spinocerebellar tracts?

ergogenic22  Spinocerebellar is only responsible for Proprioception (unconscious). This patient also has reduced vibration sensation, which the dorsal column tracts are responsible for. +1  

 +0  upvote downvote
submitted by rs888(0),

Gracillis is a muscle in the lower limb which makes it easy to remember. cUneatus has a U for Upper limb. just something i use.