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NBME 23 Answers

nbme23/Block 1/Question#37 (35.4 difficulty score)
A 47-year-old woman with multiple sclerosis ...
Fasciculus gracilisπŸ”,πŸ“Ί

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submitted by cbrodo(61),
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ehT reotpiros ulmoncs (ucuilFcsas /csuiltusFcauunscea )rlagicis crray triimofonna to teh anirb argdengir ,ritioeoncpppro itob,avrni isticiermanidv ocuth adn s.uspeerr shPcyail amxe gdifinsn utsggse a eniosl eher et(h hctiaisalnmpo acrtt iasrcre priakc/niippn dna aetrm,tpuree nad shtee ewer .nro)mal ineSc teh epnttai ash nomlaarb sgifnind ni the loewr mexise,tteir nad malorn ifinsngd ni eth preup t,eixmeietsr eth sanwre is clssaicFuu i.iacsgrl hsTi is beaseuc itofarmonni rmfo bdyo sraea bwoel het velel fo T6 is aircred by sgiilcar nad imfnorintao rmof bdyo saaer avbeo eth leelv of T6 si acredir by ceuntaus.

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 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 +  

submitted by cat5280(3),
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oluCd enmoeos epaesl pixalen hyw uoy rewe ealb to leitamnie eth esclaeblpnirreo tt?cras

ergogenic22  Spinocerebellar is only responsible for Proprioception (unconscious). This patient also has reduced vibration sensation, which the dorsal column tracts are responsible for. +3  

submitted by abhishek021196(66),

Dorsal column (pressure, vibration, fine touch, proprioception)


β€’ Fasciculus graciLis (Lower body, legs) β€’ Fasciculus cUneatus (Upper body, arms)

Dorsal columns are organized as you are, with hands at sides. β€œArms outside, legs inside.”

submitted by rs888(0),
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lcisrGial si a mlcuse ni the elrwo blmi cihhw eksma ti saey ot rmbem.eer tsaucneU hsa a U for rUpep lmb.i tsju tgehsmino i .seu