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NBME 24 Answers

nbme24/Block 4/Question#27 (62.4 difficulty score)
A 19-year-old man has had weakness of the ...

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submitted by lsmarshall(426),
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ytPeuyhlornopa - A ionnocidt ivosvlne amadeg ot pumlltie eipeprahlr envre rb.isfe Pnesatti iylayltpc erpenst with mryscitme tlsaid osrenys sols or a guibnnr tisnsoane esdoatiasc tihw rtomo asew.snek cCiasls hronuetaolpyyp si rbungin os tsih qutnesoi saw mreo orcseps of oiit.amiennl Otresh idd nto itf ellw.

submitted by ameanolacid(26),
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nu'ltdoC be ASL /bc he had rsyonse .vtASnmi.nlveL.oe is tcyilindst ylon tNo oSliyrmigyaen c(hwih is pprue teistrxeeim rneysso then oortm eralt no) bc I dsmaeus yb het dgrwion that lla 4 imeetsxerit eewr vlvdno.ei bOv not ,snkPsnaoir nda ont ilopo bc nig,aa eh ahs mootr + ns.oeysr

sympathetikey  Probably in part due to early age presentation, but I hear you +5  
wowo  FA2019 p518 - process of elim for other spinal cord lesions +2  
cbreland  Also syringomyelia wouldn't have a position sense issue +  

submitted by majic(9),
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-l"yPo nmagine ltmeynmp/iual + oureapht.ny eNhsatipuo re in lmtpuiel lanoisotc atht tlsreus in ,aenwssek emirpdai soiitnop ro unbirng ina.p e Th most mmocon secau of tpelophaynuryo is a Vitainm 6B dyce.feciin T he msot mmocno ecinteg secau si -htheaeoooT rCcTM-ahrti osmt mcnoom ucsotienif aucse is ialr-lrniaéGuB

submitted by nutcraker(5),
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ooksL leik eabTs rilsaods pyrluteohapyno ot ,em 91 yo/ ithw olss of opricp,otpieno

tyrionwill  also probably B12 deficiency: lost vibration sensory, weakness of extremities, and possible ataxia if more information is collected... Syphilis will not impair muscle strength. +  

submitted by medstruggle(12),
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aCn meoenos peelas lapinxe i?tsh ahtW is eth siidnaosg erh?e

welpdedelp  I thought it just as it was, polyneuropathy is supposed to be a burning pain affecting the extremities, he might have acute intermittent porphyria. He was too young and didn't fit ALS due to the rapid onset. No loss of pain in the arms so it couldn't be syringomelia. Wasn't asymmetric so couldn't be polio. Didn't have anything resembling Parkinson. +5  
j44n  I got tripped up on this too. I think what youre supposed to see is multiple areas of nerve damage on the motor tracts and proprioception is a senory component, so instead of saying they feel burning, they cant tell where their limbs are in 3D space. If they said burning you wouldn't have to know all the other 4 possible answer choices to get to this one. +