Hi everyone, I really need someone to bounce these questions with because I don't have any friends that have taken nbme 19 and I don't want to ruin it for them. Thank you so much in advance!
1. The question about the old woman with 1 day of sudden onset of left leg weakness, with left lower extremity decreased muscle strength and 3+ DTR, can't tell if her left great toe is raised or depressed, with the remainder of the examination showing no abnormalities.
The answer is embolism of the right anterior cerebral artery. But wouldn't a right ACA emobli cause decrease sensation as well? why is it just her proprioception that is affected (knowing if her toe is raised or depressed). I picked a left ASA embolism, even though it didnt fit the picture perfectly, it was going to get me a UMN motor lesion match with a singular proprioceptive match with the vignette. Saying there's no abnormalities other than motor and proprioception leaves me to think that sensation is spared. HELP.
2. 5 y.o boy with a retinal mass, but doctor says he's at no risk for any other neoplasms? I see what they are trying to go for in saying that it is a local mass and not familial Rb is the doctor says there's no increased risk for neoplasms. BUT how in the world does a 5 y.o kid get a Retinoblastoma from just chance mutations. I thought the whole idea was that it was almost impossible to get one sporadicly and usually if you see one early in life, it's because of the 1 hit hypothesis. HELP PLZ.
Thanks!
Mr. Emboli
1. The question about the old woman with 1 day of sudden onset of left leg weakness, with left lower extremity decreased muscle strength and 3+ DTR, can't tell if her left great toe is raised or depressed, with the remainder of the examination showing no abnormalities.
The answer is embolism of the right anterior cerebral artery. But wouldn't a right ACA emobli cause decrease sensation as well? why is it just her proprioception that is affected (knowing if her toe is raised or depressed). I picked a left ASA embolism, even though it didnt fit the picture perfectly, it was going to get me a UMN motor lesion match with a singular proprioceptive match with the vignette. Saying there's no abnormalities other than motor and proprioception leaves me to think that sensation is spared. HELP.
2. 5 y.o boy with a retinal mass, but doctor says he's at no risk for any other neoplasms? I see what they are trying to go for in saying that it is a local mass and not familial Rb is the doctor says there's no increased risk for neoplasms. BUT how in the world does a 5 y.o kid get a Retinoblastoma from just chance mutations. I thought the whole idea was that it was almost impossible to get one sporadicly and usually if you see one early in life, it's because of the 1 hit hypothesis. HELP PLZ.
Thanks!
Mr. Emboli
