Help with an old NBME Q

[skk3]

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Hey guys,

please help me with an NBME 4 question

A 55-year-old man is hospitalized after having a stroke. The MRI of the head is obtained 3 days later. The patient most likely has which of the following signs on the right?

A) Weakness of the upper limb and aphasia
B) Weakness of the face and dysarthria

Picture of the stroke can be found here:

http://www.prep4usmle.com/forum/thread/27186/

Please provide any explanations. Thanks!

 

[SlaveOfTCMC]

Hey guys,

please help me with an NBME 4 question

A 55-year-old man is hospitalized after having a stroke. The MRI of the head is obtained 3 days later. The patient most likely has which of the following signs on the right?

A) Weakness of the upper limb and aphasia
B) Weakness of the face and dysarthria

Picture of the stroke can be found here:

http://www.prep4usmle.com/forum/thread/27186/

Please provide any explanations. Thanks!

I just recall for this one you had to follow the homonculus very closely.

I know it is a bit hard to visualize this, but if you think about it closely, it would be Choice B)

 

[whoknows2012]

I just recall for this one you had to follow the homonculus very closely.

I know it is a bit hard to visualize this, but if you think about it closely, it would be Choice B)

I think the answer is actually upper limb weakness and aphasia....

 

[SlaveOfTCMC]

I think the answer is actually upper limb weakness and aphasia....

The "Dr. Osha who scored an 800" marked it is dysarthria

Moreover, looking closely at the homonculus, the location of the lesion on the MRI fits the face better.

 

[mrmandrake]

I agree but when I was taking the test I went with aphasia because I thought they wanted us to know that a lesion of the dominant side of the hemisphere would produce aphasia. I always try to "think like the test makers" which gets me into a lot of trouble.

Could anyone who has taken the NBME 4 online verify this answer?

The "Dr. Osha who scored an 800" marked it is dysarthria

Moreover, looking closely at the homonculus, the location of the lesion on the MRI fits the face better.

 

[skk3]

I don't really think there is anyone who knows for sure. Even those who took it online don't know whether or not they got it right (no extended feedback for test 4).

The only person who can 100% confidently say he/she got it right is a person who got an 800 on the exam. The unofficial exam key says that the answers are from a person named Dr. Osha who supposedly got an 800. She claims the answer is dysarthria (I chose dysphasia because that's what I had learned from FA).

To be really nitpicky, the face IS lower on the homunculus than the arms. Furthermore, damage to the motor area of the mouth could result in dysarthria. This is the only way I could convince myself that the answer was dysarthria and not dysphasia. However the only place I associated "dysarthria" with the brain was with cerebellar damage...but that's another story I guess.

I'm still not sure, but anyone with conclusive evidence...please share!

 

[ThereHeIs]

I agree but when I was taking the test I went with aphasia because I thought they wanted us to know that a lesion of the dominant side of the hemisphere would produce aphasia. I always try to "think like the test makers" which gets me into a lot of trouble.

Could anyone who has taken the NBME 4 online verify this answer?

Unless they specify, the person in question is right-handed (just like right-dominant in the heart if not specified). Since the image shows a stroke on the left side in the MCA territory (and we know this because we can see the insular cortex, at least im assuming), we have to assume this is the mans dominant hemisphere.

Strokes in the dominant hemisphere produce aphasia.

 

[ThereHeIs]

Unless they specify, the person in question is right-handed (just like right-dominant in the heart if not specified). Since the image shows a stroke on the left side in the MCA territory (and we know this because we can see the insular cortex, at least im assuming), we have to assume this is the mans dominant hemisphere.

Strokes in the dominant hemisphere produce aphasia.

Now that I look in FA a bit more, I'm leaning to face/dysarthria. Who knows these days.

 

[mrmandrake]

Yea I know. That's why I went with aphasia but the answer key from someone who said they got an 800 says that the answer is "Weakness of the face and dysarthria". I guess no one will really know.

Strokes in the dominant hemisphere produce aphasia.

 

[SlaveOfTCMC]

however, working with logic:

the answer choice

"upper limb AND aphasia" would necessitate both conditions be met. The area of ischemia does not correlate to the arm on the motor homunculus.


Moreover, Broca's area is on the inferior frontal lobe and Wernicke's area is on the inferior parietal lobe anyway...

 

[Phloston]

I went with choice B. I personally think "weakness of the upper limb and aphasia" is the better answer.

The only reason I could think of as to why choice E might be the answer is based on a technicality as to how the question was asked: notice that it asks for which of the following signs on the right. Aphasia doesn't occur on the right; it's not something that can be localized. This is in contrast to facial weakness and dysarthria, where dysarthria could be localized to one side.

BS question quite frankly. Reminds me of SoM exams, where half of the battle is a guessing game as to what the question is even asking, even though it's just poorly written.

And to the person who posted above me over a year ago: Wernicke's area is in the superior temporal gyrus, not in the parietal lobe.

And to someone way up above on the thread: an 800 on an NBME doesn't mean a perfect score. It could mean 1 or 2 wrong depending on the scale. Dr. Esha supposedly got an 800 on NBME3 as well, but I know for a fact that one of the answers was wrong.

 

[thehundredthone]

Actually, AFAIK, for this question, the MRI was at the level of the horns of the lateral ventricles. The homunculus at that level is for the face. So weakness of the face + dysarthria (tongue + pharynx) is the best fit.