Total WTF question in NBME 15

[fw5tape6kq]

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I got an aphasia question wrong in NBME 15 and still have yet to understand which choice is the correct answer, even after reading the NBME 15 thread (no good consensus seems to be reached). If anyone knows the answer to this, please enlighten me because I am lost.

Basically, the question recounts a man who recently suffered a stroke and has fluent speech, but many grammatical errors, word substitutions, and neologisms. He can neither comprehend commands nor repeat phrases. The questions asks where in the brain the lesion would be located


I assumed this to be a case of conduction aphasia with damage to the arcuate fasciculus, but apparently not? Is this just straight up Wernicke's aphasia due to fluency and poor comprehension (localized to superior temporal gyrus)?

 

[walakin25]

cant remember your 1st question, but the 2nd, is D. they tell you the physician suspects surreptitious use of insulin, so next step is to then rule in/out this suspicion by checking c-peptide levels.

 

[tasar1898]

This aphasia looks wernicke to me , don't remember if its G or H , probably H ( speaks gibberish , can't comprehend commands , and thus cant repeat them , has nothing to do with arc fasc ) Arc fasc [Conducting Aphasia] would be : Speaks paraphasic , CAN comprehend commands ( i.e. raise your hand ) , CAN'T repeat them . Tricky q

 

[walakin25]

This aphasia looks wernicke to me , don't remember if its G or H , probably H ( speaks gibberish , can't comprehend commands , and thus cant repeat them , has nothing to do with arc fasc ) Arc fasc [Conducting Aphasia] would be : Speaks paraphasic , CAN comprehend commands ( i.e. raise your hand ) , CAN'T repeat them . Tricky q

tasar is right, its wernickes, the answer is not I*.

 

[dododo121]

Seconding everyone else. This is Wernicke's aphasia. The person has "fluent" speech but is unintelligible and can't repeat anything. This person also can't follow commands while someone with Broca's aphasia will follow every command you give them.

Also, it is against the terms of service to paste NBME questions word for word so I would edit your post and paraphrase the question.

 

[tasar1898]

Lol neuroanatomy left me like it was never there...

 

[skarabrae]

The answer to the first one is H, not I. Just took this exam last week.

The second question is D. C-peptide is only present in the cleavage of endogenous insulin. Absence of C-peptide = exogenous insulin use.

 

[walakin25]

my bad Tasar, apparently i got this right when i did the NBME and missed it today lol oops..

edit: dam i really hope i didnt screw up neuroanatomy on real deal

 

[worldbeater]

Just to confirm the answer with everybody else, yeah it is Wernicke's aphasia, I was reviewing this NBME earlier. The answer is the location on the far left (patient's direction) on the brain, I don't remember the letter.

To keep straight the difference between Broca's and Wernicke's, I use this:
-Broca's sounds like "Tom Brokaw", he is an announcer that has a sudden onset of difficulty speaking
-Wernicke's is like a "woman" (or man in this case) who has fluent speech that you can't understand
-In terms of location in the brain, from the patient's right to left, Broca is on the right, Wernicke is on the left and it's in alphabetical order
-for comprehension, Broca's has good comprehension (imagine a producer speaking in his ear and he can understand everything, but can't say it), Wernicke's does not
-both areas are connected by the arcuate fasciculus
-Wernicke's area is supplied by the middle cerebral artery (if they get more specific and ask which one, I believe it's left MCA)

 

[zhopv10]

Broca's is on the left (dominate hemisphere in most people) occasionally it is on the right (as can be wernicke's) as well. The vast majority of the time though they are both on the left.

 

[worldbeater]

Broca's is on the left (dominate hemisphere in most people) occasionally it is on the right (as can be wernicke's) as well. The vast majority of the time though they are both on the left.

Oh alright cool.

I was more referring to when they gave a sagittal (cut sideways) section of a hemisphere and the question asks to identify that location of Broca's/Wernicke's, the way I described above is the easiest way to orient yourself, at least for me.

 

[zhopv10]

Ah I see what your saying, sorry bout that