NBME 4 can anyone help me with this vignette? - pencil2

[ArchivalUser]

8. A 77-year-old woman is brought to the emergency department by paramedics 1 hour after the sudden onset of right-sided weakness and difficulty speaking. Her son found her at home after he became concerned because he did not get his usual morning phone call. She has a history of hypertension and hypercholesterolemia treated with a β-adrenergic blocking agent and a lipid-lowering agent. Her pulse is 72/min, and blood pressure is 160/90 mm Hg. During examination, she is only able to give single-word answers with many paraphasic errors. She has good comprehension. Examination shows normal visual fields. There is weakness of the right side of the mouth. Muscle strength of the right upper extremity is 2/5. There is mild weakness of flexion of the right hip; muscle strength of the right lower extremity is otherwise normal. Sensation to pinprick is decreased over the right upper extremity. Deep tendon reflexes are more brisk on the right side than the left, and Babinski sign is present on the right. Which of the following arteries is most likely to be occluded?

A
) Basilar

B
) Left anterior cerebral

C
) Left internal carotid

D
) Left middle cerebral

E
) Left ophthalmic

F
) Left posterior cerebral

G
) Right anterior cerebral

H
) Right internal carotid

I
) Right middle cerebral

J
) Right ophthalmic

K
) Right posterior cerebral

[ArchivalUser]

I put A and it's wrong

How can it be possible to have a weakness on the SAME side of face and extremities, not ipsilateral?
+ She has a brocha's aphasia I think...
Can you d/dx occluded artery by the Sx. of Broca's and Wernicke's aphasia?

[ArchivalUser]

is it D left middle cerebral?

[ArchivalUser]

Left Middle cerebral artery is the answer.I missed it too, I knew the concept but answered as Left ACA. well for questions like these it will be better if we remember the cerebral artery homunculus. In the time pressure this helps.By the way how did you do in your nbme over all??

[ArchivalUser]

o thanks!
krisscott/ I got 231 and I have 2 wks left... a long way to go!!

[ArchivalUser]

Can anyone know how can it be possible to have a weakness on the SAME side of face and extremities, not ipsilateral?
I am wondering how she can have weakness of the right side of the mouth if Lt. MCA is the answer...
(I think it is the right answer though because of Rt. upper extremity weakness >> Rt. lower extermity)

PLUS if she would have Wernicke's aphasia other than Broca's like it is described in the vignette, would the answer change?

[ArchivalUser]

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