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Old 08-20-2015
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Default Confused about NBME Neuro 2 question on A-fib and stroke!

A 32 year old woman is brought to the ER 1 hour after the acute onset of left-sided weakness involving the face, arm, and leg. She had rheumatic fever during childhood and was told at that time that she had had a heart murmur. Her pulse is 92/min and irregularly irregular. Examination shows moderate left-sided weakness. Babinski sign is present on the left. Which of the following is the most likely cause of these findings?


I chose F since the symptoms were consistent with a lacunar stroke, which is due to small vessel disease and has HTN as the #1 risk factor. But apparently that was incorrect? Can someone explain please? Thanks!


A) Atrial fibrillation
B) Bacterial endocarditis
C) Carotid dissection
D) Carotid atherosclerosis
E) Diabetes
F) Hypertension
G) Meningovascular syphilis
H) Migraine
I) MVP
J) PFO
K) Subclavian steal syndrome
L) VSD
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Old 08-20-2015
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A. Atrial Fibrillation
Yeah, I wouldn't say your answer is "wrong" with hypertension, but just not the "best" one. AFib seems like the better answer considering the patient has an irregularly irregular pulse. An embolism could also cause the stroke, and is more likely with a patient at such a high risk of such.

This is the classic battle of Step 2 CK: Pick the "best" answer. Sometimes we just have to guess and hope it's what THEY think is best.
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Old 08-20-2015
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yes even i agree with AF as the answer.
as said above embolus can lead to stroke and this patient is 32 yr old and no risk factors for HTN are given
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