CHAPTER 24 Flashcards
1. Broca aphasia may result from occlusion of which of the following arteries? (A) Anterior temporal artery (B) Anterior choroidal artery (C) Medial striate artery of Heubner (D) Operculofrontal artery (E) Angular artery
l-D. The Broca speech area, which is located in the lower frontal gyrus of the left hemisphere, is supplied by the operculofrontal artery. This area may also be perfused by the prerolandic artery. Both of these arteries arise from the middle cerebral artery.
2. A patient is given a pipe, tobacco, and matches and is asked to smoke the pipe. The patient rubs the matches on the pipe. Which of the following neurologic diagnoses best describes this behavior? (A) Construction apraxia (B) Ideomotor apraxia (C) Ideational apraxia (D) Prosopagnosia (E) Dysprosody
2-C. The patient, who is unable to light a match and smoke the pipe in proper sequence on com-
mand, has ideational or sensory apraxia, a disorder of a multistep action sequence. Construction
apraxia is the inability to draw an entire clock face; patients with nondominant parietal lobe le-
sions cannot draw the left side of the clock (sensory neglect). Ideomotor apraxia is the inability to follow simple commands (i.e., “stick out your tongue” or “make a fist”). Prosopagnosia is the inability to recognize faces. Dysprosody is the difficulty producing or understanding the normal pitch, rhythm, and variation in stress in speech.
3. A 65-year-old man complains of difficulty walking. He has a history of chronic subdural hematomas. Neurologic examination reveals psychomotor slowing, sphincter incontinence, and enlarged ventricles without convolutional atrophy. The most likely diagnosis is (A) Huntington disease (B) normal pressure hydrocephalus (C) Parkinson disease (D) progressive supranuclear palsy (E) Wilson disease
3-B. Normal pressure hydrocephalus is characterized by the triad of gait apraxia (frontal lobe ataxia), incontinence, and dementia. The ventricles are moderately dilated. Huntington disease is a neurodegenerative disorder, characterized by choreoathetosis, tremor, and dementia. Parkinson disease is characterized by a pill-rolling resting tremor, cog-wheel rigidity, and bradykinesia (slowness in movement). Progressive supranuclear palsy is a movement disorder characterized by paresis of downgaze. Wilson disease (hepatolenticular degeneration) is a disease of copper metabolism characterized by a coarse “wing-beating” tremor. The corneal Kayser-Fleischer ring is pathognomonic.
4. Neurologic examination indicates that a 50 year-old woman with hypertension has a left homonymous hemianopia but is not aware of her deficit (anosognosia). When asked to copy a drawing of a clock face, she neglects to draw the numerals on the left side of the clock. Based on this examination, the lesion would most likely be in the (A) frontal lobe (B) insula (C) left parietal lobe (D) right parietal lobe (E) right temporal lobe
4-D. Lesions of the nondominant (right) parietal lobe have the following deficits: anosognosia, topographic memory loss, dressing apraxia, sensory neglect, “sensory extinction,” and a left homonymous hemianopia. Frontal lobe signs may include motor abnormalities, impairment of cognitive function, personality changes (disinhibition of behavior), and incontinence. The insula receives olfactory and gustatory input. Temporal lobe signs may include Wernicke aphasia, auditory, visual, olfactory, and gustatory hallucinations, and loss of recent memory.
5. A 48-year-old woman who has had a stroke complains of weakness of her right arm and weakness of her right lower face. Language assessment reveals the following speech deficits: slow labored speech, dysarthric telegraphic speech, usually good comprehension, and poor repetition. These neurologic findings best describe which of the following types of aphasia? (A) Broca aphasia (B) Conduction aphasia (C) Transcortical motor aphasia (D) Transcortical sensory aphasia (E) Wernicke aphasia
5-A. Key features that point to Broca aphasia are slow, labored dysarthric telegraphic speech; relatively good speech comprehension; poor repetition; frequent depression; and frequent buccolingual dyspraxia. Broca aphasia is also called motor, expressive, and anterior aphasia. See Figure 24-1.
6. A 65-year-old male physician suffers a cerebrovascular accident. Language assessment reveals the following speech abnormalities: impaired comprehension; impaired repetition; and paraphrasic speech, including non sequiturs and neologisms. Spontaneity and fluency are normal. This evaluation best fits which of the following types of aphasia? (A) Broca aphasia (B) Conduction aphasia (C) Mixed transcortical aphasia (D) Transcortical motor aphasia (E) Wernicke aphasia
6-E. Wernicke aphasia is characterized by fluent speech, poor comprehension, poor repetition, and paraphrasic errors (e.g., driveling speech, nonsequiturs, and neologisms).
7. A 50-year-old man has a mass lesion underlying the left frontoparietal operculum. Language assessment reveals good comprehension, fluent speech, poor repetition, anomia, and agraphia. This case best fits which of the following types of aphasia? (A) Broca aphasia (B) Conduction aphasia (C) Global aphasia (D) Transcortical sensory aphasia (E) Wernicke aphasia
7-B. Conduction aphasia results from a lesion that transects the arcuate fasciculus, thus separating the Broca speech area from the Wernicke speech area. This condition is characterized by markedly impaired repetition, with preserved fluency and comprehension. Conduction aphasia is usually associated with agraphia.
8. A 45-year-old woman suffers a stroke. She exhibits weakness in her left arm, and she is unable to show emotion, inflection, and emphasis and gesturing in her propositional language. The lesion responsible for this language difficulty would most likely be in the (A) left frontal lobe (B) right frontal lobe (C) left parietal lobe (D) left temporal lobe (E) right temporal lobe
8-B. The center for expressive prosody is located in the posterior part of the inferior frontal gyrus of the nondominant lobe. The center for receptive prosody is located in the posterior part
of the superior temporal gyrus of the unitalize lobe.
