Clinical Cases Flashcards
A 70-year-old woman was brought to the emergency room where she was found to have weakness of right upper and lower extremities, increased muscle stretch reflexes on the right, a Babinski on the right, decreased ability to perceive proprioceptive stimuli on the right, and when her tongue was protruded it deviated to the left. Which one of these clinical signs provides a segmental localization of the lesion?
A. Babinski on the right
B. Decreased proprioceptive perception on the right
C. Hyperactive reflexes on the right
D. Protrusion of the tongue to the left
E. Weakness of the right upper and lower extremities
D. Protrusion of the tongue to the left*
Sue is a 40-year-old patient that comes into the clinic because she is noticing that it is becoming increasingly difficult to walk in the dark. Upon examination she presents with decreased vibratory sensation in the left lower extremity, and she failed her two-point discrimination test for the left lower extremity. What spinal cord tract is responsible for these clinical signs? A. Left dorsal column B. Left medial lemniscus C. Left spinothalamic tract D. Right dorsal column C. Right medial lemniscus F. Right spinothalamic tract
A. Left dorsal column
A neurological workup of a patient revealed an asterognosia and agraphognosia when testing the right upper extremity. What is the MOST LIKELY site of the neurological lesion? A. Left frontal lobe B. Left insular cortex C. Left occipital lobe D: Left parietal lobe E: Left temporal lobe F. Right frontal lobe G. Right insular cortex H. Right occipital lobe I: Right parietal lobe J: Right temporal lobe
D: Left parietal lobe
Revised question Case 8
A 55-year-old man was in good health. when he found he was unable to walk when he tried to rise from the couch. On examination several days later there was a severe flaccid paralysis with hypotonia of the lower abdominal muscles, hip flexors, hip adductors and knee extensors. Reflexes were normal in the upper extremities, absent at the knees, and hyperactive at the ankles. He had bilateral Babinski signs. There was loss of sensation for pain and temperature over the lower back, abdomen below the umbilicus, and both lower extremities, but not in a small area around the anus. Joint position and vibration sense were completely normal. All findings were symmetrical.
What is the major contributing blood supply to the area of the spinal cord involved in this lesion? A. Anterior inferior cerebellar artery B. Posterior cerebral artery C. Posterior inferior cerebellar artery D. Posterior spinal artery C. Radicular artery of Adamkiewcz F. Vertebral artery
C. Radicular artery of Adamkiewcz
A 70-year-old man awoke one morning and found that the left side of his face was paralyzed and that he had difficulty using his left hand. Neurologic examination revealed that he could not wrinkle his forehead or smile on the left side, that he had decreased sensation to pinprick over the left face and right side of the body, ptosis and miosis of the left eye, and decreased coordination of the left hand and leg. Muscle strength and reflexes were within normal limits.
Based on the clinical examination, what neurological pathway or structure was responsible for the ptosis and miosis of the left eye? A. Cerebral peduncle B. Cervical sympathetic chain C. Hypothalamo-reticulospinal tract D. Intermediolateral cell column C. Nucleus of Edinger-Wesphal F. Oculomotor nucleus G Superior cervical ganglion
C. Hypothalamo-reticulospinal tract
A 58-year-old man suddenly developed double vision and weakness on the left side of his body. On examination his right eye showed ptosis, a dilated pupil, and the eye was positioned down and out. The man had a left hemiparesis with left-sided hyperreflexia and Babinski sign. The patient could wrinkle his forehead, but when asked to smile, the left lower side of his mouth drooped. When asked to protrude his tongue, it deviated to the left.
A lesion in what neurological pathway or structure was responsible for paralysis of the left lower face? A. Corticobulbar tract neurons B. Corticospinal tract neruons C. Facial nerve lower motor neurons D. Medial lemniscus neurons E. Spinothalamic tract neurons F. Trigeminothalamic neurons
A. Corticobulbar tract neurons
