USMLE Forum Archives - USMLE Step 1 - neuroanatomy #1
neuroanatomy #1
usmlefever3 - 03-23-09 02:02
1. A 63-year-old man complains of trouble swallowing and hoarseness. On physical exam, he is noted to have ptosis
and a constricted pupil on the left, and a diminished gag reflex. Neurological examination shows decreased pain and
temperature sensation on the left side of his face and on the right side of his body. Which of the following vessels is most likely occluded?
A.anteriorinferior cerebellar artery (AICA)
B. Anterior spinal artery
C. Middle cerebral artery (MCA)
D. Posterior cerebral artery (PCA)
E. Posterior inferior cerebellar artery (PICA)
usmlefever3 - 03-23-09 02:02
1. A 63-year-old man complains of trouble swallowing and hoarseness. On physical exam, he is noted to have ptosis
and a constricted pupil on the left, and a diminished gag reflex. Neurological examination shows decreased pain and
temperature sensation on the left side of his face and on the right side of his body. Which of the following vessels is most likely occluded?
A.anteriorinferior cerebellar artery (AICA)
B. Anterior spinal artery
C. Middle cerebral artery (MCA)
D. Posterior cerebral artery (PCA)
E. Posterior inferior cerebellar artery (PICA)
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#1
Re: neuroanatomy #1 bingousmle - 03-23-09 03:28 E. Posterior inferior cerebellar artery (PICA) asit relates to wallenberg syndrome. correct me if i am wrong.
hey Btw you had your step one on 23 isnt it. so have you postponed it?
#2
Re: neuroanatomy #1
usmlefever3 - 03-23-09 04:16 correct answer E
@bingo....i was forced to reschedule on 6 th april after i got 470 in form 6 NBME last week.i am confused as i wanted to give step 1 early to get time for step 2Ck...still cant compromise on step 1 score.....i will appreciate any advice from you in this regard?
#3
Re: neuroanatomy #1 Youngdoctor - 03-23-09 06:05 What are the sign of posterior inferior cerebellar artery (PICA) ??
#4
Re: neuroanatomy #1 bingousmle - 03-23-09 06:15 @youngdoctor, the vignette itself says a lot, but still just to add1. The long tracts affected are the spinothalamic tract and the descending hypothalamic fibers.
a. Spinothalamic tract lesions result in a loss of pain and temperature sensations in the limbs and body contralateral to the lesion.
b. A lesion of descending hypothalamic fibers results in Horner’s syndrome
with miosis, ptosis, and anhidrosis ipsilateral to the lesion.
2. The cranial nerves that may be affected by the lesion and localize the lesion to the lateral medulla are the vestibular or the cochlear nuclei, the glossopharyngeal nerve, and the vagus nerve.
a. A lesion of the vestibular nuclei may result in vertigo, nausea and vomiting,and a vestibular nystagmus, in which the fast phase will be away from the side of the lesion.
b. A lesion of the cochlear nucleus results in an ipsilateral sensorineural hearing loss
c. lesion of the vagus nerve as it exits the medulla is the most common localizing cranial nerve sign of lateral medullary syndrome.
d. Vagus nerve lesions result in dysphagia (difficulty in swallowing) or
hoarseness, the palate may droop on the affected side, and the uvula may
deviate away from the side of the lesion.
e. A lesion of a glossopharyngeal nerve may result in a diminished or absent
gag reflex.
3. The spinal tract and spinal nucleus of the trigeminal nerve may be lesioned.
a. There may be loss of pain and temperature sensations from half of the face and scalp ipsilateral to the side of the lesion.
b. Touch sensations from the face and the corneal blink reflex will be intact.
c. Patients have a dissociated loss of pain and temperature; pain and temperature sensations are lost from the face and scalp ipsilateral to the lesion but are lost from the contralateral limbs and trunk.
4. The solitary nucleus may be affected.
a. Patients may have an alteration or loss of taste from the tongue ipsilateral
to the side of the lesion.
b. The facial and glossopharyngeal nerves convey sensations of taste into the solitary
nucleus from the anterior two thirds and posterior third of the tongue,
respectively.
#5
Re: neuroanatomy #1 bingousmle - 03-23-09 06:40 @usmlefever3
what i think is whatever you do in your last 15 days should do things that only boost your confidence. i could give just 45 days for an honest preparation, and as i told you i did a retrograde preparation , from day 1 i only solved mcqs so as to avoid any last minute assessments.
though nbme 5 and 6 are said to resemble the actual exam , i could not give them a thought , and since i think i performed well on u world, and gave myself a pseudo motivation and it helped.
that matters a lot in these crucial days before the exam. YOU HAVE TO KEEP YOUR SPIRITS HIGH
since all my friends were postponing their exams , even i had this temptation but then one of my pals told me to be confident and give it my best . now since you have already postponed keep 6 april as your target...
i have some good notes , if you want i may give them
#6
Re: neuroanatomy #1 usmlefever3 - 03-23-09 09:56 thx bingo for your wonderful elaboration of facts about lateral medullary syndrome
i will be thankful if u share your good notes with me .i would also like to know about the real exam u gave...........how much it really differed from UW questions.....did it have lots of neuroanatomy questions , biochemistry and genetics....did it had any audio visual questions ?
#7
Re: neuroanatomy #1 bingousmle - 03-23-09 10:39 my real exam was tougher than u world, for sure. and after coming out of the centre i was not at all satisfied . but by Gods grace i managed to pass.
there was a lot of genetics, which was very different from u world and as i already have expressed , none of the tests which i did were any close to my exam.
biochemistry , not much.
neuroanatomy , i had plenty, but its basically all MRI and CT scan. i would innately advise you to do that part very well. i think thats what saved me.
there were 2 audio visual questions. but dont worry much about them, as they are easy..
#8
Re: neuroanatomy #1 usmlefever3 - 03-23-09 11:23 thx bingo for that information.......i thought UW had lots of CT and MRI....i think i am prepared in that....does the genetics questions were very tough,hard or managable?
#9
Re: neuroanatomy #1 bingousmle - 03-23-09 14:22 genetics was kind of tough, may be i wasn't prepared. but it was heavily tested on my exam. and make a habit of reading fast , the vignettes are too long. finishing the test on time boosts you up.
#10
Re: neuroanatomy #1 usmlefever3 - 03-23-09 14:26 suppose if i finish a block 5 min before........will this 5 min added to my break time?
#14
Re: neuroanatomy #1 dinmenace - 07-27-09 05:24 1. A 63-year-old man complains of trouble swallowing and hoarseness. On physical exam, he is noted to have ptosis
and a constricted pupil on the left, and a diminished gag reflex. Neurological examination shows decreased pain and
temperature sensation on the left side of his face and on the right side of his body. Which of the following vessels is most likely occluded?
E. Posterior inferior cerebellar artery (PICA)
#18
Re: neuroanatomy #1 babbu5508 - 06-25-10 13:52 E. Posterior inferior cerebellar artery (PICA)...wallenberg syndrome...resulting in symptoms from the VIII,IX, and X nerves
#19
Re: neuroanatomy #1 bingousmle - 06-30-10 20:26 @usmlefever 3 .. hows your preparation coming along? have you taken a date? its long time that i heard from you.. lemme know
#21
Re: neuroanatomy #1 ktkmelody - 07-21-10 01:33 @bingousmle
Thank you very much for explanation of lateral Medullary syndromes.
Could you please share more about neurology please ?
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