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193 Cards in this Set
- Front
- Back
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At which end of the tRNA is the aa bound?
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The amino acid is covalently bound to the 3' end of the tRNA.
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Define transition.
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Substituting purine for purine or pyrimidine for pyrimidine.
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Define transversion.
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Substituting purine for pyrimidine or vice versa.
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Define tRNA wobble.
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-Accurate base pairing is required only in the first 2 nucleotide positions of an mRNA codon, so codons differing in the 3rd 'wobble' position may code for the same tRNA/amino acid.
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Describe topoisomerase activity
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DNA topoisomerases create a nick in the helix to relieve supercoils
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Describe Euchromatin
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Less condensed (vs. Heterochromatin), transcriptionally active
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Describe key structural differences between nucleotides.
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1) Purines (A,G) have 2 rings.
2) Pyrimidines (C,T,U) have 1 ring 3) Guanine has a ketone. 4) Thymine has a methyl |
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Loss of sensation in the lateral digits of the hand is caused by damage to what nerve?
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Median n.
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What supplies blood to the descending colon?
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Inferior mesenteric artery
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What is the role of helicase in DNA replication?
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It is at the fork doing the unwinding
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How does the Na/K pump work?
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Pumps 3Na out for every 2K in
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Is Staph catalase + or -?
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Staph is Catalase + (Strep and Enterococcus are catalase -)
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What organism causes pneumonia and grows on charcoal media?
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Legionella
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Infection in burn pt, suspect ___?
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Pseudomonas sp.
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In a pt with Alpha 1 antitrypsin def., what causes destruction of the lung?
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Unopposed action of elastase
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what is the most effective vaccine type?
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Live attenuated
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What occurs in Kartagener's syndrome?
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absent dynein arm in cilia
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A person has a crescendo-decrescendo murmur heard in the R second intercostal space that radiates to the carotids, what is the defect?
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aortic stenosis
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Pt has a stab wound to chest and there is lung collapse. What is teh pressure inside the pleural cavity?
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Same as atmospheric pressure
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When will you see WBC casts?
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pyelonephritis
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What is the triad of symptoms for Trisomy 13?
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Cleft lip/palate, polydactyly, eye abnormalities
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What is the most common location for colonic diverticulosis/-itis?
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Sigmoid Colon - 90% of the time
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Pt with painless jaundice...thoughts?
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Pancreatic Cancer
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What is Courvoisier's sign?
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patient presents with jaundice and a palpable gall bladder, the cause if likely cancer, not stones!
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AST and ALT are elevated with an AST/ALT ratio > 2, diagnosis?
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Alcoholic Hepatitis
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M/C place to find Crohn's Disease?
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75% are in the terminal Ileum
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M/C histology of colon cancer?
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Adenocarcinoma
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M/C place for colon cancer to metastasize to?
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Liver - 50-68%
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Bacterial causes of diarrhea associated with water?
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VIBRIO, Giardia, cryptosporidiosis
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What are Acanthosis nigrans? Indicative of?
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This is a velvety type rash seen in overweight kids along the neck; sign of insulin insensitivity
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What are the Erector Spinae muscles?
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Iliocostalis (most lateral), Longissimus, and Spinalis -- I Love Sex.
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What makes up the suboccipital triangle?
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Rectus capitis posterior major and minor (superior-medial border); superior oblique capitis (superior-lateral border); inferior oblique capitis (inferior border)
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What is found in the Suboccipital Triangle?
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Vertebral a., Suboccipital n. (dorsal ramus of C1), greater occipital n. (dorsal ramus of C2), and posterior atlanto-occipital membrane.
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What does a positive anterior drawer sign indicate?
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Tearing of the ACL
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When a person dislocates their shoulder anteriorly, what nerve is likely to be damaged?
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Axillary nerve (C5,6)
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X-ray shows bilateral hilar lymphadenopathy. Diagnosis?
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Sarcoidosis
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Child shows weakness and enlarged calves. Diagnosis?
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Duchenne's muscular dystrophy (X-linked recessive)
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What is found on aspiration of a joint of a pt with pseudogout?
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rhomboid calcium pyrophosphate crystals
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What are the symptoms of Achrondroplasia.
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Autosomal-dominant trait. failure of longitudinal bone growth (short limbs, normal axial skeleton)
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What is the problem in Achrondroplasia?
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Impaired cartilage maturation in growth plate caused by fibroblast growth factor receptor mutation.
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What disorder exhibits Heberden's and Bouchard's nodes?
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Osteoarthritis
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Where are Heberden's and Bouchard's nodes found?
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Heberden's nodes: DIP; Bouchard's nodes: PIP
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What is the classic presentation of Osteoarthritis?
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pain in weight bearing joints after use (end of the day) that improves with rest. No systemic symptoms
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Classic presentation of Rheumatoid arthritis?
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morning stiffness improving with use, symmetric joint involvement, and systemic symptoms (fever, fatigue, pleuritis, pericarditis)
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What deformities are seen with RA? Where?
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Boutonniere deformity: PIP flexed; Swan-neck deformity: DIP flexed
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What forms in the joints of pts with RA?
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pannus
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What are the criteria for RA? How many must occur?
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4 of the 7:
1. morning stiffness 2. arthritis in 3+ joints 3. arthritis in on ehand 4. symmetrical arthritis 5. rheumatoid factor 6. rheumatoid nodules 7. radiographic changes |
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What is rheumatoid factor?
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Anti-IgG antibody (IgM reacting to CH3 position of IgG)
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What gender is more greatly affected by RA?
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females
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What are the epidemiologies of RA and osteoarthritis?
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Osteoarthritis: Mechanical; Rheumatoid arthritis: Autoimmune
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Describe Osteoporosis
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Reduction of bone mass in spite of normal bone mineralization. Sparse trabeculae
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Describe Osteopetrosis
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Marble bone disease: failure of normal bone reabsorption. Thickened, dense bones. caused by abnormal function of osteoclasts
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What lab values are seen with osteopetrosis?
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Serum Ca, Phosphate, and alkaline phosphatase are NORMAL
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What systemic symptoms are seen with osteopetrosis?
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anemia, thrombocytopenia, and infection --> because of the decreased marrow space
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Describe osteomalacia
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Defective mineralization of osteoid (soft bones) due to a Vit. D deficiency in adults.
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Osteomalacia in kids?
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Rickets
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Describe Paget's disease
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Osteitis deformans. Abnormal bone architecture caused by increased osteoblastic and osteoclastic activity.
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What lab values are seen with Paget's disease?
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Normal serum Ca, Phosphorus, and PTH; ELEVATED serum alkaline phosphatase
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What disorder is characterized by blue sclera and fragile bones?
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Osteogenesis Imperfecta (Brittle bone dz).
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What disorder has the classic triad of xerophthalmia, xerostomia, and arthritis?
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Sjogren's syndrome (dry eyes, dry mouth, arthritis - bad hookers)
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What are the characteristics of SLE?
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I'M DAMN SHARP:
Immunoglobulins (anti-dsDNA, anti-Sm, antiphospholipid) Malar rash (butterfly) Discoid rash Antinuclear antibody Mucositis (orophrayngeal ulcers) Neurologic disorders Serositis (pleuritis, pericarditis) Hematologic disorders Arthritis Renal disorders Photosensitivity |
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What do lab tests show with SLE?
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ANA (sensitive, but not specific for SLE)
Anti-dsDNA (very specific, poor prognosis) Anti-Sm (very specific, but not prognostic) |
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What is seen with drug induced lupus?
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Antihistone antibodies
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What is seen upon aspiration with Gout?
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Needle shaped negatively birefringent monosodium urate crystals
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What is the classic manifestation of Gout? Who?
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painful MTP joint in the big toe (podagra). M/C in men
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Where does tophus formation commonly occur with Gout?
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external ear or Achilles tendon
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What is the tx for Gout?
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Allopurinol, probenecid, colchicine, and NSAIDS.
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What is Sarcoidosis characterized by?
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immune-mediated, widespread noncaseating granulomas an delevated serum ACE levels.
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Who is Sarcoidosis commonly seen in?
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black females
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What disorder shows a strong associated with HLA-B27?
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Seronegative spondylo-arthropathies (Ankylosing spondylitis, Reiter's syndrome, and Psoriatic arthritis)
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What is the classic triad for Reiter's syndrome?
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Urethritis, Conjunctivitis and anterior uveitis, and arthritis - Can't see, can't pee, and can't go out with me.
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What disorder is characterized by the "pencil in cup" seen on XR?
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Psoriatic Arthritis - DIP and/or PIP joints
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What disorder is associated with anti-centromere antibodies?
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CREST syndrome
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What is CREST syndrome?
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Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia
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What causes 'wrist drop'?
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radial nerve damage (break the humerus mid-way)
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What can cause medial winging of the scapula?
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injured long thoracic nerve (which supplies subscapularis)
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Tennis elbow vs. golf elbow?
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Tennis: lateral epicondyle; golf: medial epicondyle
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What is the Trendelenberg sign indicative of?
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Injury to the superior gluteal nerve (affecting gluteus medius and minimus)
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Describe Myasthenia gravis
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Displays muscle weakness with use. Caused by Ab to Ach.
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What gene is Myasthenia gravis associated wtih?
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HLA-DR3
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What are the characteristics of Wilson's Disease?
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ABCD:
* Asterixix * Basal ganglia degeneration (parkinsonian symptoms) * Ceruloplasmin low, Cirrhosis, Corneal deposits (Kayser-Fleischer rings), Copper accumulation, Carcinoma (hepatocellular), Choreiform movements * Dementia |
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What disorder is characterized by low serum Ceruloplasmin and high urine copper?
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Wilson's disease
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What disorder shows Kayser-Fleischer rings in its more serious stages?
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Wilson't disease
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What occurs in Wilson's disease?
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There is inadequate hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin. This leads to copper accumulation, especially in liver, brain, cornea, kidneys, and joints.
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What is Wilson's disease treated with?
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Penicillamine
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What protozoa shows ring-enhancing brain lesions?
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Toxoplasma
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How is Toxoplasmosis acquired?
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By eating the cysts in meat or from cat feces
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What is Toxoplasmosis treated with?
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Sulfadiazine + pyrimethamine
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What bug causes Chagas' disease?
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Trypanosoma cruzi
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How is Trypanosoma cruzi transmitted?
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Chagas' disease - transmitted through the Reduviid bug
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What occurs with Chagas' disease?
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Trypanosoma cruzi is the bug. Causes dilated cardiomyopathy, megacolon, and megaesophagus
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If a patient comes in complaining of seizures and has brain cysts, what parasite is thought?
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Taenia solium (cysticercosis)
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What causes cysticercosis?
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Taenia solium
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How is Taenia solium transmitted?
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Cysticercosis; transmitted through undercooked pork tapeworm
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If you find liver cysts, what parasite is thought?
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Echinococcus granulosus
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If a patient is found to have hematuria and bladder cancer, what parasite is thought?
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Schistosoma haematobium
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What is the 'Thumb print sign' on X-rays indicative of?
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edema and necrosis of the bowel
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What disorder shows a cobblestone appearance of the bowel on biopsy?
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Crohn's
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What disorder shows pseudopolyps in the colon?
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Ulcerative Colitis
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What forms the myelin sheath for the axons?
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Schwann cells in the PNS and oligodendrocytes in the CNS
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What structure produces CSF?
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Choroid plexus
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Describe the parasympathetic innervation of the submandibular gland
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Preganglionic parasympathetic fibers from the superior salivatory nucleus exit the brainstem with the facial nerve, travel thru the chorda tympani, and join with the lingual nerve before terminating in the submandibular ganglion. Postganglionic fibers from the submandibular ganglion distribute as numerous short branches to the parenchyma of the gland.
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Describe the sympathetic innervation of the submandibular gland
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Postganglionic Sympathetic fibers originate in the superior cervical ganglion, and reach the gland by coursing in the external carotid and facial plexuses in the adventitia of the respective arteries
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What arteries supply blood to the thyroid gland? Origins?
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Superior thyroid artery (arises from the common or external carotids); inferior thyroid artery (from the thyrocervical trunk off the subclavian) and the lowest thyroid artery (from the brachiocephalic, aorta, or left common carotid)
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What is a tracheotomy?
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An emergency airway that is cut through tracheal rings 2-4
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How are drugs and peptides kept out of the CSF?
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They can cross the BBB, but they are rapidly transported back into the blood via P-glycoprotein (multi-drug non-specific transporter)
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What does GABA do>
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It travels to the pre-synaptic terminal of the other axon and produces hyperpolarization by opening Cl- channels.
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What is Subclavian steal syndrome?
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Due to the obstruction of the subclavian artery proximal to the vertebral artery. During exercise, blood is shunted from the vertebral system, which supplies the brain, into the distal subclavian artery, which supplies the ipsilateral extremity. The decrease in blood flow to the brain (Vertebro-basilar insufficiency) may result in coma, quadriplegia, and numerous cranial nerve abnormalities.
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What is vertebro-basilar insufficiency?
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A type of ischemia which may result in transient or permanent neurological dysfunction.
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What is the course of the middle meningeal artery?
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It splits the auriculotemporal nerve before passing thru the foramen spinosum along with the recurrent meningeal branch of V3. At the level of the pterion, it splits into anterior and posterior branches and supplies most of the dura mater and endocranium
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What can happen with head trauma (with regard to the middle meningeal artery)?
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The middle meningeal artery may be ruptured and hemorrhage between the endocranium and dura mater creating an epidural hematoma.
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What is Nuchal rigidity?
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Rigidity or stiffness of the extensor neck muscles occurs with neuralgia, various neck lesions, posterior fossa masses, meningeal irritation, or blood in the CSF
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What is Kernig’s Sign?
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The inability to extend the leg when the thigh is flexed, and is indicative of meningeal irritation
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What is anterior scalene syndrome?
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Spasms of the anterior scalene muscle may compress the plexus (Thoracic Outlet Syndrome)
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What occurs in Vernet’s Syndrome?
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Basilar skull fracture involving the jugular foramen that result sin ipsilateral IX, X, and XI paralysis
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What occurs in Collet’s (Sicard’s/Villaret’s) Syndrome?
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Injury to retroparotid space that involves ipsilateral paralysis of CN IX-XII and cervical sympathetic trunk
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What cranial nerves carry parasympathetic fibers?
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CN III, VII, IX, and X
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What is ‘Stern’s Rule’?
**If a muscle has “___” in its name, it is innervated by: |
Tensor…CN V (Trigeminal)
Palat-… CN X (Vagus) Glossus… CN XII (Hypoglossus) **This is a hierarchical rule, so if a name has Palat- and Tensor in its name, it is innervated by CN V (Trigeminal), not Vagus |
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Describe Spurling maneuver
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Hyperextension of the neck and rotation and tilt head toward the side of the lesion causes radicular pain in neck and down the arm– indicative of cervical root compression (disc herniation/bulge)
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What is cervical radiculopathy?
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Pain caused by compression of the spinal nerve as it exits the spine radiating in the distribution of the defined nerve root
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What are the general symptoms of cervical nerve root compression?
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Sensory changes (pain and paresthesia); motor changes (weakness in affected muscles); reflex changes (decreased); positive provocative test (Spurling maneuver)
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What is the most commonly compressed nerve root in the upper extremity?
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C7
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What muscles will be weak with a C5 nerve root compression?
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Deltoid, biceps
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Pt exhibits weakness abducting whole arm and has decreased sensation over the lateral aspect of the arm. What nerve root is likely compressed?
What reflex will likely be decreased? |
C5; biceps reflex
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What reflexes will be affected with a C5 nerve root compression?
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Biceps reflex
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Where does C5 supply sensation to?
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Lateral arm
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What muscles will be weak with a C6 nerve root compression?
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Biceps and wrist extensors
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Pt is having trouble lifting objects she once could easily lift and has a decreased brachioradialis reflex. What nerve root is probably compressed? Where will there likley be sensory deficit?
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C6; lateral forearm
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What reflexes will be affected with a C6 nerve root compression?
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Brachioradialis reflex
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Where does C6 supply sensation to?
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Lateral forearm and thumb and index finger
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What muscles will be weak with a C7 nerve root compression?
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Triceps, wrist flexors and finger extensors
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What reflexes will be affected with a C7 nerve root compression?
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Triceps reflex
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Pt complains of tingling in her middle finger of her R hand. On exam, her triceps reflex is decreased in the same arm. What nerve root is likely compressed? What muscles may be affected?
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C7; triceps, wrist flexors and finger extensors
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Where does C7 supply sensation to?
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Middle finger (palmar aspect)
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What muscles will be weak with a C8 nerve root compression?
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Finger flexors and hand interossei muscles
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Where does C8 supply sensation to?
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Medial forearm
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What muscles will be weak with a T1 nerve root compression?
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Hand interossei muscles
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Where does T1 supply sensation to?
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Medial arm
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Pt complains of paresthesia in her right forearm and her pinky. What nerve root is likely compressed?
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C8
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Fracture high on the Humerus, what nerve should you worry about?
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Radial nerve
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Pt is involved in a motor vehicle accident and comes in with an injury to her right upper arm. On exam, pt exhibits wrist drop and diminished triceps reflex. What is the probable diagnosis?
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Humerus fracture involving the Radial nerve.
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Pt complains of pain in the left upper forearm on the thumb side. On exam, the lateral, upper forearm is tender and the pt has difficulty extending her wrist. Supination against resistance elicits pain in the upper, lateral forearm. What is the likely diagnosis?
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Radial tunnel syndrome (chronic tennis elbow) - pain 5cm distal to the lateral epicondyle
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What are the symptoms of compression of the radial nerve high on the humerus?
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Wrist drop, weakness of elbow flexion, possible triceps involvement, +/- triceps reflex diminished, pain/numbness
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Pt complains of paresthesia and numbness on the back side of her right hand. Likely diagnosis?
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Radial compression at the wrist (aka Handcuff Neuropathy)
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35 yr old professional baseball player complains of achy pain in the mid forearm. On exam, he has numbness in his thumb and middle finger and pronation against resistance elicits pain in the mid-forearm. Likely diagnosis?
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Pronator Syndrome - compression of the Median nerve by pronator teres
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What are the provocative tests for pronator syndrome?
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Flexion of the middle finger against resistance (compression by flexor digitorum); pronation against resistance with forearm in supination (compression by pronator teres); and flexion of wrist against resistance (compression by lacertus fibrosus)
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While performing a routine exam, you notice your pt is unable to hold a piece of paper between the tips of her index finger and thumb (she has to use the more proximal part of her index finger to keep ahold of the paper). She denies pain in her forearm and shows no other symptoms. What is the likely diagnosis?
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Interosseous syndrome - compression of the anterior interosseous branch of the median nerve.
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What is the most common compression syndrome?
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Carpal Tunnel
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What occurs in Carpal Tunnel syndrome?
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Compression of the median nerve as it passes with the flexor tendons thru the carpal tunnel under the flexor retinaculum
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40 y/o UPS worker complains of pain in her wrist and says that she keeps dropping things. She also says that her thumb and index finger deep going numb when she lays down. What is the likely diagnosis? Tests that could be done to confirm this?
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Carpal Tunnel syndrome; EMG, Phalen's and Tinel's Sign; 2-pt discrimination
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Woman complains that she is having trouble turning her car on (turning the key) and is having tingling in her pinky finger. On exam, tapping over the elbow elicits pain radiating to the hand. What is the likely diagnosis?
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Cubital tunnel ulnar nerve compression
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35 y/o cycler complains of numbness in her pinky and ring finger. On exam, her hypothenar muscles are diminished in size compared to the other hand. What nerve is compressed and where? B/w what bones?
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Ulnar nerve; in Guyon's canal; b/w the pisiform and hook of hamate
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A pt comes in with a shoulder dislocation, what nerve should you worry about?
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Axillary nerve
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26 y/o male complains that he is no longer able to curl as much weight as he used to. On exam his lateral forearm is very sensitive to pain. What muscle is causing this dysfunction?
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Coracobrachialis muscle is compressing the musculocutaneous nerve
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40 y/o female complains that her hands fall asleep when she is blow drying her hair in the morning. On exam, she has a positive Wright's Test. What is the diagnosis? What muscle?
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Thoracic Outlet Syndrome; Pectoralis Minor is compressing the brachial plexus
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What is the origin and insertion for Pectoralis minor?
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O: Coracoid Process (of scapula)
I: ribs 3-5 |
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What is the Distraction test?
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Testing for cervical nerve root compression: place one hand under ching and on occiput and lift head; if the pain is relieved/reduced = (+) test
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What is the Compression test (Spurling)?
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Extend, rotate and side bend towrad the side of the pain and compress the head; if pain is worsened = (+) test (for cervical nerve root compression)
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What is Adson test?
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For Thoracic Outlet syndrome caused by Scalene muscles: monitor radial pulse with arm abducted and flexed; have pt look away; if pulse decreases = (+) test
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What are 'normal' reflexes? (number)
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2/4
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What is normal strength of a muscle? (number)
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5/5
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What are the S/S of Meniere’s disease?
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Triad:
1. Repeated episodes of vertigo 2. tinnitus 3. progressive sensorineural hearing loss |
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What is the tx for Meniere’s disease?
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Diuretics, Na restriction (to decrease the volume in the semicircular canals) and possibly surgical procedures
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What is one of the first signs of salicylate poisoning? Then?
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Tinnitus; eventually can cause dizziness
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What is the inheritance pattern of Friedreich's ataxia? Chromosome?
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Autosomal recessive mutation on Chromosome 9 - idiopathic cerebellar degeneration
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17 y/o comes in complaining of becoming clumbsy and feeling weak in his legs (it has stopped him from running in track) and he says that he has felt dizzy lately. On exam, you note that his leg muscles are weak (3/5 bilaterally) and his leg DTR are absent. He also has mild Nystagmus. Likely diagnosis?
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Friedreich’s ataxia – chromosome 9
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14 yr old comes in complaining of recurrent sinus infections (5 in the past year) and his mom says that he has become very clumsy lately. On exam, you note red ‘spider’ veins in the corners of his eyes and the pt demonstrates a decreased sense of balance. What is the likely diagnosis?
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Ataxia-Telangiectasia – chromosome 11
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43y/o male states that he becomes dizzy whenever he rolls over in bed. He denies any head trauma, illness or other injury. Likely diagnosis? Tx?
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Benign positional vertigo; treat with positional exercises and a trial of meclizine or valium
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30 y/o complains of repeated episodes of dizziness and ringing in his ears. On exam, Weber test shows lateralization of sound to the R ear and Rinne test shows decreased bone-to-air conduction ratio in the L, but air conduction is still longer than bone conduction. What is the likely diagnosis?
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Meniere’s disease (sensorineural hearing loss)
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What are the expected findings for conductive hearing loss (Weber and Rinne tests)?
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Weber test: lateralization of deaf ear
Rinne test: bone conduction heard longer than air conduction in affected ear (Rine neg.) |
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What are the expected findings for sensorineural hearing loss (Weber and Rinne tests)?
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Weber: lateralization to better ear
Rinne: air conduction heard longer than bone conduction in affected ear, but less than 2:1 ratio |
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25 y/o complains of sudden attacks of dizziness accompanied by nausea and vomiting. He claims that it doesn’t seem to matter what he’s doing at the time, it just happens. Pt denies hearing loss and tinnitus and Weber and Rinne tests are normal. What is the likely diagnosis?
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Vestibular Neuronitis
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Pt complains of sudden onset of dizziness, ringing in the ears, and facial pain. On exam, you note an asymmetrical smile. What is a likely cause?
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Cerebellopontine angle tumor (acoustic neuroma, meningioma, and cholesteatomas)
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If you see a pt with anisocoria and slight ptosis, what should be thought?
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Horner’s syndrome
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If you see a pt with anisocoria, ptosis and ophthalmoplegia, what should be thought?
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Third Nerve Palsy
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Pt presents with bilateral ptosis, up-gaze palsy and pupils are slow to accommodate. What is the likely diagnosis?
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Nuclear third nerve palsy
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Pt presents complaining of a really bad HA. On exam, the pt has ptosis and external strabismus of the R eye and the R eye does not accommodate. What is the likely diagnosis? What tests should be ordered?
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Aneurysm of the posterior communicating artery that is compressing on the third nerve (pupil-involving peripheral 3rd nerve palsy); angiography is the best way to see these!
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What nerves would be affected with Cavernous Sinus problems?
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CN III, IV, V, and especially VI
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Bitemporal field defects is a _____ until proven otherwise?
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Pituitary tumor (compressing on optic chiasma)– do an MRI
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Pt complains of seeing double. While talking to the pt, you notice that he tilts his head to the R to try to keep his eyes level. On exam, pt is not able to adduct and depress his left eye. What nerve is affected and where is the lesion?
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Trochlear nerve – midbrain lesion (can’t tell if lesion is on R or L)
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Pt complains that he can’t open his left eye. On exam, his left eye is looking to the left and his pupil is dilated and is unreactive to light. What nerve is involved and where is the lesion?
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Left Oculomotor nerve – midbrain lesion
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Pt complains that he can’t feel his right cheek and is having problems chewing. On exam, he has no sensation in the right side of the face and when he is asked to clench his teeth, Temporalis and Masseter muscles cannot be palpated. When the pt opens his mouth, his chin deviates to the Right. What nerve is affected? Where?
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Right Trigeminal nerve in the middle cerebellar peduncle
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Pt complains that he can’t see very much in his R peripheral vision. On exam, pts R eye is looking in and on examination of the cardinal signs of gaze, he is unable to follow your finger laterally with his R eye. All other signs of gaze are normal. What nerve is affected? Where?
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Right Abducens nerve – pontomedullary sulcus
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Pt complains that he can’t taste his favorite candy and he says that the music in your office is way too loud. While talking with the pt you notice that he has an asymmetrical smile and is drooling from the R side of his mouth. What nerve is involved? Where?
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Right Facial nerve – pontomedullary sulcus
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Pt shows spastic hemiplegia of his entire R side and L leg. On exam, his tongue shows atrophy on the L side and when he sticks his tongue out, it deviates to the L. Where is the lesion?
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Left Alternating Hypoglossal Hemiplegia with involvement of the contralateral (Right) CST
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Pt complains that the music is your office is too loud. On exam, he cannot move the left side of his face and his left eye is passively pointed inward. He is also demonstrating R spastic hemiplegia. What is the lesion?
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Millard-Gubler’s Syndrome – Left A6H + 7
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Pt shows spastic hemiplegia of the L side of his body and he cannot feel a vibrating tuning fork on his L medial malleolus. On exam, pt has an asymmetrical smile and is drooling from the L side of his mouth. He also cannot feel anything on the R side of his face, his tongue deviates to the L when protruded, and his L eye is passively pointing inward. Where is the lesion?
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R alternating trigeminal hemiplegia with a dorsal expansion (into ML & uncrossed CBT)
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Pt shows spastic hemiplegia of his left side. When testing position sense, he cannot tell if his finger or toe on the L side is bent or straight when the Dr. moves it. When pt sticks out his tongue, it deviates toward the R side. Where is the lesion?
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Right Alternating Hypoglossal Hemiplegia and destruction of the R Medial Lemniscus
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Pt shows spastic paralysis of the Right side. When asked to clench his teeth, Temporalis and masseter muscles cannot be palpated on the L side of his face. Upon sensation testing, he cannot feel anything on the left side of his face. What is the lesion?
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R side lesion of Trigeminal nerve and CST - Alternating Trigeminal Hemiplegia
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Pt shows spastic hemiplegia of her R side and her left eye is passively pointed inward. When she speaks to you, she turns her head to the Left in an attempt to line her eyes up. What is the lesion?
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Left Alternating Abducent Hemiplegia
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Pt shows spastic hemiplegia of his L side. On exam, when he is asked to stick out his tongue, it deviates to the R side and there is some atrophy of the R side of the tongue. What is the lesion?
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Right Alternating Hypoglossal Hemiplegia
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Pt shows spastic hemiplegia of the L side of his body and he cannot open his R eye. When you lift up his R eyelid, the eye is passively pointed outward and his pupil is dilated. Where is the lesion?
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R alternating Oculomotor Hemiplegia (Weber’s syndrome)
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Pt exhibits Left spastic hemiplegia and is unable to decifer between 1 and 2 ends of a paperclip touching his left hand and sole of his foot. His Right eye is passively pointed inward and his tongue deviates to the R when he is asked to stick it out. What is the lesion?
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Right A6H + ML + crossed CBT
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