Pixorize 2021 videos and questions bank

Educational objective: A lesion in Wemicke's area can cause receptive aphasia, which is characterized by well-articulated, nonsensical speech paired with a lack of language comprehension (Wernicke-Word salad). Wemicke's area is located in the auditory association cortex within the posterior portion of the superior temporal gyrus in the dominant temporal lobe. The middle cerebral artery supplies Broca's area (superior division) and Wemicke's area (inferior division).

A highly agitated 54-year-old man is brought to the emergency department by his family because he is unable to effectively communicate. He speaks clearly and with conviction but his sentences are incomprehensible. He does not appear to understand the doctor's questions, does not follow oral or written instructions, and cannot repeat simple phrases.

Educational objective: Transient global amnesia is a self-limited syndrome characterized by the sudden onset of prominent anterograde amnesia accompanied by repetitive questioning. Symptoms correlate with transient dysfunction of the hippocampus, the brain area responsible for the formation of new memories.

A 65-year-old woman is brought to the emergency department due to abnormal behavior. The patient was in her usual state of health until 3 hours ago, when she suddenly became confused and kept asking repetitive questions. She has had no headache, abnormal motor activity, or focal weakness or numbness. Medical history is significant for hypertension and migraine. Blood pressure is 136/84 mm Hg and pulse is 80/min. On physical examination, the patient is awake and alert but keeps asking, "What happened?" She can state her date of birth and address correctly, recognizes her family members, and is aware of current events. The patient recalls 0 of 3 objects after several minutes and cannot retain the physician's name despite many repetitions. Speech is fluent without dysarthria or aphasia. Cranial nerve examination shows no abnormalities. Motor strength, reflexes, and sensation are normal throughout. Blood cell count and serum chemistry panel are within normal limits. Urine drug screen is negative. CT scan of the head shows no hemorrhage. Two hours later, the patient spontaneously returns to normal.

Educational objective: Meningiomas are common adult intracranial tumors that typically arise in regions of dural reflection (eg, falx cerebri, tentorium cerebelli). Parasagittal lesions compressing the medial portion of the primary somatosensory cortex in the parietal lobe can result in contralateral lower limb sensory loss along with contralateral hemineglect if there is also damage to the parietal association cortex (nondominant hemisphere).

A 43-year-old, right-handed woman is evaluated in the clinic for progressively worsening neurologic symptoms. The patient has a history of diabetes mellitus and hyperlipidemia for which she takes metformin and a statin. She has no history of head trauma or seizures. The patient occasionally drinks wine but does not use tobacco or illicit drugs. Her mother has a history of migraine headaches. A brain MRI is obtained and is shown in the image below:

Educational objective: Postherniorrhaphy neuropathy refers to groin pain following hernia repair due to injury involving the cutaneous nerves of the lower abdomen/groin. Neuropathy of the ilioinguinal nerve presents with pain and allodynia in the anterior scrotum (labia majora in women), base of the penis (mons pubis), and medial thigh.

A 24-year-old man is being evaluated for a nerve block procedure. The patient has had intermittent burning and stabbing pain in the left groin since undergoing mesh repair of an inguinal hernia a year ago. The pain is often brought on by physical activity and coughing. He has no other medical conditions and takes no medications.signs are within normal limits. On physical examination, there is no weakness of anterior abdominal or lower extremity muscles. Lightly touching the upper medial thigh or upper part of the scrotum elicits burning pain. Cremasteric reflex is normal. The clinical diagnosis is entrapment of a nerve traversing the superficial inguinal ring with the spermatic cord.

Educational objective: Radial nerve injury can occur with repetitive pressure/trauma at the axilla (eg, improperly fitted crutches). Findings include weakness of the forearm, hand, and fingers extensors (eg, wrist drop, absent triceps reflex) and sensory loss over the posterior arm and forearm, dorsolateral hand, and dorsal thumb. More distal lesions spare the triceps brachii.

A 25-year-old man fractures his right tibia in a motor vehicle accident. His right leg is fixed in a cast and he requires underarm crutches to ambulate. Two weeks later, he comes to the clinic with right upper-extremity weakness and numbness. He has no neck or arm pain. The patient is concerned because he is right handed and cannot perform his duties as an electrician. On neurologic examination, there is diminished strength on extension of the right wrist with an absent triceps reflex.

Educational objective: Rabies virus has a bullet-shaped envelope with knob-like glycoproteins that bind to nicotinic acetylcholine receptors. Once transmission occurs (usually due to a bite wound from an infected animal), the virus replicates locally in muscle tissue for several days or weeks before spreading in a retrograde fashion through the peripheral nerve axons to the central nervous system.

A 32-year-old man is brought to the emergency department due to fever, agitation, and disorientation. According to his family, the patient has been acting strangely and seeing and hearing things that do not exist. He also drools excessively and has severe, painful throat spasms when he attempts to eat or drink. The patient returned 4 weeks ago from a camping trip in New Mexico. Physical examination shows a confused and combative patient with mydriasis and neck rigidity.

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Educational objective: The anterior cerebral arteries supply the medial portions of the 2 hemispheres (frontal and parietal lobes). Occlusion can cause contralateral motor and sensory deficits of the lower extremities, behavioral changes, and urinary incontinence.