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d****y
发帖数: 2180 | 1 ☆─────────────────────────────────────☆
firefly (飞萤扑火) 于 (Fri Jan 4 14:45:32 2013, 美东) 提到:
在offline form里是block3 #47.
72 yo woman who is right-handed is brought to the ER by her husband 3 hours
after the sudden onset of difficulty speaking. She has a history of afib.
She is alert. Neuro exam shows weakness of lower 2/3 face on right. She
understands verbals commands such as "raise your right arm." Her speech is
not spontaneous and consists of brief phrases without intonation (prosody).
Damage to which of the following labeled structures in the drawing of the
brain is the most likely caue of the language findings in this patient?
给了一个大脑的图问病变在哪儿的那个。选项A是Broca， 选项B像是premoter area, C
是motor cortex(中央前回），D是sensory cortex(中央后回)。
我看到的标准答案给的是A，也就是broca area。我不太明白，这个人还有下2/3脸部的
weakness,可不可能是面瘫导致的。我觉得应该选C。Google了一下没有很清
楚的解释，特此请教。多谢！
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QIUHONG (Julie) 于 (Fri Jan 4 16:55:14 2013, 美东) 提到:
MCA provides blood to frontal and temporal lobe which controling face
sensoring,motor and speaking.
其实这道题，你就记住血供的那个小人的分布图就可以了
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firefly (飞萤扑火) 于 (Fri Jan 4 21:00:06 2013, 美东) 提到:
谢谢回复。
如果只有运动皮质的脸部区域和 voicebox 区域受损，会不会出现题里描述的症状？
另外MCA的供血面积很大呀。为什么只有说话和面瘫两个症状呢？这两个区距离算不上
很近呀。
多谢！
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DaoBanID (daobanid) 于 (Fri Jan 4 22:35:15 2013, 美东) 提到:
呵呵，脑筋急转弯，主要考dysarthria vs. expressive aphasia
单侧面瘫，所以是单侧滴问题，单侧中央前回问题不会造成dysarthria，因为除了下半
边脸，都是双侧支配滴^_^
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Aplusplus (Hakuna Matata) 于 (Fri Jan 4 23:35:08 2013, 美东) 提到:
Just for fun, let me take a look:
“72 yo woman who is right-handed is brought to the ER by her husband 3
hours
A stroke from cardiac emboli causing speech difficulties。
“Neuro exam shows weakness of lower 2/3 face on right.”
Central facial palsy from the stroke involving motor cortex close to Broca's
area. This could cause dysartheria due to facial muscle weakness.
“She understands verbals commands such as "raise your right arm."
No comprehensive aphasia
”Her speech is not spontaneous and consists of brief phrases without
intonation (prosody).“
Classic Broca's aphasia
You can argue about dysatheria due to facial muscle weakness. But the best
answer is broca's aphasia. She even could not talk so how do you tell she
was dysartheric?
hours
.
C
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firefly (飞萤扑火) 于 (Sat Jan 5 01:55:06 2013, 美东) 提到:
多谢牛人指教。Stroke引起的中央前回central facial palsy是可能引起dysarthria的
，随便google了一个例子：
http://clinicalcases.org/2004/09/stroke-or-bells-palsy-facial-d
现在想想觉得题里没提病人有facial droop这一重要线索，可能就是提示应该选broca'
s吧。
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firefly (飞萤扑火) 于 (Sat Jan 5 02:00:01 2013, 美东) 提到:
前辈的step1基本功果然扎实，多谢了！
's
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DaoBanID (daobanid) 于 (Sat Jan 5 13:34:23 2013, 美东) 提到:
嘎嘎，还是前辈分析滴透彻，学习啦^_^
's
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DaoBanID (daobanid) 于 (Sat Jan 5 13:36:50 2013, 美东) 提到:
嘎嘎，学无止境啊，多谢楼主提醒。
单侧UMN面瘫还是会引起dysarthria的，不过跟题干里描述滴症状差得比较远，题干描
述是比较经典滴broca.
broca' |
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