Chapter·AnatomyBrainstem nuclei

Pontine nucleiDownloads

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1

A 45-year-old patient presents with difficulty speaking and swallowing following a stroke. MRI reveals an infarct in the medulla. Which of the following cranial nerve nuclei is most likely affected?

AVestibulocochlear nucleus

BTrigeminal nerve nucleus

CFacial nerve nucleus

DNucleus ambiguus

2

A 72-year-old woman is brought in to the emergency department after her husband noticed that she appeared to be choking on her dinner. He performed a Heimlich maneuver but was concerned that she may have aspirated something. The patient reports a lack of pain and temperature on the right half of her face, as well as the same lack of sensation on the left side of her body. She also states that she has been feeling "unsteady" on her feet. On physical exam you note a slight ptosis on the right side. She is sent for an emergent head CT. Where is the most likely location of the neurological lesion?

APons

BInternal capsule

CCervical spinal cord

DMedulla

EMidbrain

3

A 27-year-old man is brought into the emergency department by ambulance. The patient was at an appointment to receive welfare when he began acting abnormally. The patient was denied welfare. Shortly afterwards, he no longer responded to questions and stared blankly off into space, not responding to verbal stimuli. Other than odd lip-smacking behavior, he was motionless. Several minutes later, he became responsive but seemed confused. The patient has a past medical history of drug abuse and homelessness and is not currently taking any medications. His temperature is 98.9°F (37.2°C), blood pressure is 124/78 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam reveals cranial nerves II-XII as grossly intact with 5/5 strength in the upper and lower extremities and a stable gait. The patient seems confused when answering questions and has trouble remembering the episode. Which of the following is the most likely diagnosis?

AAbsence seizure

BMalingering

CFocal impaired awareness seizure

DTransient ischemic attack

EGeneralized seizure

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