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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{Rim}} (Reviewed by  {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Anatomy, Pathophysiology
|MainCategory=Anatomy, Pathophysiology
Line 21: Line 21:
|MainCategory=Anatomy, Pathophysiology
|MainCategory=Anatomy, Pathophysiology
|SubCategory=Neurology
|SubCategory=Neurology
|Prompt=A 72 year old male patient with history of atrial fibrillation on warfarin was admitted to the hospital for progressively increasing headache since 10 days and recent weird speech. The patient's wife informs the physician that the patient complained about a headache that started insidiously almost 10 days ago and has been progressively getting worse. The wife reports a history of mild trauma three weeks ago, during which the patient tripped and fell on his head. Upon questioning the patient, he answers back fluently and says: "A plane drink and I can not shower for coffee feet the trash". CT scan reveals subdural hematoma. Which of the following is the most likely area of the brain responsible for the patient's speech dysfunction?
|Prompt=A 72-year-old man with a history of atrial fibrillation on warfarin is admitted to the hospital for progressively increasing headaches and speech dysfunction for the past 10 days. The patient's wife informs the physician that the patient complained of a headache that started insidiously almost 10 days ago following a head trauma and has been progressively getting worse. Upon questioning the patient, he answers back fluently and says: "A plane drink and I can not shower for coffee feet the trash". CT scan of the brain reveals a subdural hematoma. Which of the following brain regions is most likely responsible for the patient's speech dysfunction?
|Explanation=The patient's presentation of progressively worsening [[headache]] and sensory [[aphasia]] following a history of trauma three weeks ago is suggestive of chronic [[subdural hemorrhage]]. The patient's age, use of anticoagulants and history of mild trauma support the diagnosis.  The diagnosis is confirmed by the findings on CT scan. The patient's speech dysfunction is manifested by intact fluency and impaired comprehension which is characteristic of Wernicke's aphasia. Wernicke's aphasia is also known as sensory or receptive aphasia. There are several types of aphasia:
|Explanation=The patient's presentation of progressively worsening [[headache]] and sensory [[aphasia]] following trauma is suggestive of chronic [[subdural hemorrhage]]. The patient's age, symptoms, use of anticoagulants, and history of mild trauma support the diagnosis, which is confirmed by the findings on CT scan. The patient's speech dysfunction is manifested by intact fluency and impaired comprehension, which is characteristic of Wernicke's aphasia. Wernicke's aphasia is also known as sensory or receptive aphasia.  
* Wernicke's aphasia: impaired comprehension, intact speech fluency and impaired repetition.
There are several types of aphasia:
* [[Broca]]'s aphasia: intact comprehension, impaired speech fluency and impaired repetition.
* Wernicke's aphasia: impaired comprehension, intact speech fluency, and impaired repetition.
* Global aphasia: impaired comprehension, impaired speech fluency and impaired repetition.
* [[Broca]]'s aphasia: intact comprehension, impaired speech fluency, and impaired repetition.
* Conduction aphasia: intact comprehension, intact speech fluency and impaired repetition.
* Global aphasia: impaired comprehension, impaired speech fluency, and impaired repetition.
* Conduction aphasia: intact comprehension, intact speech fluency, and impaired repetition.


Shown below is an image depicting the different areas involved in the different types of aphasia.
Shown below is an image depicting the different areas involved in aphasias.<br>
 
[[Image:Aphasia.gif|600px]]
[[Image:Aphasia-types.gif|center|500px]]
|AnswerA=Superior temporal gyrus
|AnswerA=Superior temporal gyrus
|AnswerAExp=[[Wernicke's aphasia]] is a speech dysfunction characterized by impaired comprehension, intact speech fluency and impaired repetition. It results from damage to the superior temporal gyrus.  Wernicke's aphasia is also known as sensory or receptive aphasia.
|AnswerAExp=[[Wernicke's aphasia]] is a speech dysfunction characterized by impaired comprehension, intact speech fluency, and impaired repetition. It results from damage to the superior temporal gyrus.
|AnswerB=Inferior frontal gyrus
|AnswerB=Inferior frontal gyrus
|AnswerBExp=[[Broca's aphasia]] is a speech dysfunction characterized by intact comprehension, impaired speech fluency and impaired repetition. It results from damage to the inferior frontal gyrus. Broca's aphasia is also known as motor or expressive aphasia.
|AnswerBExp=[[Broca's aphasia]] is a speech dysfunction characterized by intact comprehension, impaired speech fluency, and impaired repetition. It results from damage to the inferior frontal gyrus. Broca's aphasia is also known as motor or expressive aphasia.
|AnswerC=Superior temporal and frontal gyri
|AnswerC=Superior temporal and frontal gyri
|AnswerCExp=[[Global aphasia]] is a speech dysfunction characterized by impaired comprehension, impaired speech fluency and impaired repetition. It results from damage to a larger area of the brain involving the superior temporal and inferior frontal gyri.
|AnswerCExp=[[Global aphasia]] is a speech dysfunction characterized by impaired comprehension, impaired speech fluency, and impaired repetition. It results from damage to a larger area of the brain that involves the superior temporal and inferior frontal gyri.
|AnswerD=Arcuate fasiculus
|AnswerD=Arcuate fasiculus
|AnswerDExp=Conduction aphasia is a speech dysfunction characterized by intact comprehension, intact speech fluency and impaired repetition. It results from damage to the [[arcuate fasciculus]].
|AnswerDExp=[[Conduction aphasia]] is a speech dysfunction characterized by intact comprehension, intact speech fluency, and impaired repetition. It results from damage to the [[arcuate fasciculus]].
|AnswerE=Between the supplementary motor area and the frontal perisylvian speech zone
|AnswerE=Area between the supplementary motor area and the frontal perisylvian speech zone
|AnswerEExp=Transcortical motor aphasia is a speech dysfunction characterized by impaired comprehension, impaired speech fluency and intact repetition. It results from damage to the area between the supplementary motor area and the frontal perisylvian speech zone.
|AnswerEExp=[[Transcortical motor aphasia]] is a speech dysfunction characterized by impaired comprehension, impaired speech fluency, and intact repetition. It results from damage to the area between the supplementary motor area and the frontal perisylvian speech zone.
|EducationalObjectives=Wernicke's aphasia is a speech dysfunction characterized by impaired comprehension, intact speech fluency and impaired repetition. It results from damage to the superior temporal gyrus.  Wernicke's aphasia is also known as sensory or receptive aphasia.
|EducationalObjectives=Wernicke's aphasia is a speech dysfunction characterized by impaired comprehension, intact speech fluency, and impaired repetition. It results from damage to the superior temporal gyrus.  Wernicke's aphasia is also known as sensory or receptive aphasia.
|References=First Aid 2014 page 457
|References=First Aid 2014 page 457
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=Aphasia, Wernicke aphasia, Frontal lobe, Subdural hematoma
|WBRKeyword=Aphasia, Wernicke aphasia, Frontal lobe, Subdural hematoma, Wernicke's aphasia, Receptive aphasia, Sensory aphasia
|Approved=No
|Approved=No
}}
}}

Latest revision as of 01:01, 28 October 2020
Author [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Anatomy, MainCategory::Pathophysiology
Sub Category SubCategory::Neurology
Prompt [[Prompt::A 72-year-old man with a history of atrial fibrillation on warfarin is admitted to the hospital for progressively increasing headaches and speech dysfunction for the past 10 days. The patient's wife informs the physician that the patient complained of a headache that started insidiously almost 10 days ago following a head trauma and has been progressively getting worse. Upon questioning the patient, he answers back fluently and says: "A plane drink and I can not shower for coffee feet the trash". CT scan of the brain reveals a subdural hematoma. Which of the following brain regions is most likely responsible for the patient's speech dysfunction?]]
Answer A AnswerA::Superior temporal gyrus
Answer A Explanation [[AnswerAExp::Wernicke's aphasia is a speech dysfunction characterized by impaired comprehension, intact speech fluency, and impaired repetition. It results from damage to the superior temporal gyrus.]]
Answer B AnswerB::Inferior frontal gyrus
Answer B Explanation [[AnswerBExp::Broca's aphasia is a speech dysfunction characterized by intact comprehension, impaired speech fluency, and impaired repetition. It results from damage to the inferior frontal gyrus. Broca's aphasia is also known as motor or expressive aphasia.]]
Answer C AnswerC::Superior temporal and frontal gyri
Answer C Explanation [[AnswerCExp::Global aphasia is a speech dysfunction characterized by impaired comprehension, impaired speech fluency, and impaired repetition. It results from damage to a larger area of the brain that involves the superior temporal and inferior frontal gyri.]]
Answer D AnswerD::Arcuate fasiculus
Answer D Explanation [[AnswerDExp::Conduction aphasia is a speech dysfunction characterized by intact comprehension, intact speech fluency, and impaired repetition. It results from damage to the arcuate fasciculus.]]
Answer E AnswerE::Area between the supplementary motor area and the frontal perisylvian speech zone
Answer E Explanation [[AnswerEExp::Transcortical motor aphasia is a speech dysfunction characterized by impaired comprehension, impaired speech fluency, and intact repetition. It results from damage to the area between the supplementary motor area and the frontal perisylvian speech zone.]]
Right Answer RightAnswer::A
Explanation [[Explanation::The patient's presentation of progressively worsening headache and sensory aphasia following trauma is suggestive of chronic subdural hemorrhage. The patient's age, symptoms, use of anticoagulants, and history of mild trauma support the diagnosis, which is confirmed by the findings on CT scan. The patient's speech dysfunction is manifested by intact fluency and impaired comprehension, which is characteristic of Wernicke's aphasia. Wernicke's aphasia is also known as sensory or receptive aphasia.

There are several types of aphasia:

  • Wernicke's aphasia: impaired comprehension, intact speech fluency, and impaired repetition.
  • Broca's aphasia: intact comprehension, impaired speech fluency, and impaired repetition.
  • Global aphasia: impaired comprehension, impaired speech fluency, and impaired repetition.
  • Conduction aphasia: intact comprehension, intact speech fluency, and impaired repetition.

Shown below is an image depicting the different areas involved in aphasias.

Educational Objective: Wernicke's aphasia is a speech dysfunction characterized by impaired comprehension, intact speech fluency, and impaired repetition. It results from damage to the superior temporal gyrus. Wernicke's aphasia is also known as sensory or receptive aphasia.
References: First Aid 2014 page 457]]

Approved Approved::No
Keyword WBRKeyword::Aphasia, WBRKeyword::Wernicke aphasia, WBRKeyword::Frontal lobe, WBRKeyword::Subdural hematoma, WBRKeyword::Wernicke's aphasia, WBRKeyword::Receptive aphasia, WBRKeyword::Sensory aphasia
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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