Fact Sheet - Texas Tech University Health Sciences Center

Texas Tech MedCast Podcast Episode Fact Sheet
Podcast Series Reynolds Geriatrics Series • USMLE Step 1 Prep
Episode Title The Jitterbug Blues - Question 51
Personnel
Robert Andrews, Julie Dai, James McKenny, Veronica Parker, Jason Phillips,
Natalie Rodriguez, William Steele, Matthew Turrie, Amy Ventura
Group 14
Recording Date April 21, 2011
A 68-year-old woman has the sudden onset of weakness in her right arm and leg.
USMLE Question
She can speak, but her words are not enunciated clearly. Neurologic examination
Number: 51 6 weeks later shows an extensor plantar reflex on the right. When she is asked to
protrude her tongue, it deviates to the left, and the muscle in the left side of the
Pg #: 36
tongue shows considerable atrophy. Which of the following labeled areas in the
transverse sections of the brain stem is most likely damaged?
Texas Tech MedCast Producer: Betsy Goebel Jones, Ed.D., betsy.jones@ttuhsc.edu
Prepared for the MS2 Aging Block at Texas Tech University Health Sciences Center School of
Medicine, Andrew Dentino, M.D., Block Director, andrew.dentino@ttuhsc.edu
http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseries/gerstep1prep.aspx

Texas Tech MedCast Podcast Episode Fact Sheet
Learning
Objectives
The listener should
be able to:
Key Teaching
Points
USMLE Test
source:
Keywords
References
1. Understand the anatomy of the human brain stem cross section.
2. Correlate the region of brain stem injury to its physical manifestations.
Specifically, appreciate the symptoms of an anterior spinal artery infarct.
3. Recognize the presentation of a positive Babinski reflex.
4. Trace the pathway of normal motor signaling.
• Medial Medullary Syndrome is due to an infarction of the anterior spinal or left
vertebral artery.
• Symptoms of Medial Medullary Syndrom include contralateral hemiparesis,
ipsilateral paralysis of the hypoglossal nerve, and positive Babinski reflex.
• A positive Babinski reflex is extension of the great toe and abduction of the
other toes instead of the normal flexion reflex to plantar stimulation. It is
considered indicative of pyramidal tract involvement.
• The corticospinal tract desscutates at the pyramids in the medulla. This is the
reason for contralateral motor symptoms if an infarction is superior to the
pyramids.
http://www.usmle.org/examinations/step1/2011Step1.pdf
Geriatrics, USMLE step exam, medial medullary syndrome, stroke, tongue
atrophy, paresis, paralysis, upper motor neuron.
Blumenfeld, hal. Neuroanatomy through clinical cases. 2 nd edition.
Sinauer Associates Inc, 2010. 653. Print
E. Duane. Neuroanatomy: an Atlas of Structures, Sections, and Systems.
7 th ed. Philadelphia: Lippincot Williams & Wilkins, 2008. 229. Print
Le, Tao. First Aid for the USMLE STEP 1 2011. 21 edition. USA: McGraw-Hill
Medical, 2011. 405. Print
Texas Tech MedCast Producer: Betsy Goebel Jones, Ed.D., betsy.jones@ttuhsc.edu
Prepared for the MS2 Aging Block at Texas Tech University Health Sciences Center School of
Medicine, Andrew Dentino, M.D., Block Director, andrew.dentino@ttuhsc.edu
http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseries/gerstep1prep.aspx