EMQs in Clinical Medicine.pdf - Peshawar Medical College

Antiepileptic drug therapy – answers 101
The non-dominant lobe is largely responsible for visuospatial skills and
this is reflected in the signs encountered, e.g. visual agnosia, dressing
apraxia, constructional apraxia.
H
J
C
E
A 65-year-old woman with suspected dementia is noted to be
aggressive and sexually disinhibited.
Socially and sexually disinhibited behaviour is a feature of frontal lobe
lesions. Other signs include apathy, emotional lability, incontinence and
perseveration.
A 65-year-old man has been unable to understand the ward staff over
the last few days and speaks fluently in jargon that cannot be understood.
His speech and language were previously normal.
This man is exhibiting signs of Wernicke’s receptive dysphasia. His comprehension
is impaired and his speech is fluent but full of jargon (that he
is oblivious to). Look out for neologisms (in the absence of psychosis).
A lesion in Broca’s area (located in the dominant frontal lobe) gives
rise to an expressive dysphasia, i.e. non-fluent speech with intact
comprehension.
A 34-year-old woman with multiple sclerosis is found to have bilateral
internuclear ophthalmoplegia.
Bilateral internuclear ophthalmoplegia is almost exclusively found in
multiple sclerosis and is caused by bilateral involvement of the MLF.
When the patient is asked to look towards the right, the left eye fails to
adduct and the right eye develops coarse nystagmus in abduction. This is
caused by the left MLF lesion.
When the patient is asked to look towards the left, the right eye fails to
adduct and the left eye develops coarse nystagmus in abduction. This is
caused by the right MLF lesion.
A 41-year-old man presents with dementia and irregular jerky
movements of the trunk and limbs. His father suffered from a similar
problem.
This is a presentation of Huntington’s disease, an autosomal dominant
condition, which usually presents in middle age. Pathologically, there is
progressive degeneration of the striatum (caudate nucleus and putamen)
and cerebral cortex (see Question 34, p. 95).
39 Antiepileptic drug therapy
Answers: G L C E J
A 45-year-old woman on antiepileptic therapy complains of acne and
increased facial hair growth. She is on no other medication.