WBR0579

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Anatomy, MainCategory::Pathophysiology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 65 year old female patient, admitted to the neurology ward for a stroke, is being evaluated for speech dysfunction. When the patient is asked questions, she is able to initiate speech and respond fluently in full meaningful sentences. She succeeds in naming the objects that the physician points to. During the assessment, the physician asks the patient to repeat the sentence: "No ifs ands or buts"; however, the patient is unable to do so. Which of the following is the most likely area of the brain that was affected by the stroke and is 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. Wernicke's aphasia is also known as sensory or receptive aphasia.]]
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 involving 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::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::D
Explanation	[[Explanation::The patient suffered from stroke and is exhibiting a form of aphasia characterized by the inability to repeat sentences in the absence of any impairment of comprehension or speech fluency which are all consistent of conduction aphasia. Conduction aphasia is caused by involvement of the arcuate fasciculus that links the Wernicke area to the Broca area. 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 the different types of aphasia. Educational Objective: Conduction aphasia is a speech dysfunction characterized by intact comprehension, intact speech fluency and impaired repetition. References: First Aid 2014 page 457]]
Approved	Approved::No
Keyword	WBRKeyword::Aphasia, WBRKeyword::Conduction aphasia, WBRKeyword::Arcuate fasciculus, WBRKeyword::Stroke
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::