AIPGMEE 2014 - 2015

Question 1

While shaving, a 75-year-old man noticed that his left superior eyelid was drooping. His wife, concerned that he might have had a mild stroke, insisted that he see their family physician. On examination, ptosis (drooping of the superior eyelid), miosis (contraction of the pupil), and narrowing of palpebral fissure were detected. Which of the following statements best describes the most likely cause of the man’s eye problems?

• Interruption of the cervical sympathetic trunk, resulting in part of the symptom complex called Horner Syndrome.
• Injury of the levator palpebrae superioris.
• A lesion of the superior division of CN III.
• A lesion involving the parasympathetic component of CN III.

A lesion of a sympathetic trunk in the neck results in a sympathetic disturbance (the Horner syndrome), which indicated the ptosis and miosis. These diagnostic signs result from the unopposed action of the parasympathetic nerve supply to the sphincter pupillae, and reduced opposition to gravity by the paralyzed superior tarsal muscle, embedded in the deep layer of the levator palpebrae superioris.

Question 2

A pitcher was hit on the right side of his head by a baseball. He fell to the ground and was unconscious for about four minutes. When he awoke, he complained of a severe headache and considerable pain and was rushed to hospital. He was initially conscious but suddenly became drowsy. On examination, a large bruise was observed on his right temple and his right pupil was dilated. A radiograph of his cranium revealed a fracture of the squamous part of the temporal bone. An MRI showed an extradural (epidural) hematoma. Which of the following statements best describes the most likely cause of the pitcher’s symptoms and signs?

• Fracture of the calvaria and rupture of the anterior branch of the middle meningeal artery.
• Compression of the brain by a dural border (subdural) hematoma.
• Hemorrhage into the subarachnoid space.
• A cerebral laceration resulting from a depressed cranial fracture.

The depressed fracture tore the artery traveling within the vascular grooves in the inner table of the cranial bone and blood collected between the dura and the calvaria in the region of the pterion. This produced an extradural hematoma that compressed the lateral aspect of the brain. This is the type of intracranial hemorrhage most commonly associated with lateral blows to the head.

Question 3

A 55-year-old man consulted his family physician about a small swelling anteroinferior to his left ear. As he had had an infected left upper third molar tooth, the physician advised him to see his dentist, who extracted the tooth. However, she said that the swelling on his face did not appear to be related to the infected tooth. She advised him to consult his physician again. By this time the swelling had increased in size and the man complained that the left side of his face felt weak and the corner of his mouth was drooping. On examination, the physician detected a hard mass deep within the substance of the parotid gland. He also observed that the man’s facial muscles on the left side were weaker than on the right side. Which of the following statements best describes the most likely cause of the patient’s complaints?

• The parotid plexus of the facial nerve (CN VII) was being compressed by a carcinoma of the left parotid gland.
• An abscess from the infected upper left third molar tooth enlarged and caused swelling of the parotid gland, which compressed the buccal branch of the facial nerve, causing weakness of the facial muscles.
• Inflammation of the facial nerve near the stylomastoid foramen.
• An acute infectious disease (mumps) caused by the mumps virus.

The damaged facial nerve caused the weakness of the facial muscles on the left side and the sagging of the left corner of his mouth.