A 81 year old female came to the ER because in the morning (1 hour ago) she developed vomiting, pallor, diaphoresis and vertigo. The physical examination reveals nystagmus, left miosis and ptosis. She is unable to feel pain or temperature in the left side of the face and in the right side of the body.She has difficulty trying to speak and she has salivary dribbling. The sensorium is normal and she has no motor deficits. The vital signs are: blood pressure 150/95, temperature 98 F, heart rate 92/min, respiratory rate 14/min. Laboratory tests show:

Cholesterol 270 mg/dL

Triglycerides 210 mg/dL

Normal CBC

1-This patient has:

A-Infarction of the left posterior cerebral artery

B-Infarction of the right posterior cerebral artery

C-Infarction of the basilar artery

D-Infarction of the left posterior cerebellar artery

E-Infarction of the right posterior inferior cerebellar artery

2-This artery:

A-Supplies the lateral portion of the medulla

B-Supplies the spinothalamic tracts

C-When infarcted, produces the "lateral medullary syndrome"

D-Supplies the inferior surface of the cerebellum

E-All of the above

3-The temperature and pain loss are related to a lesion of:

A-Vestibular nuclei

B-Spinal trigeminal nucleus

C-Nucleus ambiguus

D-Spinothalamic tract

E-All of the above

4-The inability to feel pain and temperature on one side of the face are due to irritation of which of the cranial nerve tracts:

A-VIII

B-X

C-V

D-III

E-None of the above

5-What other clinical signs may these patients present:

A-Dysarthria

B-Dysphonia

C-Dysphagia

D-All of the above

6-Dysphagia, dysphonia and dysarthria are due to a deficit of:

A-Nucleus ambiguus

B-Cranial nerve X

C-Ipsilateral paralysis of palate, larynx and pharynx

D-None of the above

E-All of the above