A patient presents to the emergency department (ED) with a two-hour history of hemiparesis of the right arm and leg. Also, it is noted during assessment (examination) that the left side of her face moves normally, but the other side droops. Identify the item which helps to explain the connection between the pathophysiology of this illness and the pattern of signs and symptoms (555)

Ischemia of the brain tissue is causing cellular injury, swelling and malfunction of the contralateral side

The functioning of the right cranial nerve controlling facial movement is compromised by cerebral edema

The sensorimotor tracts leading from the brain to the body decussate and control the arm and leg on the same side as the lesion,

The corticospinal tracts leading from the brain to the body decussate and control the ipsilateral arm and leg.

Answer and Explanation

The Correct Answer is A

A. Ischemia of the brain tissue is causing cellular injury, swelling, and malfunction of the contralateral side: Hemiparesis occurs on the side opposite to the brain lesion due to the crossing (decussation) of motor pathways.

B. The functioning of the right cranial nerve controlling facial movement is compromised by cerebral edema: While facial nerve involvement can cause drooping, the hemiparesis suggests a central (brain) rather than peripheral issue.

C. The sensorimotor tracts leading from the brain to the body decussate and control the arm and leg on the same side as the lesion: This is incorrect because the tracts control the contralateral side of the body.

D. The corticospinal tracts leading from the brain to the body decussate and control the ipsilateral arm and leg: This is incorrect; the corticospinal tracts control the contralateral side.

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Correct Answer is A

Explanation

A. Paralytic ileus: Paralytic ileus is a common complication of major abdominal surgery and prolonged bed rest. It is a temporary cessation of normal bowel peristalsis, leading to a lack of bowel sounds and the inability to pass gas or stool.

B. Esophageal dysplasia: This condition refers to abnormal changes in the cells of the esophagus, typically related to chronic gastroesophageal reflux disease (GERD), not prolonged bed rest.

C. Gastroparesis: This is a condition in which the stomach cannot empty itself of food in a normal fashion, often related to diabetes or damage to the vagus nerve. It is not a direct result of prolonged bed rest.

D. Paralytic ileum: This should refer to "paralytic ileus."

A. Diminished serum albumin levels causes water to shift from blood to tissue. B. Portal hypotension causes a fluid shift from the abdominal cavity into the portal veins. C. Hypoaldosteronism causes a fluid volume deficit: shifting water from blood into tissue. D. Aberrations of the portal system cause a back-up of blood that leads to hydronephrosis.

Correct Answer is A

Explanation

A. Diminished serum albumin levels cause water to shift from blood to tissue: In cirrhosis, liver dysfunction leads to decreased production of albumin, a protein that helps maintain oncotic pressure. Low albumin levels cause fluid to shift from the vascular space into the tissues, resulting in ascites and peripheral edema.

B. Portal hypotension causes a fluid shift from the abdominal cavity into the portal veins: Portal hypertension, not hypotension, is a common feature of cirrhosis, but it leads to ascites by increasing pressure in the portal venous system, not by shifting fluid into the portal veins.

C. Hypoaldosteronism causes a fluid volume deficit: shifting water from blood into tissue: Cirrhosis often leads to hyperaldosteronism, not hypoaldosteronism, resulting in sodium and water retention, which contributes to edema.

D. Aberrations of the portal system cause a back-up of blood that leads to hydronephrosis: Hydronephrosis is related to obstruction of the urinary tract, not a complication of portal hypertension or cirrhosis.

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