Answer and Explanation 15

15.  Choice A is the correct answer.  The hypoglossal nerve allows for the tongue to be protruded, and move it up and down.  It also helps with articulating your words.  The vagus nerve is responsible for the gag reflex, and swallowing.  The glossopharyngeal nerve helps with the majority of taste as well as the gag reflex and ability to swallow.

Question 15

15.  Which cranial nerve allows the tongue to be pressed against your cheek?

A.  Hypoglossal

B.  Vagus

C.  Glossopharyngeal

D.  Facial nerve

Answer and Explanation 14

14. C is the correct answer.  This patient has SCIWORA (Spinal Cord Injury Without Radiologic Abnormality).  This usually comes from spinal cord edema that is not seen on MRI.  An EMG may need to be done at some point, but is not indicated right now.  There are many physical exam maneuvers that can be done to determine if the patient is malingering.  Decadron has really not been shown in the latest studies to be helpful in SCIWORA.  This patient will need to go to rehab after being admitted to neurosurgery.

Question 14

14.  Your patient is a 42 year old male that was involved in a rollover MVA that was unrestrained.  He is complaining of neck pain and cannot move his left arm.  He is not intoxicated and is alert and oriented.  His MRI of his cervical spine was normal.  Repeat examination is unchanged.  Which of the following is best management action?

A. Start the patient and Decadron and analgesics

B.  Get an EMG of his arm.  He is likely malingering given the fact his MRI of his Cervical Spine is negative.

C.  Admit the patient to neurosurgery with a consult to physical medicine and rehabilitation.

D.  The patient needs an MRI of his brain now. He may have a mass effect from an incidental brain lesion now that is causing his arm paralysis.

 

Answer and Explanation 13

13.  B is the correct answer.  Patients with Bell's Palsy will have the forehead wrinkle stop on the left side of face that is affected.  It is a palsy of cranial nerve VII (facial nerve).  It typically presents with weakness around the eye on the same side as the facial droop and an inability to shut the eye on that side.  Patients with an acute CVA will usually have the wrinkle that extends across the forehead.

Question 13

13.  Your patient is a 42 year old male that present with left side facial droop, during the course of your examination you observe the photograph below.

Based on this information, what is the most likely diagnosis?

A.  Acute CVA

B.  Bell's Palsy

C.  Side effect of Botox

D.  Brain Mass

Answer 12

12.  C is the correct answer.  Cocaine, oral contraception have been identified as a risk factor as long as sympathomimetics.  Atrial fibrillation that is not anti-coagulated is a risk factor.  Marijuana use is not been identified as a risk factor.  Other common risk factors are diabetes, hypertension, smoking, family history of premature vascular disease, hyperlipidemia, prior history of TIA, recent myocardial infarction, and CHF with a low ejection fraction.