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.

Question 12

12.  Which of the following has not been identified as a risk factor for ischemic stroke?

A.  Cocaine abuse

B.  Atrial Fibrillation

C.  Marijuana Abuse

D.  Oral Contraception

Answer and Explanation 11

11.  Choice C is the correct answer.  This patient is presenting with a history concerning for cerebellar infarct.  Patients with central vertigo typically do not have nystagmus or any visual affect.  They can have some truncal ataxia.  Patients that have peripheral types of vertigo typically do not have ataxia.  Patients with  labyrinthitis typically have severe vertigo accompanied with a viral infection.  They may also have some tinnitus.  They will respond typically to antivert, ativan or valium.  Patients with vestibular neuritis have recurrent attacks of peripheral vertigo without hearing problems.  Meniere's disease is a chronic condition of vertigo spells accompanied by progressive unilateral hearing problems and tinnitus.

Question 11

11.  Your patient is a 54 year old female that presents with a gradual onset of dizziness, with nausea.  They also are having some ataxia.  These symptoms started this morning.  Neurologic exam is otherwise negative including no evidence of Nystagmus.  She has no vision complaints or recent illnesses.  Based upon this data, what is the most likely given this clinical scenario?

A.  This patient has labyrinthitis.  Start the patient on Antivert, encourage plenty of fluids, and discharge the patient home with reassurance.

B.  This patient has vestibular neuritis.  Start the patient on Valium, encourage plenty of fluids, and refer the patient to physical therapy for vestibular therapy.

C.  This patient is presenting with a history and exam concerning for a cerebellar infarct, order a head CT scan and admit the patient to the hospital.

D.  This patient has Meniere's disease.  Reassure the patient they are going to be okay.  Start the patient on Ativan PRN.