Clinical Medicine

Question 1

Answer 1

C - Right CN XII

• The tongue will deviate toward the lesion side, becaues the muscle pushing it out is impaired

Question 2

Which nerve root is associated wtih the triceps reflex?

Answer 2

C7

Question 3

What is the most likely cause of a horizontal (altitudinal) field defect?

Answer 3

Occlusion of the central retinal artery

OR

Ischemia of the optic nerve

Question 4

What are normal results for a Rinne test?

Answer 4

AC > BC

Rinne test: assesses for conductive hearing loss.

• A vibrating tuning fork is placed on the mastoid process. When the patient no longer hears the tone, the fork is immediately placed over the outer ipsilateral ear.
• A patient with normal conductive hearing will hear the tuning fork again once it is held over the ear because air conduction is greater than bone conduction (positive Rinne test).
• If the patient does not hear a sound again, the test is negative, which indicates that the patient has conductive hearing loss.

Question 5

Which vertebral level corresponds with the inguinal ligament?

Answer 5

L1

Question 6

If a patient has a left CN IV palsy, the anormality will be most pronounced when you ask the patient to look in which direction?

Answer 6

In and down

• Looking in “traps” the inferior rectus
• If the patient cannot look down while looking in, the superior oblique (CN IV) is impaired

Question 7

What is “normal” for the babinski reflex?

Answer 7

Downgoing

If the toes curl up, indicates possible UMN lesion

Question 8

Which vertebral level corresponds with the umbillicus?

Answer 8

T10

Question 9

Movement against gravity indicates __/5 strength

Answer 9

3/5

Question 10

When is it okay to assume a patient’s pronouns?

Answer 10

NEVER!

• Always ask

Question 11

What is a normal result for a Weber hearing test?

What does an abnormal result indicate?

Answer 11

Can hear/feel sound vibraton equally in both ears

• Conductive hearing loss: sound is louder in the impaired ear
  
  • Lateralizes to the impaired ear
  • Rinne test will show BC > AC
• Sensineural hearing loss: sound is louder in the good ear
  
  • Lateralizes to the good ear
  • Rinne will show AC > BC

Question 12

A patinet has weakness when turning their head to the right.

Which cranial nerve is likely affected?

Answer 12

Left CN XI

Question 13

Answer 13

F - Left CN VI

Question 14

Which nerve root is associated wtih the achilles reflex?

Answer 14

S1

Question 15

Which nerve root is associated wtih the medial hamstring reflex?

Answer 15

L5

Question 16

Which nerve roots (2) are associated wtih the patellar reflex?

Answer 16

L3, L4

Question 17

What is “normal” for reflexes?

Answer 17

2+ = normal

• 0 = no response
• 4+ = hyperactive
  
  • Indicates spasticity, present in UMN lesions

Question 18

Which nerve roots (2) are associated wtih the biceps reflex?

Answer 18

C5, C6

Question 19

What are the differences between a CN VII central vs. peripheral lesion?

Answer 19

• Central
  
  • Paralysis of the contralateral lower face
  • Spares the forehead
  • Likely has other symptoms of brain tumor or stroke
• Peripheral
  
  • Flaccid paralysis of the entire ipsilateral face
  • Facial paralysis may be the only symptom

Question 20

Which vertebral level corresponds with the clavicle?

Answer 20

C5

Question 21

Which nerve root is associated wtih the brachioradialis reflex?

Answer 21

C6

Question 22

Which vertebral level corresponds with the nipples?

Answer 22

T4/T5

Question 23

When you ask a patinet ot lean forward while you auscultate the aortic and pulmonic areas of the heart at the end of exhalation, what murmur are you listening for?

Answer 23

Aortic regurgitation

Question 24

Splenomegaly on percussion sounds…

Answer 24

Dull

Question 25

Answer 25

B - Left CN II

• Left optic nerve is not perceiving light = CN II defect
• Left CN III is fine, because pupil constricts when light is shined into the right eye
  
  • Consensual response intact

Question 26

List 4 typical signs of an upper motor neuron lesion

Answer 26

Weakness

Increased tone (spasticity)

Hyperreflexia

Babinski sign