Post Midterm Lab #6 and #7

Question 1

How do we test olfaction in a patient?

Answer 1

by presenting the patient with familiar, non-irritating odourants such as coffee, cloves, vanilla.

Question 2

What is an asymmetric test result for CNI suggest?

Answer 2

central lesions

Question 3

what is a bilateral test result for CNI suggest?

Answer 3

peripheral explanations

Question 4

For CN II, if a patient is unable to read the top line of the chart, then you should stand half of the specified distance from the patient and ask to count how many fingers you are holding up, this is called CF @X. What if a patient is unable to see the fingers.

Answer 4

If they cannot count finger, but can see your hand moving, record HM (hand motion) @ X. if they cant see hand motion, assesss light perception by shining a pen torch.

Question 5

For color vision, a score of what indicates color vision deficiency?

Answer 5

score of 7 or less

Question 6

what are most cases of color vision deficiencies?

Answer 6

protan (red cones)
deutan (Green cones)
mild=malia
severe = opia

Question 7

For visual field testing, what increases the size of the physiologic blind spot?

Answer 7

papilloedema increases the size of the physiological blind spot as the swelling impairs the function of surrounding retina.

Question 8

For the visual pathway, what are the two nuclei involved?

Answer 8

optic nerve to pretectal nuclei
oculomotor nerve from the edinger-westphal nucleus to the ciliary ganglion.
to the sphincter muscles of the eye

Question 9

what is papilloedema?

Answer 9

blurred or elevated optic disc that most often results from transmission of increase intracranial pressure to the eye

Question 10

what three layers is the optic nerve covered with?

Answer 10

cranial meninges: meningeal dura, arachnoid mater and pia mater

Question 11

What are the physical exam findings of papilloedema?

Answer 11

blurred, elevated margins of the disc, visible haemorrhages on or around the papilla.

Question 12

Clinical Case: Diminished Libido: A 35 year old unmarried night club owner presents to his urologist with concerns about decreased interest in sexual activity and impotence. The symptoms started a few months ago and since then have gradually worsened. whats significant?

Answer 12

age occupation
worsening symptoms
indicates tumor

Question 13

lab findings of case: low free cortisol. Free T4 levels were slightly below the lower limit of normal. interpret these results

Answer 13

low T4 and cortisol suggest a problem with the anterior pituitary hormone or hypothalamic regulatory hormone

Question 14

exam findings: direct and consensual pathway reactions were somewhat sluggish in the left eye ( CNII/). Visual field confrontation test, patient had diminished vision in the upper and lower quadrants of both temporal visual hemifields (CNII)

Answer 14

CNII and bitemporal hemianopia means a pituitary tumor

Question 15

How does a pituitary tumor lead to his symptoms?

Answer 15

Inhibiting the release of anterior pituitary hormones one of which is sex steroid
additionally you have increases prolactin now since your prolactin inhibiting hormone is not active
patient needs dopamine to stop excess prolactin and this should increase sex drive.

Question 16

Describe the basic pathway of the corneal reflex?

Answer 16

1) Trigeminal nerve to the spinal trigeminal nucleus via the spinal trigeminal tract
2) activates the facial nucleus through interneurons.

Question 17

Muscles of mastication and jaw jerk reflex are what CN?

Answer 17

CNV

Question 18

An UMN lesion does what to the face?

Answer 18

weakness in the contralateral lower half of the face; forehead wrinkling will be preserved (upper spares upper)

Question 19

A LMN lesion will do what to the face?

Answer 19

entire ipsilateral half of the face tends to be affected

Question 20

Webers test??

Answer 20

placement: forehead
sound lateralizes to one side this is an auditory deficit
Conductive hearing loss –> lateralizes to affected side
sensorineural hearing loss –> lateralizes to unaffected side

Question 21

Rinne’s Test ??

Answer 21

Norma: AC>BC
in conductive hearing loss, BC>AC
in sensorineural hearing loss AC>BC

Question 22

Clinical Case: Hearing Loss: A 53 year old left handed university professor realized that, during the last three months, he has been changing the hand in which he holds his telephone receiver to hear more clearly. Recently he also developed headaches and dizziness. Since yesterday, he has had difficulties that he cannot fully describe and is not able to walk like he used to. Explain?

Answer 22

Age and occupation matter
CN VIII –> not being able to walk like he use to
Headaches and dizziness–>CN VIII

Question 23

Neuro Exam: Nystagmus during H test, left side of the face, the nasolabial fold was flattened and the angle of the mouth drooped downwards (left facial nucleus CN VII). Wrinkling of the forehead was also diminished on the left side. Corneal reflex on the left side was reduced (CN VIII). Weber test lateralized to the right and Rinne test = Right AC>BC and Left AC>BC. (sensorineural on left). Thoughts?

Answer 23

Acustic Neuroma or Vestibular Schwanoma
pathological nystagmus= vision difficulties on baseline and nystagmus is only elicited as you go toward extreme vision movements.
Left UMN syndrome (bilateral hearing loss, left sensorineural hearing loss, wrinkling diminished but still intact)