What is that brain part?
Image 1
What is the optic tract?
A 38-year-old woman comes to her primary care doctor because of a 4-month history of dizziness and a buzzing sound in her right ear. The dizzy spells last for 1 to 2 hours and she feels like the room is spinning; spells are sometimes accompanied by nausea and vomiting. Also during these episodes she experiences tinnitus and ear pressure, worse on the right side. Physical examination reveals that air conduction is greater than bone conduction in both ears. However, when a tuning fork is placed on her forehead, she says that the sound is better heard on the left.
What is most likely responsible for the patient’s symptoms? 1 point for name of disease, 2 points for what physiology explanation of what causes disease
What is increased volume of endolymph? What is Meniere disease?
A 5-year-old boy is brought to the pediatrician because of a 3-day history of sore throat, conjunctivitis, rhinitis, and cough. His mother explains that more than 10 children in his class at school have similar symptoms. Physical exam showed red conjunctiva. What is likely the causative agent for this child's illness?
What is adenovirus
A 24-year-old woman comes to her physician because of increasing fatigue and double vision that began 2 weeks ago. She reports that it only occurs when she tries to look right or left. On neurologic examination, when the patient attempts to look to one side, the eye on that side exhibits beating horizontal movements, and the contralateral eye will not adduct past midline.
MRI would most likely reveal a lesion in which location(s)?
What is the MLF?
A 67-year-old man comes to the physician’s office because of tremor, described as his hands shaking when he lays them still on the table. The shaking subsides when he moves his hands around or picks something up. He is able to work and write but finds this bothersome. On examination, his motions appear slow and halting, but he is able to perform fine motor tasks. He is prescribed a medication that has also been used as an antiviral agent. What is the medication?
What is Amantadine? Mechanism: Promotes dopamine release while inhibiting reuptake
pic 2
A. Abducens nucleus, B- superior olivary nucleus
A 32-year-old woman comes to the clinic because of dizziness and difficulty walking. Her symptoms started 3 days ago with a feeling of the room spinning around her. It has since progressed to vertigo with nausea and vomiting, as well as difficulty maintaining balance. She had an upper respiratory infection 2 weeks ago, which has since resolved. On examination, she is unable to maintain visual fixation on the physician when rapidly turning her head toward her left side. Rapidly turning her head toward her right elicits no symptoms. While the patient is looking straight ahead there is a slow oscillation of her eyes with nystagmus. An MRI of the head is normal.
Which of the following best describes the nystagmus? Bilateral vertical nystagmus? Horizontal with fast phase to the left? Horizontal with fast phase to the right?
What is horizontal nystagmus with fast phase to the right?
A 55-year-old man comes to his primary care physician because of a 2-month history of cough, left shoulder pain, and hoarseness. On ocular examination, the right pupil is larger than the left, (as shown in the photograph). The patient has no smoking history. A CT scan reveals a 3 cm nodule on one lung. What does the patient have (name of illness/disorder), and what is the likely cause (side matters!)?
What is Horner syndrome in the left eye? What is adenocarcinoma on the left upper lobe of the lung (AKA a left Pancoast tumor).
A 78-year-old man comes to his general practitioner with vision abnormalities. He has difficulty recognizing his wife as well as friends and acquaintances. He reports that he often depends on mannerisms, clothing, and voices to determine people’s identities. Brain imaging shows a lesion of the right anterior temporal lobe extending posteriorly and laterally to include the middle fusiform and inferior temporal gyri. What would be his visual field?
If draw, #1 in eye field squares
An 80-year-old man with long-standing Parkinson disease is treated with levodopa in combination with carbidopa to alleviate the movement symptoms associated with the disease.
Why are these drugs are taken together?
pic 3
B. hair cells, c. crista ampullari
An 18-year-old man comes to his primary care physician with ringing and progressive hearing loss in both ears, which has been worsening for the past several weeks. On evaluation, he is found to have bilateral sensorineural hearing loss, multiple skin nodules, and bilateral posterior subcapsular cataracts.
What genetic disease does this patient likely have?
What is NF2? Neurofibromatosis type 2
A 56-year-old man comes to the clinic with blurry vision, which is worse when reading. He has never worn glasses, though has noted a decline in vision over the past few years. A Snellen test performed at 20 feet away shows visual acuity of 20/20 in both eyes. Fundoscopic examination reveals no papilledema, pathologic cupping of the optic disc, hemorrhages, or exudates.
What is the most likely cause of this patient’s blurry vision? Myopia? Hyperopia? Glaucoma? Presbyopia?
What is presbyopia? Old age changes to lens-- other ones would cause blurred vision in other fields. Hyperopia may be an issue, but usually presented in early adulthood, the man is 56.
PLOT TWIST, another eye question:
This is...
***Val will show image in separate thing cuz she ain't gonna pay to add pics to this thing
What is retinal detachment?
A 75-year-old man comes to the clinic because of 3 months of weakness in his hands and shoulders and difficulty swallowing. His first symptom 3 months ago was in the left foot, which then progressed to the right foot and then both arms and hands. He is unable to hold a pen or pick up small objects with either hand. His left foot drags on the ground when he walks. Physical examination reveals bilateral leg weakness and foot drop, worse on the left. He has mild hand weakness with atrophic intrinsic hand muscles. He has decreased deep tendon reflexes in the lower extremities, and hyperactive reflexes in the upper extremities. Scattered muscle twitches are observed in the arms and legs. His speech is mildly slurred. When asked to drink a glass of water, he coughs and is unable to drink it quickly.
What pathologic changes would be most likely in this patient’s central nervous system?
What is Wallerian degeneration of the lateral corticospinal tract? What is ALS?
Pic 4
Q- putamen, P globus pallidus
A 35-year-old woman comes to the emergency department because of dizziness, nausea, and hearing loss in the left ear for 1 day. She says she feels off-balance and feels like the room is spinning. She had viral gastroenteritis last week, which resolved. On physical examination, her eyes slowly drift to the left before quickly jerking to the right. A vibrating tuning fork is placed in the center of the forehead, and the patient hears the vibration best in the right ear. The tuning fork is then placed onto the mastoid bone of the right ear, then outside of the same ear. This is repeated on the left side. The patient hears the vibration better when the prongs are placed outside the ear, bilaterally, but she states that the sounds are overall quieter in the left ear as compared to the right ear.
What does the patient have?
What is Labyrinthitis?
A 2-week-old girl is brought to the pediatrician for a well-child checkup. She was born at full term with no complications and her mother had normal prenatal screening. Vital signs are within normal limits. She is tracking in the 30th percentile for height and weight. The posterior fontanelle is open and soft. Shining a light shows normal red reflex on right eye, but a white reflex on the left eye.
What gene mutation is likely responsible for the finding?
***its loss of function in Rb-- need to know for step but not this exam
A 50-year-old man is brought to the emergency department because of severe back pain after a motor vehicle collision. Examination of the right lower limb shows weakness, hyperreflexia, positive right Babinski sign, and loss of tactile, vibratory, and proprioceptive senses. The left lower extremity has a loss of pain and temperature sensation from the toes to the left iliac crest, with intact motor function. Transection of which fiber tract resulted in the left lower extremity sensory abnormalities?
What is the right spinothalamic tract? What is Brown-Sequard syndrome?
A 40-year-old man presents for evaluation with his wife, who reports that her husband has become increasingly restless over the past 2 years. Recently, he has been making jerky, dancelike movements with his arms and legs and is unable to control his extremities during these episodes. His wife also reports that the patient has become forgetful and has trouble completing tasks.
Disease in of which brain regions is most common in this patient’s most likely diagnosis?
What is the Putamen? Patient has Huntington disease
pic 5
A- CN IV, B. CN III, C- CN VI, D- CN V, E- CN vii, F. CN VIII, G XII
A 27-year-old woman comes to the clinic with pain and difficulty hearing in her right ear. The pain started acutely last night while she was cleaning her ear with a Q-tip. When she woke up this morning, she noticed difficulty hearing her roommates through her right ear. On examination there is a visible hole in the tympanic membrane on the right side. What would be her Weber and Rinne test?
What is Left: AC>BC, Right: BC>AC Weber to the Right ***Weber in conductive hearing loss is lateralized to the ear with the problem (Worse). Weber in SNHL lateralized to the ear with BETTER hearing
A 77-year-old man presents to the clinic with complaints of trouble reading, developing gradually over the past year. He has increasing difficulty seeing things in the center of his vision; he no longer drives amid family concerns about his vision impairment. He is otherwise healthy. He has a 50-pack-year history of smoking. Visual acuity is decreased bilaterally, and formal testing shows severe loss of central vision with intact peripheral vision. What would be seen in funduscopic finding?
Patient has dry-age related macular degeneration-- therefore, what is extracellular lipid deposits?
A 32-year-old woman comes to the clinic with a progressive inability to detect pain or temperature changes in both arms for the last 2 weeks and multiple second-degree burns on her hands, but she does not recall sustaining them. The patient has no prior medical history. Physical examination reveals the absence of pain and temperature sensation in the upper extremities bilaterally. Strength and position and vibration sense are intact. There are no lower extremity abnormalities. An MRI shows dilation within the cervical spinal cord.
What most likely diagnosis?
What is syringomyelia?
A 67-year-old man comes to the clinic because of fatigue and shortness of breath 1 week after starting levodopa-carbidopa for mild Parkinson disease. Hemoglobin is 7.8 g/dL, hematocrit is 23.4%, mean corpuscular volume is 88 μm3, and platelet count is 250,000/mm3.
What laboratory findings would be primarily affected due to an adverse effect of levodopa?
What is increased indirect bilirubin level? Levodopa can cause autoimmune hemolytic anemia, which causes increased indirect bilirubin