I had a couple if neuro questions which i had difficulty answering, Any help would be appreciated.
1. A 52-year-old with 1-month history of numbness and tingling on ring and small fingers of his right hand. His symptoms are now constant and exacerbated at night. He has a 2-week history of decreased grip strength and wasting of !he small muscles in his right hand. He has not had
neck or arm pain Four months ago. he was diagnosed with pancreatic cancer urrently receiving chemotherapy with gemcitabine. he has had significant fatigue and an 18-kg (40.lb)weight loss He is
temperature (98 6"F). pulse is 95/min. and blood pressure is 120ll9 mm Hg.
wasting of the interosseous muscles on the right. Muscle strength is 3/5 in
the right interosseous and hypothenar muscles and llexor digitorum prolundus of the ring and small fingers, it is full elsewhere Deep tendon reflexes are 2+.Babinski sign absent & Sensation to pinpnck and temperature is decreased over the ulnar aspect of the palm and dorsum of the hand and ring and small fingers.proprioception is intact .most likely cause of this patient's symptoms?
• A C8 nerve root infiltrabon by tumor ( I chose this)
• B Cervrcal disc herniaition
•C Chemotherapyneurotoldc1ty
•D Ulnar nerve compress1on
• E Vitamin B12 (cobalamm) deficiency
2.
A 22-year-old man with Duchenne nuscular dystrophy is brought to the phys ician by his parents because of increased difficu lty clearing secretions over the past 3 weeks. He is
confined to bed or a chair and needs assistance with all activities of daily l ivin g. He li ves with his parents who are upset th at he does not want to have friends visit He says that he
is often irritated by their attempts to keep his spirits up and to make hi m more comfortable. B oth the patient and family ha ve avoided discuss ing the patient's wishes regardi ng endof-
life care. Vital signs today are within normal limits. Examination shows generalized muscle weakness and wasting; he needs support to remain seated in his wheelchair. Upper
airway sounds are heard without the stethoscope. Which of the following is the most a ppropriate next step in management?
A) Clarify the patient's preferences for treatn1ent as his disease progresses (This to be done first?)
B) Obtain permission for tracheostomy
C) Refer the patient for a psychiatric evaluation
D) Begin fluoxetine therapy
E) Begin nasopharyngeal s uctioning with oxygen via nasal cannula as needed
3. A 42-year- old man comes to the physician because of double vision. Two days ago, he was hit in the left eye with a softball. There was no loss of consciousness, but he was unable to continue playing He took aspirin and rested yesterday Examination is normal except when he is asked to look up A photograph is shown. (SHows vertical gaze palsy of left eye). Which of the following
is the most li kely cause of the diplopia?
A) Entrapn1ent of inferior oblique ( i Tthink is answer)
B) Orbital hemorrhage
C) Paresis of the sixth cranial nerve
D) Paresis of the third cranial nerve
E) Subdural hematoma
1. A 52-year-old with 1-month history of numbness and tingling on ring and small fingers of his right hand. His symptoms are now constant and exacerbated at night. He has a 2-week history of decreased grip strength and wasting of !he small muscles in his right hand. He has not had
neck or arm pain Four months ago. he was diagnosed with pancreatic cancer urrently receiving chemotherapy with gemcitabine. he has had significant fatigue and an 18-kg (40.lb)weight loss He is
temperature (98 6"F). pulse is 95/min. and blood pressure is 120ll9 mm Hg.
wasting of the interosseous muscles on the right. Muscle strength is 3/5 in
the right interosseous and hypothenar muscles and llexor digitorum prolundus of the ring and small fingers, it is full elsewhere Deep tendon reflexes are 2+.Babinski sign absent & Sensation to pinpnck and temperature is decreased over the ulnar aspect of the palm and dorsum of the hand and ring and small fingers.proprioception is intact .most likely cause of this patient's symptoms?
• A C8 nerve root infiltrabon by tumor ( I chose this)
• B Cervrcal disc herniaition
•C Chemotherapyneurotoldc1ty
•D Ulnar nerve compress1on
• E Vitamin B12 (cobalamm) deficiency
2.
A 22-year-old man with Duchenne nuscular dystrophy is brought to the phys ician by his parents because of increased difficu lty clearing secretions over the past 3 weeks. He is
confined to bed or a chair and needs assistance with all activities of daily l ivin g. He li ves with his parents who are upset th at he does not want to have friends visit He says that he
is often irritated by their attempts to keep his spirits up and to make hi m more comfortable. B oth the patient and family ha ve avoided discuss ing the patient's wishes regardi ng endof-
life care. Vital signs today are within normal limits. Examination shows generalized muscle weakness and wasting; he needs support to remain seated in his wheelchair. Upper
airway sounds are heard without the stethoscope. Which of the following is the most a ppropriate next step in management?
A) Clarify the patient's preferences for treatn1ent as his disease progresses (This to be done first?)
B) Obtain permission for tracheostomy
C) Refer the patient for a psychiatric evaluation
D) Begin fluoxetine therapy
E) Begin nasopharyngeal s uctioning with oxygen via nasal cannula as needed
3. A 42-year- old man comes to the physician because of double vision. Two days ago, he was hit in the left eye with a softball. There was no loss of consciousness, but he was unable to continue playing He took aspirin and rested yesterday Examination is normal except when he is asked to look up A photograph is shown. (SHows vertical gaze palsy of left eye). Which of the following
is the most li kely cause of the diplopia?
A) Entrapn1ent of inferior oblique ( i Tthink is answer)
B) Orbital hemorrhage
C) Paresis of the sixth cranial nerve
D) Paresis of the third cranial nerve
E) Subdural hematoma
