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Question: Read this article (http://openstaxcollege.org/l/3word) to learn about a young man who texts his fiancée in a panic as he finds that he is having trouble remembering things. At the hospital, a neurologist administers the mental status exam, which is mostly normal except for the three-word recall test. The young man could not recall them even 30 seconds after hearing them and repeating them back to the doctor. An undiscovered mass in the mediastinum region was found to be Hodgkin's lymphoma, a type of cancer that affects the immune system and likely caused antibodies to attack the nervous system. The patient eventually regained his ability to remember, though the events in the hospital were always elusive. Considering that the effects on memory were temporary, but resulted in the loss of the specific events of the hospital stay, what regions of the brain were likely to have been affected by the antibodies and what type of memory does that represent?
Choices:
The patient was unable to form episodic memories during the events described in the case, so the medial temporal lobe structures might have been affected by the antibodies.
Question: How is the diagnostic category of TIA different from a stroke?
Choices:
The main difference between a stroke and TIA is time. If the result of a cerebrovascular accident lasts longer than 24 hours, then it is considered a stroke. Otherwise, it is considered transient and is labeled a TIA.
Question: Watch this video (http://openstaxcollege.org/l/neuroexam2) for an introduction to the neurological exam. Studying the neurological exam can give insight into how structure and function in the nervous system are interdependent. This is a tool both in the clinic and in the classroom, but for different reasons. In the clinic, this is a powerful but simple tool to assess a patient's neurological function. In the classroom, it is a different way to think about the nervous system. Though medical technology provides noninvasive imaging and real-time functional data, the presenter says these cannot replace the history at the core of the medical examination. What does history mean in the context of medical practice?
Choices:
History is the report from the patient, or others familiar with the patient, that can assist in diagnosis and formulation of treatment and care-essentially the result of an interview with the patient.
Question: Watch this video (http://openstaxcollege.org/l/reflextest) to see how to test reflexes in the abdomen. Testing reflexes of the trunk is not commonly performed in the neurological exam, but if findings suggest a problem with the thoracic segments of the spinal cord, a series of superficial reflexes of the abdomen can localize function to those segments. If contraction is not observed when the skin lateral to the umbilicus (belly button) is stimulated, what level of the spinal cord may be damaged?
Choices:
The region lateral to the umbilicus is innervated by T9-T11, approximately. A lack of contraction following that stimulation would therefore suggest damage at those levels.
Question: Watch this short video (http://openstaxcollege.org/l/facialnerve) to see an examination of the facial nerve using some simple tests. The facial nerve controls the muscles of facial expression. Severe deficits will be obvious in watching someone use those muscles for normal control. One side of the face might not move like the other side. But directed tests, especially for contraction against resistance, require a formal testing of the muscles. The muscles of the upper and lower face need to be tested. The strength test in this video involves the patient squeezing her eyes shut and the examiner trying to pry her eyes open. Why does the examiner ask her to try a second time?
Choices:
She has just demonstrated voluntary control by closing her eyes, but when he provides the resistance that she needs to hold tight against, she has already relaxed the muscles enough for him to pull them open. She needs to squeeze them tighter to demonstrate the strength she has in the orbicular oculi.
Question: Watch the video (http://openstaxcollege.org/l/2brains) titled "The Man With Two Brains" to see the neuroscientist Michael Gazzaniga introduce a patient he has worked with for years who has had his corpus callosum cut, separating his two cerebral hemispheres. A few tests are run to demonstrate how this manifests in tests of cerebral function. Unlike normal people, this patient can perform two independent tasks at the same time because the lines of communication between the right and left sides of his brain have been removed. Whereas a person with an intact corpus callosum cannot overcome the dominance of one hemisphere over the other, this patient can. If the left cerebral hemisphere is dominant in the majority of people, why would righthandedness be most common?
Choices:
The left hemisphere of the cerebrum controls the right side of the body through the corticospinal tract. Because language function is largely associated with the dominant hemisphere, the hand with which a person writes will most likely be the one controlled by the left hemisphere.
Question: Watch this video (http://openstaxcollege.org/l/neuroexam) that provides a demonstration of the neurological exam-a series of tests that can be performed rapidly when a patient is initially brought into an emergency department. The exam can be repeated on a regular basis to keep a record of how and if neurological function changes over time. In what order were the sections of the neurological exam tested in this video, and which section seemed to be left out?
Choices:
Coordination and gait were tested first, followed by mental status, motor, sensory, and reflexes. There were no specific tests of the cranial nerves.
Question: A patient's performance of the majority of the mental status exam subtests is in line with the expected norms, but the patient cannot repeat a string of numbers given by the examiner. What is a likely explanation?
Choices:
The patient has suffered a stroke to the prefrontal cortex where working memory is localized.
Question: Why is a rapid assessment of neurological function important in an emergency situation?
Choices:
If an ischemic event has occurred, nervous tissue may be compromised, but quick intervention-possibly within a few hours-may be the critical aspect of recovery.
Question: Watch this short video (http://openstaxcollege.org/l/stationtest) to see a test for station. Station refers to the position a person adopts when they are standing still. The examiner would look for issues with balance, which coordinates proprioceptive, vestibular, and visual information in the cerebellum. To test the ability of a subject to maintain balance, asking them to stand or hop on one foot can be more demanding. The examiner may also push the subject to see if they can maintain balance. An abnormal finding in the test of station is if the feet are placed far apart. Why would a wide stance suggest problems with cerebellar function?
Choices:
A wide stance would suggest the person needs to maintain balance by broadening their base. Instead of continuous correction to posture, this can keep the body stable when the cerebellum cannot.
Question: Watch this video (http://openstaxcollege.org/l/2point) to see a quick demonstration of two-point discrimination. Touching a specialized caliper to the surface of the skin will measure the distance between two points that are perceived as distinct stimuli versus a single stimulus. The patient keeps their eyes closed while the examiner switches between using both points of the caliper or just one. The patient then must indicate whether one or two stimuli are in contact with the skin. Why is the distance between the caliper points closer on the fingertips as opposed to the palm of the hand? And what do you think the distance would be on the arm, or the shoulder?
Choices:
The fingertips are the most sensitive skin on the hand, so the points of the caliper can be closer together and still be recognized as two separate points. On the palm, the sensitivity is less, so the points need to be farther apart. This will continue on the arm and shoulder, as sensitivity decreases, the discrimination of separate stimuli will be wider.
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