INBDE Final Exam

INBDE Final Exam Patient: 52-year-old white male. Chief complaint: "Suddenly I can't move half my face or close my eye and my ear is ringing! Everything has less taste. My mouth is a little dry." Background/or patient history: Not applicable. Current Findings: Symptoms appeared suddenly. Facial paralysis on the left half of the face, including the forehead. The patient has tenderness posterior to his left ear. Eyes are moist. Which nerve do you suspect has a lesion? A. Facial Nerve (CN VII) B. Glossopharyngeal nerve (CN IX) C. Trigeminal Nerve (CN V) D. Vagus Nerve (CN X) - A. Facial Nerve The facial nerve innervates the muscles of facial expression and the nerve to stapedius (which dampens sound). Patient: 52-year-old white male. Chief complaint: "Suddenly I can't move half my face or close my eye and my ear is ringing! Everything has less taste. My mouth is a little dry." Background/or patient history: Not applicable. Current Findings: Symptoms appeared suddenly. Facial paralysis on the left half of the face, including the forehead. The patient has tenderness posterior to his left ear. Eyes are moist. The nerve in question exits the skull through: A. the stylomastoid foramen and passes through the parotid gland. B. formen ovale and passes deep to the parotid gland. C. through the external acoustic meatus and passes through the parotid gland. D. the jugular foramen and passes superficial to the parotid gland. - A. the stylomastoid foramen and passes through the parotid gland. Patient: 52-year-old white male. Chief complaint: "Suddenly I can't move half my face or close my eye and my ear is ringing! Everything has less taste. My mouth is a little dry." Background/or patient history: Not applicable. Current Findings: Symptoms appeared suddenly. Facial paralysis on the left half of the face, including the forehead. The patient has tenderness posterior to his left ear. Eyes are moist. What is the location of the lesion? (Refer to diagram on quiz) A. 1 (proximal to geniculate ganglion, nerve to stapedius, chorda tympani, and branches to muscles of facial expression) B. 2 (distal to geniculate ganglion and proximal to nerve to stapedius, chorda tympani, and branches to muscles of facial expression) C. 3 (distal to geniculate ganglion and nerve to stapedius and proximal to chorda tympani and branches to muscles of facial expression) D. 4 (distal to geniculate ganglion, nerve to stapedius, chorda tympani, and branches to muscles of facial expression) - B. The lesion is distal to the geniculate ganglion, so the patient has moist eyes, but is proximal to the nerve to stapedius (which dampens sound), the chorda tympani (which consists of taste fibers from the anterior 2/3 of the tongue and parasympathetics to the submandibular ganglion) and branches to the muscles of facial expression. Patient: 52-year-old white male. Chief complaint: "Suddenly I can't move half my face or close my eye and my ear is ringing! Everything has less taste. My mouth is a little dry." Background/or patient history: Not applicable. Current Findings: Symptoms appeared suddenly. Facial paralysis on the left half of the face, including the forehead. The patient has tenderness posterior to his left ear. Eyes are moist. Which nerve is responsible for the patients loss of taste? A. Chorda tympani B. Greater petrosal nerve C. Glossopharyngeal nerve D. Vagus nerve - A. Chorda tympani Chorda tympani consists of taste fibers to the anterior 2/3 of the tongue and preganglionic parasympathetic fibers to the submandibular and sublingual glands. Patient: 23-year-old Caucasian woman Chief complaint: "My jaw feels a lot better than it did the last time I was here - I hope it's healing ok." Background/or patient history: The patient was in a motor vehicle accident 2 months ago, in which she fractured the body of her mandible.