Archives: Medical Student Years 1-3

MS-3999

During a clinical examination of a 26-year-old woman with a history of relapsing-remitting multiple sclerosis, you observe nystagmus of the left eye and significant weakness in adduction of the right eye when she looks to the left. What is the location of the lesion responsible for these findings?

MS-3996

A 35-year-old female patient with a history of relapsing-remitting multiple sclerosis presents with new-onset double vision. She reports that in the last week, she has noticed double vision when trying to focus on objects on the left side of her visual field. She reports no double vision when looking to the right.

During examination, asking the patient to track the examiner’s finger and look to the left (i.e. left horizontal conjugate gaze) elicits double vision, with the patient reporting that images appear ‘side by side.’ Additionally, there is a failure of the right eye to adduct past the midline, and nystagmus is noted in the left eye. Asking the patient to look to the right elicits no symptoms or abnormal findings. Asking the patient to converge her eyes on a nearby, midline object elicits no abnormalities, and the patient can abduct both eyes.

Which part of the nervous system is most likely responsible for this patient’s symptoms?

MS-3997

A 35-year-old woman presents with a 2-day history of vision difficulty. She is experiencing peripheral vision loss and feels nauseous and dizzy when attempting to look towards the sides. Two months ago, she had a tingling sensation in her left foot. During physical examination, there is a limitation in adduction of both eyes and nystagmus with lateral gaze. An MRI of the brain is scheduled.

Based on the current clinical presentation and likely diagnosis, what is the expected location of lesions on the MRI scan?

MS-3991

Which one of the following is not a direct branch of the facial nerve?

MS-3992

A 13-year-old boy comes to the clinic with his mother complaining of ear pain. He experienced the pain last night and was unable to sleep. As a result, he stayed home from school today. He reports that sounds are muffled on the affected side. During the examination, he has a fever. Otoscopy reveals a bulging tympanic membrane with visible fluid level, indicating a middle ear infection. The nerve to tensor tympani arises from which nerve?

MS-3998

Sarah is a 31-year-old woman presenting with diplopia. She has a history of type 1 diabetes and multiple sclerosis. Over the past 3 days, she has been experiencing double vision, particularly when looking to the right.

Sarah denies any associated double vision when looking vertically. She has not noticed any difficulty in moving her eyelids, increased sensitivity to light, or redness in her eye.

During examination, both eyelids display normal strength. With the left eye closed, the right eye displays a full range of movement. However, with the right eye closed, the left eye fails to adduct when looking towards the right. Nystagmus on the right eye is noted when the patient is asked to look to the right with both eyes. On convergence, both eyes can adduct towards the midline. The pupillary exam is normal with both pupils reacting appropriately to light.

What is the underlying pathology responsible for Sarah’s diplopia?

MS-4000

A 23-year-old man is involved in a physical altercation and suffers a stab wound in his upper forearm. Upon examination, a small yet deep laceration is observed. There is an evident loss of pincer movement in the thumb and index finger, with minimal sensation loss. Which nerve is most likely to have been injured?

MS-3993

A 45-year-old man visits a neurology clinic due to difficulty eating and wasting of the left masseter. He has been experiencing these symptoms for the past 4 months since he fell from scaffolding at work and suffered a basal skull fracture.

During the examination, the left masseter is visibly atrophied compared to the right, and the mandible deviates towards the left side. The patient also reports decreased sensation around the body of the mandible.

Which area of the skull base is likely responsible for the patient’s symptoms?

MS-3995

During your clinical rotation in the ear, nose, and throat department, you have been tasked with delivering a presentation on the boundaries of the oral cavity. Can you identify the structure that forms the roof of the oral cavity?