A 70-year-old woman has been brought to the emergency department ...

[strangeaffliction]

A 70-year-old woman has been brought to the emergency department by her daughter who noticed the woman is weak, confused, and forgetful in recent months, along with uncoordinated movements and visual disturbances at times.
 
  Which of the following questions by the physician are most likely to address her probable diagnosis? Select all that apply.
  A)
  What medications is your mother currently taking?
  B)
  Does your mother drink alcohol?
  C)
  Does your mother have a history of stroke?
  D)
  Is your mother facing significant stressors right now?
  E)
  Is your mother lonely?

Question 2

As the eyes rotate upward, the upper eyelid reflexively retracts. Which cranial nerve is primarily responsible for this response?
 
  A)
  Cranial nerve I
  B)
  Cranial nerve III
  C)
  Cranial nerve VI
  D)
  Cranial nerve IV

[trog]

Answer to Question 1

Ans:
A, B

Feedback:

The client's symptoms are characteristic of Wernicke-Korsakoff syndrome, which is associated with alcohol abuse. Medications can cause numerous cognitive and motor disturbances in elderly clients. Prior CVA and stress are less likely to contribute to her symptomatology.

Answer to Question 2

Ans:
B

Feedback:

The CN III (oculomotor) nucleus, which extends through a considerable part of the midbrain, contains clusters of lower motor neurons for each of the five eye muscles it innervates. Because of its plane of attachment, the inferior oblique rotates the eye in the frontal plane pulling the top of the eye laterally. In other words, as the eyes rotate upward, the upper eyelid is reflexively retracted, and in the downward gaze, it is lowered, restricting exposure of the conjunctiva to air and reducing the effects of drying. CN I is involved in olfactory function; CN VI (abducens nerve) innervates the lateral rectus, which abducts the eye. CN IV (trochlear nerve) innervates the superior oblique muscle, which depresses, rotates laterally, and intorts the eyeball.