Question

A 38-year-old saleswoman developed left neck and shoulder pain. Evaluation revealed a cervical disc herniation with surgery recommended. In the recovery room following surgery, she noticed a marked change in her voice, which now had a breathy quality. She was reassured that this was only a temporary effect of the intubation. However, over the next 2 months she continued to have severe breathiness of her voice making it difficult to use her voice at work. After 2 months, she was referred to an otolaryngologist. His observations included a soft, breathy voice suggesting that an air leak was present in her larynx. Based on the case history, where is the most likely site of lesion? A.cranial nerve V, superior laryngeal branch B. bilateral upper motor lesions in region of internal capsule outflow from motor stripes C. cranial nerve X, inferior (recurrent) laryngeal branch D. left cerebellar hemisphere E. precentral gyrus, right hemishere

          A 38-year-old saleswoman developed left neck and shoulder pain. Evaluation revealed a cervical disc herniation with surgery recommended. In the recovery room following surgery,  she noticed a marked change in her voice, which now had a breathy quality.  She was reassured that this was only a temporary effect of the intubation. However, over the next 2 months she continued to have severe breathiness of her voice making it difficult to use her voice at work. After 2 months, she was referred to an otolaryngologist. His observations included a soft, breathy voice suggesting that an air leak was present in her larynx.
Based on the case history, where is the most likely site of lesion?
A.cranial nerve V, superior laryngeal branch
B. bilateral upper motor lesions in region of internal capsule outflow from motor stripes
C. cranial nerve X, inferior  (recurrent) laryngeal branch
D. left cerebellar hemisphere
E. precentral gyrus, right hemishere

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Added by Daniel M.

Biology for AP Courses

Julianne Zedalis, John Eggebrecht

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Solved by Expert Dave Kratz

02/19/2024

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The patient experienced a marked change in her voice, specifically a breathy quality, following cervical disc herniation surgery. This symptom persisted for two months, indicating a potential issue with her larynx. Show more…

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A 38-year-old saleswoman developed left neck and shoulder pain. Evaluation revealed a cervical disc herniation with surgery recommended. In the recovery room following surgery, she noticed a marked change in her voice, which now had a breathy quality. She was reassured that this was only a temporary effect of the intubation. However, over the next 2 months she continued to have severe breathiness of her voice making it difficult to use her voice at work. After 2 months, she was referred to an otolaryngologist. His observations included a soft, breathy voice suggesting that an air leak was present in her larynx. Based on the case history, where is the most likely site of lesion? A.cranial nerve V, superior laryngeal branch B. bilateral upper motor lesions in region of internal capsule outflow from motor stripes C. cranial nerve X, inferior (recurrent) laryngeal branch D. left cerebellar hemisphere E. precentral gyrus, right hemishere

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00:02 All right, it says, after having surgery to remove a stomach tumor, derek woke up in the recovery room in extreme pain.

00:07 Hurt to move, hurt to blink, hurt to have taken even a little breath.

00:11 And here was the nurse demanding that he take a deep breath and cough.

00:15 Why was she crazy? so let's look at the questions.

00:18 Number one, which of these muscles would not contract when derek complied with the nurse's instructions? so we have the diaphragm, serratus anterior, rectus abdominis, external intercostals.

00:32 So the diaphragm contracts during inhalation, increases the volume of thoracic cavity.

00:39 Serratus anterior helps with the movement of the shoulder girdle, but is not primarily involved in respiration.

00:44 So that we can eliminate.

00:47 C, rectus abdominis, that contracts during forced exhalation like coughing to help expel air.

00:53 And d, external intercostals, those contract during inhalation to elevate the ribs and increase thoracic volume.

00:59 So which one would not be directly involved in the mechanics of breathing or coughing? let's see.

01:17 So the best option here would be b, serratus anterior, because that really does not have much to do with inhalation or exhalation.

01:30 All right, which statement best describes the mechanics of derek's inhalations? so we have the thoracic cavity decrease in size, lowering the alveolar pressure and air flows from high to low.

01:40 Thoracic cavity increases in size, lowering the alveolar pressure and air flows from high to low.

01:46 So first we had that it decreases in size, then we had an increase in size.

01:54 C, air flows from high to low and expands the thoracic cavity.

01:59 Or d, air flows from high interpolar pressure to low alveolar pressure and expands through the thoracic cavity.

02:09 So looking at the statements, let's see here.

02:14 Our best option would be b...

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