Problem Solving Activity The following problem solving assessment is presented in a multiple-choice format. Each choice should be considered individually and an argument should be written for accepting or rejecting it. Since the problem has one best answer, there should be one argument for acceptance and four for rejection. For each response, you must first state whether you are accepting or rejecting that statement. Then, you must write a detailed explanation why you accept or reject each of the choices. PROBLEM: You are examining a patient complaining of numbness and tingling of the hand and fingers. How might you determine whether this problem was due to pinching of nerve C? or due to carpal tunnel syndrome (i.e., compression of the median nerve along its course)? A. The patient will not be able to squeeze an object with the hand and fingers if the median nerve is involved; nerve C? does not carry a motor supply to these muscles and cannot be involved. B. The patient will be unable to extend the fingers if damage is to C?, since the median nerve is not involved in this action. C. The patient will have sensation impairment in the lateral three and a half digits but not in the medial one and a half if the condition results from median nerve damage. D. The patient will have sensation enhancement in the medial two digits and medial forearm if carpal tunnel syndrome is involved. E. Choices A and C both are correct.
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This statement is accepted because it is medically accurate. The median nerve does supply the muscles that allow for squeezing an object with the hand and fingers. If the median nerve is compressed, as in carpal tunnel syndrome, this action would be impaired. On Show moreā¦
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Bryan V.
A 30-year-old woman, Isabel Yang, was brought into the emergency room. She had been dining in a restaurant, and while eating dessert, she noticed the following symptoms. Initially, there was a tingling sensation that affected her mouth and lips, but then spread to the face and neck. Then the tingling spread down her arms and legs, to the fingers and toes. At the hospital, Isabel reported numbness of the areas that previously tingled and had difficulty walking in a coordinated fashion. She was asked to describe the meal she had just eaten and stated that she had shrimp cocktail as an appetizer, followed by a salad, steak, baked potato, green beans, and apple pie and coffee for dessert. Isabel had no history of allergic response to shellfish. Her superficial reflexes were almost absent, and her deep reflexes were markedly hypoactive. An extracellular electrode was placed on Isabel's ulnar nerve. Then the palmar surface of her little finger was scraped with the physician's fingernail in a way that would normally be painful to the patient. The patient could not feel this stimulus, and no action potentials were detected in the ulnar nerve. When an intracellular microelectrode was placed on a sensory nerve fiber in the ulnar nerve, the resting membrane potential was found to be near -70 mV (normal). When an action potential was evoked by repeated vigorous scraping of the skin of the little finger as described earlier, the action potential was slower to rise and of shorter amplitude than that expected from measurements in normal individuals. The duration of the action potential was normal. 1. What can be concluded from the failure to elicit an action potential in the ulnar nerve by vigorous scraping of the skin of the little finger? 2. What can be concluded from the gross neurologic symptoms and findings taken together? 3. What can be concluded from the findings that the resting membrane potential in the sensory fibers in the ulnar nerve is near normal? 4. What might explain the finding that the action potential in the sensory fiber in the ulnar nerve is slow to rise and of smaller amplitude than normal? 5. Why is the action potential in the sensory fiber of normal duration? 6. What may be the cause of Isabel's difficulties? 7. How should Isabel's care be managed, and what is her prognosis?
Sri K.
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