question archive John Angleman, a 41-year-old machinist, presents in June to the employee health doctor with complaints of difficulty hearing in the right ear
John Angleman, a 41-year-old machinist, presents in June to the employee health doctor with complaints of difficulty hearing in the right ear
Subject:BiologyPrice: Bought3
John Angleman, a 41-year-old machinist, presents in June to the employee health doctor with complaints of difficulty hearing in the right ear. This began about three months ago and he thinks it is getting worse. His wife noticed him turning his left ear towards her to hear her speak, and he has noticed that he has to use the phone on his left side. He has also been a bit unsteady, but attributes this to getting older. He states that he usually wears his protective ear plugs when working. The physician examines him, and confirms that he cannot hear a high-pitched tuning fork as well with the right ear as he can with his left. He is referred to an audiologist. The audiologist performs a formal assessment, and confirms severe loss of high- and medium-pitched tones and moderate loss of low-pitched tones. No formal patient history is conducted at this visit. John returns to his employee health doctor on 17 August of the same year. His hearing problems have progressed, and now he is also complaining of facial numbness and clumsiness of the right hand. He occasionally makes mis-steps with his right leg. The employee health doctor refers John to a neurologist. Physical Exam: A physical exam is conducted by the neurologist, and an examination of past medical records from the health doctor and audiologist confirms that John has seen a slight progression in his hearing loss since June. The physical exam yields the following results: Facial numbness on the right side of the face on examination with a pin and cold tuning fork when placed against the skin. Nystagmus was with beating to the right side primary gaze and worse when looking to the right. There is virtually no perception of the tuning fork on the right side. Clumsiness of the right hand with alternating movements and also when asked to do fast foot tapping on the right. An observation of gait also demonstrates mis-steps in John's gait. The neurologist orders a CT scan. The CT scan results are negative for lesions. However, because a CT scan does not visualize the posterior cranial fossa well, an MRI is ordered. Utilizing sound logic, consider the following questions: 1. What is your diagnosis of this patient? Explain your rationale.
