CASE STUDY Mrs. Markus is a 37-year-old woman with a history of migraine headaches and visual field disturbances. She has a left medial lower quadrant defect (an area of reduced visual function) that  was noted in December of 1999 and has been stable. She recently developed a right temporal lower quadrant defect, which was first noted in September of 2004 and has had worsening symptoms in October.

An MRI in November showed a normal study of the brain including visual cortex and periventricular white matter, with a normal study of the orbits, optic nerves, and extra ocular muscles. A pituitary microadenoma (small benign tumor of the pituitary gland) of approximately 3 mm on the left side of the gland was found with no compromise of the optic chiasm. Mrs. Markus underwent further evaluation by MRI with pituitary cuts and the microadenoma was again noted left of midline causing no compression of the optic nerves nor invasion of the cavernous sinus. The microadenoma is approximately 5 mm.

Past medical history is also significant for depression, asthma, and a hiatal hernia. Her current medications include Prozac, Imitrex, and Azmacort MDI.

In summary, Mrs. Markus is a patient with an incidentally noted pituitary microadenoma on MRI. This is reportedly new when compared with prior studies. We cannot explain the new visual field disturbances except for the adenoma. A pituitary workup has been initiated and her prolactin level is mildly elevated but this can be secondary to her medications, especially Prozac, which can cause hyperprolactinemia. Thyroid function is normal and a growth hormone test level is pending. I will proceed to rule out hypercortisolemia and Cushing’s disease.

OUTPATIENT OFFICE ENCOUNTER

Howard Solo is a 65-year-old patient and a retired airline ground maintenance technician. He worked for 40 years for American Airlines. He complains of tinnitus and hearing loss that have worsened over the past year. An audiogram was obtained on July 24, 2009 at the time of the patient’s initial visit. This audiogram revealed an average 75 dB (decibel) hearing loss through the speech frequencies in the right ear with an average loss of 80 dB loss in the left ear.

DISCUSSION QUESTIONS:

1.    After reviewing the case study, discuss the following in your post. Given the above medical case, perform a quality assessment of the medical terminology used by identifying one or two terms that may be inaccurate or confusing within the context of the case presented.

 2.    Reviewing the outpatient encounter of Bernard Collins, accomplish the following and report in your findings and comments in your post.

A.   Go to Research a disease or condition in the A.D.A.M. multimedia encyclopedia. Read all the information under Hearing loss – occupational and look at the image entitled Ear Anatomy. View the video entitled Hearing and the cochlea. Read the related articles under Hearing loss. Under Learn About a Test, read the information in Audiometry.

B.   After studying the material, summarize or paraphrase any information that you use in response to the discussion questions this week. Be sure and cite your source appropriately. Do not copy and paste.

C.  Discuss how you would classify the type of hearing loss that Howard has experienced. Include the degree of severity of hearing loss based on the results of the audiometry. What kind of treatment would you recommend?

3.      General questions:

A.    Define the parts of the brain.

B.     Name and define the cranial nerves I-XII.