SYTM 6509 WEEK 6 PRACTICE QUESTIONS SYSTEMS
ENGINEERING COURSE 2025/2026 | VERIFIED QUESTIONS
AND ANSWERS GRADED A+ | ENGINEERING PRINCIPLES &
PROBLEM-SOLVING STUDY GUIDE | GUARANTEED
SUCCESS
[6A] A 16-year-old boy notices he has difficulty understanding the teacher in
class. He has been a good student but his grades are falling. At the clinic, he
admits to the physician he has enthusiasm for loud rock music. Weber's test
shows no localization of sound to either ear. Rinne test shows air conduction is
better than bone conduction. Audiometry demonstrates a 50 dB loss of hearing
at frequencies above 2500 Hz. Which structure(s) is/are most likely to be
affected?
A: Temporal lobe
B: Cochlear nerve
C: Hair cells of cochlea
D: Ossicles of the middle ear
E: Tympanic membrane - CORRECT ANSWER - -C: Hair cells of cochlea
Bending of cilia towards tall kinocilium increases frequency of action potentials
in cochlear nerve. This is b/c K+ from endolymph (high K+ & low Na+) flows
into cell & depolarizes it, leading to opening of voltage-gated Ca2+ channels.
Influx of Ca2+ causes release of Glu to create receptor potential in auditory
nerve.
Prolonged exposure to loud noise typically destroys hair cells of cochlea,
leading to inability to stimulate nerves of hearing. Sensory nerves themselves
are intact, as well as temporal lobe. Since Weber's & Rinne's tests are normal,
that would rule out conductive hearing loss, i.e. damage to ossicles or tympanic
membrane.
[6A] A 40-year-old man presents to the emergency department complaining of
heavy feeling on the right side of the face. Neurological examination showed
paralysis of the of the right side of her face and decreased taste sensation on the
right side of her tongue. What other clinical feature is likely to be present in this
patient?
,A: Increased sensitivity to loud sounds in her right ear
B: Decreased sensation over her left upper cheek
C: Decreased sensation over her right upper cheek
D: Deviation of the uvula and soft palate to the left when the patient is asked to
say Ahh
E: Deviation of the uvula and soft palate to the right when the patient is asked to
say Ahh - CORRECT ANSWER - -A: Increased sensitivity to loud sounds in
her right ear
Patient has CN VII dysfunction. CN VII innervates facial muscles of
expression, sympathetic innervation to multiple glands, taste sensation to
anterior 2/3rd of tongue, & stapedius muscle. CN VII is also in charge of
attenuation reflex, where sudden loud noise initiates reflex contraction of
muscles of middle ear after 40-80 ms. This reflex is mediated by tensor tympani
(CN V) & stapedius muscles, which protect cochlea, prevent saturation of hair
cell transduction mechanism, & suppresses low frequency sounds. Therefore,
CN VII lesion can result in stapedius paralysis & hyperacusis.
[6A] A 48 year old woman presents with a unilateral hearing deficit in the left
ear that has progressively developed over the past 10 years. Her history is
positive for measles at age 7. Hearing tests reveal a conduction loss but normal
nerve function. Dysfunction of which of the following auditory structures is
most likely responsible for her hearing loss?
A. Incus
B. Malleus
C. Oval window
D. Round window
E. Stapes - CORRECT ANSWER - -E. Stapes
Patient has otosclerosis, where there is increased ossification of stapes. This
progressively reduces conduction of ossicles in middle ear over time.
Otosclerosis is linked to previous measles infections, stress fractures of bones of
middle ear, & immune disorders. Very rarely, incus & malleus may be affected
by otosclerosis, but normally stapes is only one affected. Conditions affecting
oval & round windows are typically congenital & would therefore present much
earlier than middle age.
,[6A] A 44 year old woman suffered a stroke that involved part of her midbrain.
A hearing impairment resulted, which included a reduced ability to localize
sound or to distinguish between sounds. Which structure in this area of the brain
may have been damaged by the stroke and could account for these deficits?
A. Inferior colliculus
B. Nucleus of the lateral lemniscus
C. Cochlear nucleus
D. Red nucleus
E. Reticular activating system - CORRECT ANSWER - -A. Inferior colliculus
Cell bodies of 1st order neuron form spiral ganglion -> 2nd order neurons in
cochlear nucleus -> ipsilateral or contralateral superior olivary nucleus via
lateral lemniscus -> inferior colliculus in midbrain -> medial geniculate nucleus
of thalamus -> auditory cortex in superior temporal lobe.
[6B] A 60-year-old woman complains of repeated episodes of the room
spinning. The event occurs usually in the morning when she bends to pick up an
object. The spinning lasts less than a minute and she is otherwise in good health.
On further questioning and examination, you make a diagnosis of Benign
Paroxysmal Positional Vertigo (BPPV). What will be a suitable treatment?
A: Benzodiazepine
B: Antihistamine
C: Antiemetic
D: Head repositioning maneuvers
E: Refer to otolaryngologist for surgery - CORRECT ANSWER - -D: Head
repositioning maneuvers
BPPV is short (< 60 sec) episodes of vertigo due to falling of otoliths into
semicircular canal, which stimulate hair cells in crista ampullaris & create false
sense of motion. Drugs & surgery aren't really useful; instead, do Epley!
[6B] A 50-year-old woman visits an otolaryngologist for sudden bouts of
dizziness that subside after about 20 minutes. She also has temporary hearing
, losses and a feeling of fullness in her right ear; low-pitched buzzing sounds
occur intermittently in her right ear. Physical examination shows nystagmus
during a dizzy spell. What could be the underlying problem in this patient?
A: Damage to the right saccule of the inner ear
B: Damage to the right utricle of the inner ear
C: A lesion in the vestibular nucleus
D: A lesion affecting Cranial nerve VIII
E: A build-up of endolymph in the semicircular canals - CORRECT
ANSWER - -E: A build-up of endolymph in the semicircular canals
Pt has Meniere's disease, which is idiopathic buildup of endolymph causing
increased fluid volume & pressure.
[6B] A 50 year old woman is admitted to hospital in moderate level of coma
(Glasgow Coma Score of 12) following a vehicle accident. Her pupillary light
reflexes are normal. What is the most likely finding on flushing the patient's
right ear with cold or warm water?
A. Cold water causing ipsilateral saccadic movement
B. Warm water causing ipsilateral saccadic movement
C. Warm water causing contralateral slow pursuit
D. Warm water mimicking the head turning left
E. Cold water causing contralateral slow pursuit - CORRECT ANSWER - -C.
Warm water causing contralateral slow pursuit
Normally, vestibulo-ocular reflex is composed of slow pursuit & saccadic (fast)
eye movements in opposite directions. Cold water in one ear would cause slow
pursuit towards that ear & saccadic correction back away from that ear, while
warm water would stimulate opposite (COWS). In comatose patients, slow
component is intact while fast correction is lost. In brain-dead patients, both
components are lost, aka doll's eyes.
[6B] A 60 year old woman complains of repeated episodes of the room
spinning. The event occurs usually in the morning when she bends to pick up an
object. The spinning lasts less than a minute and she is otherwise in good health.
ENGINEERING COURSE 2025/2026 | VERIFIED QUESTIONS
AND ANSWERS GRADED A+ | ENGINEERING PRINCIPLES &
PROBLEM-SOLVING STUDY GUIDE | GUARANTEED
SUCCESS
[6A] A 16-year-old boy notices he has difficulty understanding the teacher in
class. He has been a good student but his grades are falling. At the clinic, he
admits to the physician he has enthusiasm for loud rock music. Weber's test
shows no localization of sound to either ear. Rinne test shows air conduction is
better than bone conduction. Audiometry demonstrates a 50 dB loss of hearing
at frequencies above 2500 Hz. Which structure(s) is/are most likely to be
affected?
A: Temporal lobe
B: Cochlear nerve
C: Hair cells of cochlea
D: Ossicles of the middle ear
E: Tympanic membrane - CORRECT ANSWER - -C: Hair cells of cochlea
Bending of cilia towards tall kinocilium increases frequency of action potentials
in cochlear nerve. This is b/c K+ from endolymph (high K+ & low Na+) flows
into cell & depolarizes it, leading to opening of voltage-gated Ca2+ channels.
Influx of Ca2+ causes release of Glu to create receptor potential in auditory
nerve.
Prolonged exposure to loud noise typically destroys hair cells of cochlea,
leading to inability to stimulate nerves of hearing. Sensory nerves themselves
are intact, as well as temporal lobe. Since Weber's & Rinne's tests are normal,
that would rule out conductive hearing loss, i.e. damage to ossicles or tympanic
membrane.
[6A] A 40-year-old man presents to the emergency department complaining of
heavy feeling on the right side of the face. Neurological examination showed
paralysis of the of the right side of her face and decreased taste sensation on the
right side of her tongue. What other clinical feature is likely to be present in this
patient?
,A: Increased sensitivity to loud sounds in her right ear
B: Decreased sensation over her left upper cheek
C: Decreased sensation over her right upper cheek
D: Deviation of the uvula and soft palate to the left when the patient is asked to
say Ahh
E: Deviation of the uvula and soft palate to the right when the patient is asked to
say Ahh - CORRECT ANSWER - -A: Increased sensitivity to loud sounds in
her right ear
Patient has CN VII dysfunction. CN VII innervates facial muscles of
expression, sympathetic innervation to multiple glands, taste sensation to
anterior 2/3rd of tongue, & stapedius muscle. CN VII is also in charge of
attenuation reflex, where sudden loud noise initiates reflex contraction of
muscles of middle ear after 40-80 ms. This reflex is mediated by tensor tympani
(CN V) & stapedius muscles, which protect cochlea, prevent saturation of hair
cell transduction mechanism, & suppresses low frequency sounds. Therefore,
CN VII lesion can result in stapedius paralysis & hyperacusis.
[6A] A 48 year old woman presents with a unilateral hearing deficit in the left
ear that has progressively developed over the past 10 years. Her history is
positive for measles at age 7. Hearing tests reveal a conduction loss but normal
nerve function. Dysfunction of which of the following auditory structures is
most likely responsible for her hearing loss?
A. Incus
B. Malleus
C. Oval window
D. Round window
E. Stapes - CORRECT ANSWER - -E. Stapes
Patient has otosclerosis, where there is increased ossification of stapes. This
progressively reduces conduction of ossicles in middle ear over time.
Otosclerosis is linked to previous measles infections, stress fractures of bones of
middle ear, & immune disorders. Very rarely, incus & malleus may be affected
by otosclerosis, but normally stapes is only one affected. Conditions affecting
oval & round windows are typically congenital & would therefore present much
earlier than middle age.
,[6A] A 44 year old woman suffered a stroke that involved part of her midbrain.
A hearing impairment resulted, which included a reduced ability to localize
sound or to distinguish between sounds. Which structure in this area of the brain
may have been damaged by the stroke and could account for these deficits?
A. Inferior colliculus
B. Nucleus of the lateral lemniscus
C. Cochlear nucleus
D. Red nucleus
E. Reticular activating system - CORRECT ANSWER - -A. Inferior colliculus
Cell bodies of 1st order neuron form spiral ganglion -> 2nd order neurons in
cochlear nucleus -> ipsilateral or contralateral superior olivary nucleus via
lateral lemniscus -> inferior colliculus in midbrain -> medial geniculate nucleus
of thalamus -> auditory cortex in superior temporal lobe.
[6B] A 60-year-old woman complains of repeated episodes of the room
spinning. The event occurs usually in the morning when she bends to pick up an
object. The spinning lasts less than a minute and she is otherwise in good health.
On further questioning and examination, you make a diagnosis of Benign
Paroxysmal Positional Vertigo (BPPV). What will be a suitable treatment?
A: Benzodiazepine
B: Antihistamine
C: Antiemetic
D: Head repositioning maneuvers
E: Refer to otolaryngologist for surgery - CORRECT ANSWER - -D: Head
repositioning maneuvers
BPPV is short (< 60 sec) episodes of vertigo due to falling of otoliths into
semicircular canal, which stimulate hair cells in crista ampullaris & create false
sense of motion. Drugs & surgery aren't really useful; instead, do Epley!
[6B] A 50-year-old woman visits an otolaryngologist for sudden bouts of
dizziness that subside after about 20 minutes. She also has temporary hearing
, losses and a feeling of fullness in her right ear; low-pitched buzzing sounds
occur intermittently in her right ear. Physical examination shows nystagmus
during a dizzy spell. What could be the underlying problem in this patient?
A: Damage to the right saccule of the inner ear
B: Damage to the right utricle of the inner ear
C: A lesion in the vestibular nucleus
D: A lesion affecting Cranial nerve VIII
E: A build-up of endolymph in the semicircular canals - CORRECT
ANSWER - -E: A build-up of endolymph in the semicircular canals
Pt has Meniere's disease, which is idiopathic buildup of endolymph causing
increased fluid volume & pressure.
[6B] A 50 year old woman is admitted to hospital in moderate level of coma
(Glasgow Coma Score of 12) following a vehicle accident. Her pupillary light
reflexes are normal. What is the most likely finding on flushing the patient's
right ear with cold or warm water?
A. Cold water causing ipsilateral saccadic movement
B. Warm water causing ipsilateral saccadic movement
C. Warm water causing contralateral slow pursuit
D. Warm water mimicking the head turning left
E. Cold water causing contralateral slow pursuit - CORRECT ANSWER - -C.
Warm water causing contralateral slow pursuit
Normally, vestibulo-ocular reflex is composed of slow pursuit & saccadic (fast)
eye movements in opposite directions. Cold water in one ear would cause slow
pursuit towards that ear & saccadic correction back away from that ear, while
warm water would stimulate opposite (COWS). In comatose patients, slow
component is intact while fast correction is lost. In brain-dead patients, both
components are lost, aka doll's eyes.
[6B] A 60 year old woman complains of repeated episodes of the room
spinning. The event occurs usually in the morning when she bends to pick up an
object. The spinning lasts less than a minute and she is otherwise in good health.
