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Neurology Week 1 2018/19 > 7: Anatomy - Clinical testing of cranial nerves > Flashcards

7: Anatomy - Clinical testing of cranial nerves Flashcards

1
Q

What is the name and modality of CN I?

Where does it emerge from the skull and where does it connect to the CNS?

A

Olfactory nerve; Special sensory

Remember the part afterwards is the olfactory tract because CN I synapses at the olfactory bulb

Cribriform plate of the ethmoid bone, goes straight to olfactory areas

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2
Q

What is the name and modality of CN II?

Where does it emerge from the skull and where does it connect to the CNS?

A

Optic nerve; Special sensory

Optic canal

Diencephalon

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3
Q

What is the name and modality of CN III?

Where does it emerge from the skull and where does it connect to the CNS?

A

Oculomotor nerve; Motor

Superior orbital fissure

Midbrain

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4
Q

What is the name and modality of CN IV?

Where does it emerge from the skull and where does it connect to the CNS?

A

Trochlear nerve; Motor

Superior orbital fissure

POSTERIOR aspect of the midbrain

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5
Q

What is the name and modality of CN V?

Where does it emerge from the skull and where does it connect to the CNS?

A

Trigeminal nerve; Both sensory and motor

Depends on branch - V1 = superior orbital fissure, V2 = foramen rotundum, V3 = foramen ovale (“standing room only”)

Only CN to connect to CNS at the PONS

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6
Q

What is the name and modality of CN VI?

Where does it emerge from the skull and where does it connect to the CNS?

A

Abducens nerve; Motor

Superior orbital fissure

Ponto-medullary junction

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7
Q

What is the name and modality of CN VII?

Where does it emerge from the skull and where does it connect to the CNS?

A

Facial nerve; Both

Stylomastoid foramen / Internal acoustic meatus

Ponto-medullary junction

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8
Q

What is the name and modality of CN VIII?

Where does it emerge from the skull and where does it connect to the CNS?

A

Vestibulocochlear nerve; Sensory (special)

Internal acoustic meatus

Ponto-medullary junction

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9
Q

What is the name and modality of CN IX?

Where does it emerge from the skull and where does it connect to the CNS?

A

Glossopharyngeal nerve

Jugular foramen

Medulla

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10
Q

What is the name and modality of CN X?

Where does it emerge from the skull and where does it connect to the CNS?

A

Vagus nerve; Both

Jugular foramen

Medulla

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11
Q

What is the name and modality of CN XI?

Where does it emerge from the skull and where does it connect to the CNS?

A

Spinal accessory nerve; Motor

Actually ascends through foramen magnum THEN down through jugular foramen

Cervical spinal cord

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12
Q

What is the name and modality of CN XII?

Where does it emerge from the skull and where does it connect to the CNS?

A

Hypoglossal nerve; Motor

Hypoglossal canal

Medulla

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13
Q

Some people say CN II isn’t a real cranial nerve - why?

A

It has its own meninges, so arguably it’s an extension of the CNS

Remember increases in intracranial pressure cause compression of CN II – papilloedema

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14
Q

Which cranial nerve(s)

a) emerge from the pons

b) emerge from the ponto-medullary junction

c) emerge from the opposite side of the brainstem to the others?

A

a) CN V

b) CN VI, VII and VIII

c) CN IV

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15
Q

Where is CN I actually found?

What is everything called proximal to the olfactory bulb?

A

Olfactory mucosa of nasal cavity

Olfactory tract

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16
Q

Through which hole does CN II reach the brain from the orbit?

A

Optic canal

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17
Q

What sense are you testing when you test CN II?

A

Vision

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18
Q

How can CN II be tested?

A

Visual acuity (Snellen chart)

Colour (Ishihara plates)

Visual fields

Visual reflexes

Direct fundoscopy

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19
Q

Which specific modalities are found in CN III?

A

Somatic motor for eye movements

Parasympathetics for pupillary constriction

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20
Q

Which blood-filled space in the brain carries the internal carotid arteries, CN III, IV, V and VI?

A

Cavernous sinus

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21
Q

Which ocular muscles are supplied by CN III?

A

Medial rectus

Superior rectus

Inferior rectus

Inferior oblique

(Also - LPS, dilator and sphincter pupillae, ciliary muscles)

LR6 SO4 AO3

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22
Q

Which cranial nerves supply

a) lateral rectus
b) levator palpebrae superioris
c) superior oblique?

A

a) CN VI

b) CN III

c) CN IV

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23
Q

Which cranial nerves connect to the CNS via the

a) pons
b) ponto-medullary junction
c) cervical spinal cord
d) midbrain
e) medulla?

A

a) CN V

b) CN VI, VII and VIII

c) CN IX

d) CN III, IV (posteriorly)

e) CN IX, X and XII

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24
Q

When the eye is adducted only, which muscle are you testing?

A

Medial rectus

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25
Q

When the eye is adducted AND

a) elevated
b) depressed?

Which muscles are you testing?

A

a) Inferior oblique

b) Superior oblique

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26
Q

When the eye is abducted only, which muscle are you testing?

A

Lateral rectus

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27
Q

When the eye is abducted AND

a) elevated
b) depressed

which muscle are you testing?

A

a) Superior rectus

b) Inferior rectus

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28
Q

Which special senses does CN VIII control?

A

Hearing (Cochlear nerve)

Balance (Vestibular nerve)

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29
Q

Where do CN VI, VII and VIII connect to the CNS?

A

Ponto-medullary junction

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30
Q

How is CN VIII tested?

A

Rinne-Weber tests

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31
Q

How do you perform Weber’s test?

What are the possible findings?

A

Ask patient which ear is affected

Use a 512Hz tuning fork (smallest), strike and press to patient’s forehead

LOUDEST ON BOTH SIDES = NORMAL

LOUDEST ON AFFECTED SIDE = CONDUCTIVE HEARING LOSS

LOUDEST ON UNAFFECTED SIDE = SN HEARING LOSS

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32
Q

How do you perform Rinne’s test?

What are the possible findings?

A

Ask patient which ear is affected

Strike 512Hz (smallest) tuning fork and press to MASTOID PROCESS for bone conduction

Then move in front of ear for air conduction

Ask patient which was louder

AIR CONDUCTION > BONE CONDUCTION = NORMAL

BONE CONDUCTION > AIR CONDUCTION = CONDUCTIVE HEARING LOSS

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33
Q

CN XI has a unique connection to the CNS - where is it?

A

Cervical spinal cord

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34
Q

What is the function of CN XI?

A

Somatic motor to trapezius and sternocleidomastoid

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35
Q

CN XI connects to the cervical spinal cord.

How does it

a) enter
b) exit the cranium?

A

a) Foramen magnum

b) Jugular foramen

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36
Q

Which point in the neck is a point where much of the cervical plexus (C1-4) overlaps?

A

Erb’s point

At the midpoint of the posterior border of sternocleidomastoid

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37
Q

Keeping in mind that it supplies trapezius and sternocleidomastoid, how do you test CN XI?

A

Shrug shoulders

Laterally flex neck

38
Q

Where does CN XII connect to the CNS?

A

Medulla

39
Q

CN XII descends through the neck to the carotid sheathe, then turns anteriorly at the level of which bone?

What muscles does CN XII supply?

A

Hyoid bone

Intrinsic tongue muscles (except palatoglossus, which is CN X)

40
Q

Which muscles does CN XII supply?

How do you test CN XII?

A

Intrinsic tongue muscles (exception: palatoglossus CN X)

Ask patient to stick their tongue out

41
Q

If a patient with unilateral CN XII dysfunction sticks their tongue out, which side will their tongue droop to?

A

Towards the affected side

REMEMBER: “tongue tells tales”

42
Q

What are the three divisions of the trigeminal nerve (CN V)?

A

V1 - ophthalmic division

V2 - maxillary division

V3 - mandibular division

43
Q

Which nerve modalities are carried in

a) CN V1
b) V2
c) V3?

A

a) Sensory

b) Sensory

c) Sensory and Motor

44
Q

Which part of the brainstem does CN V connect to?

A

Pons

only one which does this, important fact

45
Q

From which cranial fossa does each branch of CN V exit?

A

All middle cranial fossa

46
Q

What is the mnemonic for remembering the cranial foramina that CN V exits from?

A

Standing room only

CN V1 = superior orbital fissure

CN V2 = foramen rotundum

CN V3 = foramen ovale

47
Q

Which aspects of the nose are supplied by CN V1?

A

Bridge

Tip

48
Q

Which infection follows nerves and can damage the cornea if CN V1 is affected?

A

Herpes zoster

or ‘Ophthalmic zoster’

49
Q

Which aspect of the nose is supplied by CN V2?

A

Alae (sides)

50
Q

Which nerves supply sensory fibres to

a) the angle of the mandible
b) the TMJ
c) most of the skin of the mandible?

A

a) Great auricular nerve (C2 and 3)

b) CN V3

c) CN V3

51
Q

What the named nerves and levels of the cervical plexus?

A

Lesser occipital (C2)

Greater auricular (C2-3)

Transverse cervical (C2-3)

Supraclavicular (C3-4)

52
Q

Which aspects of the nasal cavity are given sensory fibres by branches of the trigeminal nerve?

A

CN V1 - upper, anterior aspect

CN V2 - lower, posterior aspect

53
Q

Which paranasal sinuses are supplied with sensory fibres by CN V1?

A

Frontal sinus

Ethmoidal air cells

Sphenoid sinuses

54
Q

Which paranasal sinus is given sensory fibres by CN V2?

A

Maxillary sinus

Or ‘maxillary antrum’

55
Q

CN V3 gives off both sensory AND motor fibres. Which facial muscles are supplied by CN V3?

A

Muscles of mastication

(Masseter, temporalis, medial and lateral pterygoids)

56
Q

Which muscles of mastication

a) open
b) close the jaw?

A

a) Lateral pterygoid OPENS the jaw

b) Masseter, temporalis and medial pterygoid CLOSE the jaw

57
Q

In addition to the muscles of mastication, CN V3 supplies two other muscles in the head and neck.

What are they called?

A

TENSOR VELI PALATINI

TENSOR TYMPANI

Trigeminal nerve does the tensors

58
Q

How do you test the sensory fibres of CN V?

A

Touch skin in divisions of trigeminal nerve

59
Q

How do you test the motor fibres of CN V?

A

Ask patient to CLENCH THEIR TEETH - tests masseter and temporalis

Ask patient to OPEN JAW AGAINST RESISTANCE - tests lateral pterygoid

60
Q

Which nerve modalities are carried by CN VII?

A

Somatic motor - to muscles of facial expression AND stapedius

Parasympathetic - to submandibular and sublingual glands

Special sensory - to taste buds of anterior 2/3rds of tongue

61
Q

Does CN VII supply the parotid gland?

A

No, but its fibres pass through it

62
Q

Which bone does CN VII run through?

A

Temporal bone

IN via the internal acoustic meatus, OUT via the stylomastoid foramen

63
Q

Which specific part of the temporal bone does CN VII run through?

A

Petrous part

via the facial canal

64
Q

Which passage connects the internal acoustic meatus to the stylomastoid foramen?

A

Facial canal

65
Q

Through which foramen does most fibres of CN VII exit the temporal bone?

A

Stylomastoid foramen

66
Q

What happens to the somatic motor fibres of CN VII which exit the stylomastoid foramen?

A

Run down into parotid gland

Then split into 5 named nerves to supply the muscles of facial expression

67
Q

Which branch of CN VII supplies special sensory fibres to the anterior 2/3rds of tongue and parasympathetic fibres to the submandibular and sublingual glands?

A

Chorda tympani

68
Q

Which cranial nerve does the chorda tympani hitch a ride with to supply the tongue and salivary glands?

A

CN V3

Mandibular division of trigeminal nerve

69
Q

What are some of the muscles of facial expression?

A

Frontalis

Orbicularis oculi

Orbicularis oris

70
Q

How can you test the motor fibres of CN VII?

A

Ask patient to make facial expressions

71
Q

Which skeletal muscle, the smallest found in the body, is supplied by CN VII?

A

Stapedius

72
Q

What is supplied with special sensory fibres by CN IX?

A

Posterior 1/3rd of tongue

73
Q

What is supplied with somatic sensory fibres by CN IX?

A

Pharynx

Tonsils

Posterior 1/3rd of tongue

Eustachian tube

Middle ear

74
Q

Which muscle is the only one supplied with somatic motor fibres by CN IX?

A

Stylopharyngeus

75
Q

Which receptors, found in the carotid sinus, are supplied with visceral afferent fibres by CN IX?

A

Chemoreceptors

Baroreceptors

76
Q

Which gland is given parasympathetic fibres by CN IX?

A

Parotid gland

77
Q

Which cranial nerves supply the

a) submandibular
b) parotid
c) sublingual glands?

A

a) CN VII

b) CN IX

c) CN VII

78
Q

Which cranial nerves supply

a) stylopharyngeus
b) palatoglossus
c) stapedius
d) tensor veli palatini and tensor tympani
e) sternocleidomastoid and trapezius?

A

a) CN IX

b) CN X

c) CN VII

d) CN V

e) CN XI

79
Q

Which cranial nerve is also known as the wanderer because it has so many modalities and travels throughout the body?

A

CN X

80
Q

Where does CN X extend to?

A

Midgut

81
Q

In the neck, CN X runs within the ___ ___.

A

carotid sheathe

82
Q

What is the course of the

a) left
b) right recurrent laryngeal nerve?

A

a) Hooks under arch of aorta
b) Hooks under right subclavian artery

83
Q

CN X passes (anterior / posterior) to the lung roots.

A

posterior to lung roots

84
Q

In what arrangement do the left and right vagus nerves pass along the oesophagus?

At which level does the oesophagus penetrate the diaphragm?

A

LARP - left anterior, right posterior

T10 (dermatomal level of the umbilicus)

85
Q

Where in the abdomen do the vagus nerve’s LAST parasympathetic axons go?

A

Splenic flexure

86
Q

Where in the abdomen do CN X’s parasympathetic nerves synapse?

A

Coeliac ganglion

Superior mesenteric ganglion

because it extends to the midgut only

87
Q

Which muscles are supplied by CN X?

A

Muscles of palate (except tensor veli palatini, which is CN V)

Pharyngeal muscles

Laryngeal muscles

Plus palatoglossus (the rest are CN XII)

88
Q

In terms of testing CN X, how do you test

a) the muscles of the palate
b) pharyngeal muscles
c) laryngeal muscles?

A

a) Say AAAAAH

b) Swallow

c) Speak

89
Q

If a palatal muscle e.g levator veli palatini isn’t working, which structure will deviate when the patient says ahhh?

A

Uvula

90
Q

What side does the uvula deviate to when a palatal muscle isn’t working?

A

AWAY from dysfunctional side

(Tongue tells tales i.e it deviates to affected side, uvula does the opposite)

Neurology Week 1 2018/19 (10 decks)

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