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YEAR 3 NEURO > ANATOMY - cranial nerves > Flashcards

ANATOMY - cranial nerves Flashcards

1
Q

what is the modality of CN I (olfactory nerve)

A

special sensory - smell

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2
Q

what is the extracranial location of CN I (olfactory nerve)

A

lies within the olfactory mucosa in nasal cavity

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3
Q

what cranial foramina does CN I (olfactory nerve) pass through

A

cribriform plate of the ethmoid bone in the anterior cranial fossa

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4
Q

what is the intracranial course of CN I (olfactory nerve)

A

olfactory nerve synapses in the olfactory bulbs then pass through olfactory tract to cortical areas

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5
Q

where is the primary olfactory cortex

A

temporal lobe

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6
Q

how would you test CN I (olfactory nerve)

A

ask patient to smell a smell and cover other nostril

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7
Q

CN I is the ____ cranial nerve

A

shortest

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8
Q

CN I (olfactory nerve) is the only sensory modality that doesnt synapse in the _____ prior to reaching cortex

A

thalamus

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9
Q

what is the modality of CN II (optic nerve)

A

special sensory - vision

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10
Q

what is the extracranial course of the CN II (optic nerve)

A

neurones of the retina travel posteriorly via optic nerve from posterior hemisphere of eye through the orbit

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11
Q

what cranial foramina does CN II (optic nerve) pass through

A

optic canal in the middle cranial fossa

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12
Q

what is the intracranial course of CN II (optic nerve)

A

travels around the pituitary stalk to optic chiasm to form optic tract

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13
Q

what is the CN II (optic nerve) connection with the CNS

A

diencephalon

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14
Q

how can CN II (optic nerve) be tested

A 
Acuity - snellen chart
colour - ishihara plates
fields - 4 quadrants
reflexes - pupillary light reflexes
fundoscopy
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15
Q

what is the modality of CN III (oculomotor)

A

somatic motor

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16
Q

what does CN III (oculomotor) supply motor control to

A

levator palpebra superioris (LPS)

SR, MR, IR, IO (AO3)

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17
Q

CN III (oculomotor) also has autonomic features. What does it provide autonomic supply to and what does this cause

A

sphinter pupillae and ciliary muscle - pupil constriction

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18
Q

what is the intracranial course of CN III (oculomotor)

A

travels towards the orbit in the lateral wall of the cavernous sinus

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19
Q

what cranial foramina does CN III (oculomotor) pass through

A

SOF

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20
Q

what is the extracranial course of CN III (oculomotor)

A

passes through SOF into orbit and supplies all extraocular muscles except 2

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21
Q

where is the parasympathetic synapse of CN III (oculomotor)

A

ciliary ganglion

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22
Q

what is CN III (oculomotor) connection with the CNS

A

superior colliculus of the midbrain (mesencephalon)

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23
Q

how can the parasympathetics of CN III (oculomotor) be tested

A

pupillary light reflex

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24
Q

how can the motor supply of CN III (oculomotor) be tested

A

H test

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25
Q

where are preganglionic parasympathetic neurons of CN III (oculomotor) found

A

Edinger-Westphal nucleus

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26
Q

where are somatic motor neurons of CN III (oculomotor) found

A

oculomotor nucleus

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27
Q

what is the modality of CN IV (trochlear)

A

somatic motor

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28
Q

what does the motor supply of CN IV (trochlear) go to

A

Superior oblique

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29
Q

what is the intracranial course of CN IV (trochlear)

A

travels towards the orbit in the lateral wall of the cavernous sinus

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30
Q

what cranial foramina does CN IV (trochlear) pass through

A

SOF

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31
Q

what is the extracranial course of CN IV (trochlear)

A

passes through SOF into orbit and supplies SO

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32
Q

what is CN IV (trochlear) connection with the CNS

A

inferior colliculus - lower midbrain (mesencephalon)

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33
Q

how can the motor supply of CN IV (trochlear) be tested

A

H test

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34
Q

CN IV (trochlear) is the only cranial nerve to exit _____

A

posteriorly

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35
Q

does CN IV (trochlear) cross the midline

A

yes

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36
Q

what are the 3 divisions of the trigeminal nerve (CN V)

A

CN V1 - opthalmic division
CN V2 - maxillary division
CN V3 - mandibular division

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37
Q

what are the modalities of the 3 branches of trigeminal nerve (CN V)

A

CN V1 - sensory
CN V2 - sensory
CN V3 - sensory and motor

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38
Q

what is trigeminal nerve (CN V) connection with the CNS

A

Pons

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39
Q

what is the intracranial course of trigeminal nerve (CN V)

A

inferior to edge of tentorium cerebelli between the posterior and middle cranial fossa

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40
Q

what cranial foramina do the branches of trigeminal nerve (CN V) go through

A

V1 - SOF
V2 - foramen rotundum
V3 - foramen ovale

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41
Q

what is the extracranial course of the sensory axons of trigeminal nerve (CN V)

A

course from the superficial and deep structures of the face posteriorly towards respective cranial foramena

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42
Q

what is the extracranial course of the motor axons of mandibular division of trigeminal nerve CNV3

A

course from the foramen ovale towards the skeletal muscles they supply

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43
Q

what is the superficial sensory supply of CN V1 (5)

A 
forehead
upper eyelid
cornea
all conjunctiva
skin of root/tip/bridge of nose
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44
Q

what is the deep sensory supply of CNv1 (4)

A

bones and soft tissue of the orbit (except orbital floor and lower eyelid)
upper anterior nasal cavity
paranasal sinuses (Except maxillary sinus)
anterior and posterior cranial fossa

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45
Q

what is the superficial sensory supply of CN V2 (4)

A

skin of lower eyelid
skin over maxilla
skin of ala of nose
skin/mucosa of upper lip

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46
Q

what is the deep sensory supply of CN v2 (5)

A 
lower posterior nasal cavity 
maxilla
maxillary sinus
floor of nasal cavity/palate
maxillary teeth and assoc. soft tissues (gingiva and mucosa)
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47
Q

what is the superficial sensory supply of CN V3

A

skin over mandible and TMJ

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48
Q

what is the deep sensory supply of CN V3 (6)

A 
middle cranial fossa
mandible 
anterior 2/3 of tongue 
floor of mouth
buccal mucosa
mandibular teeth and assoc. soft tissues
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49
Q

what supplies the angle of the mandible

A

C2 C3 (greater auricular nerve)

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50
Q

what does CN V3 provide motor supply to (5)

A 
muscles of mastication
tensor veli palatini
tensor tympani
mylohyoid
anterior belly of digastric
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51
Q

what are the 3 jaw closing muscles

A

masseter
temporalis
medial pterygoid

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52
Q

what is the jaw opening muscle

A

lateral pterygoid

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53
Q

what nucleus receives sensory information from trigeminal nerve (CN V) with proprioceptive information from chewing muscles

A

mesencephalic nucleus

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54
Q

what is the main nucleus involved in trigeminal nerve (CN V)

A

pontine trigeminal nucleus

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55
Q

what does the pontine trigeminal nucleus receive information about

A

discriminative touch, vibration

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56
Q

what trigeminal nuclei receives information regarding pain and temperature

A

spinal nucleus

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57
Q

the mesencephalic nucleus is the only site in the CNS where …

A

cell bodies of primary afferent neurons live inside the CNS

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58
Q

sensory nuclei of trigeminal nerve (CN V) forms a long column of neurones that stretch down from _____ to ____

A

midbrain

upper 2 segments of the cervical spinal cord

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59
Q

what forms the 1st part of the afferent branch of the corneal reflex

A

long ciliary nerves

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60
Q

what forms the 2nd part of the afferent branch of the corneal reflex

A

CN V1

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61
Q

what forms the efferent limb of the corneal / blink reflex

A

CN VII

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62
Q

how can the sensory innervation of trigeminal nerve (CN V) be tested

A

ask patient to close eyes and gently brush the skin in each area with a fine tip of cotton wool
ask patient to say when they can feel it and compare both sides

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63
Q

how could the motor innervation of trigeminal nerve (CN V) be tested

A

palpate the strength of contraction of the masseter and temporalis by asking patient to clench teeth
ask patient to open jaw against resistance

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64
Q

what is the modality of CN VI (abducent)

A

somatic motor - eye movement

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65
Q

what does CN VI (abducent) supply

A

Lateral rectus

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66
Q

what is the way to remember what nerves supply what extraocular eye muscles

A

LR6 SO4 AO3

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67
Q

what is CN VI (abducent) connection with the CNS

A

pontomedullary junction (caudal pons)

68
Q

what is the intracranial course of CN VI (abducent)

A

travels towards the orbit within the cavernous sinus

69
Q

what cranial foramina does CN VI (abducent) pass through

A

SOF

70
Q

what is the extracranial course of CN VI (abducent)

A

passes through SOF into orbit to supply LR

71
Q

how can the motor function of CN VI (abducent) be tested

A

H test

72
Q

what is the modality of CN VII (facial nerve)

A

special sensory (taste)
motor
parasympathetic

73
Q

what is the connection of CN VII (facial nerve) with the CNS

A

pontomedullary junction (caudal pons)

74
Q

what is the intracranial course of CN VII (facial nerve)

A

directly into IAM in posterior cranial fossa

75
Q

what cranial foramen does CN VII (facial nerve) pass through

A 
IAM (in)
stylomastoid foramen (out)
76
Q

where is the IAM located

A

petrous temporal bone

77
Q

the facial nerve courses through the petrous part of the temporal bone in the ____ ear via the ____ ___

A

middle

facial canal

78
Q

the facial nerve splits into 4 main branches what are they

A

chorda tympani
nerve to stapedius
greater petrosal nerve
terminal motor branches

79
Q

what does the chorda tympani supply

A 
special sensory (taste) to anterior 2/3 of the tongue 
parasympathetic supply to submandibular and sublingual glands (secretomotor)
80
Q

what does the greater petrosal nerve supply

A

parasympathetic supply to mucous glands and lacrimal glands

81
Q

what does the nerve to the stapedius supply

A

motor supply to stapedius muscle

82
Q

CN VII (facial nerve) increases/reduces stapedius muscle movement

A

reduces

to protect internal ear from excessive noise

83
Q

parasympathetics to the lacrimal and mucous glands of the midface come from CN VII (facial nerve) that supplies parasympathetics to the ______ ganglion

A

pterygopalatine ganglion

84
Q

the somatic motor axons of CN VII (facial nerve) supply what

A

muscles of facial expression

85
Q

the motor branch of CN VII (facial nerve) passes out of the ________ ____, passes ____ to the ear and goes through the _____ ____

A

stylomastoid foramen, anterior to the ear

goes through the parotid gland

86
Q

what are the 5 branches of the facial nerve

A 
Temporal branch
Zygomatic branch
Buccal branch
Marginal mandibular branch
Cervical branch
87
Q

give 4 muscles of facial expression

A

frontalis
orbicularis oculi
elevators of lips
orbicularis oris

88
Q

where do the muscles of facial expression originate and insert

A

on bone

insert into superficial fascia

89
Q

how can the motor function of the facial nerve be tested

A

ask patient to raise eyebrows, close eyes tightly, smile, puff out cheeks, hold air

90
Q

what nerve does chorda tympani join with to supply the sublingual and submandibular glands

A

lingual nerve (CN V3)

91
Q

the facial nerve has _ components and _ nuclei

A

3

2

92
Q

what is the modality of CN VIII (vestibulocochlear)

A

special sensory - hearing and balance

93
Q

what is the extracranial course of CN VIII (vestibulocochlear)

A

axons from cochlear and vestibular apparatus

94
Q

what cranial foramina does CN VIII (vestibulocochlear) pass through

A

IAM in posterior cranial fossa

95
Q

where is CN VIII (vestibulocochlear) connection with the CNS

A

pontomedullary junction

96
Q

how can CN VIII (vestibulocochlear) be tested

A

Renne and Weber tests

97
Q

what is the modality of CN IX (glossopharyngeal)

A 
special sensory - taste
sensory
motor 
visceral afferent 
parasympathetic
98
Q

what is CN IX (glossopharyngeal) connection with the CNS

A

upper medulla

99
Q

CN IX (glossopharyngeal) has _ components

A

4

100
Q

what are the 4 nuclei of CN IX (glossopharyngeal)

A

solitary nucleus
spinal trigeminal nucleus
inferior solitary nucleus
nucleus ambiguus

101
Q

what is the intracranial course of CN IX (glossopharyngeal)

A

directly towards jugular foramen in posterior cranial fossa

102
Q

what cranial foramina does CN IX (glossopharyngeal) pass through

A

jugular foramen

103
Q

what is the extracranial course of CN IX (glossopharyngeal)

A

descends towards pharynx and mouth

104
Q

what does CN IX (glossopharyngeal) provide general sensory innervation to

A

posterior 1/3 tongue
mucosa of most of nasopharynx and oropharynx
mucosa of some of laryngopharynx (overlap with CN X)
palatine tonsil
eustachian tube
middle ear cavity

105
Q

what does CN IX (glossopharyngeal) provide special sensory (taste) to

A

vallate papillae (with taste buds) or posterior 1/3 tongue

106
Q

what does CN IX (glossopharyngeal) provide visceral afferent to

A

carotid sinus baroreceptors and carotid body chemoreceptors

107
Q

what does CN IX (glossopharyngeal) provide somatic motor to

A

stylopharyngeus

108
Q

what does CN IX (glossopharyngeal) provide parasympathetic supply to

A 
parotid gland (secretomotor)
otic ganglion
109
Q

general sensory axons of CN IX (glossopharyngeal) form the afferent limb of what reflex

A

gag

110
Q

how can you test to see if CN IX (glossopharyngeal) is working

A

gag reflex

111
Q

pain from the pharynx can refer where and why

A

ear

both sensory supply from CN IX (glossopharyngeal)

112
Q

carotid sinus massage is used in the management of what

A

specific tachycardias

113
Q

what splits tongue into posterior 1/3 and anterior 2/3

A

midline location of foramen caecum - site of origin of thyroid

114
Q

what is the modality of CN X (vagus nerve)

A

sensory + special sensory
motor
visceral afferent
parasympathetic

115
Q

where is CN X (vagus nerve) connected to the CNS

A

upper medulla, immediately inferior to CN IX

116
Q

CN X (vagus nerve) has _ components

A

4

117
Q

what are the 4 nuclei of CN X (vagus nerve)

A

dorsal nucleus - motor and parasympathetic
solitary nucleus
spinal trigeminal nucleus
nucleus ambiguus

118
Q

what is the intracranial course of CN X (vagus nerve)

A

directly towards jugular foramen in posterior cranial fossa

119
Q

what cranial foramen does CN X (vagus nerve) pass through

A

jugular foramen

120
Q

in the neck CN X (vagus nerve) runs within what

A

carotid sheath

121
Q

in the carotid sheath CN X (vagus nerve) travels posterior to and between what

A

common carotid artery

internal jugular vein

122
Q

CN X (vagus nerve) gives off the recurrent laryngeal nerves. what do these hook under

A

left - under arch of aorta

right - under right subclavian artery

123
Q

in the chest the right vagus nerve travels on the lateral aspect of ____

A

trachea

124
Q

in the chest the left vagus nerve travels on the lateral aspect of the ____

A

aortic arch

125
Q

both vagus nerves pass ____ to the lung root

A

posterior

126
Q

both vagus nerves pass through diaphragm on the surface of the ____ at level ____

A

oesophagus

T10

127
Q

what ganglia do branches of the vagus nerve pass onto in the abdomen

A

coeliac and superior mesenteric ganglia

128
Q

both CN X pass onto surface of ___ in the abdomen

A

stomach

129
Q

CN X provides parasympathetic function to what

A

smooth muscle of the trachea, bronchi and gastro-intestinal tract up until the splenic flexure and regulates heart rhythm

130
Q

where do the very last parasympathetic axons of the vagus nerve pass to

A

splenic flexure

131
Q

CN X provides motor innervation to what

A

majority of the muscles of the pharynx, soft palate and larynx (not the stylopharyngeus)
also palatoglossus

132
Q

CN X provides special sensory (taste) to what

A

epiglottis

133
Q

what branches of CN X innervate the muscles of the pharynx

A

pharyngeal branches

134
Q

what branches of CN X innervate the muscles of the larynx

A

recurrent laryngeal nerves

except cricothyroid - external laryngeal nerve

135
Q

vagus nerve provides sensory innervation to what

A

pharynx larynx trachea oesophagus and thoracic and abdominal viscera

136
Q

how could you test CN X motor function: muscles of the palate

A

ask patient to say ahh
uvula should lift straight up in the midline
if there is unilateral pathology, uvula will point to the working side

137
Q

how could you test CN X motor function: pharyngeal muscles

A

ask patient to swallow small amount of water

138
Q

how could you test CN X motor function: laryngeal muscles

A

ask patient to speak

139
Q

asking the patient to say ahh also tests what

A

CN V3

140
Q

what is the modality of CN XI (spinal accessory nerve)

A

motor

141
Q

what does CN XI (spinal accessory nerve) provide motor supply to

A

sternocleidomastoid and trapezius

142
Q

what is CN XI (spinal accessory nerve) connection with the CNS

A

cervical spinal cord

143
Q

what is the intracranial course of CN XI (spinal accessory nerve)

A

ascends through foramen magnum then travels towards jugular foramen in posterior cranial fossa

144
Q

what cranial foramina does CN XI (spinal accessory nerve) pass through

A

jugular foramen in posterior cranial fossa

145
Q

what is the extracranial course of CN XI (spinal accessory nerve)

A

axons supply SCM on deep surface then continue across the posterior triangle to supply trapezius and SCM

146
Q

how can you test CN XI (spinal accessory nerve)

A

ask patient to shrug shoulders, turn head, flex neck and turn towards opposite side

147
Q

what modality is CN XII (hypoglossal nerve)

A

motor

148
Q

what does CN XII (hypoglossal nerve) supply motor function to

A

muscles of the tongue (except 1)

149
Q

what is the exception to CN XII (hypoglossal nerve) supplying muscles of the tongue

A

palatoglossus is supplied by CN X

150
Q

what muscles of the tongue does CN XII (hypoglossal nerve) supply

A

genioglossus
hyoglossus
styloglossus

151
Q

what is the CN XII (hypoglossal nerve) connection to the CNS

A

via many rootlets lateral to the pyramids of the medulla

152
Q

what is the intracranial course of CN XII (hypoglossal nerve)

A

passes anteriorly to hypoglossal canal

153
Q

what is the extracranial course of CN XII (hypoglossal nerve)

A

descends lateral to carotid sheath and at level of hyoid turns anteriorly towards lateral aspect of tongue

154
Q

how can CN XII (hypoglossal nerve) be tested

A

ask patient to stick out tongue - tongue will point to side of unilateral lesion

155
Q

what is the only cranial nerve to exit laterally

A

VIII

156
Q

the soma of sensory nerve cells of cranial nerves will be found where

A

ganglia outside the CNS - analogous to the DRGs for the spinal nerves (except mesencephalic - CN V)

157
Q

what CNs emerge close to midline

A

III
IV
VI
XII

158
Q

true/false

each cranial nerve has their own nuclei which is only used by that nerve

A

false

many nuclei in the brainstem are shared by more than one cranial nerve

159
Q

what tract gives motor input to cranial nerves

A

corticobulbar

160
Q

corticobulbar input is bilateral except for ….

A

facial nerve which is only bilateral to area of forehead and around eyes - below this is only a crossed fibre (contralateral)

161
Q

CN palsy:
down and out eye
dilated pupil
ptosis

A

CN III

162
Q

CN IV palsy

A

vertical diplopia and head tilt away from the affected side

163
Q

what makes the vertical diplopia of CN IV palsy worse

A

walking

reading

164
Q

CN palsy:
diplopia
affected eye resting in adduction and inability to abduct the eye.

A

CN VI

affected eye resting in adduction (due to unopposed activity of the medial rectus)

165
Q

what is the most common cause of accessory nerve palsy

A

iatrogenic e.g. lymph node removal

166
Q

inputs to parasympathetic cranial nerves mainly come from where

A

hypothalamus

YEAR 3 NEURO (12 decks)

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