clinical correlates

Question 1

accommodation/conversion reflex

Answer 1

adaptation of the visual apparatus of the eye for near vision

• increase in curvature of lens (edinger-westphal nucleus)
• pupillary constriction (EW nuc)
• convergence of eyes (oculomotor nuc)

Question 2

lower motor neuron lesion of oculomotor nerve (CN III)

Answer 2

ptosis - loss of levator palpebrae superioris
frontalis activated to compensate
dilated pupil (loss of parasympathetics)
downward and abducted eye - unopposed action of superior oblique and lateral rectus

Question 3

pupillary light reflex is a good test for

Answer 3

optic nerve damage
oculomotor nerve damage
brain death
depressant drugs (barbiturates)

Question 4

the optic nerve is responsible for the _____ limb of the pupillary reflex

Answer 4

afferent

senses incoming light

Question 5

the oculomotor nerve is responsible for the _____ limb of the pupillary reflex

Answer 5

efferent

drives muscles that constrict pupil

Question 6

symptoms of optic nerve damage on one side

Answer 6

ipsilateral direct reflex lost
contralateral reflex intact
ipsilateral consensual reflex intact (light shone onto opposite eye triggers constriction of both pupils)
contralateral consensual reflex lost (light shone into damaged eye cannot signal brain)

Question 7

symptoms of oculomotor damage on oneside

Answer 7

ipsilateral direct reflex lost
contralateral direct reflex intact
ipsilateral consensual reflex lost (light shone onto oppposite eye should trigger both pupils to constrict, but doesn’t)
contralteral consensual reflex intact

Question 8

touching the cornea with a cotton swab tests

Answer 8

blink reflex

occurs between V1 (nasociliary) and facial (to orbicularis oculi)

Question 9

sensory testing of V1

Answer 9

nose/forehead/front of scalp

Question 10

sensory testing v2

Answer 10

zygomatic area

Question 11

sensory testing v3

Answer 11

chin, skin in front of ear

Question 12

sensory testing transverse cervical nerve

Answer 12

front of neck

Question 13

sensory testing great auricular nerve

Answer 13

skin under ear/back of jaw

Question 14

sensory testing lesser occipital nerve

Answer 14

skin behind ear

Question 15

sensory testing greater occipital nerve

Answer 15

back of head

Question 16

testing muscles of face

Answer 16

have pt go through various facial exprssions and look for asymmetry

Question 17

test motor component of V3

Answer 17

muscles of mastication

bite down on tongue depressor on one side and try to pull it out, repeat on other side

Question 18

upper motor neuron lesion to facial nerve symptoms

Answer 18

paralysis of muscles iin the contralateral lower face

Question 19

lower motor neuron lesion of facial nerve symptoms

Answer 19

paralysis of muscles in ipsilateral upper and lwoer face

Question 20

weber test

Answer 20

hearing test
normal - mild sound in center
conductive loss (ossicles) - sound louder on affected side
sensorineural loss (nerve) sound absent on affected side

Question 21

romberg test

Answer 21

balance test
pt asked to stand feet together, arms by side with eyes open
close eyes
positive = pt sways/falls when eyes closed
indicative of intracranial lesion affecting vestibular system

Question 22

lesion to right accessory nerve

Answer 22

right shoulder may drop
test strength with resisted shrug
weakness in right scm
test by resisting motion of right SCM (sidebend right, rotate left)

Question 23

torticollis

Answer 23

contraction/shortening of SCM

Question 24

upper motor neuron lesion hypoglossal

Answer 24

tongue leans to opposite side of lesion

no atrophy in tongue muslces on affected side

Question 25

lower motor neuron lesion hypoglossal

Answer 25

flaccid paralysis of tongue
atrophy of tongue muscles on affected side
tongue deviates to same side of lesion