Clinical Cranial Nerve Testing Flashcards

Clinically Relevant anatomy of cranial nerve testing.

1
Q

Olfactory Nerve is

A

special sensory

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2
Q

Optic nerve is

A

special sensory

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3
Q

Oculomotor nerve is

A

motor and parasympathetic

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4
Q

Trochlear nerve

A

is motor

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5
Q

Trigeminal Nerve is

A

V1+2 are sensory only, V3 is sensory and motor.

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6
Q

Abducent nerve is

A

motor

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7
Q

Facial nerve is

A

special sensory, motor and parasympathetic.

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8
Q

Vestibulocochlear is

A

Special sensory

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9
Q

Glossopharyngeal is

A

special sensory, sensory, motor and parasympathetic.

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10
Q

Vagus nerve is

A

sensory, motor, parasympathetic and visceral afferent.

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11
Q

Spinal accessory nerve is

A

motor

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12
Q

Hypoglossal nerve is

A

motor.

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13
Q

Cranial nerves from the midbrain

A

Oculomotor and trochlear

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14
Q

Cranial nerves from the pons

A

V1,2,3

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15
Q

The cranial nerve from the pontomedullary junction

A

Abducens, facial, and vestibulocochlear.

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16
Q

Cranial nerves from the medulla oblongata

A

Glossopharyngeal, vagus, hypoglossal.

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17
Q

The spinal nerve from the spinal cord

A

Spinal accessory.

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18
Q

The olfactory nerve leaves the skull via

A

The cribriform plate of the ethmoid.

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19
Q

Base of skull fracture can lead to anosmia T/F

A

T - can be regained as olfactory nerves grow back

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20
Q

Only cranial nerve found in the anterior cranial fossa?

A

Olfactory nerve

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21
Q

The optic nerve goes through the

A

Optic canal

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22
Q

Course of optic nerve

A

Optic nerve goes through the optic canal in the middle cranial fossa. It travels around the pituitary stack to the optic chiasm, to form the optic tract. Connect to the CNS via the diencephalon.

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23
Q

5 Ways to test the optic nerve

A

Acuity (Snellen charts), colour (Ishihara plates - colour blindness), fields (four quadrants), reflexes (pupillary light reflexes), fundoscopy.

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24
Q

Nerves that go through the superior orbital fissure

A

Oculomotor, trochlear, abducens. Frontal, lacrimal and nasocilliary branches of V1.

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25
Q

How to test CNIII parasympathetics?

A

Use a light to check for pupillary contraction.

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26
Q

Trochlear nerve supplies the

A

superior oblique muscle.

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27
Q

Abducent nerve supplies the

A

Lateral rectus muscle

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28
Q

The abducents nerves travel through the

A

cavernous sinus and the superior orbital fissure.

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29
Q

The vestibulocochlear nerve travels through which cranial foramen

A

Internal aucoustisc meatus, in the posterior cranial fossa

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30
Q

Clinically testing of vestibulocochlear nerve

A

Rinnie and Weber.

31
Q

The spinal accessory nerve supplies the

A

Sternocleoidmastoid and the trapezius.

32
Q

The cranial fossa that the spinal accessory nerve travels through is the

A

It ascends through the foramen magnum and then travels to the jugular foramen in the posterior fossa to innervate the SCM and trapezius.

33
Q

Clinical testing of the spinal accessory nerve

A

Ask patient to shrug shoulders. Ask them to turn head to flex neck and turn towards the opposite side.

34
Q

The hypoglossal nerve goes through which cranial foramen

A

Hypoglossal canal in the posterior fossa

35
Q

The hypoglossal nerve passes anterior to the carotid sheath TF.

A

F - the hypoglossal nerve passes lateral to the carotid sheath. At the level of the hyoid it turns anteriors towards to the lateral aspects of the tongue.

36
Q

The hypoglossal supplies which tongue muscles?

A

Genioglossus, styloglossus, hypoglossus, and intrinsic muscles of the tongue.

37
Q

What tongue muscle does the hypoglossal nerve NOT supply?

A

Palaoglossus - supplied by the vagus.

38
Q

Clinical testing of the hypoglossal

A

Ask patient to stick tongue straight out. Both CNXIIs are functioning normally the tongue remains in the midline. If there is unilateral CN XII pathology the tongue tip will point towards the side of the injured nerve.

39
Q

What are the divisions of the trigeminal

A

V1 - ophthalamic - sensory
V2 - Maxillary - sensory
V3 - Mandibular - motor and sensory

40
Q

Nerve that passes though the foramen rotundom

A

V2

41
Q

Nerve that passes thought he foramen ovale

A

V3

42
Q

CN V1 supplies the

A

Upper eyelid, cornea, all the conductive, skin of the root/bridge/tip of the nose.
Paranasal sinuses, anterior and posterior cranial fossa.

43
Q

Hutchison’s sign

A

Herpes zoster of V1 - rash at the tip of the nose.
Lower posterior nasal cavity, maxilla and maxillary sinuses, floor of the nasal cavity/palate. Maxillary teeth and soft tissues(gingival and mucosal).

44
Q

CN V2 supplies the

A

Skin of the lower eyelid, skin over the maxilla, skin of the ala of the nose, skin/mucosa over the upper lip.

45
Q

CN V3 supplies sensation to

A

The skin over the mandible and temporomandibular joint. Except the angle of the mandible.
Middle cranial fossa, mandible, anterior 2/3rds of the tongue, floor of mouth, buccal mucosa, mandibular teeth.

46
Q

Nerves that supply the angle of the mandible and some of the external ear

A

Great auricular nerve of C2,3.

47
Q

What can cause loss of sensation around teeth

A

Disruption of the foramen rotundum.

48
Q

Motor innervation of V3

A

Muscles of mastication - master, temporals, medial pterygoid, lateral pterygoid.
Tensor veli palatini. Tensor tympani.

49
Q

Facial nerve goes through which cranial foramen

A

Internal acoustic meatus in the posterior fossa.

50
Q

The facial nerve exits the skull via the

A

Stylomastoid foramen.
It goes through the IAM and then into the facial canal of the petrous temporal bone (to give off chords tymapni and supply stapediues) and then (motor component) exits via the stylomastoid foramen.

51
Q

What is the chorda tympani and what does it do?

A

Branch of the facial. Supplies the taste buds of the anterior 2/3rds of the tongue.
Parasympathetic supply to the submandibular and sublingual glands (salivation).

52
Q

Nerve supply to the stapedius muscle

A

Supplies by facial, reduces stapes movement to protects the internal ear from excessive noise.

53
Q

Muscles of facial expression

A

Frontalis, orbicularis occult, elevators of lips, orbicularis oris.

54
Q

Clinically testing the facial nerve

A

Raise the eyebrows, close eyes tightly, smile, puff out cheeks and hold air.

55
Q

Glossopharyngeal goes through which cranial foramen

A

Jugular foramen.

56
Q

Special sensory functions of the glossopharyngeal

A

The valuate papillae - taste buds of posterior 1/3rd of tongue.

57
Q

Parasympathetic functions fo glossopharyngeal

A

Secretomotor - to the parotid gland (salivary).

58
Q

General sensory of the glossopharyngeal

A

The posterior 1/3rd of the tongue, mucosa of most of nasopharynx and oropharynx. Some mucosa o laryngopharynx. Palatine tonsils, eustachine tube, middle ear cavity.

59
Q

Nerve responsible for referred pain from pharynx to ear and vice versa

A

Glossopharyngeal

60
Q

The general sensory axons of this nerve form the afferent limb of the gag reflex.

A

Glossopharyngeal nerve.

61
Q

Visceral afferent nerves to the carotid sinus baroreceptors and the carotid body receptors.

A

Glossopharyngeal nerve

62
Q

Somatic motor innervation of glossopharyngeal.

A

Stylopharyngeus.

63
Q

Exists cranial cavity via

A

jugular foramen.

64
Q

CN X runs lateral to the carotid sheath TF

A

F - the vagus runs within the carotid sheath.

65
Q

Left recurrent laryngeal nerve curves under the ____ _______

A

Arch of the aorta

66
Q

Right recurrent laryngeal curves under the __________

A

Right subclavian

67
Q

The recurrent laryngeal nerve is a branch of the

A

Vagus!

68
Q

The vagus nerve passes posterior to lung root and onto the oesphagus TF

A

T

69
Q

Vagus nerve testing

A

Ask patient to say Ahhhhhh. (tests muscles of palate) Uvula should lift straight in midline, unilateral pathology will pull uvula away from non-functioning side.

70
Q

You ask the patient to say aaaa and observe the uvula is pointed away from the midline towards the right. What side is the pathology on?

A

Left

71
Q

You ask the patient to stick their tongue out and observe that it is pointed away from he midline towards the left. What side is the pathology on?

A

Left

72
Q

By asking the patient to swallow a small amount of water what muscles and cranial nerve are you testing?

A

Pharyngeal, vagus.

Splutter may suggest abnormal swallow.

73
Q

Hoarse voice may suggest what?

A

Abnormal function of muscles of larynx, and recurrent laryngeal.