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NMS > CN 1,2,3,4,6 > Flashcards

CN 1,2,3,4,6 Flashcards

1
Q

What cranial nerves originate on the midbrain

A

3,4

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2
Q

Cranial nerves originating on the pons

A

5,6,7,8

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3
Q

What nerves originate on the medulla

A

9,10,11,12

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4
Q

Basic function of cranial nerves:
1
2
3

A

Smell
Vision
Light accommodation

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5
Q

Basic nerve functions of CN
3
4
6

A

Eye movements

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6
Q

Basic functions of CN
5
7

A

Sensation of face/motor to mastication

Facial muscles/taste ant. 2/3

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7
Q

Basic functions of CN
8
9

A

Auditory/balance

Taste/gag

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8
Q

Basic functions of CNs
10
11
12

A

Voice/swallow
Shoulder shrug
Tongue movement

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9
Q

Where do cranial nerves 5,7,8 run together that might affect all nerves

A

Cerebellopontine angle

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10
Q

Contents of cribiform plate

A

Olfactory nerves

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11
Q

Contents of optic canal

A

Optic nerve

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12
Q

Contents of superior orbital fissure

A

CN 3,4, 5-1, 6

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13
Q

Contents of foramen rotundum

A

5-2

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14
Q

Contents of foramen ovale

A

5-3

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15
Q

Contents of internal auditory meatus

A

CN 7,8

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16
Q

Contents of jugular foramen

A

CN 9-11

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17
Q

Contents of hypoglossal foramen

A

CN 12

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18
Q

What may a patient with olfactory impairment complain of other than lack of smell

A

Lack of taste

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19
Q

Olfactory nerves penetrate _____ ____ and synapse with _____ cells in the _____ _____

A

Cribiform plate
Mitral
Olfactory bulbs

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20
Q

Olfactory tracts project mainly to the ______ of the ______ ______

A

Uncus of the temporal lobes

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21
Q

Olfaction is the only sensation not directly processed where?

A

Thalia is

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22
Q

What pathologies affect CN1?

A
  • Frontal lobe tumor
  • Increased intracranial pressure
  • Fractures of the cribiform plate
  • minor trauma to the head
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23
Q

Olfactory deficits can be divided into what two catetgories

A

Conductive and sensorineural

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24
Q

Conductive deficit

A

Process interfering with the ability of odorants to contact olfactory epithelium

Aka something stopping air from getting to receptor

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25
Q

Sensorineural deficits

And examples

A

Dysfunction of receptors or central connections

Ex: TBI, cribiform plate tumor/fracture, brain tumor

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26
Q

Important questions to ask patient with smell/taste disturbance

A
  • head injury?
  • smoker?
  • recent URTI?
  • nutrition
  • exposure to toxins, medications, drugs
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27
Q

What nutritional deficiencies are linked to lack of smell?

A

Vitamin A, B6, B12

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28
Q

Examination of CN1

A
  1. Observe external nose
  2. Observe internal nasal passage (head tilt back)
  3. Patency bilaterally
  4. Close one nostril and test smell
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29
Q

Anosmia

A

Loss of smell

Ex: Alzheimer’s, Parkinson’s, Lewis body dementia

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30
Q

Hyposmia

A

Decreased smell

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31
Q

Hyperosmia

A

Increased smell

Ex: pregnant, migraines, substance abuse, deaf/blind people

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32
Q

Presbyosmia

A

Decreased smell due to aging

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33
Q

Parosmia

A

Perversion or distortion of smell

Ex: head trauma, psychiatric disease

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34
Q

Cacosmia

A

Abnormally and inappropriately disagreeable smell

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35
Q

Percent population that have impaired olfaction at the following ages:

  • under 65
  • 65-80
  • 80+
A
  • 2%
  • 50%
  • 75%
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36
Q

Why does olfaction decrease as we age?

A
  • ossification of cribiform plate foramina
  • neurogegenerative diseases
  • repeated insults (lose proper structure/function)
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37
Q

Causes of impaired smell

A
  • URTI
  • nasal/sinus disease
  • normal aging
  • blocked nasal passage
  • toxic chemicals/smoking
  • Vitamina A, B6,12, zinc
  • neurodegenerative disorders (Alzheimer’s/Parkinson’s)
  • frontal lobe tumors
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38
Q

Foster-Kennedy syndrome

A

Large tumor in orbitofrontal region

Ex: olfactory groove meningioma

  • Anosmia
  • Unilateral ipsilateral optic atrophy
  • contralateral papilledema (swelling of optic disc)
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39
Q

What would the findings be in Foster-Kennedy syndrome if a tumor was found in the orbitofrontal region on the RIGHT side

A
  • anosmia
  • right sided optic atrophy
  • left sided papilledema
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40
Q

What is the most likely cause of of loss of smell with a patient?

A. Trauma
B. Concussion
C. Viral infection
D. Frontal lobe tumor

A

C. Viral infection

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41
Q

What is the function and structure of CN 2?

A

Detect and interpret light stimuli and strains it impulses that mediate accommodation and reflex responses

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42
Q

What are the sensory receptors for vision

A

Photoreceptors

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43
Q

Rods

A

Night vision
Low acuity
Peripheral vision
NO color

44
Q

Cones

A

Day vision
Higher acuity
Central vision
Color vision

45
Q

What photoreceptor is most numerous?

A

Rods

46
Q

Where are cones found?>

A

Macula

47
Q

CN two information is received by _______ on retina and synapse with ______ cells which synapse with _____ cells.

A

Photoreceptors
Bipolar
Ganglion

48
Q

Axons from ganglion cells form optic ____ and _____ and synapse where?

A

Nerves and tracts

Lateral geniculate nucleus of the thalamus

49
Q

After optic tracts synapse in the lateral geniculate nucleus of the thalamus they _____ to where?

A

Ascend

Visual cortex in geniculocalcarine tract

50
Q

Lesion in the optic nerve causes what

A

Blindness in ipsilateral eye

51
Q

Lesion in optic chiasm is known as what and causes what

A

Heteronymous bitemporal hemianopia

Loss of temporal visual fields

52
Q

Lesion in optic tract is known as what and causes what

A

Homonymous contralateral hemianopia

Loss of contralateral 1/2 visual field in each eye

53
Q

Heteronymous bitemporal hemianopia

A

Optic chiasm lesion

54
Q

Homonymous contralateral hemianopia

A

Lesion in the optic tract

55
Q

Lesion in geniculocalcarine tract is known as what and causes what

A

Homonymous contralateral hemianopia

Loss of contralateral 1/2 of visual field but SPARES MACULA

56
Q

Homonymous contralateral hemianopia with macular sparing

A

Geniculocalcarine tract lesion

57
Q

Exam process for CN 2

A
  1. observation of eye
  2. Acuity
  3. Visual field test
  4. Pupillary light reflex
  5. Swinging flash light test
  6. Ophthalmoscopic exam
58
Q

Visual acuity test

A

Measurement of central vision

Can use newspaper at 14 inches. Equivalent to 20/30

59
Q

Gross visual field test/peripheral vision/confrontation normals

A

50-superior
60-nasal
70-inferior
90-lateral

60
Q

What does pupillary light reflex test

A

CN2/3

Tests for response to light both directly and indirectly

61
Q

During pupillary light reflex test on the right eye the response showed pupil constricted from 4 to 3 mm. The indirect response was also 4 to 3mm. When performating the exam on the left eye the direct response was 4 to 1mm and the indirect response was 4 to 1mm. What is most likely the diagnosis?

A

R2: x
L2: good
R3: good
L3: good

CN 2 lesion on the right

62
Q

On the right, the direct response was 4 to 3mm. The indirect response was 4 to 1mm. On the left eye, direct response was 4 to 1mm and the indirect was 4 to 3mm. what is the likely issue?

A

R2: good
L2: good
R3: x
L3: good

Lesion of cranial nerve 3 on the right

63
Q

What does an abnormal swinging flashlight test indicate?

A

Afferent pupillary defect on CN2 on the side that illumination caused dilation

64
Q

What would the finding be if the swinging flashlight test was abnormal

A

Both eyes would dilate

65
Q

If in the swinging flashlight test when the light is shown in the patients left eye, both eyes dilate?

A

Afferent pupillary defect of CN2 on left

66
Q

If there was an afferent pupillary defect on CN2 on the LEFT what would occur when light shown in right eye? Left eye?

A

Right: both pupils constrict
Left: both dilate

67
Q

What is Marcus-Gunn phenomenon?

A

Pupils dilate in response to light when afferent pupillary defect of CN 2 present

Seen with optic neuritis

68
Q

What diseases is Marcus-Gunn phenomenon found

A

Optic neuritis

69
Q

Optic/retrobulbar neuritis

A

Inflammation of optic nerve

  • rapid vision loss/scotoma (patch of loss)
  • pain
70
Q

What may optic neuritis be indicative of

A

MS

71
Q

What may cause optic neuritis

A

MS
Infection
Autoimmune

72
Q

Papilledema aka?

A

Chocked disc

73
Q

Findings in papilledema

A

Increased intracranial pressure causes disc swelling

-usually bilateral, preservation of vision

74
Q

What causes increased ICP that may lead to papilledema

A

HTN
Meningitis
Head trauma

75
Q

S/S of ICP

A

headache
Vision issues
Nausea/vomiting

76
Q

Exception to papilledema not being bilateral

A

Foster-Kennedy

Papilledema contralateral

77
Q

Optic atrophy

A

Deterioration of optic nerve

78
Q

What visual change occurs with optic atrophy

A

Decreased acuity

79
Q

What color change occurs with optic atrophy

A

Light pink to white/grey

80
Q

When may optic atrophy be seen?

A

Sign of more serious condition like glaucoma/stroke

81
Q

Tay-Sachs AKA

A

Amaurotic familial idiocy

82
Q

Amaurotic familial idiocy aka Tay-Sachs disease

A

Inherited neurodegenerate disorder causing excess gangliosides in brain/nerves

83
Q

S/S of amaurotic familial idiocy aka Tay-Sachs

A
  • decreased development, motor skills, mental functions
  • blind, deaf, mentally restarted, and non-responsive to environment
  • DARK CHERRY red spot in middle layer of eyes
  • usually die by 5
84
Q

Argyle Robertson pupil

A

Bilateral small pupils

-react only to accommodation

85
Q

What is argyll-Robertson pupil associated with

A

Neurosyphillis (tabes dorsalis)
Diabetes
MS
Stroke

86
Q

Holmes-adie syndrome

A

-one pupil larger than the other and constricts slowly to light

87
Q

DTR in Holmes-adie syndrome

A

Absences of DTR

88
Q

Extraocular muscles work in pairs that are _____?

A

Yoked

89
Q

Cranial 3 arises from _____ ____ _____ in _____ and conveys ____ _____ to _____ muscles and ______ fibers to _____ and _____ _____

A

Oculomotor nuclear complex
Motor fibers to extraocular muscles
Parasympathetic fibers to pupil and ciliary body

90
Q

CN 3 has motor fibers to? And parasympathetic fibers to?

A

Extraocular muscles

Pupil and ciliary body

91
Q

CN 3 has two divisions. Superior supplying what?

Inferior supplying what?

A

Superior: levator palpebrae superioris

Inferior: medial and inferior recti
Inferior oblique and pupil

92
Q

Action and nerve of inferior recti

A

CN 3

Eye down and out

93
Q

Action and nerve of inferior oblique

A

Up and in, CN3

94
Q

CN 4 arises from _____ _____ in ______ and is the only CN to exit the brain stem _______

A

Trochlear nucleus in midbrain

Posteriorly

95
Q

CN 4 supply

A

Superior oblique

96
Q

What structure do CN 3,4,6 all run through?

A

Cavernous sinus

97
Q

What may occur in the cavernous sinus that would affect CN 3,4,6

A

Pituitary tumor

Aneurism

98
Q

Extensive fiber tract running midline in the dorsal tegmentum of brainstem and extends to upper thoracic spinal cord

A

Medial longitudinal fasculus

99
Q

Primary function of MLF

A

Coordinate lateral gaze by connecting nuclei of CN 3,4,6

Allows eyes to move synchronously

100
Q

Lesions here may have internuclear ophthalmoplegia

A

MLF

101
Q

Findings in patient with MLF lesion

A
  • issues with horizontal eye movements—may describe as DOUBLE VISION
  • MC complaint is trouble looking inward (reading)
102
Q

What may cause a lesion in the MLF?

A

Older-Stroke (unilateral)

Younger-MS (bilateral)

103
Q

Exotropia

A

Outward/lateral deviation

104
Q

Heterotropia AKA ______? And meaning

A

Strabismus

Deviation of bilateral eye alignment

105
Q

Esotropia

A

Inward and medial deviation

106
Q

Hypertropia

A

Upward deviation

107
Q

Hypotropia

A

Downward deviation

NMS (12 decks)

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