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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
Sensorineural deficits | And examples
Dysfunction of receptors or central connections Ex: TBI, cribiform plate tumor/fracture, brain tumor
26
Important questions to ask patient with smell/taste disturbance
- head injury? - smoker? - recent URTI? - nutrition - exposure to toxins, medications, drugs
27
What nutritional deficiencies are linked to lack of smell?
Vitamin A, B6, B12
28
Examination of CN1
1. Observe external nose 2. Observe internal nasal passage (head tilt back) 3. Patency bilaterally 4. Close one nostril and test smell
29
Anosmia
Loss of smell Ex: Alzheimer’s, Parkinson’s, Lewis body dementia
30
Hyposmia
Decreased smell
31
Hyperosmia
Increased smell Ex: pregnant, migraines, substance abuse, deaf/blind people
32
Presbyosmia
Decreased smell due to aging
33
Parosmia
Perversion or distortion of smell Ex: head trauma, psychiatric disease
34
Cacosmia
Abnormally and inappropriately disagreeable smell
35
Percent population that have impaired olfaction at the following ages: - under 65 - 65-80 - 80+
- 2% - 50% - 75%
36
Why does olfaction decrease as we age?
- ossification of cribiform plate foramina - neurogegenerative diseases - repeated insults (lose proper structure/function)
37
Causes of impaired smell
- 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
38
Foster-Kennedy syndrome
Large tumor in orbitofrontal region Ex: olfactory groove meningioma - Anosmia - Unilateral ipsilateral optic atrophy - contralateral papilledema (swelling of optic disc)
39
What would the findings be in Foster-Kennedy syndrome if a tumor was found in the orbitofrontal region on the RIGHT side
- anosmia - right sided optic atrophy - left sided papilledema
40
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
C. Viral infection
41
What is the function and structure of CN 2?
Detect and interpret light stimuli and strains it impulses that mediate accommodation and reflex responses
42
What are the sensory receptors for vision
Photoreceptors
43
Rods
Night vision Low acuity Peripheral vision NO color
44
Cones
Day vision Higher acuity Central vision Color vision
45
What photoreceptor is most numerous?
Rods
46
Where are cones found?>
Macula
47
CN two information is received by _______ on retina and synapse with ______ cells which synapse with _____ cells.
Photoreceptors Bipolar Ganglion
48
Axons from ganglion cells form optic ____ and _____ and synapse where?
Nerves and tracts | Lateral geniculate nucleus of the thalamus
49
After optic tracts synapse in the lateral geniculate nucleus of the thalamus they _____ to where?
Ascend Visual cortex in geniculocalcarine tract
50
Lesion in the optic nerve causes what
Blindness in ipsilateral eye
51
Lesion in optic chiasm is known as what and causes what
Heteronymous bitemporal hemianopia Loss of temporal visual fields
52
Lesion in optic tract is known as what and causes what
Homonymous contralateral hemianopia Loss of contralateral 1/2 visual field in each eye
53
Heteronymous bitemporal hemianopia
Optic chiasm lesion
54
Homonymous contralateral hemianopia
Lesion in the optic tract
55
Lesion in geniculocalcarine tract is known as what and causes what
Homonymous contralateral hemianopia Loss of contralateral 1/2 of visual field but SPARES MACULA
56
Homonymous contralateral hemianopia with macular sparing
Geniculocalcarine tract lesion
57
Exam process for CN 2
1. observation of eye 2. Acuity 3. Visual field test 4. Pupillary light reflex 5. Swinging flash light test 6. Ophthalmoscopic exam
58
Visual acuity test
Measurement of central vision Can use newspaper at 14 inches. Equivalent to 20/30
59
Gross visual field test/peripheral vision/confrontation normals
50-superior 60-nasal 70-inferior 90-lateral
60
What does pupillary light reflex test
CN2/3 | Tests for response to light both directly and indirectly
61
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?
R2: x L2: good R3: good L3: good CN 2 lesion on the right
62
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?
R2: good L2: good R3: x L3: good Lesion of cranial nerve 3 on the right
63
What does an abnormal swinging flashlight test indicate?
Afferent pupillary defect on CN2 on the side that illumination caused dilation
64
What would the finding be if the swinging flashlight test was abnormal
Both eyes would dilate
65
If in the swinging flashlight test when the light is shown in the patients left eye, both eyes dilate?
Afferent pupillary defect of CN2 on left
66
If there was an afferent pupillary defect on CN2 on the LEFT what would occur when light shown in right eye? Left eye?
Right: both pupils constrict Left: both dilate
67
What is Marcus-Gunn phenomenon?
Pupils dilate in response to light when afferent pupillary defect of CN 2 present Seen with optic neuritis
68
What diseases is Marcus-Gunn phenomenon found
Optic neuritis
69
Optic/retrobulbar neuritis
Inflammation of optic nerve - rapid vision loss/scotoma (patch of loss) - pain
70
What may optic neuritis be indicative of
MS
71
What may cause optic neuritis
MS Infection Autoimmune
72
Papilledema aka?
Chocked disc
73
Findings in papilledema
Increased intracranial pressure causes disc swelling -usually bilateral, preservation of vision
74
What causes increased ICP that may lead to papilledema
HTN Meningitis Head trauma
75
S/S of ICP
headache Vision issues Nausea/vomiting
76
Exception to papilledema not being bilateral
Foster-Kennedy Papilledema contralateral
77
Optic atrophy
Deterioration of optic nerve
78
What visual change occurs with optic atrophy
Decreased acuity
79
What color change occurs with optic atrophy
Light pink to white/grey
80
When may optic atrophy be seen?
Sign of more serious condition like glaucoma/stroke
81
Tay-Sachs AKA
Amaurotic familial idiocy
82
Amaurotic familial idiocy aka Tay-Sachs disease
Inherited neurodegenerate disorder causing excess gangliosides in brain/nerves
83
S/S of amaurotic familial idiocy aka Tay-Sachs
- 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
Argyle Robertson pupil
Bilateral small pupils | -react only to accommodation
85
What is argyll-Robertson pupil associated with
Neurosyphillis (tabes dorsalis) Diabetes MS Stroke
86
Holmes-adie syndrome
-one pupil larger than the other and constricts slowly to light
87
DTR in Holmes-adie syndrome
Absences of DTR
88
Extraocular muscles work in pairs that are _____?
Yoked
89
Cranial 3 arises from _____ ____ _____ in _____ and conveys ____ _____ to _____ muscles and ______ fibers to _____ and _____ _____
Oculomotor nuclear complex Motor fibers to extraocular muscles Parasympathetic fibers to pupil and ciliary body
90
CN 3 has motor fibers to? And parasympathetic fibers to?
Extraocular muscles | Pupil and ciliary body
91
CN 3 has two divisions. Superior supplying what? | Inferior supplying what?
Superior: levator palpebrae superioris Inferior: medial and inferior recti Inferior oblique and pupil
92
Action and nerve of inferior recti
CN 3 | Eye down and out
93
Action and nerve of inferior oblique
Up and in, CN3
94
CN 4 arises from _____ _____ in ______ and is the only CN to exit the brain stem _______
Trochlear nucleus in midbrain Posteriorly
95
CN 4 supply
Superior oblique
96
What structure do CN 3,4,6 all run through?
Cavernous sinus
97
What may occur in the cavernous sinus that would affect CN 3,4,6
Pituitary tumor | Aneurism
98
Extensive fiber tract running midline in the dorsal tegmentum of brainstem and extends to upper thoracic spinal cord
Medial longitudinal fasculus
99
Primary function of MLF
Coordinate lateral gaze by connecting nuclei of CN 3,4,6 | Allows eyes to move synchronously
100
Lesions here may have internuclear ophthalmoplegia
MLF
101
Findings in patient with MLF lesion
- issues with horizontal eye movements—may describe as DOUBLE VISION - MC complaint is trouble looking inward (reading)
102
What may cause a lesion in the MLF?
Older-Stroke (unilateral) | Younger-MS (bilateral)
103
Exotropia
Outward/lateral deviation
104
Heterotropia AKA ______? And meaning
Strabismus | Deviation of bilateral eye alignment
105
Esotropia
Inward and medial deviation
106
Hypertropia
Upward deviation
107
Hypotropia
Downward deviation

NMS (12 decks)

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