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MD4001 > cranial nerve examination > Flashcards

cranial nerve examination Flashcards

1
Q

what cranial nerve is affected in Bell’s palsy

A

7

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2
Q

why might the head be tilted in a cn 4 lesion

A

paralysis of superior oblique which brings eye inwards and down
this causes the patient to compensate by lifting the eye away from the side of the lesion

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3
Q

what is the main nerve that supplies taste

A

7

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4
Q

what nerve identifies irritant odors

A

5 (not 1)

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5
Q

what nerve is tested for when you ask the patient about walking downstairs

A

occulomotor/ trochlear

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6
Q

what does a skewed position of the eyes suggest

A

lesion of the medial longitudinal fasciculus ( carries information about the direction that the eyes should move)

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7
Q

what type of ptosis is found in horner’s

A

partial always

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8
Q

what type of ptosis is found in third nerve palsy

A

may be partial but is usually complete

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9
Q

what are some other causes of ptosis

A

congenital, myasthenia gravis

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10
Q

what is the innervation of levator palpebrae superioris

A

occulomotor and also sympathetic

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11
Q

what does miosis mean

A

small pupil

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12
Q

what is enopthalmos

A

partial backwards displacement of the eyeball

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13
Q

how do you use a snellen chart

A

ask patient to read the lowest line down possible
from 6m away
can wear corrective glasses

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14
Q

what should you do if they cant read the top line

A

can the count fingers/ recognise hand movements or see light

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15
Q

what are limbs of the light reflex (pupil constricts in response to light)

A

optic nerve afferent

psymp of occulomotor is efferent

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16
Q

what is the parasympathetic supply to the pupil controlled by

A

edinger westphal nucleus

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17
Q

what does the consensual response mean

A

the pupil on the opposite side to that which light is being shone in constricts

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18
Q

what are Argyll Robertson pupils

A

accommodate but do not react to light

caused by neurosyphilis

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19
Q

how far away from the patient should you place your finger when testing accommodation reflex

A

50 cm

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20
Q

what mediates the accommodation reflex

A

afferent- optic (

efferent- oculomotor (psymp from edinger westphal)

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21
Q

what parts of the brain ensure that both eyes move together

A

frontal and occipital lobes
cerebellum and vestibular nuclei
integrated in the brainstem
medial longitudinal fasciculus

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22
Q

where is the medial longitudinal fasciculus found

A

runs between nuclei of 3 and 4 in the midbrain and 6 in the pons

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23
Q

what supplies superior oblique

A

4

24
Q

what supplies lateral rectus

A

6

25
Q

what muscles elevates the eye

A

superior rectus and inferior oblique

26
Q

what muscles depress the eye

A

inferior rectus and superior oblique

27
Q

what is the function of superior oblique

A

depresses, abducts and intorts the pupil (crosses eyes)

28
Q

what is the function of inferior oblique

A

elevates, abducts and extorts the pupil

29
Q

where can lesions be found

A 
supranuclear
internuclear (mlf)
nuclear
nerve
nmj
muscle
30
Q

what part of the brain controls eye pursuit

A

occipital lobe

patient tracks a moving target

31
Q

how is nystagmus described

A

in the direction of the fast phase

32
Q

what can cause peripheral nystagmus

A

vestibular system abnormalities

eight cn or nucleus

33
Q

what causes retinal nystagmus

A

damage to the retina so inability to fix on an image

34
Q

eye deviated laterally and slightly downward, pupil may be dilated and unresponsive, ptosis

A

cn 3 paresis

35
Q

impaired depression of the fully adducted eye, head may be tilted to the opposite side to avoid diplopia

A

cn 4

36
Q

impaired abduction

A

cn 6

37
Q

what are the limbs of the corneal reflex

A

afferent- cn 5
efferent - cn 7

pt should blink

38
Q

when you ask the patient to open their mouth against resistance, what muscle are you testing

A

pterygoids

39
Q

if the lower jaw deviates to the left what does this suggest

A

left sided paralysis

lesion of the trigeminal nerve

40
Q

what are the limbs of the jaw jerk reflex

A

both are 5

proprioception travels to the mesencephalic nucleus (midbrain)

then go to pontine motor nucleus

then to muscles of mastication

41
Q

what does an abnormally brisk jaw jerk reflex suggest

A

bilateral upper motor neurone lesions affecting the corticobulbar pathway

42
Q

what is bulb another name for

A

medulla

43
Q

what muscles are being tested when pt is asked to grimace and show me your teeth

A

platysma and dilators

44
Q

say me me me

A

lips and front of mouth tested

45
Q

puff out your cheeks and don’t let me push them in

A

orbicularis oris

46
Q

how do you differentiate between an upper and lower motor neurone lesion of the facial nerve

A

in an UMN lesion frontalis and orbicularis oculi are usually spared

in a lower motor neurone lesion the lower and upper part of the face are paralysed

47
Q

bell’s palsy

A

swelling of the facial nerve withing the facial canal

may be hyperacusis

48
Q

what is Bells phenomenon

A

eyeball turned upwards when the patient closes their eyes

49
Q

what supplies taste in the anterior 2/3 of tongue

A

chorda tympanii from the facial nerve

50
Q

what is webers hearing test

A

tuning fork is held on the forehead

51
Q

what is rinnes test

A

tuning fork is held on the mastoid

tests for conductive deafness- bone conduction is better than air

52
Q

what does it suggest if the uvula moves to the left side

A

there is a lesion of the vagus on the right side

53
Q

parotid secretions and taste on posterior tongue

A

glossopharyngeal

54
Q

what is the cranial accessory nerve

A

arises from the caudal extension of the nucleus ambiguous and joins the vagus

55
Q

how is visual acuity calculated

A

distance at which test is performed in meters / line number that was read successfully

MD4001 (38 decks)

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