Cranial Nerve Testing AND Acute Otitis Media

Question 1

Most frequent diagnosis in sick children visiting the pediatricians office

-80% of children under 2 have experienced this

Answer 1

Acute Otitis Media (AOM)

Question 2

Acute otitis media is a

Answer 2

Bacterial infection of the middle ear

Question 3

What are some major risk factors for AOM?

Answer 3

Age (6-18 months), day care, lack of breast feeding, tobacco smoke, pacifier use

Question 4

Shorter and more horizontal in children, making it easier to get AOM

Answer 4

Eustachian tube

Question 5

In AOM, we see inflammatory edema of the mucosa of the

Answer 5

Nose, nasopharynx, and Eustachian tube

Question 6

In AOM, the Eustachian tube gets obstructed, which causes a negative middle ear pressure that leads to

Answer 6

Fluid accumulation

Question 7

In AOM, the eardrum is initially stretched

Answer 7

Inward

Question 8

Once the infection progresses and fluid pressure has built up, the tympanic membrane

Answer 8

Bulges outward

Question 9

Fever, irritability, headache, poor feeding, and disturbed sleep are symptoms of

Answer 9

AOM in infants

Question 10

The most common symptom of AOM in older children is

Answer 10

Ear pain (otalgia) and ear tugging

Question 11

AOM is defined by examining the tympanic membrane, where we would see

Answer 11

Bulging of membrane, and posible whitish discoloration

Question 12

How do we test the Opthalmic nerve (CN I)?

Answer 12

By recognition of odors (test one nostril at a time)

Question 13

To test for the Optic nerve (CN II) we would do a

Answer 13

Visual field test and look for visual acuity and pupillary light reflex

Question 14

How can we test cranial nerves III, IV, and VI?

Answer 14

The H test to check eye muscle movements

Question 15

When testing CN III, it is important to distinguish the

Answer 15

Somatic motor function from the autonomic function

Question 16

How can we distinguish the somatic motor and parasympathetic innervation from CN III?

Answer 16

Somatic motor will be inferior and medial rectus and inferior oblique

Parasympathetic will be to tet sphincter pupillae

Question 17

Ptosis is going to be a lesion in either

Answer 17

CN III or a sympathetic lesion (we have to distinguish)

Question 18

How can we test the Trigeminal nerve (CN V)?

Answer 18

Cutaneous sensation (for all 3 divisions) and mastication (for V3)

Question 19

Testing sensation above the eyes tells us about the

Answer 19

Opthalmic division (V1) of V

Question 20

Testing sensation between the eyes and mouth lets us test the

Answer 20

Maxillary division (V2) of the Trigeminal nerve

Question 21

Testing sensation below the mouth tells us about the

Answer 21

Mandibular division (V3) of the trigeminal nerve

Question 22

To test for the mandibular division, we can also check mastication. If there is a lesion, upon protrusion, the mandible will deviate

Answer 22

TOWARDS the side with the lesion (due to paralysis of ipsilateral lateral pterygoid)

Question 23

How can we test the Facial Nerve (VII)

Answer 23

Facial movements, facial symmetry, posterior auricular sensation, and taste

Question 24

If we test the ability to close the eyes tightly we are testing the

Answer 24

Orbicularis oculi which is innervated by VII

Question 25

If we test the ability to close the lips tightly while puffing out the cheeks, we are testing the

Answer 25

Orbicularis oris (innervated by CN VII)

Question 26

How can we test the frontalis branch of VII?

Answer 26

Wrinkle the forehead

Question 27

By having the patient smile, we are testing the

Answer 27

Zygomaticus major and minor (VII)

Question 28

Also, when testing CN VII we want to look for symmetry of

Answer 28

Labionasal folds

Question 29

How can we test the Vestibular cochlear nerve?

Answer 29

Hearing test (i.e. bone conduction vs air conduction) and we can test for vestibular function

Question 30

The Weber and Rinne test will test which cranial nerve

Answer 30

Cochlear division of CN VIII

Question 31

How can we test The Glossopharyngeal nerve (CN IX)

Answer 31

Test the gag reflex and sensation from mucosa of oropharynx

Question 32

We can test the Vagus nerve (CN X) by testing

Answer 32

Palate movement, the voice, and swallowing

Question 33

Contraction of the palatal and pharyngeal muscles (levator palati, pharyngeal constrictors, and palatopharyngeus) will asses the

Answer 33

Vagus nerve (CN X)

Question 34

How can we test the Accessory nerve (CN XI)

Answer 34

Shoulder shrug (traps) and Head turn (sternoclediomastoid)

Question 35

How can we test the function of the Hypoglossal Nerve (CN XII)

Answer 35

Tongue protrusion (genioglosus)

Question 36

With a lesion of the Hypoglossal nerve (XII) the tongue will deviate

Answer 36

TOWARDS the side of the lesion (due to paralysis of the genioglossus)

Question 37

What are the SYMPATHETIC pathologies of the head and neck?

Answer 37

1. ) Ptosis
2. ) Miosis
3. ) Anhydrosis

Question 38

Paralysis of the smooth muscle component of the lavator palpebrae superioris

Answer 38

Ptosis

Question 39

Paralysis of the dilator pupillae muscle

Answer 39

Miosis

Question 40

Loss of sweat gland innervation

Answer 40

Anhydrosis

Question 41

The pupillary light reflex and accomidation reflex will test the

1. ) Sensory (Afferent) limb of
2. ) Motor (Eferrent) Limb of

Answer 41

1. ) CN II

2. ) CN III (parasympathetic)

Question 42

The corneal blink reflex will test the

1. ) Sensory (Afferent) limb of
2. ) Motor (Eferrent) Limb of

Answer 42

1. ) V1

2. ) VII

Question 43

The jaw jerk reflex will test the

1. ) Sensory (Afferent) limb of
2. ) Motor (Eferrent) Limb of

Answer 43

1. ) V3

2. ) V3

Question 44

The gag reflex will test the

1. ) Sensory (Afferent) limb of
2. ) Motor (Eferrent) Limb of

Answer 44

1. ) IX

2. ) X

Question 45

The cough reflex will test the

1. ) Sensory (Afferent) limb of
2. ) Motor (Eferrent) Limb of

Answer 45

1. ) X

2. ) X and spinal nerves (Thoracic and Lumbar)

Question 46

The tensor tympani reflex will test the

1. ) Sensory (Afferent) limb of
2. ) Motor (Eferrent) Limb of

Answer 46

1. ) VIII

2. ) V3