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Cranial Nerves Flashcards

1
Q

Cranial nerve 1 origin

A

Olfactory

Cerebrum

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2
Q

CN 1 exit skull

A

Cribriform plate

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3
Q

CN 1 modality /components

A

Special visceral Sensory (senses derived from endoderm)

Smell

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4
Q

CN II origin

A

Cerebrum

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5
Q

CN II exit skull

A

Optic canal

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6
Q

CN 2 modalities/components

A

Special somatic sensory (senses derived from ectoderm)

Sight

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7
Q

CN 3 origin

A

Midbrain - pontine junction

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8
Q

CN 3 components/modality

A

Motor
General somatic motor: 4 extrinsic eye muscles and levator palpebrae superioris
General visceral motor: parasympathetic to pupillary sphincter and ciliary m

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9
Q

CN 3 exit skull

A

Superior orbital fissure

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10
Q

CN 4 origin

A

Midbrain posterior (longest intracranial length of all CNs)

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11
Q

CN4 exit skull

A

Superior orbital fissure

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12
Q

CN4 modality/components

A

Motor

General somatic motor: superior oblique

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13
Q

CN V origin

A

Pons

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14
Q

CN 5.1 exit skull

A

Superior orbital fissure

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15
Q

Ophthalmic nerve modality/components

A

General somatic sensory (skin): scalp, forehead, nose

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16
Q

CN 5.2 exit skull

A

foramen rotundum

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17
Q

Maxillary nerve modality/ components

A

General somatic sensory: cheeks, lower eye lid, nasal mucosa, upper lip, upper teeth, palate

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18
Q

CN 5.3 exit skull

A

Foramen ovale

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19
Q

Mandibular nerve modality/ components

A

General somatic sensory: anterior 2/3 tongue, skin over mandible, lower teeth
Special visceral motor (mm derived from pharyngeal arches) :muscles of mastication, tensor tympani muscle

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20
Q

CN 6 origin

A

Pontine - medulla junction

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21
Q

CN 6 exit skull

A

Superior orbital fissure

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22
Q

CN6 modality/components

A

General somatic motor: lateral Rectus

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23
Q

CN 7 origin

A

Pontine-medulla junction

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24
Q

CN 7 exit skull

A

Internal acoustic meatus

Stylomastoid foramen

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25
CN 7 modality/components
Motor and sensory General somatic sensory: external ear . stapedius mm Special visceral sensory: taste ant 2/3 tongue, hard and soft palate Special visceral motor: muscles facial expression General visceral motor: parasympa- lacrimal, submandibular, sublingual, mucous glands of mouth and nose.
26
CN 8 origin
Pontine- medullary junction
27
CN8 exit skull
Internal acoustic meatus
28
CN8 modality/components
Special somatic sensory: hearing and balance
29
CN IX origin
Medulla oblongata posterior to olive
30
CN IX exit skull
Jugular foremen
31
CN IX modality/components
Motor and sensory General somatic sensory: posterior 1/3 tongue, external ear, middle ear cavity General visceral sensory: carotid body and sinus Special visceral Sensory: taste post 1/3 tongue General visceral motor: parotid gland parasympa Special visceral motor: stylopharyngeus
32
CN X origin
Medulla oblongata posterior to the olive
33
CN X exit skull
Jugular foramen
34
CN X modality/components
Motor and sensory (vagus) General somatic sensory: external ear, larynx, pharynx General visceral sensory: larynx, pharynx, thoracic and abdominal viscera Special visceral sensory: taste from epiglottis region of tongue General visceral motor: parasympa. smooth muscles pharynx, larynx, most of GIT. Palatoglossus Special visceral motor: most muscles pharynx and larynx
35
CNXI origin
Medulla oblongata posterior to olive
36
CN XI exit skull
Jugular foramen
37
CN XI modality/components
Motor General somatic motor: trapezius, sternocleidomastoid Special visceral motor: a few fibres run with CNX to viscera
38
CNXII origin
Medulla oblongata anterior to olive
39
CNXII exit skull
Hypoglossal canal
40
CN XII modality/components
General somatic motor: intrinsic and extrinsic muscles of tongue, except palatoglossus (CNX)
41
How test olfactory nerve
Ask if any changes in smell
42
How test optic nerve (8)
- Pupil size, symmetry and shape - visual acuity with Snellen chart! - direct and consensual pupillary reflex! - swinging light test to check for relative afferent pupillary defect (Marcus Gunn pupil) (positive = paradoxical dilatation of affected pupil when light shone into it) - Accommodation reflex: pupillary convergence and constriction when focus from far object to finger! - colour vision using Ishihara plates at arms length - visual fields: pt cover one eye and you mirror patient. Your finger equal distance between you and patient. Bring closer to test peripheral visual field! Ask if can see your face to check for central scotoma . Then how many hands do they see to test for hemisnopia eg. Then how many fingers in each visual field. Then how many fingers total for visual neglect. Then tell me when you can see my finger for periph field. Do opposite to test blind spot - fundoscopy!
43
Describe the muscles responsible for the eye movements (6)
Up: superior rectus and inferior oblique Down: inferior rectus, superior oblique Adduction: medial rectus (and secondary action of superior rectus, inferior rectus) Abduction: lateral rectus, superior oblique, inferior oblique Medial rotation: superior oblique (superior rectus) Lateral rotation: inferior oblique (inferior rectus )
44
Function superior rectus?
Primary: elevation Secondary: adduction, medial rotation
45
Function inferior rectus?
Primary: depression Secondary: adduction, lateral rotation
46
Function medial rectus?
Adduction
47
Function lateral rectus?
Abduction
48
Function superior oblique?
- depress - abduct - medial rotation
49
Function inferior oblique?
- Elevate - Abduct - laterally rotate
50
How test trigeminal nerve (6)
Sensory - light touch and pinprick of forehead (ophthalmic division v1 ) , cheek (maxillary v2 ), lower jaw (mandibular V3) Motor: muscles of mastication - masseter muscle (clench teeth) - temporalis muscle - lateral and medial plerygoid muscles (open and close jaw against resistance ) Reflexes - jaw jerk reflex - corneal reflex - nasal tickle
51
How test facial nerve (10)
Sensory - ask if taste changes (anterior 2/3 of tongue) Motor - ask if hearing changes (stapedius muscle. Paralysis = hyperacusis ) - frontalis muscle: raise eyebrows - orbicularis oculi: scrunched eyes - buccinator: blow out cheeks - levator anguli oris and zygomaticus major: smile - buccinator and orbicularis oris: pursed lips (whistle) - platysma Autonomic - lactimation - salivation
52
How test vestibulocochlear nerve (5)
Sensory only - ask if change in hearing - whisper word from 60 cm away - Rinne and Weber's test - turning test: patient march on spot with arms out and eyes closed. If vestibular lesion, will turn towards side of lesion - Vestibular-ocular reflex: patient fixate on your nose throughout. Use your hands to rapidly rotate their head each way. Should maintain ocular fixation.
53
How test glossopharyngeal nerve (3)
Motor - stylopharyngeus muscle: elevates pharynx during swallow and speech (Afferent limb of swallow) Sensory - taste post 1/3 tongue Reflex - afferent limb of gag reflex
54
How test vagus nerve (5)
Motor - speech - say "ahh" and inspect soft palate and uvula. Lesion = deviate to normal side - cough: lesion = weak, non-explosive bovine cough - swallow: efferent limb Reflex - efferent limb of gag reflex
55
How test accessory nerve (2)
Motor - sternocleidomastoid: palpate both heads - trapezius
56
How test hypoglossal nerve (3)
Motor to extrinsic muscles of tongue except palatoglossus (vagus) - fasciculation's and wasting while tongue in mouth - protrude: deviation (will deviate to side of lesion) - push pt tongue against cheek - speed of tongue movement
57
How does CN iii palsy present
- Down and out (unopposed action of lateral rectus and superior oblique) - Ptosis (levator palpebrae superioris) - mydriasis (loss of parasympathetic fibres to sphincter pupillae muscle) (With: surgical 3rd nerve palsy, without: medical 3rd nerve palsy )
58
How does CN iv palsy present
- Vertical diplopia, often compensated for by tilting head forward and tucking chin in - Torsional diplopia compensated by tilting head to other side
59
How does CN vi palsy present
Convergent squint and horizontal diplopia
60
Define exotropia
Eye at rest: laterally Cover test direction of shift: medially
61
Define esotropia
Eye at rest: medial Cover test direction of shift: laterally
62
Define hypertropia
Eye at rest: up Cover test direction of shift: down
63
Define hypotropia
Eye at rest: Down Cover test direction of shift: up
64
How does facial nerve palsy caused by lower motor neuron present and example
- Weakness of all ipsilateral muscles of facial expression - Bell's palsy
65
How does facial nerve palsy caused by upper motor neuron lesion present and example
- Unilateral facial weakness with sparing of upper facial muscles ( frontalis) - stroke
66
Name features Bell's palsy (5)
= CN VII LMN palsy - Weakness of all ipsilateral muscles of facial expression - decreased/ absent lacrimation - hyperacuses - Loss taste anterior 2/3 tongue - Vesicles external ear canal and lobe due to herpes zoster infection
67
Name the near triad of accommodation
- Convergence - miosis - accommodation of lens
68
Name the afferent and efferent limbs of the corneal reflex
Afferent: cn V Efferent: cn vii (orbicularis oculi)
69
Define bulbar palsy
Impaired function of cranial nerves 9, 10,11 and 12. All originate in medulla oblongATA
70
Describe innervation of the tongue
Sensory - anterior 2/3: trigeminal Nerve (mandibular division, lingual nerve) - posterior 1/3 : glossopharyngeal Nerve Taste - anterior 2/3: facial nerve (chorda tympani) - posterior 1/3 : glossopharyngeal Nerve
71
Name 6 causes LMN CN VII lesions
- vascular: cerebrovascular ischaemia - idiopathic: Bell’s palsy (pregnancy, DM) - nerve; posterior fossa tumours - infective: herpes zoster (Ramsay Hunt syndrome), EBV, CMV, HIV - inflammatory: sarcoidosis - autoimmune: rheumatoid arthritis
72
Name 4 causes umn CN VII lesions
- Cerebrovascular incident - intracranial tumour - multiple sclerosis - HIV

Neurology (17 decks)

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