Cranial Nerves 21% Flashcards
1
Q
Sensory:
- Smell (coffee, mint) is tested one nostril at a time with eyes closed
A
Olfactory (I)
2
Q
Lost sense of smell (CN I)
A
Anosmia
3
Q
Distorted sense of smell (CN I)
A
Parosmia
4
Q
Sensory:
- Vision is tested with Snellen Chart for visual acuity, visual fields (peripheral vision)
A
Optic (II)
5
Q
Direct Light Reflex CN
A
CN II Optic & III Oculomotor
6
Q
Indirect (consensual) Light Reflex CN
A
CN II Optic & III Oculomotor
7
Q
Eyes converge, pupils constrict & lens convexity (CN II)
A
Accommodation
8
Q
What cranial nerves are tested together with the Six Cardinal Fields of Gaze?
A
CN III Oculomotor, IV Trohlear, VI Abducens
LR6, SO4, O3
9
Q
Motor:
Levator Palpebrae, Inferior Oblique, Superior, Medial and Inferior Rectus
A
Oculomotor (III)
10
Q
Parasympathetic: Ciliary muscles (lens shape) and constrictor papillae
A
Oculomotor (III)
11
Q
Which CN:
- Direct Light Reflex
- Indirect Light Reflex
- Accommodation
A
CN II Optic & III Oculomotor
12
Q
Deviation of one or both eyes
A
Strabismus
13
Q
Eyelids droop due to weakness or paralysis of levator palpebrae
A
Ptosis
14
Q
Motor:
Superior Oblique muscle (down, in)
Ex: look at the tip of your nose
A
Trochlear (IV)
15
Q
Sensory:
To Face (V1-3)
Touch forehead, cheekbone & chin with cotton wisp
A
Trigeminal (V)
16
Q
Corneal Reflex
- What CN is for afferent & which is efferent?
Touch cornea with cotton wisp, both eyes blink or tear normally
TQ
A
CN V (Trigeminal) is afferent (sensory) CN VII (Facial) is efferent (motor)
17
Q
Jaw Jerk Reflex CN?
The mandible is tapped with hammer and jaw draws upward
A
CN V Trigeminal
18
Q
Oculocardiac Reflex CN for afferent & efferent?
Press on eye and heart rate decreases
A
CN V Trigeminal is afferent (sensory)
CN X Vagus is efferent (motor)
19
Q
General sensation to the anterior 2/3 of the tongue (sensory)
TQ
A
CN V Trigeminal
20
Q
Motor:
Muscles of Mastication
TQ
A
Trigeminal (V)
21
Q
Extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. Lightening like, excruciating pain is repetitive, occurring several times per day. Pain is typically felt on one side of the jaw or cheek.
A
Tic Douloureaux aka Trigeminal Neuralgia
CN V Trigeminal
22
Q
Motor:
to Lateral Rectus Muscle
TQ
A
Abducens (VI)
23
Q
Sensory:
Taste - anterior 2/3 of tongue
(sweet, sour, salty)
A
Facial (VII)
24
Q
Motor:
Muscles of facial expression
A
Facial (VII)
25
Unilateral facial paralysis caused by trauma, virus, or immune mediated response and is not permanent. Initial pain behind ipsilateral ear, twitching, weakness or paralysis, drooping eyelid, drooping corner of mouth, drooling, dry eye & impairment of taste.
TQ
Bell's Palsy
| Facial VII CN
26
What is the difference between Bell's Palsy and Stroke?
Bells: Ipsilateral Motor loss of entire face & forehead does NOT wrinkle
Stroke: contralateral motor loss below eye & forehead does wrinkle
27
Sensory:
| Balance, Mittelemeyer, Barany Caloric Test, Rombergs
VIII. Vestibulocochlear - Vestibular part
28
Sensory:
Hearing, Weber, Rinne, Whisper, Auditory Acuity/Watch
TQ
VIII. Vestibulocochlear - Cochlear part
29
Cause is unknown, but probably results from an abnormality in the fluids of the inner ear. Symptoms are episodic rotational vertigo, hearing loss, & tinnitus.
Meniere's Disease
aka Endolymphatic Hydrops
VIII. Vestibulocochlear CN
30
Sensory (Afferent):
- Gag (Pharyngeal) Reflex
- Uvula Reflex
- Carotid Reflex: massage carotids and heart rate drops
- Taste to posterior 1/3 of tongue (bitter)
TQ
IX. Glossopharyngeal
31
Motor:
| Stylopharyngeus muscle elevates pharynx & larynx; dilates pharynx to permit swallowing
IX. Glossopharyngeal
32
Sensory:
| Epiglottis & laryngeal muscles of swallowing (palate, pharynx, contracting muscles)
X. Vagus
33
Motor (efferent):
- Gag Reflex
- Uvular Reflex
- Carotid Reflex
TQ
X. Vagus
34
Uvular Reflex: palate and uvula deviate to the _____ side of lesion when patient says "AHHHH"
TQ
Opposite side of lesion (Vagus)
35
Motor:
Trapezius & SCM muscles
- Shoulder shrug against resistance
TQ
XI. Spinal Accessory
36
Spasm of SCM muscle?
Torticollis aka Wry Neck
| XI. Spinal Accessory CN
37
Motor:
Tongue muscles
- Stick tongue out; tongue will deviate _____ side of lesion
- Look for atrophy & fasciculations
TQ
XII. Hypoglossal
Toward side of lesion
38
Involuntary motor responses to potentially harmful stimuli?
Reflexes
39
T/F - All reflex tests are done bilaterally with the normal side tested first.
True
40
Absence of any DTR, especially patellar (LMNL)
Westphal's Sign
41
Brings out reflexes by cortical distraction?
Jendrassik's Maneuver
| aka Reinforcement Test
42
```
Deep Tendon Reflexes: Wexler Scale
0+
1+
2+
3+
4+
5+
```
```
0+ Absent with reinforcement
1+ Hypoactive with no reinforcement
2+ Normal
3+ Hyperactive
4+ Hyperactive with transient clonus ~~ TQ
5+ Hyperactive with sustained clonus
```
43
DTR: Jaw Jerk
Trigeminal V
44
DTR: Biceps
Musculocutaneous (C5)
45
DTR: Brachioradialis
TQ
Radial (C6)
46
DTR: Triceps
TQ
Radial (C7)
47
DTR: Patella aka Knee Jerk
Femoral (L4)
48
DTR: Medial Hamstring
Sciatic (L5)
49
DTR: Achilles aka Ankle Jerk
Tibial (S1)
50
Superficial Reflexes:
| Corneal - touch with cotton wisp produces blinking or tearing
V. Trigeminal (afferent)
| VII. Facial (efferent)
51
Superficial Reflexes:
| Gag/Pharyngeal - touch back of tongue with tongue blade to produce gagging
IX. Glossopharyngeal (afferent)
| X. Vagus (efferent)
52
Superficial Reflexes:
| Stroke inner thigh of male; ipsilateral rise in testes
```
Cremasteric (L1)
Femoral Nerve (afferent)
Genitofemoral Nerve (efferent)
```
53
Superficial Reflexes:
| Stroke inner thigh of female; poupart's ligament contracts
```
Geigel's (L1)
Femoral Nerve (afferent)
Genitofemoral Nerve (efferent)
```
54
Superficial Reflexes:
| Stroke up sole of foot; see curling of toes & pulling away of foot
```
Plantar (L4-S2)
Tibial Nerve (afferent & efferent)
```
55
Superficial Reflexes:
Abdominal - stroke in all 4 abdominal quadrants away from umbilicus.
Normal = umbilicus moves toward side stroked
Afferent & Efferent:
| Upper T7-T9 & Lower T10-T12
56
Superficial Reflexes:
While observing the umbilicus, the pt does a partial sit up.
Normal = umbilicus stays midline
TQ
Beevor's
Afferent & Efferent:
Upper T7-T9 & Lower T10-T12
57
Lesion of the brain and spinal cord not including the anterior horn cells
UMNL
58
Lesion of the anterior horn cells out to the myoneural junction
LMNL
59
Paralysis: UMNL? LMNL?
UMNL: Spastic
LMNL: Flaccid
60
Deep Tendon Reflexes: UMNL? LMNL?
UMNL: Hyperactive
LMNL: Hypoactive/Absent
61
Pathological Reflex: UMNL? LMNL?
UMNL: Present
LMNL: Absent
62
Clonus: UMNL? LMNL?
UMNL: Present
LMNL: Absent
63
Tone: UMNL? LMNL?
UMNL: Hypertonic
LMNL: Hypotonic
64
Reaction of Degeneration: UMNL? LMNL?
UMNL: Absent
LMNL: Present
65
Atrophy: UMNL? LMNL?
UMNL: Absent
LMNL: Present
66
Fasiculation: UMNL? LMNL?
UMNL: Absent
LMNL: Present
67
Superficial Reflexes: UMNL? LMNL?
UMNL: Absent
LMNL: Absent
68
Visceral Organic Reflexes:
Absent in UMNL & LMNL
Pinch neck while noting dilation of the eyes
Ciliospinal - Sensory from neck
| Cervical sympathetics
69
Visceral Organic Reflexes:
Absent in UMNL & LMNL
Press on eye while noting the slowing of the heart by 10 bpm
Oculocardiac
V. Trigeminal
X. Vagus
70
Visceral Organic Reflexes:
Absent in UMNL & LMNL
Press on carotid sinus while noting the slowing of the heart & decreased pressure
Carotidcardio reflex
IX. Glossopharyngeal
X. Vagus
71
Which CN are sensory only?
I. Olfactory
II. Optic
VIII. Vestibulocochlear
72
Which CN are motor only?
```
III. Oculomotor
IV. Trochlear
VI. Abducens
XI. Spinal Accessory
XII. Hypoglossal
```
73
Which CN are both sensory & motor?
V. Trigeminal
VII. Facial
IX. Glossopharyngeal
X. Vagus
74
Pathological Reflex indicates UMNL:
| Stroke up lateral aspect of foot to great toe
Babinski:
| Dorsiflexion of great toe with splaying of other toes (+)
75
Pathological Reflex indicates UMNL:
| Stroke lateral malleolus to fifth toe
Chaddock:
| Babinski-like response (+)
76
Pathological Reflex indicates UMNL:
| Stroke down tibial crest to the ankle
Oppenheim:
| Babinski-like response (+)
77
Pathological Reflex indicates UMNL:
Squeeze the calf below the knee
TQ
Gordon's Calf:
| Babinski-like response (+)
78
Pathological Reflex indicates UMNL:
| Squeeze Achilles tendon
Schaefer:
| Babinski-like response (+)
79
Pathological Reflex indicates UMNL:
| Tap the ball of the foot
Rossolimo:
| Plantar flexion of great toe with curling of other toes (+)
80
Pathological Reflex indicates UMNL:
| Examiner extends middle phalanx & flicks distal phalanx inferior
Hoffman:
| Flexion & adduction of thumb and flexion of fingers (+)
81
Pathological Reflex indicates UMNL:
| Examiner sharply taps the tips of the middle 3 fingers
Tromner:
| Flexion & adduction of thumb and flexion of the fingers (+)
82
Pathological Reflex indicates UMNL:
| Examiner strokes the pisiform of the pt
Gordon's finger:
| Flexion of wrist & fingers, or thumb & index finger (+)
83
Pathological Reflex indicates UMNL:
| Examiner strokes the distal ulnar side of the forearm near the wrist
Chaddock's Wrist:
| Flexion of wrist with extension & fanning of fingers (+)
84
Muscle Grading:
5, 4, 3, 2, 1, 0
TQ
5 - Normal: complete ROM, against gravity, full resistance
4- Good: complete ROM, against gravity, some resistance
3 - Fair: complete ROM, against gravity
2 - Poor: complete ROM, no gravity
1 - Trace: evidence of slight contractility w/ no joint motion
0 - Zero: no evidence of contractility
85
C5 nerve root: Motor function?
Arm Abduction / Forearm Flexion
86
C5 nerve root: Muscle?
Middle Deltoid / Biceps Brachii
87
C5 nerve root: Sensory?
Lateral Arm
88
C5 disorder
Erb's Palsy
Paralysis of the arm primarily from dystocia; LMN syndrome; MC affected nerves are Suprascapular N, Musculocutaneous N, and Axillary N.
89
C6 nerve root: Motor function?
Wrist Extension
90
C6 nerve root: Muscle?
Extensor Carpi Ulnaris/Radialis & Brachialis
91
C6 nerve root: Sensory?
Lateral Forearm & Digits 1-2
92
C6 disorder
*** Erb's Palsy
93
C7 nerve root Motor Function?
Wrist Flexion & Finger extension
94
C7 nerve root muscles
Flexor Carpi Ulnaris/Radialis & Triceps
95
C7 nerve root sensory?
3rd Digit
96
C7 nerve root disorder
Wrist Drop
97
C8 motor function
Finger Flexion
98
C8 muscles
Flexor Digitorum Superficialis/Profundus & Lumbricals
99
C8 sensory
Medial Forearm & Digits 4-5
100
C8 nerve root disorder
*** Klumpke's Paralysis (C8-T1)
| Paralysis involving the intrinsic muscles of the forearm & hand; "Claw Hand"; lower brachial plexus injury
101
T1 nerve root motor function
Finger abduction & adduction
102
T1 nerve root muscle
Dorsal Interossei & Palmer Interossei
103
T1 nerve root sensory
Medial Elbow
104
T5-T12 nerve root motor function
Trunk Flexion
105
T5-T12 nerve root muscle
Rectus Abdominus
106
T5-T12 nerve root sensory
T5-T12 follow vertebral levels
107
L1-L3 nerve root motor funtion
Hip Flexion
108
L1-L3 nerve root muscle
Iliopsoas
109
L1-L3 nerve root sensory
Inguinal Ligament (L1), Oblique (L2), Oblique across Knee (L3)
110
L1-L3 nerve root disorder
*** Meralgia Paresthetica
Numbness/pain in outer thigh caused by injury to the nerve from thigh to spinal column.
Lateral Cutaneous Nerve of the thigh
111
L2-L4 nerve root motor function
Hip flexion & adduction
| Knee extension
112
L2-L4 nerve root muscle
Quadriceps & Adductors
113
L4 nerve root motor function
Inversion & Dorsiflexion
114
L4 nerve root muscle
Tibialis Anterior
115
L4 nerve root sensory
Medial aspect of leg & foot
116
L4 nerve root disorder
Foot Drop
| Gait abnormality; Common Fibular Nerve; unable to extend toe or dorsiflex ankle; common with ALS, MS, Cerebral Palsy
117
L5 nerve root motor function
Toe extension, Heel walk, Hip abduction
118
L5 nerve root muscle
Extensor digitorum
Extensor Hallucis Longus
Gluteus Medius & Minimus
119
L5 nerve root sensory
Lateral aspect of the leg across dorsum of foot to big toe
120
L5 disorder
Foot Drop
| Gait abnormality; Common Fibular Nerve; unable to extend toe or dorsiflex ankle; common with ALS, MS, Cerebral Palsy
121
S1 nerve root motor function
Eversion
Plantar Flexion
Hip Extension
122
S1 nerve root muscle
Peroneus longus/brevis
| Gluteus Maximus
123
S1 nerve root sensory
Lateral aspect of foot & plantar surface of foot
124
S2-S4 nerve root motor function
Anal wink
125
S2-S4 nerve root muscle
Levator Ani & Coccygeus
126
S2-S4 nerve root sensory
Perianal
127
S2-S4 nerve root disorder
Cauda Equina
128
Axillary Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Arm Abduction
Deltoid & Teres Minor
Lateral Arm
Glenohumeral Dislocation
129
Radial Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Wrist/Finger Extension & Thumb Abduction
Wrist/Finger Extensors & Triceps
Dorsal web between thumb and index
Wrist Drop, Crutch Palsy, Erb's Palsy
130
Musculocutaneous Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Elbow Flexion
Biceps, Brachialis, Coracobrachialis
Lateral Forearm
Impingement
131
Median Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Thumb pinch, Opposition of thumb
Wrist & thumb flexors, Thumb abductors, Thenar
Distal Radial hand, 2nd digit
Carpal Tunnel, Pronator Teres, Ape Hand
132
Ulnar Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Abduction of 5th digit & Adduction of Thumb
Finger abductors/adductors & Thumb adductors
Distal Ulnar Hand, 5th digit
Claw Hand
133
Dorsal Scapular Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Elevation & Retraction of Scapula
Rhomboids & Levator Scapula
NO sensory
Flaring of Scapula
134
Long Thoracic Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Protraction of Scapula
Serratus Anterior
NO sensory
Winged Scapula
135
Lateral Femoral Cutaneous Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
No Motor function
No Muscle innervation
Lateral Thigh
Meralgia Paresthetica
136
Saphenous Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
No motor function
No muscle
Anteromedial Knee & Medial Leg
No disorder
137
Obturator Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Hip Adduction
Hip Adductor muscles
Medial Thigh
Impingement
138
Femoral Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Hip Flexion, Knee Extension
Iliopsoas, Quadriceps
Anteromedial Thigh & Leg
Impingement
139
Sciatic Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Flexion of the Knee
Hamstrings
Ant/Post Leg & Sole/Dorsum of Foot
Piriformis Syndrome (15%)
140
Peroneal Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Foot Dorsiflexion, Inversion & Eversion
Tib Anterior, Toe Extensors, Peroneals
Anterior leg & Dorsum of foot
Fibular Head fracture
141
Medial Plantar Nerve:
- Motor function
- Muscle
- Sensory
- Disorder
Toe Flexion
Toe Flexor muscles
NO sensory
Tarsal Tunnel Syndrome
142
List the 10 Peripheral Nerve Entrapments
```
"DR CUMA"
D - Drop Wrist
R - Radial Nerve
C - Claw Hand
U - Ulnar Nerve
M - Median Nerve
A - Ape Hand
```
143
Pain along the sensory distribution of a nerve root
Dermatogenous
144
Pain that originates within a muscle
Myotogenous
145
Pain that arises from structures derived from embryological sclerotomes (joint pain)
Scleratogenous
146
Pain along the course of a dermatome due to irritation of a nerve root
Radicular
147
Pain along scleroderm of origination involving more than one kind of tissue (shared pathway)
Referred
148
Muscle - type of pain
Cramping, spasm, aching, dull
149
Nerve - type of pain
Shooting, radiating, burning
150
Circulation - type of pain
Throbbing, pulsating
151
Bone Cancer - type of pain
Constant, deep, boring, nocturnal, progressive, unremitting
152
Scleratogenous - type of pain
Poorly localized, dull, ache
153
Myofascial - type of pain
Trigger Points
154
Gallbladder referred pain sites
Right Shoulder, Inferior Scapula
155
Pancreas referred pain sites
Spine & T10 level (epigastric)
156
Heart referred pain sites
Left Shoulder & Medial Left arm
157
Intestines referred pain sites
Periumbilical
158
Appendix referred pain sites
Epigastric (early) or RLQ (late)
159
Kidney referred pain sites
Flank pain
160
Ureter referred pain sites
Groin
161
Bladder referred pain sites
Suprapubic area
162
Normal findings include ability for patient to distinguish between sharp and dull sensations with their eyes closed.
Dermatomes
163
Abnormalities for Dermatomes
Anesthesia - no feeling
Hypoesthesia - minimal sense of feeling
Hyperesthesia - increased sense of feeling
164
C4 dermatome
Neck (C7 location)
165
C5 dermatome
Lateral arm shoulder to elbow
166
C6 dermatome
Lateral forearm & 1st two digits
167
C7 dermatome
Middle finger (3rd digit)
168
C8 dermatome
Medial forearm & 4th and 5th digits
169
T1 dermatome
Medial Elbow
170
T2 dermatome
Medial upper arm into axilla
171
T10 dermatome
Waist at bellybutton level
172
T11 dermatome
Waist just below bellybutton
173
T12 dermatome
Above hip down to groin area
174
L1 dermatome
Upper 1/3 of thigh
175
L2 dermatome
Middle 1/3 of thigh
176
L3 dermatome
Lower 1/3 of thigh just above knee
177
L4 dermatome
Medial calf to bottom of foot
178
L5 dermatome
Lateral calf to top of toes
179
S1 dermatome
Lateral foot
180
Ménière's disease is associated with what CN?
VIII. Vestibulocochlear
181
Torticollis aka Wry Neck is associated with which CN?
XI. Spinal Accessory Nerve
182
Paralysis of the arm from dystopia;
LMN Syndrome;
MC affected nerves are Suprascapular, Musculocutaneous, and Axillary
Erb's Palsy
183
Paralysis involving intrinsic muscles of forearm and hand from lower brachial plexus injury.
Klumpke's paralysis
184
Numbness/Pain in outer thigh caused by injury to nerve from thigh to spinal column.
Lateral cutaneous nerve of the thigh
Meralgia Paresthetica
185
Gait abnormality; Common Fibular Nerve; associated with ALS, MS, and Cerebral Palsy.
Nerve roots affected are L4-5
Foot Drop
