Cranial nerves Flashcards
What questions do you ask before testing smell?
Have you noticed any changes in your sense of smell?
Have you had a blocked nose?
Causes of unilateral anosmia
Head trauma
tumour
nasal polpys
Causes of nasal polpys
Allergic rhinitis
CF
Causes of bilateral anosmia
Neurodegenerative e.g. parkinsons and alzhiemers disease
URTI
Kallman’s
Tumour
Give the name of a nose tumour
Subfrontal meningioma
What do you do when you inspect the eye?
Size
Shape
Symmetry
What do you call a dliated pupil?
Mydriasis
What is another name for exopthalmos?
Proptosis
Anisocoria
Assymetrical eyes
What’s the mnemonic for testing eyes?
A acuity F fields R reflexes O opthalmoscopy C colour vision A attention B blind spot
How do you write up the snellen?
Distance from chart over lowest line number read + how many letters in the line you read e.g. if 2
e.g. 6/4
What happens if the patient can’t see anything on the snellen chart?
Reduce distance from 3m to 1m
If still not seen, ask pt to
Wat may cause decreased visual acuity?
Myopia - near sightedness Hyperopia - long sightedness Presbyopia Astigmatism Ambylopia - lazy eye Cataracts Age related macular degenration Optic neuritis Lesions
How far must you be to do visual fields?
1m
What is the
homonymous hemianopia
what is the quarter vision called?
superior homonymous h
What are the two types of reflexes for the eye?
pupillary
accommodation reflex
What do you ask about after doing these
double vision or pain?
What would cause constriction of the eye? Myosis
Opiod overdose
Horners (sympathetic is affected)
What would cause dilation of the eye? Mydriasis
3 nerve palsy
Tropicamide
What do you do to test for attention?
Put both fingers out and ask which one wiggles
How do you test the blind spot?
Use the red pin
Which of the AFROCAB would you offer to do?
Acuity
Opthalmoscopy
Colour vision
Blindspot
How would you test for CN 3, 4 and 6 and what would you say?
Exaggerated H test (go all our, extend your arms)
Keep your head in the same position and only move your eyes
When you go up, what must you do?
Tilt finger side ways when going up and down in the H test
When you’re testing the eye, looking at the eye coming inwards (down and also up), which muscles are involved?
Oblique
Where does the eye look in fourth nerve palsy?
Eye looks up and in
Where does the eye look in sixth nerve palsy?
Eye looks medially
What might cause 3rd nerve palsy?
Diabetes
Trauma
Surgery
Tumour
Which eye conditions might come up in the OSCE?
Bitemporal
homonymous
Optic neuritis
How do you test cranial nerve 5?
Fine touch, sensation Pinprick Assess temporalis and masseter Try to open jaw against reflex Jaw jerk reflex (tap against the jaw like a knee reflex) Corneal
How would you test the motor and sensory
Raise eyebrows Screw up eyes Puff out cheeks Show gums (smile) Any change in taste? Troubled by loud noises?
Differentials for
Ramsey Hunt - shingles
If forehead does wrinkle, what does it suggest?
Upper motor neuron
If forehead is not spared, what do we think?
Lower motor neuron
How do you test for the sensory and motor
Lower motor neuron facial nerve
Right sided facial weakness and numbness Incomplete eye closure Loss of brow movement Loss of smile and lip pucker Mouth drooping
Look up teh rest of teh conditions which cause ear problems
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If the ear pain lateralises to the right, what can it be?
Right conductive, or left sensorineural
Pelvic pain plus hearing loss
Bone remodelling disorder which can cause ear problems
How do you test for CN 10?
Uvula
sensory = 9
How do you test CN 12?
Ask pt to move tongue side to side
UMN lesion
corticobulbar supply is affected
What are the symptoms of pseudobulbar palsy?
Spasticity
Hyperreflexia
Expressionless face
Donald duck high pitched speech
Bulbar palsy is upper or lower MN?
Lower motor neuron lesion
Symptoms of bulbar palsy
Hypo-gag and jaw jerk reflexia Fasciculations Wasting Normal fascial expressions Nasal speech
Is pseudobulbar due to an upper motor or lower motor lesion? Which supply is affected?
corticobulbar supply is affected
UMN lesion
Which cranial nerves are affected in pseudobulbar palsy?
5, 7, 9, 10, 11, 12
What can cause lower motor neuron problems?
Guillian barre
Myasthenia gravis
Motor neuron disease
