Cranial nerves

Question 1

What questions do you ask before testing smell?

Answer 1

Have you noticed any changes in your sense of smell?

Have you had a blocked nose?

Question 2

Causes of unilateral anosmia

Answer 2

Head trauma
tumour
nasal polpys

Question 3

Causes of nasal polpys

Answer 3

Allergic rhinitis

CF

Question 4

Causes of bilateral anosmia

Answer 4

Neurodegenerative e.g. parkinsons and alzhiemers disease
URTI
Kallman’s
Tumour

Question 5

Give the name of a nose tumour

Answer 5

Subfrontal meningioma

Question 6

What do you do when you inspect the eye?

Answer 6

Size
Shape
Symmetry

Question 7

What do you call a dliated pupil?

Answer 7

Mydriasis

Question 8

What is another name for exopthalmos?

Answer 8

Proptosis

Question 9

Anisocoria

Answer 9

Assymetrical eyes

Question 10

What’s the mnemonic for testing eyes?

Answer 10

A acuity
F fields
R reflexes
O opthalmoscopy
C colour vision
A attention
B blind spot

Question 11

How do you write up the snellen?

Answer 11

Distance from chart over lowest line number read + how many letters in the line you read e.g. if 2

e.g. 6/4

Question 12

What happens if the patient can’t see anything on the snellen chart?

Answer 12

Reduce distance from 3m to 1m

If still not seen, ask pt to

Question 13

Wat may cause decreased visual acuity?

Answer 13

Myopia - near sightedness
Hyperopia - long sightedness
Presbyopia 
Astigmatism 
Ambylopia - lazy eye 
Cataracts 
Age related macular degenration
Optic neuritis
Lesions

Question 14

How far must you be to do visual fields?

Answer 14

1m

Question 15

What is the

Answer 15

homonymous hemianopia

Question 16

what is the quarter vision called?

Answer 16

superior homonymous h

Question 17

What are the two types of reflexes for the eye?

Answer 17

pupillary

accommodation reflex

Question 18

What do you ask about after doing these

Answer 18

double vision or pain?

Question 19

What would cause constriction of the eye? Myosis

Answer 19

Opiod overdose

Horners (sympathetic is affected)

Question 20

What would cause dilation of the eye? Mydriasis

Answer 20

3 nerve palsy

Tropicamide

Question 21

What do you do to test for attention?

Answer 21

Put both fingers out and ask which one wiggles

Question 22

How do you test the blind spot?

Answer 22

Use the red pin

Question 23

Which of the AFROCAB would you offer to do?

Answer 23

Acuity
Opthalmoscopy
Colour vision
Blindspot

Question 24

How would you test for CN 3, 4 and 6 and what would you say?

Answer 24

Exaggerated H test (go all our, extend your arms)

Keep your head in the same position and only move your eyes

Question 25

When you go up, what must you do?

Answer 25

Tilt finger side ways when going up and down in the H test

Question 26

When you're testing the eye, looking at the eye coming inwards (down and also up), which muscles are involved?

Answer 26

Oblique

Question 27

Where does the eye look in fourth nerve palsy?

Answer 27

Eye looks up and in

Question 28

Where does the eye look in sixth nerve palsy?

Answer 28

Eye looks medially

Question 29

What might cause 3rd nerve palsy?

Answer 29

Diabetes Trauma Surgery Tumour

Question 30

Which eye conditions might come up in the OSCE?

Answer 30

Bitemporal homonymous Optic neuritis

Question 31

How do you test cranial nerve 5?

Answer 31

``` 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 ```

Question 32

How would you test the motor and sensory

Answer 32

``` Raise eyebrows Screw up eyes Puff out cheeks Show gums (smile) Any change in taste? Troubled by loud noises? ```

Question 33

Differentials for

Answer 33

Ramsey Hunt - shingles

Question 34

If forehead does wrinkle, what does it suggest?

Answer 34

Upper motor neuron

Question 35

If forehead is not spared, what do we think?

Answer 35

Lower motor neuron

Question 36

How do you test for the sensory and motor

Answer 36

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 ```

Question 37

Look up teh rest of teh conditions which cause ear problems

Answer 37

???????????

Question 38

If the ear pain lateralises to the right, what can it be?

Answer 38

Right conductive, or left sensorineural

Question 39

Pelvic pain plus hearing loss

Answer 39

Bone remodelling disorder which can cause ear problems

Question 40

How do you test for CN 10?

Answer 40

Uvula | sensory = 9

Question 41

How do you test CN 12?

Answer 41

Ask pt to move tongue side to side

Question 42

UMN lesion

Answer 42

corticobulbar supply is affected

Question 43

What are the symptoms of pseudobulbar palsy?

Answer 43

Spasticity Hyperreflexia Expressionless face Donald duck high pitched speech

Question 44

Bulbar palsy is upper or lower MN?

Answer 44

Lower motor neuron lesion

Question 45

Symptoms of bulbar palsy

Answer 45

``` Hypo-gag and jaw jerk reflexia Fasciculations Wasting Normal fascial expressions Nasal speech ```

Question 46

Is pseudobulbar due to an upper motor or lower motor lesion? Which supply is affected?

Answer 46

corticobulbar supply is affected UMN lesion

Question 47

Which cranial nerves are affected in pseudobulbar palsy?

Answer 47

5, 7, 9, 10, 11, 12

Question 48

What can cause lower motor neuron problems?

Answer 48

Guillian barre Myasthenia gravis Motor neuron disease