Cranial nerves and cerebellar exam

Question 1

What cranial nerve(s) are involved in the corneal reflex?

Answer 1

Trigeminal and Facial

Question 2

What cranial nerve (s)are involved in the pupillary light reflex?

Answer 2

Optic (CN II) and Occulomotor (CN III)

Question 3

What cranial nerve is affected by Bell’s Palsy?

Answer 3

Facial nerve

Question 4

What cranial nerve would primarily be involved in a patient presenting with a hoarse voice?

Answer 4

Vagus nerve

Question 5

What cranial nerve receives taste sensory information from the posterior third of the tongue?

Answer 5

Glossopharyngeal

Question 6

What three arteries supply the cerebellum?

Answer 6

PICA, AICA and SCA

Question 7

What is the primary purpose of the rapid Alternating Movements (RAM) test

Answer 7

testing dysdiadochokinesia

Question 8

What type of information does the spinocerebellar pathway carry?

Answer 8

proprioception

Question 9

where is the motor planning and coordination information from the cerebellum sent for execution?

Answer 9

Basal ganglia

Question 10

how do you establish the field of vision in the cranial nerve II test?

Answer 10

ask the patient to cover one eye, you cover the opposite eye; stretch fingers to the most lateral; move two fingers as you bring your hand diagonally down from the side and all 4 corners to the center; bring fingers from behind the head to check peripheral vision.

Question 11

what muscles are controlled by CN III?

Answer 11

4 of the 6 extraocular muscles and levator palpebrae muscle

Question 12

how do you test CN III

Answer 12

“keep eyes on my finger”; move it towards the nose, testing convergence; test all other movements by going left then right up 10 cm down 10 cm check that both eyes move in unison look for nystagmus at end range- observe for lid lag and shine torch in one eye briefly, look for constriction of the pupil, uncover eye, see if both pupils constrict

Question 13

CN III controls what functions of the eye?

Answer 13

pupillary constriction, extraocular eye muscles, and eyelid muscles.

Question 14

what are the three areas of the face provided with cutaneous sensation by CN V?

Answer 14

ophthalmic, maxillary, mandibular

Question 15

how do you test the motor functions of C N V?

Answer 15

inspect for muscle wasting; patient to clench teeth, then palpate masseters for tone and have patient open jaw against resistance.

Question 16

Dysfunction of the abducens nerve will show as…?

Answer 16

affected eye deviates to the center, unable to look laterally.

Question 17

Test the Facial nerve.

Answer 17

ask the patient to raise their eyebrows, smile widely, tightly shut their eyes, and resist opening by the clinician. blow out cheeks with mouth closed and resist pushing on the cheeks

Question 18

what is the Weber test?

Answer 18

test for lateralization of hearing. nerve deafness causes the sound to be heard better in the normal ear, but with conduction deafness, the sound is heard better in the abnormal ear. Place a vibrating t-fork on the center of the skull. if the sound is heard louder in the right ear, the left ear has nerve deafness or the right ear has conduction deafness… use the Rinne test to confirm which.

Question 19

what is the Rinne test?

Answer 19

compares air and bone conduction. Place the vibrating t-fork on the mastoid process. When sound can no longer be heard, move the fork close to the auditory canal and it will be heard again.

Question 20

how do you test the glossopharyngeal nerve?

Answer 20

check for the gag reflex. Failure indicates dysfunction in CN IX

Question 21

what functions does the Vagus nerve control?

Answer 21

swallowing, speech, and supply to thoracic & abdominal viscera (parasympathetic)

Question 22

how do you test the accessory nerve?

Answer 22

patient to shrug shoulders against pressure, and assess for symmetry. Test the strength of SCM by having the patient turn their head against resistance.

Question 23

how do you test CN XII?

Answer 23

ask the patient to put out their tongue. look for deviation (same side as lesion) involuntary movement, wasting. Test strength by asking the patient to press the tongue into the inside of the cheek against resistance, then assess strength symmetry.

Question 24

what does the A of DANISH stand for and how is it tested?

Answer 24

Ataxia- unsteady gait. this is tested by having the patient walk a straight line for several meters, watching for coordination and balance problems. Have the patient walk heel-to-toe to show ataxia

Question 25

What is Rhomberg’s test and what is it used for?

Answer 25

the patient stands with feet together arms at sides and eyes closed. Observation for unsteadiness swaying, and loss of balance over 10-15 seconds. this is a test of proprioception rather than cerebellar dysfunction.

Question 26

What does the S of dANISH stand for?

Answer 26

Speech slurring

Question 27

What is nystagmus?

Answer 27

condition in which eyes make repetitive uncontrolled movements

Question 28

what are saccades?

Answer 28

Saccades are rapid, ballistic movements of the eyes that abruptly change the point of fixation

Question 29

how do you Assess eye-hand coordination?

Answer 29

have the patient touch therapist’s fingertip, the nose, then the fingertip… move the fingertip, and repeat the sequence.

Question 30

what is the rebound test?

Answer 30

have the patient extend their arms flexed at the shoulder to 90 degrees. press down on the arm but instill that the patient is not to move the arm. the patient has their eyes closed. Release pressure suddenly and observe if the arm continues to move upward abnormally.

Question 31

what is the H in DANISH?

Answer 31

Hypertonia, inspect muscles and ease of movement of limbs.

Question 32

how will cerebellar dysfunction affect reflexes?

Answer 32

pendular movements of limbs… they will continue to swing

Question 33

what is alexia? agraphia? Ataxia?

Answer 33

Alexia is lexia is a rare condition in which reading comprehension is nonexistent or significantly limited due to brain injury, damage, or trauma. It can be associated with other forms of neurological deficits and is often associated with agraphia, the inability to write. This condition is most commonly seen following cerebrovascular accidents.
Agraphia is inability to write letters, symbols, words, or sentences, resulting from damage to various parts of the brain
Ataxia means without coordination. People with ataxia lose muscle control in their arms and legs. This may lead to a lack of balance, coordination, and trouble walking.

Question 34

what is hemiplegia and hemiparesis?

Answer 34

hemiplegia is Partial or total paralysis in one half of the body
Hemiparesis is Weakness in half of the body. This may manifest in multiple ways, such as a loss of motor
control, inability to feel one side of the body or general sensations of weakness

Question 35

what are the symptoms of posterior cerebral artery stroke syndrome?

Answer 35

generalized headache; dizziness and confusion; contralateral homonymous hemiopia (half vision field lost); contralateral sensory deficit alexia without agraphia

Question 36

what are the symptoms of an anterior cerebral artery stroke?

Answer 36

personality changes. decreased ability in planning & movements; hemiparasthesis and hemiparesis contralateral lower limb; speech abnormalities; micturition dysfunction.

Question 37

the vertebral artery branches are the?

Answer 37

Anterior Spinal artery
Posterior Inferior Cerebellar Artery

Question 38

The rule of Fours… 4 CNs in each section of the brainstem, four CNs are motor nuclei and are found in the midline… which four?

Answer 38

Oculomotor III, Trochlear IV, Abducens IV, HypoGlossal XII

Question 39

Does the Wallenberg syndrome occur in the …?

Answer 39

a stroke occurring in the Medulla