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Yr 3 MedEd > Cranial Nerves and Ophthalmology > Flashcards

Cranial Nerves and Ophthalmology Flashcards

1
Q

List 5 differentials for anosmia

A
  • Ageing
  • Traumatic brain injury
  • Alzheimer’s
  • Parkinson’s
  • Tumour
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2
Q

What is the first step in assessing optic acuity (clarity of vision)

A

Use a Snellen chart

  • 6 metres from chart, one eye at a time
  • Record lowest line able to read with 2 or fewer mistakes
  • Acuity is distance of chart as numerator over number of lowest line read as denominator
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3
Q

Give 5 symptoms of conjunctivitis

A
  • Conjunctival hyperaemia
  • Chemosis
  • Crust and discharge
  • “foreign body” sensation
  • Photophobia
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4
Q

Give 4 ways to differentiate between bacterial and viral conjunctivitis.

A

Bacterial: Unilateral, thick discharge. reduced vision, urethritis/ vaginal discharge

Viral: Bilateral, watery discharge, normal vision, signs of viral infection

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5
Q

What type of hypersensitivity is allergic conjunctivitis? What 3 extra symptoms occur with allergic conjunctivitis?

A
  • Type 1 hypersensitivity (IgE), Pollen, dust, chemical scents. Young adults.
  • Itching
  • Sneezing,
  • Red, watery and oedematous eye
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6
Q

Give 5 signs of cataracts

A
  • Painless
  • Clouding of lens
  • Visual impairment and glare
  • Visual halos
  • Reduced red reflex
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7
Q

What is glaucoma?

For an acutely red, painful eye, what must be ruled out?

A
  • Vision loss resulting from optic nerve damage (retinal ganglion cells) and cupping of the optic disc. Normally due to increased intraocular pressure
  • 2nd leading cause of blindness worldwide

Closed angle glaucoma must be ruled out.

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8
Q

Give 4 ways to differentiate open angle and closed angle glaucoma.

A
  • Open angle: bilateral, progressive visual loss, initially asymptomatic, mild nonspecific symptoms. 90% of cases are open angle.
  • Closed angle: unilateral, sudden onset, severely painful, N&V, cloudy cornea, headache, dilated pupil
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9
Q

Give 4 investigative techniques for glaucoma.

A
  • Fundoscopy- may show disc cupping
  • Gonioscope: enables you to look at angle of iris and determine closed or open angle
  • Slit lamp allows closer examination of whole eye.
  • Tonometry measures intra-ocular pressure
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10
Q

Which structures are involved in anterior and posterior uveitis respectively?

A
  • Anterior: iris and ciliary body
  • Posterior: vitreous body, choroid plexus, retina

Complete uveitis is everything.

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11
Q

Differentiate anterior and posterior uveitis by the following:

  • Cause
  • Pain
  • Vision change-
  • Other symptoms
A

Anterior:

  • Autoimmune conditions
  • Painful, ocular hyperaemia
  • Blurry vision
  • Increased lacrimation and photophobia

Posterior:

  • Infective cause
  • Painless
  • Blurry vision
  • Floaters and scotomata
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12
Q

Give two investigations for uveitis.

A
  • Fundoscopy

- Slit lamp

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13
Q

Visual fields- What are the medical terms for the following visual field defects and where is the lesion:

  1. total vision loss in one eye
  2. loss of peripheral vision in both eyes
  3. Loss of half of vision on same side in both eyes
  4. Loss of upper/ lower quarter of vision on same side in both eyes
  5. Loss of half of vision on same side in both eyes apart from the centre.
A
  1. Monocular vision loss- optic nerve
  2. Bitemporal hemianopia- optic chiasm
  3. Contralateral homonymous hemianopia- optic tract
  4. Contralateral superior/ inferior quadrantinopia- optic radiations
  5. Contralateral homonymous hemianopia with macular sparing- occipital lobe
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14
Q

List 2 prechiasmal causes of vision loss.

List 2 chiasmal causes of vision loss.

A
  • Ischaemia: TIA- amaurosis fugax: veil coming down over vision in one eye.
  • Inflammation- MS, temporal arteritis
  • Pituitary tumour, craniopharyngioma (compresses from top, not bottom)
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15
Q

What is neglect syndrome? What is it due to?

A
  • Patients completely ignore left side of their world/ body. Patients only eat food on right side of plate/ shave right side of face.
  • Due to damage to right parietal lobe.
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16
Q

What 4 optic reflexes are conducted in an exam?

A
  • Direct pupillary
  • Consensual pupillary
  • Swinging light
  • Accommodation
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17
Q

Which nerve is lesioned when there is a loss of consensual pupillary light reflex?

Which nerve is lesioned when there is loss of direct pupillary reflex?

A
  • CN III

- CN II

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18
Q

What does the swinging light (relative afferent pupillary defect) test show?

How is it performed.

A
  • Shows if there is a minor defect in afferent pathway of one eye.
  • Swing torch from normal eye to damaged eye rapidly-
  • Pupil in damaged eye appears to dilate as it doesn’t pick up as much light from the torch as a normal eye.
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19
Q

Give 3 symptoms of Horner’s syndrome

A
  • Ptosis
  • Miosis
  • Anhidrosis

Loss of sympathetic stimulation.

20
Q

Give 3 differentials for Horner’s syndrome

A
  • Brainstem tumour: sympathetic supply originates from hypothalamus and passes down brainstem.
  • Pancoast tumour: sympathetic nerve passes along apex of lung.
  • Carotid artery dissection- nerve passes up carotid artery to eyes.
21
Q

Give 3 investigations for the 3 different causes of Horner’s syndrome and when you would suspect each cause.

A
  • CXR: Pancoast tumour- upper limb pain
  • CT head: brainstem tumour
  • MRI/ MR angiography: carotid dissection- ipsilateral face/ neck pain, trauma,
22
Q

What 3 signs would be expected from oculomotor nerve palsy?

A
  • down and out eye
  • Ptosis
  • Mydriasis
23
Q

What is the difference in presentation between medical and surgical CN3 palsy?

A

Pupillary control is dorsal and peripheral part of CN3.

Surgical: Mydriasis first
Medical: down and out pupil first

  • Surgical: compression on pia mater blood supply of nerve. Parasympathetic fibres affected first, which are more superficial in CN3. Mydriasis first.
  • Medical: diabetes/ vasculitis cause CN3 palsy with pupillary sparing. Down and out pupil occurs before pupil dilation.
24
Q

What sign would be seen in trochlear nerve palsy? What is the most common cause?
What is seen in abducens palsy? What is the most common cause?

A

Eye in and up.
- most common cause is trauma. May also result from diabetes/ atherosclerosis/ HTN.
Eye inwards- abducens has long nerve course in brain.
- Most commonly caused by stroke in adults and trauma in children.

25
Q

Which way does the jaw deviate to in trigeminal nerve palsy when patient holds jaw open?

A

Towards the lesioned side: weak master and temporals muscles.

26
Q

Give two reflexes to test trigeminal nerve function.

A
  • Corneal reflex: afferent V1, efferent V2

- Jaw-jerk: afferent V3, efferent motor V.

27
Q

Give 4 actions to test trigeminal nerve.

Which condition may these actions be lost in?

A
  • Blow out cheeks
  • Give big grin showing teeth
  • Screw eyes shut
  • Raise eyebrows

Bell’s palsy

28
Q

Other than idiopathic, give two causes of Bell’s palsy

A
  • Compression of facial nerve in facial canal
  • Inflammation e.g. viral infection: herpes simplex 1 or varicella zoster.

Diabetes is risk factor.

29
Q

What is the medical management for Bell’s palsy?

What is a key complication of Bell’s palsy?

A

Steroids: prednisolone

  • Corneal abrasions- can’t close eyes at night so debris gets in. Corneal damage can be irreversible. Use eye patch to prevent this.
30
Q

What is Ramsay Hunt syndrome and what is it caused by?

A
  • LMN facial nerve palsy due to varicella zoster.
  • Pain is a prominent feature.

Type of Bell’s palsy with more pronounced symptoms.

Should be suspected in over 60s with significant pain.

31
Q

Where can vesicles form in Ramsay Hunt syndrome?

A

Ipsilateral:

  • ear
  • hard palate
  • Anterior two thirds of tongue.
32
Q

Give 1 prominent feature and 2 other possible features of Ramsay Hunt syndrome.

A
  • Pain is prominent feature

- Can include deafness and vertigo, other cranial nerve involvement.

33
Q

Why does forehead sparing occur in upper motor neurone damage to CN 7 (e.g. stroke)?

A
  • CN 7 has double motor nerve innervation from both hemispheres in forehead only
  • If forehead is affected then it is a lower motor neurone lesion
34
Q

Which tuning fork is used for hearing testing?

What are the two types of hearing loss?

A

512 Hz

Conductive vs sensorineural.

35
Q

What is tested by the Weber’s test?

Where is the tuning fork placed?

A
  • Tests sensorineural hearing loss.
    Weber’s lateralises away from the deficit.
  • In conductive hearing loss, sound is louder in the affected side.
36
Q

What is tested in Rinne’s test?

How is it performed?

A
  • Tests conductive hearing loss
  • 512Hz tuning fork placed against mastoid bone and then held 1cm away from ear.
  • Louder in air is positive Rinne’s. Normal
  • Louder on bone is Rinne’s negative, conductive hearing loss as ear is not amplifying sound in ear.
37
Q

Give causes of conductive hearing loss in the following locations:

  • External auditory canal
  • Drum
  • Middle ear
  • Oval window
A

EAC: Wax, foreign body, otitis externa

Drum: perforation; infection/ trauma

Middle ear: acute otitis media, serous otitis media

Oval window: osteosclerosis.

38
Q

Give causes of sensorineural hearing loss for the following:

  • Inflammation (2)
  • Tumour (1)
  • Ototoxic drugs (3)
  • 2 other causes
A
  • Inflammation: meningitis, viral-MMR
  • Tumour: acoustic neuroma. assoc with Neurofibromatosis type 2.
    Drugs:
  • amino glycoside antibiotics- gentamicin, streptomycin.
  • Aspirin (overdose)
  • Loop diuretics

Other:

  • trauma
  • Meniere’s disease
39
Q

What is the inheritance pattern for Neurofibromatosis?

How does Type 1 present?

A
  • Autosomal dominant

Type 1: cafe-au-lait spots, lisch nodules neurofibromas. Short stature

40
Q

How does Neurofibromatosis type 2 present?

A
  • Sensorineural hearing loss
  • Bilateral acoustic neuromas
  • Symptomatic by age 20.

Type 1: 1 body, so affects whole body.
Type 2: 2 ears so only affects ears.

41
Q

What is the triad of Meniere’s disease?

A
  • Sensorineural hearing loss
  • Vertigo
  • Tinnitus
42
Q

What are the afferent and efferent CN of the gag reflex?

What respiratory symptom results from damage to these nerves?

What is sign of CN X damage?

A
  • Afferent IX, efferent X.
  • Bovine cough caused by damage to IX and X.
  • Uvula deviates away from side of lesion.
43
Q

What can be seen in hypoglossal nerve lesion?

How is hypoglossal nerve tested?

A
  • Tongue wasting
  • Tongue fasciculations
  • Tongue deviation toward lesion.
  • Push tongue against inside of cheek to test power.
44
Q

What is Bulbar palsy?

A

Palsy in CN 10, 11, 12 (bulb is medulla oblongata).

45
Q

Give 4 signs of bulbar palsy.

A
  • Absent gag reflex
  • Tongue- wasted, fasciculations
  • Jaw jerk- absent or normal
  • Speech- nasal
46
Q

What is pseudo bulbar palsy?

A

Multiple small lesions in cortex/ brainstem interrupt corticobulbar supply to motor nuclei of CNs.

Issue with UMNs supplying cranial nerves. CN 5 and 7 also affected.

47
Q

Give 5 signs of pseudobulbar palsy

A
  • Gag reflex increased/ normal
  • Tongue- spastic
  • Jaw jerk- increased
  • Speech: monotonous slurred, high-pitched “donald duck”.
  • Emotions labile.

Yr 3 MedEd (31 decks)

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