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examinations > Cranial Nerves examination > Flashcards

Cranial Nerves examination Flashcards

1
Q

Where is the most likely place of lesion for a RAPD (relative afferent pupillary defect)

A

lesion of the optic nerve (between the retina and the optic chiasm

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2
Q

Both pupils constrict to light regardless of which pupil is illuminated. In RADP however, the … is damaged meaning whatever light the dominant eye is exposed to determines both pupil size.

A

CN 2 Optic nerve

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3
Q

How does RAPD manifest itself?

A

inappropriate pupillary dilation with light shining on.

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4
Q

How would a CN 3 lesion manifest itself? (3)

A

Ptosis
Dilated pupil
Eye out and downwards pointing

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5
Q

The … muscle is responsible for ptosis and it is innervated by CN …

A

levator palpebrae superioris

3

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6
Q

CN3 (via Edinger-Westphal–>ciliary ganglion; parasympathetic) controls accomodation via … muscles and pupillary constriction via … muscle.

A

Ciliary muscles

Sphincter pupillae

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7
Q

how would a trochlear nerve lesion present

A

Diplopia on looking down and in.

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8
Q

How do you remember the muscles innervated by CN4 and CN6

A

SO4LR6

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9
Q

CN3 lesion presents how

A

Horizontal diplopia on looking outwards

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10
Q

Horizontal nystagmus indicates … lesion

A

vestibular

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11
Q

Nystagmus can be normal in which 2 circumstances

A

2 or less oscillations

at the extremes of gaze

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12
Q

Acute horizontal nystagmus is present when pointed towards or away from the lesion??

A

Away

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13
Q

Chronic vestibular horizontal nystagumus is present when the eyes point…

A

Towards the lesion

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14
Q

Cerebellar lesion nystagmus will present with uni or bilateral lesion

A

Unilateral lesion

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15
Q

Cerebellar lesions present with nystagmus towards/away from affected side

A

Towards

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16
Q

How would Foramen Magnum lesions present ocularly

A

Downbeat nystagmus

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17
Q

Upbeat nystagmus is indicative of lesions of (2)

A

Midbrain

Base of 4th ventricle

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18
Q

What may also be present if ocular problems are present with tinnitus or deafness

A

CN 8 lesion (a peripheral cause)

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19
Q

How would you check pterygoids (CN5)

A

Opening jaw against resistance (jaw deviates to weak side)

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20
Q

how would you check masseters

A

Clench (feel for mass)

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21
Q

CN7 UMN lesions are represents in which 3rds of the face

A

The lower 2/3s on the contralateral side

22
Q

What is the result of the forehead having bilateral representation in the brain?

A

UMNL are only represented in the lower 2/3s of the face. (unless bilateral identical lesions - Low % chance!!)

23
Q

IN CN7 LMN lesions what parts of the face will be affected

A

Ipsilateral full 3/3s of face.

24
Q

Describe Bell’s Sign

A

upgaze on attempted eye closure

25
Q

When would you see bell’s sign

A

Facial nerve palsy (e.g. Bells)

26
Q

What 2 non-facial questions could you ask to elucidate any CN7 palsys

A

Troubled by loud noises

noticed any change in taste

27
Q

Why might a patient with a CN7 palsy have noticed a change in taste.

A

The chorda tymapani (a branch of 7) supplies the anterior 2/3s of tongue

28
Q

Why might a patient with a CN7 palsy be troubled by loud noises

A

Prevents excessive movement of stapes. Reduced amplitude, dampens noise.

29
Q

What is the mneumonic to remember Rinnes test.

A

SNAC-RIP

30
Q

In what circumstances would air conduction>bone conduction (2)

A

Normal

Sensorineural hearing loss (SNHL)

31
Q

In severe sensorineural hearing loss bone conduction is … than air conduction. Outline the pathophysiology.

A

>

Other cochlea picks up sound via conduction

32
Q

If sound is similar in both ears when performing Webers test what can this mean (2)

A

Normal

Bilateral SNHL

33
Q

In conductive hearing loss on which side would the sound localise during Webers

A

Affected (because the ambient noise in the room is masked so it sounds louder)

34
Q

In SNHL hearing loss on which side would the sound localise during Webers

A

Contralateral

35
Q

Vagus nerve lesions cause the … to be pulled … from the side of the lesion

A

palate (look at uvula)

away

36
Q

The tongue is innervated by CN… and deviates …. the side of the palsy

A

12

Towards

37
Q

What are the 3 ∆∆ of bilateral ptsosis

A

Myasthenia gravis
Myotonic dystrophy
congenital

38
Q

What are the 3 ∆∆of unilateral ptosis

A

Horners syndrome
Congenital
CN 3 palsy

39
Q

What cranial nerves can Pagets disease of the bone affect (3)

A

V
VII
VIII

40
Q

What is the most common CN to be affected in Pagets

A

8

50% get hearing loss

41
Q

Which 4 cranial nerves pass along the lateral wall of the cavernous sinus

A

III
IV
V (V1 and V2 only)

42
Q

Which CN runs with the internal carotid artery through the cavernous sinus centre

A

Abducens

43
Q

What would be the motor nerves affected in a cavernous sinus thrombosis.

A

III
IV
VI*

*most common

44
Q

How might a cavernous sinus thrombosis present in sensory terms?

A

V1 and V2 pain (most frequently ophthalmic)

45
Q

Which reflex may be lost in a cavernous sinus thrombosis

A

Corneal reflex

46
Q

A cavernous sinus thrombosis may a present with what general clinical signs on top of motor and sensory signs (3)

A

Proptosis
peri-orbital oedema
headache

47
Q

Syringobulbia: what would be the signs/symptoms you’d expect in VIII affection

A

Vertigo/nystagmus

48
Q

Syringobulbia: what would be the signs/symptoms you’d expect in V affection

A

pain or sensory loss

49
Q

What CN a part of a ‘Bulbar Palsy’

A

9,10,11,12

50
Q

In syringobulbia which CN nerve is specifically spared

A

7

examinations (9 decks)

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