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Patient Assessment Methods I > Cranial Nerves VII-XII > Flashcards

Cranial Nerves VII-XII Flashcards

1
Q

How is the corneal reflex tested?
What is a present finding and what would it indicate?

A

Use a clean pointed cotton ball, have the patient look up and away, and touch the cornea of the eye near the iris
Present finding is absence of the blink reflex indicating a CN VII lesion

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2
Q

The corneal reflex arc is comprised of ___ (sensory) and ___ (motor)

A

CN V trigeminal sensory and CN VII facial motor

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3
Q

CN VII facial carries sensory for taste on the ___ of the tongue

A

anterior 2/3rds

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4
Q

CN VII facial provides motor innervation to which muscles?

A

Facial muscles (NOT muscles of mastication)

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5
Q

When evaluating CN VII facial, what is asked of the patient?

A

Perform the following facial expressions:

  • Raise eyebrows
  • Close eyes
  • Wrinkle nose
  • Smile
  • Frown
  • Puff cheeks
  • Pucker/whistle

(positive finding is asymmetry or inability)

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6
Q

What are some symptoms of acoustic neuroma?

A
  • Hearing loss
  • Loss of balance
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7
Q

The superior aspect of CN VII nucleus receives ___ innervation

A

bilateral

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8
Q

What are the five branches of CN VII facial?

A
  • Temporal branch
  • Zygomatic branch
  • Buccal branch
  • Marginal mandibular branch
  • Cervical branch
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9
Q

What are the two main functions of CN VIII vestibulocochlear?

A
  • Acoustic division (cochlear branch) carries sensory information for hearing
  • Vestibular branch carries sensory information from the semicircular canals to the cerebellum for balance and orientation
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10
Q

CN VIII and CN VII share passage through the…

A

internal auditory canal

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11
Q

How is Weber test performed?

A
  • Place vibrating 512 Hz tuning fork on top of the head
  • Orient it so the flat part of the tines face forward like bunny ears
  • Ask the patient if the sounds lateralizes to one ear more than the other
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12
Q

What is a positive finding in Weber test? What do these indicate?

A
  • Air conduction loss on the louder side (something blocking air conduction)
  • Nerve conduction loss on the quieter side (acoustic division of CN VIII lesion or injury to sensory organ)
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13
Q

How is Rinne test performed?

A
  • Place a vibrating 512 Hz tuning fork on the mastoid process (bone conduction)
  • Orient it so the flat part of the prongs face forward
  • Time how long the patient can hear the sound
  • When patient cannot hear it anymore, hold the tuning fork so the side is pointed to the ear (air conduction)
  • Time how long the patient can hear the sound
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14
Q

What are positive findings of Rinne test? What do these indicate?

A
  • Air conduction is not at least equal to bone on mastoid
  • One side’s time is less than the other

Something in the ear may be blocking air conduction or acoustic division of CN VIII lesion (or injury to sensory organ)

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15
Q

What are the neurologic evaluations we use for CN VIII cochlear division?

A

Weber and Rinne tests

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16
Q

What are the neurologic evaluations we use for CN VIII vestibular division?

A
  • Mittlemeyer marching
  • Babinski-Weil
  • Swivel chair test
17
Q

How is Mittlemeyer marching performed for CN VIII?
What is a positive finding and what would it indicate?

A

Patient has shoes and socks off, examiner stays close to the patient to ensure safety, patient marches in place then closes eyes and continues to march for a minimum of 10 seconds
Positive finding is drifting, particularly in rotation; the patient will rotate towards the side of vestibular division of CN VIII lesion

18
Q

How is Babinski-Weil performed?
What is a positive finding for CN VIII vestibular division dysfunction vs for cerebellum issues?

A

Patient is barefoot and walks forward with normal gait at least five to seven steps, then backwards, with eyes open and examiner nearby
CN VIII vestibular lesion (or vestibulocochlear apparatus): lean toward dysfunctional side walking forwards and toward the opposite while walking backwards
Cerebellar lesion: lean toward the side of the lesion walking forward and backward

19
Q

How is the swivel chair test performed?

A

Patient is seated on a swivel chair and procedure is explained:
1. Patient turns their head left and right with shoulders still, 4 to 6 times
2. If patient is dizzy, have them sit still for up to 30 seconds until it subsides
3. While holding the patient’s head still, have them turn their body left and right using their feet and legs

20
Q

What is a positive finding for a patient with cervical proprioceptive dysfunction in the swivel chair test?

A

Symptoms of dizziness occur in both parts of the test

21
Q

What is a positive finding for a patient with vestibular dysfunction in the swivel chair test?

A

Symptoms will not occur with the head immobilized

22
Q

Which cranial nerve is responsible for taste from the posterior 1/3 of tongue?

A

CN IX glossopharyngeal

23
Q

For the palatal reflex and gag reflex, CN ___ is sensory and CN ___ is motor

A

CN IX is sensory and CN X is motor

24
Q

What may be evaluated when interested in CN IX and CN X?

A
  • Phonation
  • Palatal reflex
  • Gag reflex
  • Taste of posterior 1/3rd of tongue
25
Q

What are the types of dysarthria and what issues are they associated with?

A

Slurred speech: slow speech indicating cerebellum (fastigial nuclei) issue
Difficulty with articulation: difficulty pronouncing words indicating CN XII hypoglossal issue
Dysphonia: hoarseness, weakness, or loss of voice indicating CN IX and or CN X issue

26
Q

How is palatal reflex evaluated?
What is a present finding and what would it indicate?

A

Patient says “ahhh” and soft palate should rise equally on both sides
Present finding is asymmetry of elevation and uvula deviation away from the weak side indicating CN IX (sensory) or CN X (motor) issue

27
Q

How is gag reflex evaluated?
What is an absent reflex and what would it indicate?

A

Using a tongue blade, contact the posterior pharynx (each side) and observe elevation of the soft pallet
Absent reflex is asymmetry or failure of soft pallet elevation indicating an upper motor neuron lesion (CN IX sensory and CN X motor)

28
Q

Alteration or absence of taste in the posterior 1/3 of the tongue indicates…

A

CN IX glossopharyngeal nerve lesion (only)

29
Q

CN XI accessory supplies motor innervation to which muscles?

A

Sternocleidomastoid muscles and upper trapezius muscle

30
Q

How is the sternocleidomastoid muscle assessed for CN XI?

A

Two parts:
1. Test lateral flexion of the cervical spine against resistance towards the side being tested (laterally flex head to left against resistance for left SCM)
2. Test resisted rotation away from the side being tested (patient turns right against resistance for left SCM)

31
Q

What is a positive finding when assessing the sternocleidomastoid muscle?
What would this indicate?

A

Weakness (can be graded on a scale out of 5) indicating CN XI accessory lesion or muscle injury

32
Q

How is the upper trapezius muscle assessed for CN XI?
What is a positive finding and what would that indicate?

A

Stabilize the patient’s head on the side being tested, ask patient to elevate the shoulder (shrug) while examiner pushes downward assessing for strength
Positive finding is weakness (graded out of 5) indicating CN XI accessory lesion or muscle injury

33
Q

CN XI accessory roots enter through the ___, join the primary fibers, and exit through the ___

A

enter through the foramen magnum, join the primary fibers, and exit through the jugular foramen

34
Q

Biting the tongue can be CN ___ because it controls the action of the tongue, or CN __ because it innervates the muscles of mastication

A

can be CN XII because it controls the action of the tongue, or CN V because it innervates the muscles of mastication

35
Q

CN XII hypoglossal motor nerve exits the skull through the…

A

hypoglossal canal

36
Q

How is cranial nerve XII hypoglossal evaluated?

A
  • Tongue protrusion
  • Tongue strength (tongue in cheek)
37
Q

How is tongue protrusion used to evaluate CN XII hypoglossal?

A

Examiner looks for deviation
Positive finding of the tongue towards the side of weakness indicating CN XII lesion or muscle injury to the tongue

38
Q

How is tongue strength used to evaluate CN XII hypoglossal?

A

Patient pushes their tongue into the cheek, examiner then pushes against the patient’s cheek to assess for relative strength and repeated on the opposite side
Positive finding is weakness of the ability of the tongue to push against pressure applied to the cheek; the weakness will be evident on the opposite side of the lesion

Patient Assessment Methods I (22 decks)

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