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EM Cervicals > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

How is CN 1 tested?

A

One would have the patient close one naris at a time and have them exhale, then inhale deeply.

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2
Q

When testing CN 1, what two things are you as an examiner looking for?

A
  1. Identify some type of scent

2. Specifically ID the scent

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3
Q

What should not be used as an odorant for the patient? (CN 1)

A

Alcohol or Mint, these will cool the mucosa and give false responses

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4
Q

What are the three basic examples of scents to use? (CN 1)

A

Coffee
Cinnamon
Cloves

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5
Q

What two nerves never become peripheral nerves?

A

CN 1 (olfactory) and CN 2 (optic)

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6
Q

When smelling an odorant, where does the information go and get processed?

A

Ipsilateral cortex (telencephalon)

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7
Q

What is the absence of the sense of smell?

A

Anosmia

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8
Q

What is the diminished olfactory sensitivity?

A

Hyposmia

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9
Q

What is considered an alteration or distortion of smell?

A

Dysosmia

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10
Q

What is the distortion in the perception of an odorant? (aka. “this smells differently than I remember it”)

A

Parosmia

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11
Q

What is the perception that an odor is present, when there actually is nothing there?

A

Phantosmia

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12
Q

What is termed as the inability to classify, contrast, or ID odor sensations verbally, even though one can differentiate between smells…

A

Agnosia

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13
Q

What is the cause of agnosia?

A

Cortical abnormality

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14
Q

When an individual loses their sense of smell, what is their next most likely complaint?

A

Loss of taste

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15
Q

Where are the odor receptors located in the nose?

A

Sphenopalatine recess

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16
Q

Thinking about loss of smell, where does the GREATEST loss of smell come from? [aka when someone loses their smell, within what structure(s) is it normally lost within?]

A

Transport within the nose is severely decreased (major cause of loss of smell)

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17
Q

Where type of chart does the physician test distant visual acuity on?

A

Snellen Chart

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18
Q

What type of chart does the physician test near visual acuity on?

A

Rosenbaum Chart

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19
Q

How far away does the patient have to stand when testing distant visual acuity?

A

20 ft away

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20
Q

How is the patient tested on the Snellen chart? What are the steps?

A
  1. Read smallest line pt. can while covering one eye reading RIGHT to LEFT
  2. Pt. will then cover the other eye and read the smallest line they can from RIGHT to LEFT
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21
Q

What distance is the Rosenbaum chart held from the patient?

A

14 inches (usually about a forearm length away from the patients face)

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22
Q

When doing vision tests, and the patient is wearing corrective lenses, do they first use the lenses or the naked eye?

A

Test without corrective lenses first!

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23
Q

What line on the Snellen chart is the pt. considered legally bling if they cannot read it?

A

Top line

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24
Q

There are optic elements when dealing with an eye problem of Diagnostic Dilema, what are the 5 elements?

A
  1. Cornea
  2. Tear film
  3. Lens
  4. Vitreous
  5. Retina
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25
Q

There is also a pathway lesion that can be associated with Diagnostic Delema, what is this lesion?

A

Lesion in the OPTIC NERVE between the EYE and the VISUAL CORTEX

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26
Q

Where is the lesion in a Left Anopia?

A
  • Lesion in L Optic N.
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27
Q

What are two pathologies/structural anomalies that can cause a L anopia? [Note: these can also cause a R anopia but must be on the R SIDE]

A
  • Meningioma

- Orbital tumor

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28
Q

What Brodmann area is considered the primary visual cortex?

A

Area 17

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29
Q

Where would the lesion be, if a patient had a Left Nasal Hemianopia?

A

The Left Lateral Chiasm [left side of the optic chiasm]

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30
Q

If there was a pathology in the left lateral optic chiasm, what would it be to cause this deficit? [L Nasal Hemianopia]

A

An aneurysm of the internal carotid a.

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31
Q

Where would the lesion be in a bitemporal hemianopua?

A

In the Optic Chiasm, BUT ONLY AFFECTING THE DECUSSATING FIBERS [very medial]

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32
Q

What pathology would be responsible for causing a bitemporal hemianopia?

A
  • Pituitary tumor

- aka. CRANIOPHARYNGEOMA, Rathke’s pouch tumor, hypophysial duct tumor

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33
Q

If a patient is suffering from a Left Homonymous Hemianopia, where is the lesion?

A

In the R Optic Tract [The lesion will always be opposite to the field of vision lost]

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34
Q

If a patient is suffering from a Right Homonymous Hemianopia, what pathology could cause this visual field loss?

A

Tumor [NOTE: not confined to one side, can also occur in the L optic tract]

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35
Q

What events will transpire in the Lateral Geniculate Nucleus of the Thalamus?

A

This is where the superior and inferior fields of view are differentiated.

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36
Q

The fibers that carry visual information from the Lateral Geniculate Nucleus end up in which parts of the brain?

A
  • Superior visual field goes through the TEMPORAL LOBE

- Inferior visual field goes through the PARIETAL LOBE

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37
Q

If a patient is suffering from a Right Homonomous Quadrantonopia, where is the lesion?

A

Lesion is in the Left Temporal Lobe [Meyers loop is located here and is most likely what is being affected; optic radiation]

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38
Q

Where would one see a lesion if the patient suffers from a Right Inferior Homonymous Quadrantanopia?

A

Lesion is in the Left Parietal Lobe [parietal optic radiation]

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39
Q

What is central sparing [aka macular sparing], when referring to visual loss?

A

Central sparing refers to a lesion that is closed to the visual cortex. The percentage of fibers going to this area from the superior/inferior visual fields are much increased from macular vision. This occurs as a result of the lesion happening where there are a lot of fibers meeting in the occipital lobe so it makes it “harder to lesion everything” - thus living up to it’s name of central or macular sparing…

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40
Q

When testing the patient for pupil size, accomodation, direct and consensual response to light, what cranial nerve is the physician elliciting?

A

CN 3 Oculomotor

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41
Q

When the physician measures pupil size, a pupil that is <2 mm in diameter is considered what kind of pupil? Coupled with this pupil size, what autonomic nervous systems are increased/decreased?

A
  • Mitotic Pupil
  • Increased Parasympathetic
  • Decreased Sympathetic
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42
Q

When the physician measures pupil size in a pt. who has a pupil that is >6 mm in diameter it is said that the pt. has what kind of pupil? What autonomic nervous systems are increased/decreased in association with the pupil size?

A
  • Mydriatic pupil
  • Decreased Parasympathetic
  • Increased Sympathetic
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43
Q

Which nucleus provides parasympathetic innervation to the eye? [autonomic functions only, oculomotor nucleus provides motor innervation for this CN]

A

Edinger Westphal Nucleus

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44
Q

Where do the sympathetics to the eye come from? [Obviously T1-L2, but specifically on what do they enter the skull?]

A

Carotid Plexus

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45
Q

How would a physician test for accomodation, and what is the physician looking for? [hint: 3 things]

A
  • The physician would have the patient look at a distant object, then at a test object directly in front of them (4-6”) from the bridge of the nose
  • [Doc is observing for CONVERGENCE, CONSTRICTION, and NEAR VISUAL ACUITY]
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46
Q

How does one test for near vision? [hint: 2 things]

A
  • Convergence
  • Constriction
    [NV - CC]
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47
Q

What can an abnormal pupillary reflex (either fast or slow) lead to?

A

Decreased visual acuity

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48
Q

When testing direct visual acuity, what eye does the doctor look in?

A

The eye the light is being shined in [ex. light in L eye, look at L eye for pupil response]

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49
Q

When testing consensual visual acuity, what eye does the doctor look in?

A

The eye the light is not being shined in [ex. light in L eye, look at R eye for pupil response]

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50
Q

Direct pupillary light reflex in L eye, which CN are being tested?

A

L II and L III

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51
Q

Direct pupillary light reflex in the R eye, which CN are being tested?

A

R II and R III

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52
Q

Consensual pupillary light reflex in the R eye, which CN are being tested?

A

L II and R III

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53
Q

Consensual pupillary light reflex in the L eye, which CN are being tested?

A

R II and L III

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54
Q

The R direct pupillary light reflex is not responsive. The L direct and L consensual are responsive. Where is the lesion?

A

R III

[Slide 24 in Lecture 1 for chart!]

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55
Q

How would someone test for the H pattern of gaze?

A

Hold finger 12-18” away from patients face and move slowly through an H pattern looking for weakness or nystagmus

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56
Q

What does nystagmus mean?

A

Lagging or ticking of eye to follow finger

57
Q

When the L eye is looking out and up, what muscle is being used?

A

Superior rectus

58
Q

When the R eye is looking out and down, what muscle is being used?

A

Inferior rectus

59
Q

When the R eye is looking up and in, what muscle is being used?

A

Inferior oblique

60
Q

When the R eye is looking down and in, what muscle is being used?

A

Superior oblique

61
Q

What are the 5 muscles that are innervated by CN III?

A

LR6SO4…3

  • MR
  • IO
  • IR
  • SR
  • Levator Palpebrae Superioris
62
Q

When moving the finger upwards, for instance, in the H pattern, what two things are you particularly looking at?

A
  • Elevation of the eyelids

- Elevation of the globes

63
Q

What muscle does the Trochlear N CN IV innervate?

A

Superior oblique

64
Q

What are the primary, secondary, tertiary actions of the superior oblique?

A
  • AID
  • Abduction
  • Intorsion
  • Depression
65
Q

What eye muscle does the Abducens N CN VI innervate?

A

Lateral Rectus

66
Q

What does diplopia mean?

A

double vision

67
Q

When you only have double vision in one eye what does that mean?

A

Issues with the brain, not peripheral n.

68
Q

What does ptosis mean?

A

Drooping of the eye

69
Q

When a patient presents with diplopia and ptosis, what is suspected until proven otherwise? [pathology]

A
  • Myesthenia gravis
70
Q

In Myesthenia Gravis, what is normal during a CN III exam?

A

Pupillary light reflexes

71
Q

What muscle type is used in a pupillary light reflex?

A

Smooth muscle

72
Q

What is in the cavernous sinus that can cause vision loss/issues? [hint: 6 things]

A
  1. internal carotid a.
  2. CN III
  3. CN IV
  4. CN VI
  5. V1
  6. V2
73
Q

What are the muscles of mastication?

A
  • Med/Lat Pterygoids
  • Temporalis
  • Masseter
74
Q

How do you test motor function of CN V?

A

Observe face for…

  • Jaw mm. atrophy
  • Jaw deviation
  • Patient to clench teeth as doc palpates mm.
75
Q

How do you test the sensory function of CN V?

A
  • Touch V1, V2, V3 to see if patient can feel sharp/dull in each area
76
Q

Corneal reflex tests which cranial nerve?

A

CN V [have patient look up and away]

77
Q

When performing the corneal reflex, what should happen to the eyes if all findings are normal? [WNL]

A

Both eyes should blink simultaneously and symetrically

78
Q

If there is diminished blinking when performing the corneal reflex, which patient population might this be NORMAL in?

A

patients who wear contact lenses

79
Q

If there is only one eye blinking during the corneal reflex, what is not working?

A
  • Afferent limb
80
Q

What is sharp, stabbing pain that lasts seconds within the boundaries of V1,2,3?

A

Trigeminal neuraligia or Tic Doloroux [suicide pain]

81
Q

In which branches of CN V is trigeminal neuralgia most common in?

A

V2 or V3, 10-12% is BILATERAL

82
Q

Which sex is TGN most commonly present in?

A

Females

83
Q

What age group is TGN most common in?

A

> 50 y/o

84
Q

What could be two possible causes of TGN that were mentioned in class?

A
  1. Abberant superior cerebellar artery

2. Cerebellar pontine angle tumor

85
Q

How is motor function to the face evaluated by a clinician?

A

Have the patient perform facial expressions…

  1. Raise eyebrows
  2. Squeeze eyes shut
  3. Frown
  4. Smile
  5. Wrinkle forehead
  6. Show teeth
  7. Purse lips to whistle
  8. Puff cheeks [doc can push on cheeks to see if mouth will stay closed]
86
Q

What is commonly seen in patients with Facial N. muscle weakness?

A

Drooping mouth, flattened nasolabial fold, lower eyelid sagging

87
Q

When there is a cerebellar lesion what side is affected?

A

SAME SIDE

88
Q

When there is a lesion in the cortex what side is affected?

A

OPPOSITE SIDE

89
Q

Upper facial muscles are controlled by what?

A

BOTH CORTICES

90
Q

What are the lower facial muscles controlled by?

A

CONTRALATERAL CORTEX ONLY

91
Q

Which fibers run to the lower facial muscles from the contralateral cortex?

A

Corticobulbar fibers

92
Q

What can a pontine lesion lead to, in the development of issues with CN VII?

A

Asymmetry of facial expression

93
Q

The fibers for facial nerve in the pons goes around which structure in the brainstem?

A

Abducens nucleus

94
Q

What is a neuroma?

A

Schwann cell tumor

95
Q

Where is an acoustic neuroma found?

A

On the vestibular portion of VIII in the facial canal

96
Q

A patient presents with ipsilateral facial weakness, hypoguesia, hypoacusis, decreased lacrimation… what condition is this patient likely to have?

A

Simple Facial Palsy (Bell’s Palsy)

97
Q

Expansion of an acoustic neuroma compresses what structure(s)?

A

Fibers of the chochlear and vestibular portions of VIII and VII

98
Q

A person with acoustic neuroma has what type of hearing?

A

Hypoacusis

99
Q

10-15% of patient with Acoustic neuroma have what?

A

Dysequilibrium

100
Q

A person with Acoustic Neuroma will have facial palsy with decreased what? and increased what?

A
  • Decreased tearing, taste, facial expression

- Increased hearing

101
Q

Why does someone with Acoustic Neuroma have increased hearing?

A

Loss of stapedius function

102
Q

What is a corticobulbar tract lesion involved with?

A

Weakness of lower facial muscles of the contralateral face

103
Q

A 4th ventricle tumor shows what symptoms…

A
  • Ipsi face weakness

- Ipsi LR palsy

104
Q

Taste on the anterior 2/3 of the tongue senses what tastes?

A

Salty and Sweet

[apply to each lateral side of the tongue]

105
Q

Taste on the posterior 1/3 of tongue is done by which CN?

A

CN IX

106
Q

What is known as the scratch test? What CN is being tested with this test?

A
  • Make rubbing noises with thumb and index finger. Make sure pt. can hear then move fingers out till they can’t hear anymore. Both sounds should be symmetrical.
  • CN VIII is being tested
107
Q

Roughly how far out should the hands be from the ears to be considered normal hearing?

A

1-2’

108
Q

How does a doctor perform a hearing screen?

A
  • Strike 512Hz tuning fork
  • Hold in front of each ear
  • Ask if heard
  • Ask if it is symmetrical
109
Q

How does a doctor perform the Weber test?

A
  • Place 256 Hz tuning fork to midline of skull

- Ask if it is heard equally each side

110
Q

If the sound is louder on the right side according to the patient, what does this mean?

A
  • Conductive loss on the Right
    OR
  • Sensorineural deficit in the Left
111
Q

How does a doctor perform the Rinne test?

A
  • Place 256Hz tuning fork on mastoid
  • Ask pt. if they hear it and to state when they don’t anymore [BONE CONDUCTION]
  • Then hold the fork 1” away auditory canal, ask if pt. still can hear it [AIR CONDUCTION]
  • Then have pt. state when they cannot hear it anymore
112
Q

What does air conduction need to be to be sensory neuro problem on the other side?

A

2x bone conduction

113
Q

Normal hearing is considered what using the RInne test?

A

Air conduction&raquo_space; Bone conduction [2x greater]

114
Q

If Weber’s test does not lateralize, what is the finding?

A

Normal hearing in both ears

[SLIDE 9 in PPT for tuning fork test CHART]

115
Q

When cleaning out one’s ear canal, what reflex can be perceived by the brain?

A

Gag reflex

116
Q

What does CN IX Glossopharyngeal N. give sensation to? [hint: 4 things]

A
  • Oropharynx
  • Nasopharynx
  • Auditory tube and middle ear
  • Portion of ext ear canal and tympanic membrane
117
Q

CN IX serves as the sensory limb [afferent] to what reflex?

A

Gag reflex

118
Q

What CN serves as the motor limb [efferent] to the gag reflex?

A

CN X

119
Q

What else does CN X serve as the motor function for in the oral cavity?

A

Swallowing

120
Q

How to test the gag reflex?

A
  • Tell patient, I’m testing gag reflex
  • Pt. look up, tilt head up, open mouth, stick out tongue
  • touch posterior wall of pharynx with applicator, observe upward movement of palate and contraction of the pharyngeal mm.
  • soft palate should ELEVATE EQUALLY BOTH SIDES
121
Q

What does a weakness of palatal elevation result in?

A

Nasally voice

122
Q

How does the doc assess the symmetry of the soft palate?

A

have patient stick out tongue and say “Ah”

[observe movement of soft palate and uvula for asymmetry]

123
Q

If there is no or weak palatal elevation, which CN is most likely the culprit?

A

CN X Vagus

124
Q

How would the doc test for the motor function of swallowing and if it is intact?

A
  • Have patient sip and swallow water

- There should be NO RETROGRADE passage of H2O through the nose

125
Q

When thinking about the Vagus N, where do the parasympathetic fibers project on the heart?

A

The SA node of the R Atria

126
Q

If there is an increase in the parasympathetic activity, what does this do to the HR?

A

Decreases HR

127
Q

If there is decreased parasympathetic activity, what will this result in with respect to the heart?

A

Tachycardia (HR that exceeds the normal rate)

128
Q

If there is increased parasympathetics to the GI tract, what would this cause?

A
  • Increased peristalsis
  • release digestive enzymes
  • decrease transit time CORN, BEETS
  • abdominal cramping
  • Diarrhea
129
Q

If there is decreased parasympathetics to the GI tract, what would this cause?

A
  • Bloating
  • Flatulence
  • Constipation
    [decrease/ NO P/S function = no control over internal sphincters, no erection, no sexual function]
130
Q

What does increased sympathetics do to the hands?

A

The feeling of cold hands

131
Q

What nerve provides motor to the Trapezius and SCM?

A

CN XI spinal acessory n

132
Q

When testing CN XII Hypoglossal, if the tongue protrudes to the weak side what is this a sign of?

A

Lower motor neuron lesion

133
Q

With atrophy of CN XII, what would you notice with the tongue?

A

Atrophy/wrinkling of the mucosa on the side of the lesion

134
Q

How does a clinician test the motor function of the tongue?

A
  • Stick tongue out, should be midline

- Move tongue from one side to other

135
Q

What CN is involved if you can’t open your eyes?

A

CN III

136
Q

What CN involved if you can’t close your eyes

A

CN VII

137
Q

What is a myotome?

A

MM. innervated by motor fibers from the root

138
Q

What is a motor root?

A

Alpha motor neuron and what it goes to

139
Q

If you see a crescent shadow, what does this indicate?

A

Chronic glaucoma

EM Cervicals (1 decks)

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