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NMS I- KMH > Exam 1: Cranial Nerves > Flashcards

Exam 1: Cranial Nerves Flashcards

1
Q

Which cranial nerves have fibers mediating volitional movement of cranial nerve innervated musculature that arise from the per central gyrus of the cerebral cortex and descend along the corticobulbar tract of the brain?

A

All but #7

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2
Q

Why is Cranial nerve 7 different from the rest?

A

It has contralateral innervation in the lower part of the nuclei

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3
Q

Cortico means?

Bulbar means?

A

cortex

Brain stem

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4
Q

What is another name for the corticobulbar tract?

A

Upper motor or supra nuclear neruons

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5
Q

Explain the corticobulbar tract

A

Entire nerve cell resides in CNS and terminate in different cranial nerve motor nuclei in the brain stem. They synapse with LMN forming peripheral CN, which innervate specific muscles

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6
Q

What may be the greatest cause of headaches?

A

cervicogenic pain

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7
Q

What may be the greatest cause of vertigo?

A

Cervicogenic dizziness

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8
Q

What is important to keep in mind about the bilateral innervations of Cranial nerves when performing exams?

A

Equal distribution of right and left brain hemisphere innervation govern the function of a specific body part, which is why lesions of only one cerebral hemisphere will not usually permanently paralyze bilateral symmetrical movements

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9
Q

Which cranial nerves are not true nerves, but fiber tracts?

A

CN I and II

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10
Q

Cranial nerves that have motor function take their origin from where?

A

Collection of cells deep within the brain stem (motor nuclei) which are analogous to the anterior horn cells of the spinal cord

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11
Q

Where do sensory cranial nerves originate from?

A

collection of cells outside of the brainstem, usually in ganglia that may be considered analogous to the dorsal root ganglia of spinal nerves

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12
Q

Cerebellopontine angle lesion can be a problem with…?

A

Unilateral CN V, VII, VII

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13
Q

Cavernous sinus lesion can be a problem with…?

A

Unilateral CN III, V, VI

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14
Q

Jugular foramen syndrome can be a problem with…?

A

Combined unilateral CN IX, X, XI

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15
Q

Combined bilateral CN X, XI, XII problems can be associated with…?

A

LMN: bulbar palsy
UMN: psuedobulbar palsy
Myasthenic syndrome: involvement of eye muscle, facial weakness

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16
Q

Most common cause of intrinsic brain stem lesion in a younger patient? Older patient?

A

Younger: MS
Older: vascular disease

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17
Q

The nuclei of the cranial nerves lie chiefly where?

A

brain stem

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18
Q

The sensory nuclei develop where?

A

The dorsal or alar plate of the euro tube

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19
Q

The motor nuclei develop where?

A

Within the basal plate

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20
Q

The alar plate lies where?

A

In the hindbrain, lateral to the basal in the floor of the 4th ventricle

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21
Q

Explain the dinger-westphal nucleus

A

Motor nucleus of Oculomotor N (III) and is at the level of superior colliculus

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22
Q

Explain the Nucleus of the Trochelear Nerve

A

Motor nucleus; CN IV in the mid brain at the level of the inferior colliculus

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23
Q

Explain the Motor nucleus of trigeminal nerve

A

Motor nuclei of CN V at the level of mid pons

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24
Q

Explain the Nucleus of Abducens nerve

A

Motor nuclei of CN VI in dorsal pons

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25
Q

Explain the motor nucleus of facial nerve

A

Motor nuclei of CN VII near caudal border of pons

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26
Q

Explain the Nucleus salivatorius superior and inferior

A

S: Motor nuclei of CN VII
U: motor nuclei of CN IX
At the border of the pons and medulla

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27
Q

Explain the motor nucleus of vagus nerve

A

Motor nuclei of CN X in dorsal medulla

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28
Q

Explain the Nucelus ambiguous

A

Motor Nuclei of CN IX, X, XI in the dorsal medulla

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29
Q

Explain the nucleus of hypoglossal Nerve

A

Motor nuclei of CN XII in medulla beneath 4th ventricle

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30
Q

Explain the msecencephalic nucleus of trigeminal N

A

Sensory nuclei of CN V in midbrain

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31
Q

Explain the Main sensory nuclei of trigeminal N

A

Sensory nuclei of CN Vin pons

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32
Q

Explain the vestibular and cochlear nuclei of acoustic nerve

A

Sensory nuclei of CN VIII in pons and medulla

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33
Q

Explain the nucleus of tracts solitarius

A

Sensory nuclei for CN VII and CN IX in dorsal medulla

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34
Q

Explain the Nucelus of spinal tract of the trigeminal N

A

Sensory nuclei of CN V in dorsal lateral medulla

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35
Q

What are the exams for CN I?

A
  • Observation of external nose
  • Observation of internal nasal passage
  • Sense of smell
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36
Q

What are the exams for CN II?

A
  • Observation of external eyes
  • Visual acuity
  • Peripheral vision (confrontation)
  • Pupillary light reflex
  • Opthalmic exam
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37
Q

What are the exams for CN III?

A
  • Observation of external eyes
  • Corneal Light reflex
  • Pupillary light reflex
  • 6 cardinal fields of gaze
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38
Q

What are the exams for CN IV?

A
  • Observation of external eyes
  • Corneal Light reflex
  • 6 cardinal fields of gaze
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39
Q

What are the exams for CN IV?

A
  • Observation of external eyes
  • Corneal Light reflex
  • 6 cardinal fields of gaze
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40
Q

What are the exams for CN V?

A
  • Corneal Blink reflex
  • Light touch/ sharp sensation on fact
  • Inspect muscle of mastication for tone and strength
  • Jaw Jerk reflex
  • General sensation of anterior 2/3 of tongue
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41
Q

What are the exams for CN VII?

A
  • Check musculature of face ( smile, look up)

- Taste anterior 2/3 of tongue

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42
Q

What are the exams for CN VIII?

A
  • Observation of external and internal ears
  • Rinne Test
  • Webber test
  • Finger rustle test
  • Schwabach test
  • Watch tick test
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43
Q

What are the exams for CN IX, X?

A
  • Have patient say “Ahh”
  • Gag reflex (posterior 1/3 of tongue)
  • Check phonation (Kuh, La, Mi)
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44
Q

What are the exams for CN XI?

A
  • Shoulder elevation

- Muscle strength of SCM and traps

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45
Q

What are the exams for CN XII?

A
  • Stick out tongue

- Tongue in cheek test

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46
Q

What smell can be recognized by nasal epithelium that is not intact?

A

ammonia

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47
Q

What is anosmia?

A

Complete loss of smell; does not indicate a cortical lesion normally

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48
Q

What is loss of smell normally associated with?

A

viral infections, allergic rhinitis, aging, head trauma (skull fracture)

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49
Q

What may a lesion of the uncinate gyrus cause?

A

It is in the anterior temporal lobe and may cause hallucinations of smell associated with strong smells and deja vu

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50
Q

What is hyperosmia?

A

increased sense of smell

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51
Q

What is hyposmia?

A

decreased sense of smell

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52
Q

what is Parosmia?

A

perversion of smell

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53
Q

What cacosmia?

A

abnormally disagreeable smell

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54
Q

What are causes of anosmia in both nostrils?

A

blocked nasal passage
common cold
trauma
aging

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55
Q

What neurons of the olfactory tract are unmyelinated in the upper part of the nasal mucosa and pass through the cribriform plate of the ethmoid bone to the olfactory bulb?

A

Primary neurons

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56
Q

What neurons of the olfactory tract are myelinated bipolar cells and form the olfactory tract and terminate in the primary olfactory cortex?

A

Secondary neruons

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57
Q

What are the parts of the primary olfactory cortex?

A

Periamygdaloid area and perprirform cortex

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58
Q

What neurons of the olfactory tract extend from the olfactory codex or entorhinal croex (28), lateral pre optic area, amygdaloid body, and medical forebrain bundle?

A

tertiary neurons

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59
Q

Explain the path of CN II

A

Rods and cones of retina are 1st order and connect with bipolar cells, which connect with ganglion cells near surface of retina.
At optic chiasm, the fibers decussate and these for m the optic tract, which passes to the lateral geniculate bodies, superior colliculi, and pretectal region.
The Geniculocalcarine tract contains 4th order neurons from the lateral geniculate bodies and passes to occipital cortex

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60
Q

what is meyer’s loop?

A

a fan-like radiating portion that curves around the inferior horn of the lateral ventricle

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61
Q

The central connection of the optic nerve include…?

A
  • Pretectal to edinger westphal via posterior commissure
  • Superior colliculi via tectobular/spinal tracts to other cranial/spinal nuceli
  • From occipital area to other cortical and subcortical areas
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62
Q

What is the pretectal region concerned with?

A
  • Simple and consensual light reflexes

-

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63
Q

What is the Superior colliculus concerned with?

A
  • involuntary musculoskeletal reflexes

- relfex movements of these and head after optic stimulation

64
Q

What is the lateral geniculate body concerned with?

A
  • visual perception

- gives rise to geniculocalcarine that

65
Q

What are cones?

A
  • Located in the small central pit of the retina
  • is where vision is sharpest and color discrimination is most acute
  • Stimulated by high intensity light
66
Q

What are rods?

A
  • React to low intensity light

- Fucntion in twilight and night vision

67
Q

what is Retrobulbar neuritis?

A

involves optic nerve or tract– MS

68
Q

What is optic or bulbar neutritis?

A

includes various form of retinitis (syphilis, diabetic, hemorrhagic)

69
Q

What is papilledema?

A
  • AKA “Choked disc”

- increased intracranial pressure due to brain tumors, accesses, hemorrhage, hypertension

70
Q

What is optic atrophy?

A

decreased visual acuity and a change is the color of the optic disc to light pink, white, or grey

71
Q

What is primary optic atrophy?

A

caused by processes that involve the optic nerve and does not produce papilledema
- tabes dorsalis, MS, heredity

72
Q

What is secondary optic atrophy?

A

Has papilledema

- neuritis, glaucoma, increased intracranial pressure

73
Q

What is foster kennedy syndrome?

A

may be caused by tumors at the base of the frontal lobe and is characterized by ipsilateral blindness and anosmia (with atrophy of the optic and olfactory nerve) and central lateral papilledema

74
Q

What is amaurotic familial idiocy (Tay-sachs disease)?

A

cerebromacular degeneration with sever mental deficiency occurring in jewish families and is associated with blindness, optic atrophy

75
Q

What optic syndrome is associated with a dark cherry red spot in the place of the macula lutea?

A

amaurotic familial idiocy (Tay-sachs disease)

76
Q

What is argyll robertson pupil?

A

reacts only to accommodation and it has neither a direct or indirect reaction to light. Occurs as diabetic complication

77
Q

What is holmes-adie syndrome?

A

tonic pupillary reaction and the absence of more than one tendon reflexes.

  • Very slow contractions to light and slow dialtion
  • Have abnormal sensitivity to methacholine
  • MC in females and benign
78
Q

What is the adler-scheie test?

A

When a methacholine solution is instilled into the conjunctival sac
-Has a demonstrable effect in affected eyes of holmes-adie syndrome (tonic pupils constrict and pupils of normal eyes remain unaffected)

79
Q

What is heterotropia?

A

Deviation of bilateral eye alignment

80
Q

What is exotropia? Esotropia? Hypertropia? Hypotropia?

A

EX: outward/lateral movement of eye
ES: inward/medial movement
HYPER: up
HYPO: down

81
Q

Disease of what cranial nerve are sometimes responsible for deviation of eye alignment?

A

III, IV, VI

82
Q

What is the medial longitudinal fasiculus?

A
  • Primary function is to coordinate eye movements by interconnecting the nuclei of CN III, IV, VI
  • Ex of lesion is MS
83
Q

What are the 2 supra nuclear pathways for eye movement?

A

Frontal lobe: control saccadic (rapid or darting) eye movement
Occipital lobe: controls smooth or following eye movements

84
Q

What is nystagmus?

A
  • Involuntary eye oscillations

- fast component is frontal lobe and slow movement is occipital lobe

85
Q

What are the characteristics of a disease of CN III?

A

More obvious due to the accompanying parasympathetic manifestations (ptosis, corectasia)

86
Q

What are the characteristics of a disease of CN IV?

A

Difficulty for the patient when looking down and in

87
Q

What are the characteristics of a disease of CN VI?

A

Patient is unable to laterally deviate the eye on the same -side of the lesions

88
Q

What does pathological involvement of the motor portion of the eye reflex result in?

A

CNII

-results in decreased ability to carry out the act of pupilloconstriction in the ipsilateral eye

89
Q

What does loss of diencephalon or midbrain function result in?

A

unopposed sympathetic dominance, light as a stimulus causes no pupillocontriction and the pupil is fixed and dilated
-Bilateral = brain dead

90
Q

What are the signs and symptoms of horner’s syndrome?

A
  • lesion of the neck proximal to carotid
  • Ptosis
  • Pupilloconstriction (cornomiosis)
  • Facial anhydorsis (ipsilateral)
  • Ipsilateral facial vasodialtion
91
Q

Lesions along the sympathetic pathway distal to the bifurcation of the common carotid arteries will cause what?

A
  • only pupilloconstriction and ptosis
  • Vasodilation and anhydrosis if along external carotid
  • Enopthalmos
92
Q

What lesions would eyelids ptosis indicate?

A
  • hypothalamus
  • brain stem or spinal cord
  • Peripheral CN III
  • Peripheral sympathetic nerves
  • Myonerual pathways
  • possible muscular and local causes
93
Q

What is the limbus to lid distance?

A

The lower eyelids should form a tangent from the limbus

94
Q

What is the ciliospinal reflex?

A

pinching the skin on patient’s neck and observing for a brisk bilateral puillodilation
-used to assess sympathetic function in head and face

95
Q

What is the difference between legal blindness and medical blindness?

A

Legal blinds is a legal issue and medical blindness is a failure to perceive a light stimulus

96
Q

What are the 3 components of accommodation?

A
  • Convergence (CN III)
  • Pupilloconstriction (PS fibers in CN III)
  • Lens thickening (ciliary muscles, CN III)
97
Q

What is concomitant eye movement?

A

disturbance of image formation due to a cloudy cornea, cataract or macular lesions

98
Q

What is a non-concomitant eye movement?

A

results in diplopia due to the brains inability to resole the images

99
Q

Nystagmus is thought to be caused by conflicting proprioceptive inputs from what sources?

A

CN VII, cervical and cerebellar sources

100
Q

End point nystagmus is common. T/F

A

True.

Pathological nystagmus usually begins well before endpoint

101
Q

What is a simple and sensitive method to test equal pupilloconstriction?

A

Swinging flashlight test

102
Q

What is the marcus-gunn phenomenon?

A

Apparent pupillodilation with light introduction

-CN III lesion

103
Q

What 4 areas of the fundus should be examined?

A
  • Optic disc
  • vessels
  • macula
  • general background
104
Q

Increased cup to disc ratio could indicate what disease?

A

glaucoma

105
Q

What are some findings often seen with papilledema on the fundoscopic exam?

A
  • Blurred nerve fibers and cup
  • engorged veins and pulsations
  • Obliteration of physiological cup
  • Disc elevation and edema
106
Q

A pseudopapilledema has be seen in up to what percentage of the population?

A

5%– hereditary and benign

107
Q

What aspect of optic neuritis separated / papilitis differentiates it between papilledema?

A

There is visual complaint and pain

108
Q

What are collections of degenerative deposits that often appear in the funds of elderly people?

A

Drusen bodies

109
Q

What are the 3 divisions of the trigeminal nerve?

A

V1: opthalmic
V2: maxillary
V3: mandibular

110
Q

What area does CN V spare?

A

The angle of the jaw

111
Q

The mandibular branch of CN V has a recurrent or meningeal branch that innervates what area?

A

The dura of the middle and anterior cranial fossa

112
Q

What are the muscles of mastication?

A
  • Temporalis
  • masseter
  • medial pterygoid
113
Q

What does the lateral pterygoid do?

A

opens the jaw or causes lateral movement of the jaw (in the contralateral way)

114
Q

What might be responsible for bilateral jaw paralyzing issues?

A

Bilateral corticobulbar lesions and sometimes an acute unilateral corticobulbar lesion along with a CN V LMN lesion

115
Q

What is a condition of the ophthalmic division of CN V where there may be corneal inflammation and ulceration?

A

Neuroparalytic keratitis

-trouble losing eyelids

116
Q

What is an idiopathic syndrome or sharp, painful facial sensation in the clear distribution of the ophthalmic, maxillary, or mandibular division of CN V?

A

Trigeminal neuralgia (Tic Douloureux or Fothergill’s neuralgia)

117
Q

Cranial nerve V carries the sensory arc of the corneal reflex and synapses on what nerve, causing the eye to blink?

A

CN VII

118
Q

The corneal blink reflex may be absent in early cases of what disease?

A

MS

119
Q

Where does CN VII divide into the temporofacial and cervicofacial divisions?

A

within the substance of the parotid gland

120
Q

What nerve innervates the stapedius muscle?

A

CN VII

121
Q

parasympathetic stimulation of CN VII causes what? Sympathetic?

A

PS: increase secretion of thin and water saliva
S: scan supply of thick and turbid saliva

122
Q

What is peripheral facial paralysis called?

A

prosopopledia

123
Q

How can bells palsy be differentiated from a stroke?

A

In a stroke, the forehead is spared

124
Q

What is the complete loss of taste?

A

ageusia

125
Q

Peripheral lesions in CN VII must be proximal to what area to affect taste?

A

Stylomastoid foramen

126
Q

What test confirms bells palsy?

A

Complete hemifacial paralysis without loss of taste on the ipsilateral anterior 2/3 of the tongue

127
Q

Where are the receptors for the vestibular division of CN VIII?

A

semicircular canals, utricle ,saccule

128
Q

What is the pathways for the vestibular division of CN VIII?

A

From semicircular canals, utricle, and saccule to the vestibular ganglion to vestibular nerve which travels through the IAM to brain stem.
-The fibers terminate on vestibular nuclei or pass through inferior cerebellar peduncle as part of vestibulocerebellum

129
Q

What pathways is the vestibular division of CN VIII connected to?

A

CN III, IV, VI

130
Q

Where are the receptors for the cochlear division of CN VIII?

A

within the organ of corti inside the cochlea

131
Q

What is the pathway for the cochlear division of CN VIII?

A

Impulses travel to bipolar cells of cochlear ganglion, and energy as cochlear nerve, through the IAM to cochlear nuclei to the ipsilateral lateral lemniscus, and then ascend to inferior colliculus and medial geniculate body
-Terminate as auditory radiations on cortex of transverse temporal convolution (hesuchl’s gyrus)

132
Q

Which part of CN VIII has the sole function to provide hearing?

A

Cochlear division

133
Q

What is hypoascusis? Hyper?

A

Hypo: decrease or loss of hearing; conduction loss
Hyper: increasing in intensity of hearing due to CN VII disorder or central located

134
Q

Why type of lesions are not often associated with hearing loss but more commonly with hallucinations of hearing?

A

Central lesions

135
Q

What are some common etiologies for conductive hearing loss?

A

Auditory canal obstruction
Trauma of tympanic membrane
Trauma/aging of oscicles
Accumulation of fluid in middle ear

136
Q

What are some common causes of sensorineural hearing loss?

A

attributed to diseases of end organ (organ of corti) or the auditory nerve

137
Q

What are symptoms of vestibular diseases?

A 
ALWAYS vertigo
Nausea, anxiety, oscillopsia
Unsteadiness with or without falling
nystagmus
Pallor, sweating, vomiting, hypotension
138
Q

What is oscillopsia?

A

visual perception of rapid to and fro movements often accompanying nystagmus

139
Q

If there is no fast component to nystagmus, what is it termed?

A

pendular

140
Q

If the cervicospinal proprioceptive disease test comes back positive, what is the mechanism of disease?

A

cervical mechanoreceptors are over stimulated

141
Q

What exam tests for the auditopalpebral reflex (a loud noice from out of sight causing the patient to blink)?

A

Malingering test

142
Q

Which CN has innervation to the stylopharyngeus?

A

CN IX

143
Q

Disorders of CN IX are common and always include disturbance of speech. T/F

A

False

Never any speech issues, and disturbances in swallowing are never that bad unless bilateral

144
Q

What is unilateral paralysis of CN X follow by?

A

transient paresis of the soft palate, pharynx, and larynx on affect side along with absent gag reflexes and oculocardiac reflexes

145
Q

Complete bilateral CN X paralysis is compatible with life. T/F

A

FALSE

146
Q

What is the loss of voice called?

A

aphonia

147
Q

What is faulty articulation called?

A

dysarthria

148
Q

What is no articulation called?

A

anarthria

149
Q

What is faulty swallowing called?

A

Dysphagia

150
Q

What is no swallowing called?

A

aphagia

151
Q

What is hyper/hyponasal?

A

Hyper: increase air in nasal cavity
Hypo: decreased air in nasal cavity

152
Q

Which side does the usual deviate to in CN X lesion?

A

affected side

153
Q

What are the 2 parts of CN XI?

A
  1. cranial or accessory potion to the vagus

2. spinal portion (larger)

154
Q

What is the path of the nerve for CN XI?

A

Spinal portion: arise from ventral horn, ascend through foramen magnum and exit through jugular foramen and supply traps and SCM

155
Q

CN X supplies the upper portion of the traps, what innvervates the lower portion?

A

3rd and 4th cervical nerves

156
Q

Paralysis of the tongue is the cardinal finding in what CN disease?

A

CN XII

NMS I- KMH (7 decks)

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