Examination Findings

Question 1

What do we use a Snellen chart for?

Answer 1

Visual acuity

Question 2

What can cause RAPD?

Answer 2

significant retinal damage in the affected eye secondary to central retinal artery or vein occlusion and large retinal detachment; or due to significant optic neuropathy such as optic neuritis, unilateral advanced glaucoma and compression secondary to tumour or abscess

Question 3

What can cause decreased visual acuity?

Answer 3

Refractive errors
Amblyopia
Ocular media opacities such as cataract or corneal scarring
Retinal diseases such as age-related macular degeneration
Optic nerve (CN II) pathology such as optic neuritis
Lesions higher in the visual pathways

Question 4

What can cause colour vision deficiencies?

Answer 4

Optic neuritis, vit A def, chronic solvent exposure

Question 5

What typically causes visual neglect?

Answer 5

This typically occurs in the context of parietal lobe injury after stroke, which results in an inability to perceive or process stimuli on one side of the body. The side of the visual field that is affected is contralateral to the location of the parietal lesion.

Question 6

What can cause bitemporal hemianopia?

Answer 6

Bitemporal hemianopia typically occurs as a result of optic chiasm compression by a tumour (e.g. pituitary adenoma, craniopharyngioma).

Question 7

What can cause homonymous field defects?

Answer 7

Affect the same side of the visual field in each eye and are commonly attributed to stroke, tumour, abscess (i.e. pathology affecting visual pathways posterior to the optic chiasm).

Question 8

What is a scotoma?

Answer 8

an area of absent or reduced vision surrounded by areas of normal vision

Question 9

What causes scotomas?

Answer 9

wide range of possible aetiologies including demyelinating disease (e.g. multiple sclerosis) and diabetic maculopathy

Question 10

What can cause monocular vision loss?

Answer 10

total loss of vision in one eye secondary to optic nerve pathology (e.g. anterior ischaemic optic neuropathy) or ocular diseases (e.g. central retinal artery occlusion, total retinal detachment).

Question 11

What can ptosis be indicative of?

Answer 11

Horner’s syndrome, oculomotor nerve pathology, neuromuscular pathology (e.g. myasthenia gravis)

Question 12

What is strabismus?

Answer 12

Strabismus is a condition in which the eyes do not properly align with each other when looking at an object. Pathology affecting the oculomotor, trochlear or abducens nerves can cause strabismus.

Question 13

What would an abnormal jaw jerk reflex show?

Answer 13

Exaggerated in patients with an upper motor neuron lesion

Question 14

What is a normal Rinne’s result?

Answer 14

air conduction > bone conduction (Rinne’s positive)

Question 15

What is a abnormal Rinne’s +ve result?

Answer 15

Sensorineural deafness: air conduction > bone conduction (Rinne’s positive) – due to both air and bone conduction being reduced equally

Question 16

What is a Rinne’s -ve result?

Answer 16

Conductive deafness: bone conduction > air conduction (Rinne’s negative)

Question 17

What is a normal Weber’s result?

Answer 17

sound is heard equally in both ears

Question 18

What is sensorineural deafness in the Weber’s test?

Answer 18

Sensorineural deafness: sound is heard louder on the side of the intact ear.

Question 19

What is conductive deafness in the Weber’s test?

Answer 19

Conductive deafness: sound is heard louder on the side of the affected ear

Question 20

What is the turning test?

Answer 20

Ask the patient to march on the spot with their arms outstretched and their eyes closed:

Normal result: the patient remains in the same position.
Vestibular lesion: the patient will turn towards the side of the lesion

Question 21

What would you see with a vagus nerve lesion?

Answer 21

A vagus nerve lesion will cause asymmetrical elevation of the palate and uvula deviation away from the lesion.

Question 22

How would a cough sound if a pt had a vagus nerve lesion?

Answer 22

Vagus nerve lesions can result in the presence of a weak, non-explosive sounding bovine cough caused by an inability to close the glottis.

Question 23

What does a change in voice/cough after swallow test show?

Answer 23

Suggests an ineffective swallow which can be caused by both glossopharyngeal (afferent) and vagus (efferent) nerve pathology.

Question 24

What nerves are involved in the gag reflex?

Answer 24

The gag reflex involves both the glossopharyngeal nerve (afferent) and the vagus nerve (efferent).

Question 25

What is the function of the accessory nerve?

Answer 25

The accessory nerve (CN XI) transmits motor information to the sternocleidomastoid and trapezius muscles. It does not have a sensory component.

Question 26

What is the function of the hypoglossal nerve?

Answer 26

The hypoglossal nerve (CN XII) transmits motor information to the extrinsic muscles of the tongue (except for palatoglossus which is innervated by the vagus nerve). It does not have a sensory component.