Extra Mixed Deck (P1 stuff etc) Flashcards
CN I - name - function - modality (sensory / motor / both)
Olfactory - smell - sensory
How would you test CN I
- ask if they’ve noticed any change Formally: - strong and characteristic smells - lemon, peppermint, coffee - UPenn smell identification test
How would you interpret the results of CN I tests
If **anosmia**: causes are - meningioma - trauma - skull or cribriform plate - Parkinson’s - mucus block / covid / genetics
CN II - name - function - modality (sensory / motor / both)
Optic - vision - sensory retina to primary visual cortex
How would you test CN II
visual acuity - distance - Snellen chart & pinhole - colour vision - ishihara plates fields - neglect / inattention - field - formal is **Amsler chart** - blind spot optic disc - fundoscopy Pupil - pupillary light reflex (direct - ipslateral, consensual - contralateral, swing check relative afferent pupillary defect) - accomodation reflex - distant to near - size, shape
Visual field defects - key in investigation?
Test one eye while covering the other! Patient often do not realise
**bitemporal hemianopia** - what is it? - pathology?
- loss of temporal visual field in both eyes - optic chiasm tumour
**Homonymous field defects** - types - pathology?
- hemianopias or quadrantanopias - same side of visual field in each eye - pathology is behind optic chiasm in visual pathways: stroke, tumour, abscess
**Scotoma** - what is it? - pathology?
- absent or reduced vision surrounded by areas of possible vision - wide range, including demyelinating (MS, DM)
**Monocular vision loss** - what is it? - pathology?
- total loss of vision in one eye secondary to optic nerve pathology or ocular disease
How would you interpret results of a fundoscope exam?
if papilloedema, causes are - usually **ischaemia** - intracranial bleed possible - **hypertension** - systemic, intracranial (benign & malignant → suspect a brain tumour!) - **headache** - **brain tumour** causing compression - prolonged CNS infection
Nerves of the eye again!! (mnemonic & what they stand for)
SO4 LR6 3
CN III - name - function - modality (sensory / motor / both) - ?
Oculomotor - motor - mvt of the eye! - pupillary sphincter, extrinsic eye muscles and levator palpebrae superioris - parasympathetic !!
CN IV - name - function - modality (sensory / motor / both)
Trochlear - motor - superior oblique
CN VI - name - function - modality (sensory / motor / both)
Abducens - motor - lateral rectus
CN VI - name - function - modality (sensory / motor / both)
Abducens - motor - lateral rectus
What palsy & which nerve is affected when patient presents with **down and out** appearance of the ye?
Oculomotor nerve palsy - CN III supplies all muscles except SO & LR so if they have unopposed action, inferolateral action of eye = CN III palsy!
What palsy and which nerve is affected when patient tilts their head forward and tuck their chin in, or they tilt their head to the side?
Trochlear nerve (CN IV) palsy - forward, chin in: minimise vertical diplopia when looking down due to loss of SO’s action of pulling the eye downwards - tilt: SO also assist with intorsion of eye as head tilts so patient will tilt head to fuse two images together
What palsy and which nerve is affected when patient presents with a convergent squint, and/or a horizontal diplopia?
Abducens nerve (CN VI) palsy - convergent squint is due to unopposed adduction of eye by MR - also can’t abduct
CN V - name - function - modality (sensory / motor / both) - branches, mod, func?
Trigeminal - facial sensations, motor info to muscles of mastication - sensory and motor 1. Ophthalmic - sensory - scalp, forehead, nose, upper eyelid 2. Maxillary - sensory - lower eyelid, cheek, lips and gums 3. Mandibular - sensory chin, jaw, motor to mastication & part ear
CN VII - name - function - modality (sensory / motor / both) - ?
Facial - Sensory - taste anterior 2/3 tongue - Motor - facial expressions, upper bilateral, lower contralateral - Parasympathetic - salivary glands x 3
How would you test CN VII?
By facial expressions: - raising eyebrows - closing eyes - blowing out cheeks - smiling - pursing lips
CN VIII - name - function - modality (sensory / motor / both)
Vestibulocochlear - sensory - sound and balance
How would you test CN VIII
Hearing - gross hearing - Rine’s = bone conduction - Weber’s = transfer issues Vestibular - Unterberger / Turning = march on the spot - Head thrust / vestibular-ocular reflex = you turn patient’s head and see head of neck turns first - Caloric test for labyrinthe
CN IX - name - function - modality (sensory / motor / both) - ?
Glossopharyngeal - Sensory - taste, posterior 1.3 of tongue, pharynx, tube - Motor - swallow speech (1 in pharynx) - Parasympathetic for parotid gland
CN X - name - function - modality (sensory / motor / both) - ?
Vagus - Sensory - generaal sensation ENT - Motor - speech, efferent gag reflex - Parasympathetic - thoracic and abdominal viscera
How would you test CN IX and CN X?
- Gag reflex (aff 9 eff 10), swallow assessment - Inspection - vagus nerve lesion will cause asymmetrical elevation of palate and uvula deviate away from lesion
CN XI - name - function - modality (sensory / motor / both)
Accessory - Motor - info to sternocleidomastoid and trapezius
How would you assess CN XI
WEAKNESS = PALSY - raise and resist you pushing down: trapezius - turn head left or right while you resist
CN XII - name - function - modality (sensory / motor / both)
Hypoglossal - motor info to extrinsic muscle of the tongue
How would you assess CN XII
- open mouth: inspect tongue for wasting and fasciculation - protrude tongue for deviation (toward lesion) - hand on cheek, ask patient to push tongue against it - compare both sides to check
