h&n Flashcards
how do you test sensory function of trigeminal nerve?
close eyes -> neurotip -> both sides in 3 divisions of face -> equal feeling?
how do you test motor function of trigeminal nerve?
masseter and temporalis muscle = mastication
chewing motion
how do you test motor function of facial nerve?
copy facial expression I’m doing, against resistance, check for discomfort
temporal - raise eyebrow zygomatic - eyes tightly shut buccal - smile with teeth showing mandibular - blow cheeks cervical - grimace
how do you test motor function of glossopharyngeal nerve?
elicit gag reflex - gently tough the back of the throat using tongue depressor
how do you test motor function of vagus nerve?
open mouth and make ahh sound
look for uvula elevation
deviation from midline away from lesion side
how do you test motor function of hypoglossal nerve?
stick tongue out
deviation from midline towards lesion side
how do you test motor function of accessory nerve?
sternocleidomastoid muscle
look to one side against resistance
repeat to other side
how do you test extrinsic eye muscles?
H test
superior oblique - trochlear nerve (IV)
lateral rectus - abducens nerve (VI)
the 4 rest - oculomotor nerve (III)
cover one eye -> abduct or adduct -> elevate or depress
superior rectus inferior oblique lateral rectus medial rectus
inferior rectus superior oblique
inferior rectus and superior oblique both depress so have to separate them using their secondary action
how do you test ipsilateral and consensual pupillary light reflex?
shine light to one eye - observe ipsilateral pupil constriction
move light away for 3 seconds
shine light to same eye - observe other eye pupil constriction (consensual)
how do you test accommodation reflex?
focus image far away
countdown to focus on finger 5-10cm away from eye
describe afferent and efferent pathway for accommodation reflex
ganglion cell -> optic nerve -> optic tract -> pretectal nucleus -> Edinger-Westphal nucleus -> parasympathetic oculomotor nerve -> ciliary ganglion -> parasympathetic ciliary nerve (V1) -> sphincter pupillae
describe afferent and efferent pathway of corneal reflex
touch sensation -> ophthalmic branch of trigeminal nerve -> facial motor nucleus -> facial nerve -> orbicularis oculi
how do you test corneal reflex?
cotton wool onto sclera -> rapid eye closure
how many teeth are present in a complete adult teeth set?
32
4 sets of...
2 incisors
1 canine
2 premolar
3 molar
what is the significance of C7?
vertebrae prominence
how do you palpate hyoid bone?
place index finger on thyroid cartilage
ask patient to swallow
hyoid bone move up
place index and thumb in pincer position 2cm above thyroid cartilage
where is laryngeal prominence situated?
between superior thyroid cartilage and inferior cricoid cartilage
where is thyroid situated?
below cricoid cartilage
where is the lateral mass of atlas found?
between mastoid process and ramus of mandible
where and when are tracheostomy and cricothyroidotomy performed?
cricothyroidotomy: through cricothyroid membrane
in an emergency
tracheostomy: below cricoid cartilage between trachea cartilage rings
for temporary intubation or long term airway access
describe the start and end of external acoustic meatus
how is it observed?
opening of ear canal -> tympanic membrane
use otoscope
carotid pulse
common carotid artery
anterior border of sternocleidomastoid
cervical lymph nodes
circular motion
don’t lift fingers off
palpate from behind the patient
(look at the route for lymph nodes palpation)
where is central line inserted?
into internal jugular vein (lateral to common carotid artery)
superior apex of triangle (sternal head of sternocleidomastoid, medial third of clavicle, clavicular head of sternocleidomastoid)
at 30’ angle
needle pointing towards ipsilateral nipple
