Kruse 1 Flashcards
CN I
Olfactory
- Anosmia: loss of sense of smell
- Testing: use whatever is on hand (hand sanitizer, lotion)
Aniscoria
- Pupil Asymmetry, present in up to 20% of the population
- If the difference is consistent in varying levels of ambient light, its probably normal
Miosis and mydriasis
- Miosis
- pupil constriction
- parasympathetic stimulation, light, looking at a near object
- mydriasis
- pupil dilation
- sympathetic stimulation, decrease in light, looking at a far object
Pupillary reaction to light (direct/indirect)
- Direct puillary reaction to light
- light shown on the retina (afferent CN II) results in constriction of the IPSILATERAL pupil (efferent CN III)
- Indirect pupillary reaction to light
- light shown on the retina (afferent CN II) results in constriction of the CONTRALATERAL pupil (efferent CN III)
Pupillary reaction to accomodation
- Pupils constrict when focused on a near object
Marcus Gunn Pupil
Relative afferent pupillary defect
- Due to optic nerve or severe retinal disease
- direct pupillary resposne to light is absent, but the indirect response is intact because CN III remains intact
Intact to accommodation but not the light
Hallmark of neurosyphilis
Horner’s syndrome
- Loss of sympathetic tone
- Ptosis = droopy eyelid
- Miosis = pupil constricted
- anhydrosis = lack of sweating on that side of the face
CN IV palsy
- inability to bring the eye in and down
- often leads to certical diplopia with reading or near vision
- often develop head tilt AWAY from the affected eye
Saccades Vs Nystagmus
- Saccades = normal jumping movements of the eye with voluntary scanning (reading, etc)
- Nystagmus
- slow drift away from the focus with fast beat correction back to the focus
- NAMED FOR THE FAST PHASE
- cerebellar lesion: lateral, fast phase towards the side of lesion
- Vertical lesion: typically indicates a lesion in the midbrain
UMN vs LMN in the face
- Forehead has bilateral UMN involvement but unilateral LMN involvement
- this means that an UMN lesion (eg STROKE) will cause facial drooping but spare the forehead
- a patient with an LMN lesion (eg BELLS PALSY) will cause facial drooping involving the forehead
Conductive vs sensorineural hearing loss
- Conductive type hearing loss
- hearing loss is due to inefficient conduction fromthe outer ear to the ear drum to ossicles
- fluid in the middle ear, perforated ear drum, impacted cerumen, foreign body
- hearing loss is due to inefficient conduction fromthe outer ear to the ear drum to ossicles
- Sensorineural hearing loss
- damage to the inner ear apparatus or CN VIII
- med toxicity, genetic hearing loss, aging, trauma, infection, exposure to loud noises
- damage to the inner ear apparatus or CN VIII
Weber vs rinne test
- Rinne test
- vibrating handle of the turning fork against the mastoid process until the sound fades, then move the tines to just outside the auditory meatus
- the sound should be LOUDER on AIR CONDUCTION than bone
- normal test is positive, abnormal is negative
- the sound should be LOUDER on AIR CONDUCTION than bone
- vibrating handle of the turning fork against the mastoid process until the sound fades, then move the tines to just outside the auditory meatus
- Weber test
- vibrating handle of the tuning fork agaisnt midline of the skull
- the sound should be equal in both ears
- louder in one ear is considered lateralizing to that side
- vibrating handle of the tuning fork agaisnt midline of the skull
C2
C6
C7
C8
C2 = back of head
C6 = tumb
C7 = index and middle finger
C8 = ring and little finger
T1
T4
T10
T1 = anterior axilla
T4 = nipple line
T10 = umbilicus
L3
L4
L5
L3 = medial knee
L4 = medial malleolus
L5 = dorsum 3rd MTP joint
S1
S2
S3
S5
S1 = lateral heel
S2 = popliteal fossa
S3 = ischial tuberosity
S5 = perianal area
Stereognosis vs graphesthesia
- Stereognosis
- identification of objects by touch
- inability to identify objects by touch is TACTILE AGNOSIA
- Parietal lob function
- Graphesthesia
- write a letter/number on patients palm
Deep tendon reflexes (DTR)
Biceps
Brachioradial
ticeps
patellar
achilles
- Biceps –> C5 and C6
- Brachioradial –> C5 and C6
- Triceps –> C6, C7, C8
- Patellar –> L2, L3, L4
- Achilles –> S1 and S2
DTR scoring
- 0+ = no response
- 1+ = sluggish/diminished
- 2+ = active or expected
- 3+ = brisker than expected
- 4+ = brisk/hyperactive, transient clonus
Describe grading of motor strength***
- 0 = no evidence of movement
- 1 = trace movement (twitch)
- 2 = full ROM without gravity (lateral movement)
- 3 = full ROM against gravity
- 4 = Full ROM against gravity with some resistance (MOST PTS)
- 5 = Normal
Motor testing
- Upper extremity weakness is due to damage in the C-Spine or higher
- Lower extremity weakness is due to Damage in the L-spine/Sacrum or higher
- changes in bowel or bladder functions or weakness to point they can no longer ambulate, they need urgent evaluation by specialist