Lab Unit 03: Cranial Nerves Flashcards

1
Q

Sternocleidomastoid (SCM) – (Moore 991)

A

• Origin (PA):
Mastoid process
+ lateral half of superior nuchal line.
• Insertion (DA):
- Sternal head: Anterior surface of manubrium of sternum.
- Clavicular head: Superior surface of medial third of clavicle.
• Nerve:
- CN XI Accessory nerve (motor)
- AR C2, C3 (pain and proprioception).
• Action:
- Bilaterally: Flexes the neck.
- Unilaterally: Ipsilateral lateral neck flexion and contralateral rotation.

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2
Q

Upper Trapezius – (Moore 700)

A
• Origin (PA):
   Medial third of superior nuchal line
   \+ External occipital protuberance
   \+ Nuchal ligament
   \+ SP C7. 
• Insertion (DA):
   Lateral third of clavicle
   \+ Acromion.
• Nerve:
   - CN XI Accessory nerve (motor)
   - AR C3, C4 (pain and proprioception).
• Action:
   Elevates, adducts, and upwardly rotates scapula.
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3
Q

Middle Trapezius – (Moore 700)

A
• Origin (PA): SP T1-5.
• Insertion (DA):
   Medial margin of acromion
   \+ superior lip of spine of scapula.
• Nerve:
   - CN XI Accessory nerve (motor)
   - AR C3, C4 (pain and proprioception).
• Action: Adducts the scapula.
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4
Q

Lower Trapezius – (Moore 700)

A

• Origin (PA): SP T6-T12.
• Insertion (DA): Spine of scapula.
• Nerve:
- CN XI Accessory nerve (motor)
- AR C3, C4 (pain and proprioception).
• Action: Depresses, adducts, and upwardly rotates scapula.

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5
Q

Cranial Nerves

A
• CN I Olfactory
• CN II Optic
• CN III Oculomotor
• CN IV Trochlear
• CN V Trigeminal
   - CN V1 Opthalmic division
   - CN V2 Maxillary division
   - CN V3 Mandibular division
• CN VI Abducens
• CN VII Facial
• CN VIII Vestibulocochlear
• CN IX Glossopharyngeal
• CN X Vagus
• CN XI Accessory
• CN XII Hypoglossal
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6
Q

CN I Olfactory

A

• Special sensory visceral afferent
• Function: Smell
• Test:
- Unilateral test that must be performed bilaterally
- Block one nostril + place something pungent under the other nostril (coffee). Ask the patient when they smell it.

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7
Q

CN II Optic

A

• Special Sensory
• Function:
- Visual acuity
- Intactness of visual fields
• Test: w/ an Snellen chart placed 6m away
- close one eye and read the smallest line they can make out
- 1 miss is fine; 3-4 move up one line

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8
Q

CN III Olfactory

A
• Motor
• Function:
   - Pupil constriction
   - Upward / Downward / Medial gaze
   - Eyelid elevation
• Test:
   • Pupil constriction (direct & consensual)
      - Shine a light in patients eye. Look to see if the pupil of the eye the light is shone in constricts; also look if the contralateral pupil constricts.
   • Eyelid elevation
      - Look for symmetry of the eyelids
      - Ptosis (droopy eyelid)
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9
Q

CN IV Trochlear

A
  • Motor
  • Inferior with lateral eye movement (“cute shoes”)
  • Test:
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10
Q

CN V Trigeminal

A
• Mixed
• Function:
   • Sensory:
     - face, cornea, nasal & oral cavity, upper & lower teeth
    - Ophthalmic, Maxillary, Mandibular division
   • Motor:
      - Muscles of Mastication
      - Mandibular division

• Test:
• Sensory component:
- Sensation to face (hot/cold, sharp/dull)
- Corneal reflex:touch cornea w/ a paper towel
–> blinking
• Motor component:
- Palpate masseter muscles

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11
Q

CN VI Abducens

A

• Motor
• Function: Pure lateral eye movement
• Test: III, IV, VI tested together
- Smooth pursuits:
Check for smooth tracking (“follow my pen”)
- Saccades:
Accuracies (no jumping or overshooting; “look at my nose, look at my pen”)

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12
Q

CN VII Facial

A
• Mixed
• Function:
   • Sensory: Taste to the anterior 2/3rds of tongue
   • Motor: Muscles of facial exression
• Test:
   • Sensory component:
      - Taste test: ID sweet or salty
   • Motor component:
      - Corneal reflex:touch cornea w/ a paper towel
        --> blinking
      - "Make faces"
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13
Q

CN VIII Vestibulocochlear

A

• Sensory
• Function:
- Cochlear function: Hearing acuity
- Vestibular function: position in space related to position & movement of head and balance

• Test:
• Hearing tests:
- Rine Test (Air): tuning fork through air
- Weber Test (Bone): tuning fork on bony promnence: mastoid process, cranium

• Vestibular testing:

  - cold/warm stimulus
   - -> SHOULD cause vertigo/nystagmus
   - -> direction of nystagmus or eye beating
   - -> COWS: cold opposite, warm same

• Vestibulo-ocular reflex

  - Reflex test for III, VI & VIII
  - Eyes should stay on examiners nose while head thrust performed.
  - Conjugate horizontal gaze: coordinated eye movement
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14
Q

CN IX Glossopharyngeal

A
  • Mixed
  • Function:
    • Sensory: touch & taste sensaton on posterior 1-3rd of tongue and pharyngeal wall (gag reflex)
    • Motor: swolloing, gag reflex

• Test:
• Sensory component:
- Taste test: Does it taste bitter?
- Gag reflex: lightly stimulate back of throat
• Motor component:
- Have patient swallowing a liquid

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15
Q

CN X Vagus

A

• Mixed
• Function:
• Sensory: heart, lungs, trachea, pharynx, larynx, bronchi, GI tract, external ear
• Motor: heart, lungs, trachea, palate, pharynx, larynx, bronchi, GI tract
ex: constricts bronchioles, decreases HR, increases GI motility

• Test:
   • Say Ahhh - Test
      --> examine symmetry of uvula
      If lesion --> uvula deviates contralaterally
      (strong side is pulling)
      --> listen for hoarsness
  • -> If both severed –> aphonia (unable to talk)
  • -> if one severed –> deviates from affected side
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16
Q

CN XI Accessory

A
• Motor
• Function:
   - Sternocleidomastoid (SCM)
   - Trapezius
• Test:
   • Shoulder shrug test: Trapezius
   • Head turn test: Sternocleidomastoid
17
Q

CN XII Hypoglossal

A
• Motor
• Function:
   - Tongue movement, symmetry & shape
• Test:
   • Let me see your tongue test:
      --> examine resting tongue
   • Stick out your tongue test:
      --> examine tongue movement, strength & coordination

–> if lesion –> tongue deviates ipsilaterally (strong side pushing)