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Head And Neck > Midterm - Cranial Nerve more > Flashcards

Midterm - Cranial Nerve more Flashcards

1
Q

CN I

A

Olfactory nerve

Sensory: ability to smell

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2
Q

CN I test

A

Odor recognition

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3
Q

Amosmia vs hyposmia

A 
Anosmia = complete loss of sense of smell
Hyposmia = diminished sense of smell
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4
Q

Loss of smell is commonly (bilateral/unilateral) and due to _____

A

Bilateral

Chronic rhinitis, fracture to cribiform plate, etc

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5
Q

Anosmia that is a new onset and unilateral is

A

Most concerning. Suggests possible intracranial mass

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6
Q

Dysosmia/parosmia

A

Difficulty identifying odors. A CN I problem

*considered idiopathic

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7
Q

Phantosmia

A

Hallucination of an odor when none present. A CN I problem

*implies a problem in the olfactory cortex

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8
Q

CN II

A

Optic nerve

Sensory only: vision & afferent portion of pupil constriction

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9
Q

CN II tests

A
  1. Visual acuity
  2. Peripheral vision
  3. Pupillary light reflexes (affarent portion)
  4. Visualize optic disc
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10
Q

Primary open angle glaucoma can cause

A

Globally narrowed visual fields (high pressure in the eye damages the optic nerve)

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11
Q

What is Normal response to light?

And what is direct and consensual response?

A

Miosis = pupil constriction

Direct response = pupil with the light source constricts

Consensual = constriction fo the pupil in the eye opposite from the light source

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12
Q

How does light coming in one eye constrict both pupils?

A

Light come in one eye, travel along CN II which synapses with CN III. CN III generates efferent motor response bilaterally, causing pupil constriction

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13
Q

CN III

A

Oculomotor nerve. Efferent motor.

Innervates the levator palpebrea superioris muscle which causes eyelid elevation

Controls 4/6 muscles involved in moving the eye: inferior oblique, inferior superior and medial rectus

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14
Q

CN III tests

A
  1. Pupillary light reflex - motor component of pupil constriction
  2. Check for intact eyelid elevation
  3. Assess cardinal fields of gaze (evaluates CN III, IV, VI)
    - also corneal light reflection & cover/ uncover tests for strabismus
  4. Accommodation
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15
Q

Abnormal CN III function

A

Droopy eyelid (ptosis)

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16
Q

Dysconjugate gaze

A

Eyes that don’t move in parallel

Usually indicates paresis (weakness) or paralysis of extra-ocular muscles

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17
Q

End point nystagmus is ______ whereas involuntary nystagmus through the cardinal fields of gaze is ______

A

Normal, abnormal

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18
Q

Lateral rectus m is innervated by ____ and does _____

A

CN VI, eye abduction

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19
Q

Superior oblique is innervated by ____ and does ____

A

CN IV, moves eyes down and in

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20
Q

Signs of complete right CN III palsy

A

Dilated pupil (mydriasis), ptosis, can’t move the R eye medically

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21
Q

A patient with disconjugate gaze will complain of ________ and tends to occur in the direction (of/ opposite) the dysconjugate gaze

A

Double vision (diplopia), in direction of dysconjugate gaze

22
Q

Asymmetric corneal reflections indicates _____

A

Strabismus = deviation of normal ocular alignment

aka heterotropia

23
Q

The cover/ uncover test assesses for ____

A

Phoria (latent strabismus)

  • patient looks straight ahead with both eyes, cover one eye, the covered eye will deviate when not in use, the eye moves back to center when you uncover it
24
Q

In Accommodation (aka convergence), the eyes should both move inward together until about ___ inches from the bridge of the most and pupils should _____

A

5 inches, constrict

25
Q

What is the accommodation triad? Aka near reflex

A
  1. The eyes should converge (CN III)
  2. The pupils should constrict (CN III)
  3. Lenses should change shape (not visible to examiner - parasympathetic innervation)
26
Q

Cranial nerve palsies are often cause by intracranial problems such as

A
  • cerebral vascular accidents
  • tumors
  • trauma
  • multiple sclerosis
  • infection
  • migraines

Can be congenital

27
Q

CN V

A

Trigeminal nerve
Sensory and motor innervation
Muscles of mastication

28
Q

CN V tests

A
  • bite the stick
  • light touch and pain sensation
  • corneal reflex (blink reflex)
29
Q

Where do V1, V2 and V3 have sensory innervation?

A

V1 (ophthalmic) - forehead and top of nose)
V2 (maxillary) - bottom of nose, upper lip, zygomatic process
V3 (mandibular) - anterior to ear, lateral mandible and chin/bottom lip

30
Q

What is Trigeminal neuralgia/neuropathy aka Tic Doulourex?

peak onset?

Pain characteristics?

Trigger zones

Causes

Management

A

Facial pain in the trigeminal distribution between maxi alley and mandibular branch

60-70

  • sharp, lancinating,
  • lips, gums, cheek or chin
  • unilateral
  • paroxysmal
  • seconds to minutes

Trigger zones
- small areas in the region of the nose and mouth (possibly brushing teeth, chewing, cold exposure)

  • idiopathic, sometimes from contact/compression by other structures (superior cerebellar artery, multiple sclerosis plaques, tumor)
  • MRI, referral to neurologist, medication (anti-seizure)
31
Q

Corneal reflex (blink reflex) tests the ___ part of CN V and CN ____ controls eyelid closure.

What is Normal/abnormal response

A

CN V1 (ophthalmic branch)

CN VII controls orbicularis oculi muscles for lid closure

Normal: light touch to cornea (CN V) causes both eyes to blink (CN VII)

Abnormal: absent blink in either or both eyes

32
Q

CN VII

A

Facial nerve
Motor and sensory functions
Facial expression, taste, corneal reflex

33
Q

CN VII facial expression abnormalities can be due to peripheral nerve lesion (LMN) such as _____ and central lesion (UMN) such as ____

A

Bell’s palsy

Stroke or tumor

34
Q

Forehead/eyebrows have (unilateral/bilateral) UMN and (unilateral/bilateral) LMN innervation

An injury to CN VII LMN will cause loss function of the (upper/lower/both) divisions of the face? This is known as ______

A

Bilateral UMN, unilateral LMN

Both = bell’s palsy

35
Q
  • sudden onset, one-sided facial paresis/paralysis but no loss of facial sensation (exception: taste)
  • unable to raise eyebrow/wrinkle the forehead
  • can’t fully close the eye
  • loss of Nash-labial folds
  • drooping of the corner of the mouth
  • trouble with lip sounds B,P and M
A

CN VII Bell Palsy

36
Q

What are risk factors for Bell Palsy? What are the causes?

A

Diabetes, pregnancy, history of Herpes Simplex Virus (HSV) or Varicella Zoster Virus (VZV)

Idiopathic, possibly virally-mediated

37
Q

What is the management and prognosis of bell palsy?

A
  • eye drops/temporary patch
  • refer to PCP for co-management
    Urgent but not an emergency, corticosteroids +/- antivirals

Most often resolves over 3-6 weeks

38
Q

UMN lesion of CN VII (will/ will not) spare the forehead?

A

Will spare the forehead but the contralateral lower face will have deficits

39
Q

What part of the tongue does CN VII innervate?

A

Sensory (taste) to the anterior 2/3 of the tongue

40
Q

CN VIII

A

Auditory nerve
2 divisions (vestibular and cochlear)
Both sensory

41
Q

How do you test the cochlear division of CN VIII?

A

Whisper test

*if the patient fails, perform the Weber and Rinne tests to asses for conductive vs sensorineural hearing loss

42
Q

What is conductive hearing loss?

A

External sound waves from the air are not able to gain access to the inner ear

Due to trauma, infection, inflammation, foreign body, cerumen buildup, etc. in the outer or middle ear

43
Q

What is sensorineural hearing loss?

A

Caused by damage to the inner ear or the cochlear branch of CN VIII

Ex: aging and acoustic neuroma

44
Q

In Webber’s test, sound will lateralize to the _____ side in conductive hearing loss or the ______ side in sensorineural hearing loss

A

Affected, unaffected

45
Q

Abnormal rinne test results for conductive and sensorineural hearing loss

A

Conductive: Bone conduction (BC) > air conduction (AC)

Sensorineural: AC>BC in affected ear but diminished compared to normal

46
Q

CN IX and CN X

A

Glossopharyngeal & Vagus

Both have motor and sensory functions

47
Q

CN IX and CN X tests

A

“Say ahhh”
Gag reflex
Observe patients ability to speak clearly
Check the oropharynx: uvula midline, upward movement of soft palate is symmetrical, gag reflex intact and symmetrical

48
Q

What part of the tongue does CN IX innervate?

A

Sensory to the posterior 1/3 of the tongue

49
Q

CN XI

A

Spinal accessory nerve

Motor: trapezius and SCM muscles

50
Q

CN XII

A

Hypoglossal nerve

Motor: tongue movement

51
Q

CN XII tests

A
  • stick out your tongue and move side to side

- say L, D, T and N

52
Q

When there is an issue with one side of the hyppoglossal nerve, the tongue will deviate (toward/away from) the side of lesion

A

Toward

*the functioning side will dominate

Head And Neck (18 decks)

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