Neuro 2

Question 1

Patient has difficulty with smelling. What cranial nerve is affected and what type is it?

Answer 1

Cranial Nerve I: Olfactory Nerve
Type: Sensory

Question 2

Patient’s vision is affected. He is has little to no vision. What cranial nerve is affected?

Answer 2

Cranial Nerve II: Optic Nerve
Type: Sensory

Question 3

Patient has palsy eye movement, with eyes position downward and outward with the inability to to adduct, infraduct, or supraduct, as well as a dilated pupil with sluggish reaction. What cranial nerve is affected?

Answer 3

Cranial Nerve III: Oculomotor Nerve
Type: Motor
Explanation: The oculomotor nerve controls most of the eye’s movements, including adduction, supraduction, and infraduction. It also controls the constriction of the pupil. Damage to this nerve typically results in the affected eye being positioned downward and outward (due to unopposed action of the lateral rectus and superior oblique muscles), as well as a dilated pupil with a reduced response to light due to impaired parasympathetic innervation.

Question 4

What are the cranial nerves that are purely motor?

Answer 4

CN III, CN IV, CN VI, CN XI, CN XII (5 CNs)

Question 5

What are the cranial nerves that are purely sensory?

Answer 5

CN I, CN II, CN VIII (3 CNs)

Question 6

What are the cranial nerves that are mixed?

Answer 6

CN V, CN VII, CN IX, CN X (4 Cranial Nerves)

Question 7

The patient’s superior oblique muscle is affected, as such the patient has difficulty with downward and outward eye movement (depression and abduction of the eye), which makes it difficult for the patient to read or descend the stairs. To compensate for the diplopia and misalignment, the patient often tilt his head to the opposite side of the affected eye. This head tilt helps align the visual axis and reduce double vision. State what cranial nerve is affected and its type.

Answer 7

CN IV: Trochlear Nerve
Type: Motor

Question 8

This cranial nerve helps feel the face (sensation of the face), as well as the anterior 2/3 of of the tongue. It is also responsible for jaw movement. This has three branches and is known as the largest cranial nerve. State the cranial nerve and type, as well as the branches.

Answer 8

CN V: Trigeminal Nerve
Type: Mixed
V1: Opthalmic branch
V2: Maxillary branch
V3: Mandibular branch

Question 9

A 55-year-old woman presents with episodes of severe facial pain: Sharp, shooting pain in the right side of her face, particularly affecting the cheek and jaw area. Pain is triggered by light touch or activities such as chewing or brushing her teeth. No sensory loss or weakness in the face. Which cranial nerve is affected?

Answer 9

The pain is localized to the cheek and jaw area, which suggests involvement of the maxillary (V2) and mandibular (V3)branches of the trigeminal nerve.

Question 10

What are the motor aspect and sensory aspect of the trigeminal nerve?

Answer 10

Motor: Jaw movements
Sensory: Sensation for the face and anterior 2/3 of the tongue (touch, pain, temperature)

Question 11

How do you assess to check if the trigeminal nerve is affected?

Answer 11

Jaw movement: Asking the patient to open and close its mouth, and move his/her jaw from side to side. Note any difficulty or asymmetry in jaw movement.
Asking the patient to close his/her eyes to check the sensation of the overall face, while the patient touches and asks the patient where he/she felt the sensation.

Question 12

The patient was observed to have difficulty moving the affected eye laterally beyond the midline. The patient also experiences double vision that worsens when looking toward the side of the affected nerve. The muscle affected is the lateral rectus muscle. Which cranial nerve is affected?

Answer 12

Cranial Nerve VI: Abducens
Type: Motor

Question 13

This cranial nerve is responsible of facial expressions, lip movements, closing of eyes, and production of saliva and tears. This is also responsible of gustation for anterior 2/3 of the tongue. What cranial nerve is this and state the type.

Answer 13

Cranial Nerve VII: Facial Nerve
Type: Mixed

Question 14

The patient has difficulty with tasting the food that he/she is eating. He is also unable to move his eyebrows. Which cranial nerve may be affected?

Answer 14

Cranial Nerve VII: Facial Nerve
Type: Mixed

Question 15

This cranial nerve is responsible for sense of hearing and balance. State the type and cranial nerve.

Answer 15

Cranial Nerve VIII: Vestibulocochlear Nerve
Type: Sensory

Question 16

This cranial nerve elevates pharynx and larynx as it innervates the stylopharyngeus. It elevates the velum because of the pharyngeal plexus. It also innervates the parotid gland, which produces salivation. Additionally, this cranial nerve is responsible for the taste of the posterior 1/3 of the tongue, and any sensation in the pharynx, and also triggers the gag reflex.

Answer 16

Cranial Nerve IX: Glossopharyngeal Nerve
Type: Mixed

Question 17

A 60-year-old male presents with a 3-month history of difficulty swallowing, particularly with solid foods. He also reports a dull ache on the right side of his throat that occasionally radiates to his ear. On examination, you notice diminished gag reflex on the right side and deviation of the uvula to the left. Which cranial nerve is most likely affected, and what is the primary muscle this nerve innervates?
A) Cranial Nerve VII, stapedius muscle
B) Cranial Nerve IX, stylopharyngeus muscle
C) Cranial Nerve X, levator veli palatini muscle
D) Cranial Nerve XII, genioglossus muscle

Answer 17

Cranial Nerve IX, stylopharyngeus muscle

Question 18

This cranial nerve is responsible for the gag and cough reflex. It also innervates the motor movement of the muscles of the pharynx, larynx, and the velum, and the peristaltic motion of esophagus.

Answer 18

Cranial Nerve X: Vagus Nerve
Type: Mixed

Question 19

This cranial nerve is the longest cranial nerve. It has two importantce branches. Please state what cranial nerve this is and the 2 important branches.

Answer 19

CN X: Vagus Nerve
Recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN)

Question 20

This cranial nerve is responsible for the movement of the sternocleidomastoid and trapezius muscles.

Answer 20

CN XI: Accessory Nerve
Type: Motor

Question 21

This cranial nerve is responsible for all tongue movements

Answer 21

CN XII: Hypoglossal Nerve
Type: Motor

Question 22

This cranial nerve is responsible for the forced inhalation.

Answer 22

CN XI: Accessory Nerve

Question 23

A 65-year-old male presents with hoarseness, difficulty swallowing, and a weak cough. On examination, the uvula deviates to the left when the patient says ‘ah,’ and there is a loss of the gag reflex on the right side. Which cranial nerve is likely affected?

Answer 23

CN X: Vagus Nerve
Recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN)

Question 24

A 58-year-old woman complains of difficulty in turning her head to the right side and weakness in her left shoulder. On examination, there is atrophy of the left sternocleidomastoid and trapezius muscles.

Answer 24

CN XI: Accessory Nerve

Question 25

A 70-year-old patient presents with slurred speech and difficulty swallowing. On examination, the tongue is atrophied on the right side and deviates to the right when protruded.

Answer 25

CN XII: Hypoglossal nerve

Question 26

State the speech process

Answer 26

Respiration, Phonation, Resonance, Articulation

Question 27

What are the swallowing stages?

Answer 27

Oral phase, pharyngeal phase, esophageal phase

Question 28

What cranial nerve is responsible for this speech process: production of some vowels such as /a/ /ɜ/, and ensures normal resonance because it innervates the tensor veli palitini as this tenses the soft palate.

Answer 28

CN V: Trigeminal Nerve

Question 29

This cranial nerve is responsible for mastication, bolus movement, and anterior hyolaryngeal movement

Answer 29

CN V: Trigeminal Nerve

Question 30

Responsible for production of some vowels /i, u/ and consonants /p, b, m/

Answer 30

CN VII: Facial Nerve

Question 31

Responsible for gustation, lip closure, and saliva production

Answer 31

CN VII: Facial Nerve

Question 32

This cranial nerve ensures normal resonance for its speech process. Additionally, it is responsible for gustation at the 1/3 of the tongue, and detecting pharyngeal residue, and pharyngeal constriction.

Answer 32

CN IX: Glossopharyngeal Nerve

Question 33

This cranial nerve is responsible for phonation and normal resonance. Additionally, it is responsible for the pharyngeal constriction, laryngeal closure and elevation, as well as the peristaltic motion of the esophagus.

Answer 33

CN X: Vagus Nerve

Question 34

This cranial nerve is responsible for bolus manipulation and bolus transport.

Answer 34

CN XII: Hypoglossal Nerve

Question 35

What are the most common acquired medical diagnoses affecting the CN

Answer 35

Stroke, TBI, Bell’s Palsy, Trigeminal Neuralgia

Question 36

Common medical progressive diagnoses

Answer 36

Alzheimer’s disease, ALS, Guillain-barre Syndrome

Question 37

The patient was observed to have dysphagia, having difficulty identifying whether there is residue in his oral cavity. Which cranial nerve is affected?

Answer 37

CN V: Trigeminal Nerve

Question 38

The patient has diffiuclty producing plosive sounds such as /p, b, m/, additionally he was observed to have anterior spillage and has problems with production of saliva, and was observed to have difficulty identifying the taste of food.

Answer 38

CN VII: Facial Nerve

Question 39

The patient has damage to his vagus nerve, which consistency will they most likely aspirate?

Answer 39

If a patient has damage to the vagus nerve, they are most likely to aspirate thin liquids. The vagus nerve is crucial for controlling swallowing and the gag reflex. When it’s damaged, the ability to manage the swallowing of liquids decreases, making it easier for them to enter the airway instead of the esophagus, leading to aspiration.

Question 40

The esophageal phase of swallowing is thanks to the autonomic function of which nerve/s?

Answer 40

CN X Vagus Nerve

Question 41

The patient presents with buccal residue to reduced buccal tension when swallowing. Which cranial nerve is most likely causing this?

Answer 41

CN VII Facial Nerve

Question 42

The patient complains of difficulty swallowing, often accompanied by a feeling of food getting stuck in their throat. They also notice their voice is hoarse and raspy.

Answer 42

CN X: Vagus Nerve

Question 43

The patient reports a loss of taste, particularly on one side of their tongue.

Answer 43

CN VII or CN IX