Neuro

Question 1

How would you test cranial nerve 2?

Answer 1

Visual acuity, visual fields, accommodation, direct light reflex and consensual reflex, fundoscopy

Question 2

How would you test cranial nerves 3, 5 and 6

Answer 2

Inspect resting gaze, look for ptosis, test eye movements, ask about double vision

Question 3

How would you test cranial nerve 5?

Answer 3

light touch on 3 parts of the face, corneal reflex (if needed), palpate temporalis and masseter and pterygoid

Question 4

How would you test cranial nerve 7?

Answer 4

Raise eyebrows, screw up eyes, smile and show teeth, blow out cheeks

Question 5

How would you test cranial nerve 8?

Answer 5

Whisper in ear, Rinne’s test, Weber’s test

Question 6

How would you test cranial nerve 9 and 10?

Answer 6

Cough, soft palate movement, gag reflex (if necessary)

Question 7

How would you test accessory?

Answer 7

shrug shoulders, turn head to each side and push against neck

Question 8

How would test cranial nerve 12?

Answer 8

Wasting of tongue, fasciculations of tongue, protrude tongue, tongue movement

Question 9

Explain rinnes and webers test

Answer 9

Rinnes - hearing the fork longer in bone than in air means there is a conductive hearing loss in the ear

Webers - Hearing the fork lateralise to one side means there is a sensorineural hearing loss in the other ear or a conductive loss in the same ear

Question 10

What is a bitemporal hemianopia? Where is the lesion? Give e.g. of lesion

Answer 10

Loss of temporal visual fields

lesion in optic chiasm e.g. pituitary tumour

Question 11

What is homonymous hemianopia? Where is the lesion? Give e.g.

Answer 11

Loss of either right or left visual fields on both eyes.

Lesion of optic tract

e.g. vascular, tumour

Question 12

What is upper quadrant homonymous hemianopia? Where is the lesion? Give e.g.

Answer 12

Upper left or right quadrant gone

Lesion in part of optic radiation affecting that quadrant - temporal lobe

e.g. vascular, tumour

Question 13

What is a lower quadrant homonymous hemianopia? What is it caused by? e.g.

Answer 13

Loss of lower quadrant of vision. Same side

Lesion in part of optic radiation which corresponds to that quadrant - Parietal lobe lesion

tumour, vascular

Question 14

What happens in a CN 3 lesion? What can it be caused by?

Answer 14

Down and out eyes, ptosis, dilated pupil unreactive to light

compressive lesions, tumour

Question 15

What happens in a CN4 lesion?

Answer 15

Loss of Superior oblique. Difficulty reading, patient may tilt head.

Question 16

What happens in a CN6 lesion?

Answer 16

Weak lateral gaze in affected eye

Question 17

Is bells lower or upper lesion?

Answer 17

lower

Question 18

How do you differentiate between upper facial nerve lesion and bells palsy? Why is this the case?

Answer 18

Forehead sparing in upper facial nerve lesion, not in bells

The contralateral corticobulbar tract supplies the innervation of the facial nucleus, however there is also some ipsilateral corticobulbar innervation that supplies ONLY the forehead. So an upper motor neurone lesion spares the ipsilateral innervation from the corticobulbar tract, but a lower motor neurone lesion takes out all innervation from the facial nerve.

Question 19

What does uvula deviation indicate? To what side does it deviate?

Answer 19

Deviates to normal side, 10th nerve palsy

Question 20

To what side does the tongue deviate to? What is it a lesion of

Answer 20

Deviates towards affected side. Lesion of hypoglossal nerve

Question 21

Answer 21

Question 23

If blood forms between these layers, what is it called and what type of blood is it:

a) Skull and periosteal layer of dura
b) Meningeal layer of dura and arachnoid mater
c) within subarachnoid space

Answer 23

a) extradural haematoma - arterial
b) subdural hameatoma - venous
c) subarachnoid haematoma - arterial

Question 24

Explain the first order, second order, and third order neurones in the somatosensory system

Answer 24

First order - pass electrical stimulus to spinal cord

Second order - ascends to the brain and synapses with the third order neurone

Third order - Cell body Located in the ventral posterior nucleus in the thalamus of the brain takes the impulse to the necessary part of the brain

Question 25

Label the ascending pathways

Answer 25

Question 27

What fibres do the fasciculi gracilis and cuneatus contain?

Answer 27

gracilis - lower limb

cuneatus - upper limb

Question 28

In what part of the spinal cord can descending tracts be found?

Answer 28

Anterior or lateral funiculus

Question 29

What are the clinical signs of lower motoneurone lesions?

Answer 29

Muscle weakness, hypotonia or atonia, hypo or areflexia, atrophy, fasciculations

Question 30

What is the difference between a LMN and an alpha-motoneurone?

Answer 30

usually synonymous term.

Question 31

Explain the distinction between pyramidal and extra-pyramidal UMN. What tracts does each contain?

Answer 31

Pyramidal - consists of corticospinal (begins in cerebral cortex and terminates in spine) and corticobulbar tracts which are both responsible for voluntary movement of body and fascial muscles respectively. Directly innervates motor neurons

Extra-pyramidal - Modulate motor activity without directly innervating motor neurons. Involved in reflexes, locomotion, complex movement and postural control. Consists of vestibulospinal, reticulospinal, rubrospinal, and tectospinal tracts.

Question 32

Answer 32

Question 34

Give the strict definition of a reflex

Answer 34

An automatic, unlearned, repeatable response to a specific stimulus that does not require the brain to be intact

Question 35

What could cause hearing impairments?

Answer 35

Loud noises, congenital defects, infections (glue ear), trauma

Question 36

How would you assess hearing function?

Answer 36

Audiogram

Question 37

What would cause conductive hearing loss

Answer 37

blockage, ruptured ear drum, otitis media

Question 38

What would cause sensory hearing loss?

Answer 38

hair cell destruction or death

Question 39

What would cause neural hearling loss?

Answer 39

Age related, ototoxic drugs, tumours

Question 40

Explain decorticate posturing

Answer 40

Damage to the connections between thalamus and cortex. Lower limbs extended and upper limb flexed, like a mummy.

Question 41

Explain decerebrate posturing

Answer 41

Damage to the lower parts of the brain (brain stem), resulting in loss of descending inhibition. Complete extension of lower, upper limbs and head.