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Clinical > Neuro > Flashcards

Neuro Flashcards

1
Q

What can be seen in a general inspection of the patient in a cranial nerve exam? (4)

A
  • General appearance
  • Eye position (normal alignment/strabismus)
  • Ptosis (unilateral/bilateral)
  • Speech/voice abnormality (dysarthia)
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2
Q

How is the olfactory nerve (CNI) tested?

A

Change in smell?

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3
Q

What is tested to test the optic nerve (CNII) ?

A
  • Pupils inspected
  • Visual acuity + colour vision
  • Pupillary reflexes
  • Visual fields
  • Fundoscopy
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4
Q

What is inspected for in the pupils? (3)

A
  • Size
  • Shape
  • Symmetry
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5
Q

Common pupil signs and conditions associated? (2)

A
  • Unilateral large and fixed pupil : CNIII palsy

- Unilateral small and reactive: Horner’s syndrome

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6
Q

Neuro causes of decreased visual acuity (2)

A
  • Optic nerve II pathology - optic neuritis

- Visual pathway lesion

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7
Q

Difference between decreased visual acuity caused by papilloedema vs optic neuritis?

A

Papilloedema due to raised ICP doesn’t effect visual acuity until much later

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8
Q

What pupillary reflexes are tested? (4)

A
  • Direct pupillary reflex
  • Consensual pupillary reflex
  • Accomodation reflex
  • Swinging light reflex
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9
Q

What are the normal pupillary reflexes?

A
  • Both pupils (direct and consensual) CONSTRICT in response to light
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10
Q

How would an afferent pupil defect present? (CNII issue)

A

Light shone in effected nerve eye = no constriction in effected/contralateral
Light shone in contralateral pupil = constriction in both eyes

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11
Q

How would an efferent pupil defect present? (CNIII issue) (2)

A
  • One dilated pupil not responding to light in either eye (no direct/consensual reflex) = also points up and out
  • Other uneffected pupil will constrict (consensual reflex) when light shone in affected eye
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12
Q

What could an afferent pupil defect be caused by?

A
  • Optic nerve defect

- Edinger-Westphal nucleus defect

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13
Q

How is the swinging light test performed?

A

Move the pen torch rapidly between the two pupils, shining the light for three seconds in each eye.

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14
Q

How can the swinging light test detect an afferent pupillary defect?

A

Dilation of the pupil when it should normally constrict

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15
Q

How is the accommodation reflex tested? (3)

A
  • Ask the patient to focus on a distant object
  • Place your finger/object approximately 15cm in front of the eyes.
  • Ask the patient to switch from looking at the distant object to the nearby finger/object
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16
Q

What is normal accommodation reflex?

A

Convergence and constriction bilaterally

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17
Q

What is a Marcus-Gunn pupil?

A

Ill sustained contraction of pupil in swinging light test

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18
Q

What is a Marcus-Gunn pupil caused by?

A

Optic neuritis

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19
Q

What does the accommodation reflex test?

A

CNIII/efferent pathway

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20
Q

What charts are used to test colour vision?

A

Ishihara charts

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21
Q

How are visual fields assessed? (8)

A
  • Keep glasses on
  • Eye level
  • Focus on nose and not finger
  • Ask patient to cover their left eye with left hand
  • Cover your right eye with right hand (mirrors patient)
  • Position your fingertip at each border of your visual field then wiggle slowly inwards to the centre
  • Do for each quadrant
  • Only move tip of finger
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22
Q

Rare neuro cause of loss of red reflex?

A

Neuroblastoma

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23
Q

How are nerves occulomotor (III) trochlear (IV) abducens (VI) assessed? (2)

A
  • Note ptosis
  • Drawing a H
  • Checking for nystagmus
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24
Q

Causes of ptosis (4)

A
  • CN III pathology
  • Horner’s syndrome
  • Congenital/age
  • Neuromuscular pathology - myasthenia
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25
Q

How are eye movements tested?

A
  • Ask patient to fix on eye
  • Ask patient to report any double vision
  • Slowly draw Hs in front of each eye
  • Pause at each point to detect nystagmus
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26
Q

What is nystagmus?

A

Flickering involuntary eye movements

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27
Q

What is detected in testing eye movements? (2)

A
  • Nystagmus

- Restriction

28
Q

All eye muscles are innervated by the oculomotor nerve except which ones? What are their movements and what nerve innervates them instead?

A

SO4LR6

  • Superior oblique: downwards and in
  • Lateral rectus: lateral movement
29
Q

How is the trigeminal nerve tested? (2)

A
  • Light touch and pinprick sensation (sternum first for reference)
  • Feel bulk of masseter and temporalis
  • Jaw clench
  • Reflexes (jaw jerk)
30
Q

Branches of the trigeminal nerve and their areas of sensation? (3)

A

Forehead - ophthalmic branch (CNVi)
Cheeks - maxillary branch (CNVii)
Jaw - mandibular branch (CNViii)

31
Q

What muscles are felt for bulk to test CN V and where are they? (2)

A
  • Masseter (jaw)

- Temporalis (temples)

32
Q

How is the jaw jerk reflex tested?

A
  • Ask patient to open mouth loosely
  • Place finger horizontally across the chin
  • Tap finger with a tendon hammer
33
Q

Normal jaw jerk reflex

A

Slight closure of the jaw

34
Q

Abnormal jaw jerk reflex and suggested pathology

A

Brisk complete closure of the jaw - upper motor CNV lesion

35
Q

How is the facial nerve tested? (VII) (4)

A
  • Inspection
  • Facial movements
  • Inspection of external auditory meatus
  • Hearing/taste changes?
36
Q

What is inspected when testing the facial nerve? (3)

A
  • Forehead wrinkles
  • Nasolabial folds
  • Angles of the mouth
37
Q

What are the facial movements for testing the facial nerve? And what is assessed? (5)

A
  • Raise eyebrows : symmetry
  • Close eyes: power
  • Blow out cheeks: power
  • Smiling: symmetry
  • Close lips: power - each side
38
Q

Why is the external auditory meatus inspected in testing the facial nerve?

A

Herpes zoster lesions – Ramsay Hunt syndrome

Shingles causing lower motor lesion in CNV

39
Q

Why are hearing changes relevant in testing the facial nerve?

A

CNV supplies stapedius - paralysis=hyperacusis (noise sensitivity)

40
Q

Why are taste changes relevant in testing the facial nerve?

A

Supplies taste sensation to anterior 2/3 of tongue

41
Q

What are the two aspects of testing the vestibulocochlear VIII nerve? (2)

A
  • Hearing

- Vestibular

42
Q

What are the 3 hearing tests for testing the vestibulocochlear VIII nerve?

A
  • Gross hearing
  • Rhinne’s test
  • Weber’s test
43
Q

How is the test for gross hearing carried out? (5)

A
  • Mouth 15cm from ear
  • Whisper 99
  • Mask ear not being tested by making rubbing sounds
  • Ask them to repeat back
  • If can hear, assess at 60cm
44
Q

What size tuning fork is used to carry out Rhinne’s/Weber’s test?

A

512hz

45
Q

How is Rhinne’s test carried out? (4)

A
  • Tap fork and put base on mastoid process (bony process)
  • Ask if can hear (bone conduction) then to say when they stop hearing
  • Move 1cm away from external auditory process (air conduction) : ask if can hear better?
  • Do in other ear
46
Q

What is a positive Rhine’s test? And what 2 hearing states produce it?

A

Air conduction better than bone conduction

  • Normal hearing
  • Neurosensory hearing loss
47
Q

Why does neurosensory hearing loss produce a positive Rhinne’s test?

A

All hearing reduced, so air conduction still better than bone relatively

48
Q

Why does conductive hearing loss produce a negative Rhinne’s test?

A

Can’t hear physically, so air conduction bad in affected ear

49
Q

How is Weber’s test carried out? (2)

A
  • Place tuning fork in middle of forehead

- Ask which ear its heard louder in

50
Q

What is a normal Weber’s test result?

A

Hearing equal on both sides

51
Q

What would a conductive hearing loss produce in a Weber’s test and why? (2)

A

Louder in affected ear

- Bone conduction is better than air in that ear (not competing with ambient noise of room as can’t hear it)

52
Q

What would a neurosensory hearing loss produce in a Weber’s test and why? (2)

A

Louder in normal air

As hearing impulses not conducted in affected ear at all to brain

53
Q

What are the two tests of the vestibular system? (2)

A
  • Unterberger test

- Head thrust

54
Q

What reflex does the head thrust test test?

A

Vestibular-Ocular reflex

55
Q

How is the unterberger test carried out? (2)

A
  • Ask patient to march on the spot with arms outstretched and eyes closed
  • Positive: patient rotates towards the side of the vestibular lesion
56
Q

How is the head thrust test carried out to test for the vestibulocochlear VIII nerve? (5)

A
  • Ask if neck pain?
  • If not then hold head with one hand covering each ear
  • Ask patient to look at nose
  • Turn sharply to one side then the other
  • Normal: fixation on nose maintained
57
Q

What would the head thrust test in a vestibulocochlear loss of function patient result be? (2)

A
  • Eyes will move in direction of the head (loss of fixation)

- Corrective refixation saccade towards nose

58
Q

What are the tests for the glossopharyneal IX and vagus X nerves? (4)

A
  • Gag reflex (mention don’t do)
  • Uvula inspection (aah and symmetry)
  • Cough
  • Swallow
59
Q

When assessing the glossopharyneal IX and vagus X nerves what are abnormal findings in the uvula?

A
  • Deviation away from side of lesion

- Aah: uvula observed better when moving upwards

60
Q

What type of cough indicates a CNIX or CNV problem?

A

Bovine cough

61
Q

What type of swallow indicates a CNIX or CNV problem? (2)

A
  • Delayed

- Coughing during

62
Q

What are the tests for the XI accessory nerve? And what actions carry them out? (2)

A
  • Trapezius power: ask patient to shrug shoulders against resistance
  • Sternocleidomastoid power: ask patient to turn head against resistance (your hand on cheek)
63
Q

A left weak sternocleidomastoid indicates a lesion on which side?

A

Right: contralateral control

64
Q

How is the Hypoglossal XII nerve tested? (3)

A
  • Tongue fasiculations and wasting
  • Tongue deviation?
  • Put finger on cheek, ask patient to push tongue against it
65
Q

What side does a tongue deviate towards?

A

The side of the lesion

Clinical (21 decks)

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