Neurologic Exam

Question 1

This cranial nerve is responsible for sense of smell.

Answer 1

Olfactory Nerve (CN I)

Question 2

How do you test CN I?

Answer 2

One nostril at a time, you’ll have the patient smell a common aromatic scent (vanilla, cloves, coffee, cinnamon)

Question 3

What does the loss of smell indicate?

Answer 3

Injury to CN I such as sinus condition, head trauma, smoking, aging, and cocaine use.

Parkinson’s pts have this too.

Question 4

What are the two CN I lesions?

Answer 4

1. Anosmia

2. Olfactory Hallucinations

Question 5

What can cause a neurologic anosmia?

Answer 5

Intracranial Dz such as a tumor or trauma

Question 6

What can cause a non-neurologic anosmia?

Answer 6

Nasal Dz such as allergies, sinusitis, and/or smoking.

Question 7

What can cause an olfactory hallucination?

Answer 7

Temporal Lobe Dz (tumors or sz)

Question 8

This cranial nerve is responsible for visual acuity and visual fields (sight).

Answer 8

CN II: Optic Nerve

Question 9

This condition is defined as type of partial blindness where vision is missing in the outer half of both the right and left visual field. It is due to a defect in the optic chiasm, most commonly from a pituitary tumor.

Answer 9

Bitemporal Hemianopsia

Question 10

This condition is defined as a type of partial blindness where vision is missing on the same half of a visual field in each eye. This usually involved the parietal lobe and can be an associative finding due to stroke. Visual Acuity would be normal in this exam.

Answer 10

Homonymous Hemianopsia

Question 11

A poor visual acuity test could indicate?

Answer 11

Prechiasmal or anterior defects such as glaucoma, retinal emboli, or optic neuritis.

Question 12

When looking at the optic fundus using an ophthalmoscope, you notice some disc pallor. What condition would this be indicative of what condition?

Answer 12

Optic Atrophy

Question 13

When looking at the optic fundus using an ophthalmoscope, you notice some disc bulging. What condition would this be indicative of what condition?

Answer 13

Optic Papilledema

Question 14

This condition is defined by a difference of 0.4 mm in diameter of one pupil compared to the other.

Answer 14

Anisocoria

Question 15

If there is a minimal constriction of one eye during the pupillary light reflex, what could this be? (Remember: Pupillary Light Reflex also checks CN III)

Answer 15

Abnormality of the Pupillary Constrictor Muscle (Iris Disorder?)
CN III Palsy with parasympathetic denervation, ptosis, and opthalmoplegia (eyes not aligned)

Question 16

This cranial nerve is responsible for the medial rectus, superior rectus, inferior rectus, inferior oblique, levator palpebrae, and pupillary constrictor muscles.

Answer 16

CN III: Oculomotor

Question 17

You perform the H-test where the patient follows an object and notice a lack of conjugate movement. What condition do you think of and how do you test it?

Answer 17

Diplopia. Perform the cover/uncover test to check for