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DPT 520 > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

what are the 4 key functions of the CNs?

A

1) motor innervation to muscles of the face, eyes, tongue, jaw, and neck
2) sensory info from skin and muscles of the face and TMJ
3) transmit special sensory info (hearing, vision, smell, vestibular fxns)
4) parasympathetic regulation of pupil size, curvature of lens of eye, HR, BP, breathing, and digestion (3, 7, 9, 10)

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2
Q

what reflexes are mediated by CN 2 (afferent sensory) and 3 (efferent motor)?

A

pupillary reflex, accomodation reflex, and direct/consensual responses

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3
Q

what is the pupillary reflex?

A

shine pen light on eyes and the pupils constrict

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4
Q

what is the accomodation reflex?

A

thickness of the lens changes based on distance of object being focused on

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5
Q

what are direct vs consensual responses?

A

direct=in the eye being tested
consensual=in the other eye

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6
Q

what are the reflexes mediated by CN 5 (afferent sensory) and CN 7 (efferent motor)?

A

jaw jerk and corneal

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7
Q

what reflexes are mediated by CN 9 and CN 10?

A

gag reflex and swallowing reflex

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8
Q

what are the olfactory bulb targets?

A

pyriform cortex, olfactory tubercle, amygdala, and entorhinal cortex

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9
Q

where does the pyriform cortex go?

A

orbitofrontal cortex

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10
Q

where do the olfactory tubercle and amygdala go?

A

orbitofrontal cortex

thalamus

hypothalamus

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11
Q

where does the entorhinal cortex go?

A

hippocampal formation

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12
Q

where are the olfactory receptors?

A

in the nose

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13
Q

what is the primary olfactory cortex?

A

pyriform cortex

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14
Q

the orbitofrontal cortex and thalamus relay what info to each other?

A

conscious perception of smell

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15
Q

what makes up the secondary cortex?

A

insula, cingulate cortex, and orbitofrontal cortex

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16
Q

what is responsible for the emotional aspect of smell?

A

the hypothalamus

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17
Q

what is responsible for the memory of smell and the action afterward?

A

the hippocampal formation

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18
Q

what does the insula do?

A

combines taste and smell info

survival functions

perception of flavor

parasympathetic and sympathetic fxns

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19
Q

what would a lesion in the insula result in?

A

loss of taste and smell

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20
Q

what is the hippocampus responsible for?

A

hunger

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21
Q

what is the insula/orbitofrontal cortex responsible for?

A

smell and taste related to addiction (coffee)

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22
Q

what is the amygdala responsible for?

A

smell influencing hunger

memories related to smell (esp strong emotions)

emotions to food

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23
Q

what are the medial and lateral para-hippocampus responsible for?

A

quality of smell

sends signal to secondary olfactory area

action related to smell

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24
Q

what is the medial para-hippocampus responsible for?

A

judgements made based on smell

smell fire, run away

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25
Q

what is the lateral para-hippocampus responsible for?

A

integrating smell with declarative memory

related to the ability to verbalize what a smell is

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26
Q

what does CN 1 dysfunction result in?

A

anosmia/hyponosmia

parasmia

olfactory hallucinations

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27
Q

what is anosmia/hyponosmia?

A

absent/decreased ability to smell

can be temporary, permanent, or progressive

can be congenital or from infection (meningitis/cold)

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28
Q

what would cause permanent anosmia/hyponosmia?

A

a tumor in the olfactory groove

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29
Q

what is parosmia?

A

distorted sense of smell, usually unpleasant (something pleasant smells unpleasant)

usually post trauma

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30
Q

what are olfactory hallucinations?

A

unpleasant smell in the absence of stimuli

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31
Q

what are olfactory hallucinations usually associated with?

A

insular seizures and epileptic disorders

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32
Q

what can cause olfactory nerve lesions?

A

TBI-permanent

meningitis-temporary

PD-permanent progressive

Alzheimer’s disease-permanent progressive

Kallmann syndrome

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33
Q

t/f: TBIs often shear nerves in the cribriform plate

A

true

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34
Q

what is Kallmann syndrome?

A

genetic condition related to delayed/absent puberty and includes an impaired sense of smell

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35
Q

what is the fxn of CN 2 (optic nerve)?

A

visual acuity

visual fields

red saturation

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36
Q

what is the somatic motor fxn of CN 3?

A

levator palpabrae superioris

all extraocular muscles except sup oblique and lat rectus

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37
Q

what is the parasympathetic fxn of CN 3?

A

pupillary constrictor and ciliary muscles (attached to the lens) for near vision

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38
Q

what is the somatic motor fxn of CN 4?

A

superior oblique

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39
Q

what is the somatic motor fxn of CN 6 (abducens)?

A

lateral rectus

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40
Q

what CN makes up the afferent arm of the accomodation reflex?

A

CN 2

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41
Q

what CN makes up the efferent (motor) arm of the accomodation reflex?

A

CN 3

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42
Q

what is the fxn of CN 5 (trigeminal)?

A

innervate muscles of mastication

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43
Q

what are the 3 division of the trigeminal nerve (CN 5)?

A

V1
V2
V3

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44
Q

what is the V1 division of the trigeminal nerve (CN 5)?

A

ophthalmic

sensory

forehead

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45
Q

what is the V2 division of the trigeminal nerve (CN 5)?

A

maxillary

sensory

bw nose and mouth

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46
Q

what is the V3 division of the trigeminal nerve (CN 5)?

A

mandibular

sensory and motor

mandibles and temporalis

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47
Q

what is the somatosensory fxn of the trigeminal nerve (CN 5)?

A

afferents for touch , nociceptive, and temp info from the face, ant 2/3 of tongue, anterosuperior external ear, internal ear canal, sinuses, teetch, and meninges

proprioception from the face, TMJ, and tongue

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48
Q

what is the motor fxn of the trigeminal nerve (CN 5)?

A

efferents to muscles of mastication and tensor tympani muscle

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49
Q

what is the reflex fxn of the trigeminal nerve (CN 5)?

A

afferent limb corneal reflex

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50
Q

what is trigeminal neuralgia (AKA tic doulourex)?

A

abrupt onset of severe, sharp, stabbing, electric shock pain in the distribution of one/more branches of the trigeminal nerve lasting less than 2 minutes and can occur several times a day

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51
Q

what branches of the trigeminal nerve (CN 5) are usually involved in trigeminal neuralgia?

A

V2 or V3, not usually V1

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52
Q

what triggered the symptoms of trigeminal neuralgia?

A

chewing, talking, brushing teeth, shaving

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53
Q

what are the causes of trigeminal neuralgia?

A

idiopathic

classic (demyelination)

secondary to trauma, MS, post herpetic neuralgia, or tumor

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54
Q

are more males or females over 50 y/o affected by trigeminal neuralgia?

A

females

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55
Q

what is the Hallmark disease of the trigeminal nerve?

A

trigeminal neuralgia

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56
Q

t/f: in severe cases of trigeminal neuralgia, you can have dull aching pain in the absence of an attack

A

true

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57
Q

if there is a CN 5 lesion, is the direct or consensual response of the corneal (blink) reflex affected?

A

no direct or consensual responses

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58
Q

if there is a lesion in the spinal trigeminal nucleus, is the direct or consensual response of the corneal (blink) reflex affected?

A

no direct or consensual responses

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59
Q

if there is a lesion in CN 7, is the direct or consensual response of the corneal (blink) reflex affected?

A

direct response is lost, but consensual response is in tact if stimulated on the same side as the lesion

direct response is in tact, but consensual response is lost if stimulated on the opposite side of the lesion

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60
Q

what is the stimulus in the corneal (blink) reflex?

A

cornea is touches and you blink

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61
Q

what CN makes up the afferent (sensory) arm of the corneal (blink) reflex?

A

CN 5 (trigeminal)

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62
Q

what CN makes up the efferent (motor) arm of the corneal (blink) reflex)?

A

CN 7 (facial)

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63
Q

what does CN 5 do in the corneal (blink) reflex?

A

synapses on the interneuron in the spinotrigeminal nucleus in the lateral medulla

trigeminal nerve –> spinal trigeminal nucleus

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64
Q

what does CN 7 do in the corneal (blink) reflex?

A

facial nerve nucleus–>facial nerve

reflexive closing of the eyelids

ipsilateral response-direct

contralateral response-consensual

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65
Q

what is the direct response?

A

the response in the ipsilateral eye

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66
Q

what is the consensual response?

A

the response in the contralateral eye

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67
Q

is there ipsilateral face drooping with a CN 5 or CN 7 lesion?

A

CN 5 lesion

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68
Q

if there is a CN 7 lesion on the L and the L side is stimulated, what occurs?

A

no direct response

in tact consensual response

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69
Q

if there is a CN 7 lesion on the L and the R side is stimulated, what occurs?

A

in tact direct response

no consensual response

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70
Q

if there is a CN 7 lesion on the R and the R side is stimulated, what occurs?

A

no direct response

in tact consensual response

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71
Q

if there is a CN 7 lesion on the R and the L side is stimulated, what occurs?

A

in tact direct response

no consensual response

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72
Q

would CN 5 and CN 7 lesions be UMN or LMN lesions?

A

LMN lesions

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73
Q

would a spinal trigeminal nucleus lesion be an UMN or LMN lesion?

A

UMN lesion

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74
Q

if there is an UMN lesion, what happens with the corneal (blink) reflex?

A

no direct or consensual responses

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75
Q

what is one of the most common BS strokes?

A

lateral medullary lesion

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76
Q

if there is red nucleus, RAS, or cerebellar damage, what happens to the speed and strength of the corneal (blink) reflex?

A

it is slowed

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77
Q

what is the jaw jerk reflex?

A

the mandible is tapped just below the lips at the chin while the mouth is held open slightly

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78
Q

is the jaw jerk reflex test performed often? why or why not?

A

no, bc a (+) response isn’t usually present and can’t tell us what side is affected

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79
Q

if there is a LMN lesion, what happens with the jaw jerk reflex?

A

areflexia/hyporeflexia

the jaw will deviate towards the lesion side when the mouth is opened

(-) jaw jerk reflex

80
Q

if there is a unilateral UMN lesion, what happens with the jaw jerk reflex?

A

(-) jaw jerk reflex

due to bilateral innervation of the corticobrainstem tract, so one side is still intact

81
Q

if there is a bilateral UMN lesion, what happens with the jaw jerk reflex?

A

(+) jaw jerk reflex

82
Q

what is the special sensory fxn of CN 7 (facial nerve)?

A

afferents for taste from the anterior 2/3 of the tongue

83
Q

what is the somatosensory fxn of CN 7 (facial nerve)?

A

afferents for sensation from the posterior ear canal

84
Q

what is the parasympathetic fxn of CN 7 (facial nerve)?

A

efferent to lacrimal, nasal, and salivary glands except the parotid salivary gland

85
Q

what is the motor fxn of CN 7 (facial nerve)?

A

efferents to muscles of facial expression and stapedius muscle

86
Q

what is the reflex fxn of CN 7 (facial nerve)?

A

efferent limb of the corneal reflex

87
Q

what is the most common CN 7 injury?

A

bell’s palsy

88
Q

what is Bell’s palsy?

A

viral infection or immune disorder affecting CN 7

causes paralysis of muscles on one side of the face ipsilateral to the lesion (includes orbicularis oculi and frontalis muscles)

depression on the forehead ipsi to lesion (lack of frontalis)

no labial crease

droopy lips

89
Q

if Bells’s palsy is severe, what symptoms may occur?

A

drooling, difficulty eating/drinking, dry cornea (lack of eyelid closing)

90
Q

t/f: there is normal somatosensation in Bell’s palsy?

A

true

91
Q

if somatosensation is in tact, what causes numbness in Bell’s palsy?

A

lack of muscle use

92
Q

t/f: there is a loss of taste sensation in the anterior 2/3 of the tonguein Bells palsy

A

true

93
Q

can autonomic fxns be affected in Bell’s palsy?

A

yes

94
Q

if a pt has Bell’s Palsy and you ask them to close their eyes, what would you see?

A

the eyes roll back like normally but the ipsilateral eyelid doesn’t close

95
Q

why is there no loss of sensation?

A

bc CN 7 is affected and this controls muscles, CN 5 is sensations

96
Q

what are other causes of unilateral facial palsy?

A

Lyme disease

MS

cyst in the ear

tumor

trauma

Ramsey-Hunt syndrome (herpes zoster viral infection of CN 7 and 8)

97
Q

what is facial muscle synkinesis?

A

caused by abnormal reinnervation of facial muscles

involuntary movements that accompany voluntary movements

98
Q

if a pt has a CN 7 lesion and you ask them to close there eyes what would you see?

A

one eye won’t close

99
Q

if a pt has a CN 7 injury and you ask them to smile, what would you see?

A

weakness on one side of the mouth

100
Q

if a pt has a CN 7 injury and you try to make them laugh, what would you see?

A

same weakness affecting one side of the mouth as when asked to smile

101
Q

if a pt has a corticobrainstem lesion and you ask them to close their eyes, what would you see?

A

both eyes close

102
Q

if a pt has a corticobrainstem lesion and you ask them to smile, what would you see?

A

contralateral mouth weakness

103
Q

if a pt has a corticobrainstem lesion and you try to make them laugh, what would you see?

A

more symmetric smile than when asked to smile

104
Q

if a pt has a cingulate cortex lesion (emotional UMN) and you ask them to close their eyes, what would you see?

A

both eye close

105
Q

if a pt has a cingulate cortex lesion (emotional UMN) and you ask them to smile, what would you see?

A

more symmetric smile than in response to trying to laugh

106
Q

if a pt has a cingulate cortex lesion (emotional UMN) and you try to make them laugh, what would you see?

A

more weakness than when asked to smile

107
Q

what are the 2 branches of CN 8 (vestibulocochlear nerve)?

A

auditory (cochlear) branch

vestibular branch

108
Q

what is the role of the auditory (cochlear) branch of CN 8 (vestibulocochlear nerve)?

A

conscious and unconscious components

orient the eyes towards sound

conscious hearing

activates the entire NS

109
Q

what is the role of the vestibular branch of CN 8 (vestibulocochlear nerve)?

A

VOR (gaze stability from the med vestibular tract)

VSR (postural stability from the lat vestibular tract)

110
Q

what is the special sensory fxn of CN 8 (vestibulocochlear nerve)?

A

afferents for sense of head movement and head position

hearing

111
Q

what is the reflex fxn of CN 8 (vestibulocochlear nerve)?

A

afferent for vestibulo-ocular reflex

112
Q

where does the cochlear nuclei go to?

A

med geniculate body, inf colliculus, or reticular formation

113
Q

what does the sup colliculus do?

A

orient eyes and head toward sound

114
Q

what does the primary auditory cortex do?

A

conscious hearing

115
Q

what does the reticular formation do?

A

activates the entire NS

116
Q

what info is carried by the vestibular system?

A

position of the head in space relative to gravity

sudden changes in direction of head movement

117
Q

the vestibular info is important for what 3 things?

A

1) motor control
2) spatial awareness
3) autonomic NS modulation

118
Q

what are the 2 motor controls of the vestibular system?

A

VOR and VSR

119
Q

what is the role of the VOR?

A

stabilization of the eyes (gaze stability)

120
Q

what is the role of the VSR?

A

maintanance of postural stability

121
Q

what are the peripheral components of the vestibular system? (KNOW THIS)

A

vestibular sensory receptors

CN 8

everything b4 the CN enters the BS

the ear

122
Q

what are the central components of the vestibular system?

A

everything in the BS

4 vestibular nuclei

6 ascending/descending tracts

vestibulocerebellum (floculonodular)

vestibular cortex (in the parietal cortex of the R hemisphere)

123
Q

where is the vascular supply for the vestibulocochlear apparatus from?

A

limited supply from the labyrinthine artery (small branch of the anterior inferior cerebellar artery)

124
Q

t/f: vascular injury of the vestibulocochlear apparatus could mimic that of nerve injury

A

true

125
Q

what are the 2 vestibular sensory receptors?

A

1) semicircular canals (SSC)
2) otoliths

126
Q

what are the 3 semicircular canals (6 total)?

A

1) anterior
2) posterior
3) horizontal

127
Q

what are the 2 otoliths?

A

1) saccule
2) utricle

128
Q

which vestibular sensory receptors respond to rotational movement?

A

semicircular canals

129
Q

which vestibular sensory receptors respond to linear movement?

A

otoliths

130
Q

what movement does the saccule respond to?

A

vertical (elevator)

131
Q

what movement does the utricle respond to?

A

horizontal (car)

132
Q

what is an important sensory organ of the vestibular system?

A

the cupula!!!

133
Q

when the head moves one way, what way does the fluid move?

A

in the opposite direction of the movement

134
Q

when the head turns faster, is the stimulus stronger or weaker?

A

stronger

135
Q

what is the composition of the crystals of the inner ear?

A

calcium carbonate

136
Q

how are the SSC sensitive to gravity or acceleration?

A

the sensory receptors called the macula contains a unique membrane with crystals composed of calcium carbonate

137
Q

what is the orientation of the horizontal canal?

A

30 deg from the earth

138
Q

what are the functional pairs of the SCC?

A

HSCCs - horizontal SCCs pair
RALP - pairing of R ant and L post SCCs
LARP - pairing of L ant and R post SCCs

139
Q

t/f: w/movement, one side is always excited when one is inhibited in the vestibular system

A

true

140
Q

if the head turns R, which side will be excited? inhibited?

A

R excited
L inhibited

141
Q

t/f: the superior and inferior division of the vestibular apparatus supply different parts

A

true (KNOW THIS)

142
Q

is the superior or inferior division of the vestibular apparatus more susceptible to damage/virus?

A

the superior division due to anatomical phenomenon

143
Q

what are the 6 output pathways of the vestibular nuclei

A

1) medial longitudinal fasciculus
2) medial vestibulospinal tracts (2) and lateral vestibulospinal tract (1)
3) vestibulocollic
4) vestibulothalamocortical
5) vestibulocerebellar
6) vestibuloreticular

144
Q

what is the fxn of the lateral vestibulospinal tract? (KNOW THIS)

A

maintain balance and extensor tone (POSTURE)

145
Q

where does the lateral vestibular nucleus receive afferent info from?

A

the vestibular labyrinth (particularly the utricle), cerebellum, and SC

146
Q

what does the lateral vestibularspinal nucleus give rise to?

A

the lateral vestibulospinal tract (efferent arm)

147
Q

what is the primary tract for vestibular influence on LMNs to postural muscles in the limbs and trunk?

A

the lateral vestibulospinal tract

148
Q

what are the nuclei of the medial vestibulospinal tract?

A

the med and inf vestibular nuclei

149
Q

t/f: the MVST extends ONLY to the cervical spine

A

true

150
Q

what is the fxn of the MVST? (KNOW THIS)

A

controlling neck and head position

151
Q

where does the MVST terminate?

A

bilaterally in the cervical region of the SC connecting w/motor neurons innervating the neck muscles

152
Q

what are the actions of the MVST?

A

stable platform for eye movement and vision

mediating postural changes in response to head motion

153
Q

what is the medial longitudinal fasciculus (MLF)?

A

tracts along the midline in both sides of the brainstem

154
Q

the MLF connects the medial and superior vestibular nuclei to what 3 things?

A

the oculomotor nuclei

the accessory nuclei

the superior colliculus

155
Q

what is the fxn of the MLF?

A

helps bring about coordinated movements of the head and eyes

moves eyes to maintain gaze stabilization during head movement

heart of the VOR

156
Q

what are other inputs/outputs w/the vestibular nuclei?

A

vestibulocollic pathways

vestibulo-thalamo-cortical pathways

vestibular cerebellar pathways

vestibular reticular pathways

157
Q

what is the vestibulocollic pathway?

A

afferent info from the cervical region to the nucleus of CN 11 (spinal accessory) to influence head position

158
Q

what is the vestibulo-thalamo-cortical pathway?

A

provides conscious awareness of head position/movement and input to the corticospinal tracts (spatial orientation) from proprioceptive, tactile, auditory, and visual info

159
Q

what is the vestibular cerebellar pathway?

A

influences eye movement and postural muscles

adjusts the “gain” or magnitude of responses to head movements or the vestibulo-ocular reflex (VOR)

responsible for vestibular adaptation

160
Q

what is the vestibular reticular pathway?

A

excessive activity of the circuits linking vestibular nuclei, the reticular formation may result in autonomic changes (nausea, vomiting, and lightheadedness)

161
Q

what is the role of the VOR? (KNOW THIS)

A

to allow for stable vision during fast head movements (gaze stability)

162
Q

where is the best visual acuity available?

A

in the fovea of the retina (a very small area)

163
Q

how does the VOR provide gaze stability?

A

eyes move equal and opposite of the head in a head:eye ratio/”gain” of 1 deg per sec in the opposite direction of the head movement

164
Q

what happens is the head eye/ratio is slightly off of 1?

A

blurry vision

165
Q

how is the VOR tested?

A

moving the head while focusing on a stationary object (read eye chart while moving the head)

166
Q

what results from VOR dysfunction?

A

retinal slip causing dizziness and imbalance w/head movement

167
Q

what is retinal slip?

A

VOR dysfunction where the eyes aren’t moving as fast as they should

168
Q

what is Flouren’s law?

A

each canal is associated with a very specific eye movement when stimulated

169
Q

what movement stimulates the anterior SCC?

A

tilting the head down

170
Q

what movement stimulates the horizontal SCC?

A

turning the head R/L

171
Q

what movement stimulates the posterior SCC?

A

tilting the head up

172
Q

what 2 reflexes allow for gaze stabilization?

A

VOR (vestibulo-ocular reflex)

OPK (optokinetic reflex)

173
Q

what is the VOR?

A

the use of vestibular info to stabilize the visual field and images during fast head movements

174
Q

what is the OPK?

A

use of visual info to stabilize images during slow head movements

175
Q

direction of gaze is achieved by what 3 things?

A

saccades

smooth pursuits

vergence movements

176
Q

what are saccades?

A

fast eye movements that switch gaze from one object to another

177
Q

what are smooth pursuits?

A

slow eye movements that follow a moving object

178
Q

what are vergence movements?

A

movements of the eyes to adjust for different distances bw the eyes and a target

179
Q

what are the 4 functions of the vestibular system?

A

1) subjective awareness of body position and movement in space (spatial orientation)

2) postural tone and equilibrium (posture of head and body)

3) stabilization of eyes in space during head movements (coordination of head and eye movements)

4) indirect effects on consciousness and autonomic fxns

180
Q

what are the main consequences of vestibular system lesions?

A

vertigo (nystagmus)

impaired vision

impaired balance

gait “ataxia”

181
Q

what is the most common symptom of a vestibular lesion in acute vestibular disorder?

A

vertigo (nystagmus)

182
Q

what is vertigo?

A

the illusion of movement

183
Q

are symptoms present all the time in acute or chronic vestibular disorder?

A

acute

184
Q

are symptoms only present with movement in acute or chronic vestibular disorder?

A

chronic

185
Q

what is a common visual disturbances in vestibular disorder?

A

oscillopsia or visual blurriness

186
Q

is gait ataxia in vestibular disorder cerebellar or sensory ataxia?

A

neither, it is perceived discontrol that is sometimes called ataxia

187
Q

what are the secondary consequences of vestibular lesions?

A

autonomic symptoms (nausea, vomiting)

limbic symptoms (anxiety, fear)

cognitive symptoms (lightheadedness, dizziness, decreased concentration)

188
Q

what is nystagmus?

A

alternating slow and fast phases of eye movements

beating of the eyes

189
Q

when would one experience normal physiologic nystagmus?

A

after spinning around

190
Q

what are the 2 types of pathologic nystagmus?

A

spontaneous nystagmus

simple nystagmus

191
Q

what does nystagmus look like?

A

the strong side pushes the eyes to the weak side and then quickly brings them back to the stronger side

192
Q

what are the 3 pure directions of simple nystagmus?

A

1) linear (horizontal)-horizontal SCC
2) torsional-vertical SCC
3) vertical-BS dysfxn

193
Q

what is the red flag direction of nystagmus?

A

vertical (upbeating/downbeating)

194
Q

is pure vertical and direction changing nystagmus indicative of central or peripheral nystagmus?

A

central

195
Q

is fatiguable nystagmus that habituates indicative of central or peripheral nystagmus?

A

peripheral

196
Q

what are the characteristics of peripheral lesion (inner ear)?

A

delayed onset nystagmus

habituation

horizontal/rotary nystagmus

nystagmus doesn’t change directions

nystagmus is prominent only if vertigo is also present

197
Q

what are the characteristics of central lesion (BS or cerebellum)

A

immediate/delayed nystagmus

no habituation

horizontal, rotary, or vertical nystagmus

nystagmus may change directions

prominent nystagmus may occur in the absence of vertigo

DPT 520 (13 decks)

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