Ch13 Brainstem II

Question 1

Eye Movements and Pupillary Control pathways

Answer 1

1. nuclear

2. supranuclear

Question 2

nuclear pathway includes

Answer 2

nuclei of CN III, IV, VI

Question 3

supranuclear pathway includes

Answer 3

comes from frontal lobe as one chooses to visually track object

Question 4

Action of Superior Rectus

Answer 4

upward gaze

Question 5

Action of Inferior Rectus

Answer 5

downward gaze

Question 6

Action of Medial Rectus

Answer 6

medial gaze

Question 7

Action of the Lateral Rectus

Answer 7

lateral gaze

Question 8

Action of Inferior Oblique

Answer 8

up and in, primary action is rotation

Question 9

Action of Superior Oblique

Answer 9

down and in, primary action is rotation

Question 10

a condition where one eye is not tracking the same as the other is called
(Patient sees 2 images)

Answer 10

Dysconjugate gaze (Diplopia)

Question 11

Diplopia is caused by

Answer 11

Mechanical problems- orbital fracture
Disorders of the extraocular muscles- orbital myositis
Disorders of neuromuscular junction- myasthenia gravis (attacks muscle receptors)
Disorders of- III, IV, and VI.

Question 12

Question to ask Pt about deplopia

Answer 12

• Does it go away when covering one eye?
  (Suggestive of eye movement abnormality)
• ask about near vs far vision, and when looking up, down, left, or right

Question 13

Strabismus includes

Answer 13

Esotropia
Exotropia
Hypertropia
Hypotropia

Question 14

Esotropia is

Answer 14

eye deviate medially (internally)

Lateral rectus weakness

Question 15

Exotropia is

Answer 15

eye goes outside

medial rectus weakness

Question 16

Hypertropia is

Answer 16

eye up

superior oblique weakness

Question 17

Hypotropia is

Answer 17

eye down

Question 18

Strabismus is caused by

Answer 18

• Muscle weakness
• Serious in children
• Suppression amblyopia

Question 19

In Suppression amblyopia the input from ____ is ignored

Answer 19

the bad eye

Question 20

Suppression amblyopia can be treated by

Answer 20

patchin the good eye

Question 21

Diplopia Tests:

Cover test is when Pt is asked to

Answer 21

cover one eye (bad) look straight ahead

Then the covered eye is quickly uncovered

Question 22

Red glass is held over

Answer 22

the right eye

Question 23

When an eye muscle fails the images splits into

Answer 23

red and white light

should fuse and see pink

Question 24

which muscles are not affected in Oculomotor Palsy

Answer 24

SO

LR

Question 25

Oculomotor Palsy eye position

Answer 25

down and out

Question 26

Oculomotor Palsy signs include

Answer 26

ptosis | mydriassis

Question 27

Oculomotor Diplopia is least looking

Answer 27

down and out

Question 28

Oculomotor Diplopia is greatest looking

Answer 28

up and in

Question 29

Oculomotor Palsy is caused by

Answer 29

- Diabetes (complete palsy sparing pupil) - Head trauma - Compression from aneurysm (painful and partial palsy sparing pupil) - Midbrain ischemia - Ophthalmoplegic migraine (reversible)

Question 30

Trochlear IV Palsy signs

Answer 30

vertical diplopia hypertropia head tilt toward unaffected side

Question 31

The most common traumatically injured cranial nerve is:

Answer 31

Trochlear IV Palsy

Question 32

Trochlear Diplopia is least looking

Answer 32

up and out

Question 33

Trochlear Diplopia is worst looking

Answer 33

down and in

Question 34

Abducens VI Palsy is ____ diplopia

Answer 34

horizontal

Question 35

Abducens VI Palsy Eye position:

Answer 35

esotropia

Question 36

in Abducens VI Palsy, Eye will not

Answer 36

abduct

Question 37

in Abducens VI Palsy, diplopia is worsen when trying to look toward

Answer 37

affected side

Question 38

Abducens VI Diplopia is least looking

Answer 38

away from the leasion

Question 39

Abducens VI Palsy is caused by

Answer 39

increase intracranial pressure (early sign)

Question 40

Internuclear Opthalmoplegia is a sign of

Answer 40

MS

Question 41

Internuclear Opthalmoplegia | when looking right, the right eye moves fine, while the left eye _____

Answer 41

stops | no medial rectus action III

Question 42

Internuclear Opthalmoplegia accommodation

Answer 42

Both eyes converge

Question 43

Anisocoria | Oculomotor nerve lesion can cause ____ pupil

Answer 43

Dilated

Question 44

Anisocoria is ore obvious in

Answer 44

Lit environment

Question 45

Horner syndrome signs:

Answer 45

Ptosis | smaller pupil meiosis

Question 46

Horner syndrome is more obvious in

Answer 46

dim lightning

Question 47

Horner syndrome causes _____ chain problem

Answer 47

sympathetic

Question 48

Marcus Gunn Pupil direct response is

Answer 48

diminished

Question 49

Marcus Gunn Pupil indirect response is

Answer 49

normal

Question 50

Anisocoria Tested via

Answer 50

swinging light

Question 51

Anisocoria is caused by

Answer 51

MS | bullbar and retrobulbar

Question 52

Light near dissociation aka

Answer 52

Argyll Robertson Pupil

Question 53

Light near dissociation | Eyes will react to accommodation on

Answer 53

near vision

Question 54

Light near dissociation; Eyes will not react to

Answer 54

light

Question 55

Light near dissociation is caused by

Answer 55

Argyll Robertson pupil 3* syphilis

Question 56

Cavernous Sinus Syndrome involves which cranial nerves?

Answer 56

III, IV, VI, V1

Question 57

Cavernous Sinus Syndrome caused by

Answer 57

V1

Question 58

Cavernous Sinus Syndrome signs and symptoms

Answer 58

space occupying lesions (venous thrombosis) Total ophthalmoplegia fixed dilated pupil

Question 59

Orbital Apex Syndrome involves which cranial nerves?

Answer 59

III, IV, VI, V1, and II

Question 60

Orbital Apex Syndrome is caused by

Answer 60

aspergillis infection

Question 61

Orbital Apex Syndrome Signs and Symptoms

Answer 61

Loss of vision proptosis bulging of the eye

Question 62

Both Cavernous Sinus Syndrome and Orbital Apex Syndrome are considered

Answer 62

medical emergencies

Question 63

Parinaud Syndrome Signs and symptoms

Answer 63

impaired vertical upgaze Light near dissociation Impaired convergence

Question 64

Parinaud Syndrome is caused by

Answer 64

Hydrocephalus or pineal tumor