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NBEO Part 2 > Cranial nerves > Flashcards

Cranial nerves Flashcards

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1
Q

What is the primary function of Cranial Nerve I (CN I)?

A

Smell
* Sensory in function

Responsible for the sense of smell (olfaction)

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2
Q

How is the integrity of Cranial Nerve I tested?

A

Have the patient close their eyes and occlude a nostril, present an aromatic agent, and ask for identification

Repeat the process with the other nostril using a different aromatic agent

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3
Q

What substances are commonly used to test olfaction?

A
  • Vanilla
  • Mint oil
  • Coffee
  • Chocolate

The aromatic substances should not be irritating

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4
Q

What can cause a unilateral loss of olfaction?

A

Meningiomas

These tumors affect the olfactory nerve

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5
Q

What factors may lead to bilateral loss of olfaction?

A
  • Obstruction of the nasal passage
  • Heavy smoking
  • Rhinitis (stuffy nose)
  • Hay fever
  • A cold

These conditions can affect the sense of smell

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6
Q

What is the primary function of Cranial Nerve II (CN II)?

A

Vision
* Sensory in function

Responsible for vision

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7
Q

How can the integrity of the optic nerve be assessed?

A
  • Testing visual acuity
  • Testing visual fields

Visual acuity is tested monocularly, while visual fields can be assessed using confrontation or counting finger methods

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8
Q

What is the method for testing visual acuity?

A

Performed monocularly, at distance and near, with the patient’s best correction in place

This ensures accurate measurement of vision

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9
Q

What methods can be used to test visual fields?

A
  • Confrontation method
  • Counting finger method

These methods are performed without correction in place to avoid interference

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10
Q

What should be done if a defect is noted in visual fields during testing?

A

Further quantify via automated visual field testing

This provides a more detailed assessment of visual field defects

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11
Q

What is the purpose of red cap desaturation testing?

A

To compare the level of saturation of a red target between the eyes

This test helps in assessing the integrity of the optic nerve.

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12
Q

How is red cap desaturation testing performed?

A

With one eye occluded, a red object is presented to each eye, and saturation levels are compared

The test should be conducted in a fully illuminated room.

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13
Q

What perceived difference in saturation indicates a likely afferent pupillary defect (APD)?

A

A perceived difference of 20% or more

This suggests abnormalities in the optic nerve.

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14
Q

What is assessed during the observation of the optic nerve?

A

The overall integrity and health of the optic nerve

This includes techniques such as ophthalmoscopy and fundus lenses.

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15
Q

Where is the nucleus of Cranial Nerve III located?

A

In the midbrain

CN III is also known as the oculomotor nerve.

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16
Q

What muscles does the oculomotor nerve supply? (5)

A
  • Medial rectus
  • Superior rectus
  • Inferior rectus
  • Inferior oblique
  • Levator palpebral muscles

It is also involved in pupil and accommodative innervation.

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17
Q

What should patients not be wearing during the pupillary reaction assessment?

A

Glasses

This ensures accurate assessment of the pupillary response.

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18
Q

What is considered a normal pupillary reaction to light compared to near response?

A

More brisk

The pupillary reaction to light should be quicker than that associated with near response.

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19
Q

What is the purpose of extraocular motility testing?

A

To assess any restrictions or asymmetries in eye movement

Patients are asked to fixate on a target moved into the nine fields of gaze.

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20
Q

What should happen to both pupils when a near stimulus is presented?

A

Both pupils should constrict equally

This indicates a normal accommodative response.

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21
Q

What is the function of Cranial Nerve IV (CN IV)?

A

Motor in function

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22
Q

Where is the nucleus of Cranial Nerve IV located?

A

In the midbrain

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23
Q

What muscle does Cranial Nerve IV innervate?

A

Superior oblique muscles

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24
Q

How is the integrity of CN IV tested?

A

Assessing extraocular motility for any deficits
* superior oblique

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25
What are the main functions of Cranial Nerve V (CN V)?
Motor and sensory functions
26
In which part of the brain is the nucleus of Cranial Nerve V located?
In the pons
27
What are the three main divisions of the trigeminal nerve?
* Ophthalmic (V1) * Maxillary (V2) * Mandibular (V3)
28
What are the subdivisions of the ophthalmic division (V1) of CN V?
* Nasociliary * Frontal * Lacrimal NFL!!!
29
Which subdivision of V1 is most commonly affected by herpes zoster ophthalmicus?
Frontal division
30
What are the subdivisions of the nasociliary division of V1?
LINE * Long ciliary * Infratrochlear * Nasal * Posterior Ethmoid
31
What areas does the ophthalmic portion of CN V supply?
* Eyes * Nose * Forehead * Temples * Paranasal sinuses * Nasal mucosa
32
What areas does the maxillary division of CN V supply?
* Teeth * Cheeks * Lips * Upper jaw * Maxillary sinuses * Hard palate * Nasal mucosa
33
What areas does the mandibular division of CN V supply? (Name 4)
* Teeth * Lip * Lower jaw * Tongue * Buccal mucosa * External ear * Auditory meatus * Meninges *sensory innervation to lower face *motor innervation to muscles of mastication
34
What muscles do the motor fibers of CN V supply?
* Muscles responsible for mastication * Mylohyoid muscle * Anterior belly of the digastric * Tensor veli palatini * Tensor tympani
35
What is the method for testing the corneal reflex?
Patient's gaze is directed away while the clinician touches the corneal surface with a cotton wisp
36
True or False: The reaction of each eye is compared during corneal reflex testing.
True
37
What is the function of Cranial Nerve V (CN V)?
Sensory and motor functions ## Footnote CN V is also known as the Trigeminal Nerve and is responsible for sensation in the face and motor functions such as biting and chewing.
38
What are the three divisions of CN V?
* Opthalmic division * Maxillary division * Mandibular division ## Footnote Each division is responsible for sensation in different areas of the face.
39
How can CN V be assessed via superficial stimulation?
By brushing the jawbone, base of nostrils, and forehead with a cotton-tipped applicator ## Footnote The patient should be able to locate where they were brushed.
40
What does palpation of masseter muscles assess in CN V?
Muscle clenching, asymmetries, and resistance to closure ## Footnote Any irregularities may suggest a neurological defect.
41
What is the function of Cranial Nerve VI (CN VI)?
Motor function ## Footnote CN VI is also known as the Abducens Nerve.
42
Where does the nucleus of CN VI lie?
In the pons ## Footnote The pons is a part of the brainstem.
43
What muscle does CN VI supply?
Lateral rectus muscle ## Footnote This muscle is responsible for moving the eye laterally.
44
How can CN VI be tested?
By assessing extraocular motility ## Footnote This tests for any potential restrictions or deficits in eye movement.
45
What are the functions of Cranial Nerve VII (CN VII)?
* Motor functions * Sensory functions * Parasympathetic innervation ## Footnote CN VII is known as the Facial Nerve.
46
Where does the nucleus of CN VII lie?
In the pons ## Footnote This is the same location as CN VI.
47
What sensory functions does CN VII relay?
* Taste from the anterior 2/3rds of the tongue (tastes sweet, salty and sour) * Sensation from the parotid gland (major salivary gland) ## Footnote These functions are crucial for taste and salivary gland sensation.
48
What is the parasympathetic innervation provided by CN VII?
* Mucous membranes and glands of the pharynx * Nasal cavity * Paranasal sinuses * Palate * Submaxillary and sublingual glands ## Footnote This innervation is important for secretion of saliva and mucus.
49
How is CN VII tested?
By assessing facial symmetry ## Footnote This involves observing the face for any signs of asymmetry, particularly in the eyelids and mouth.
50
What is the primary function of Cranial Nerve VII (CN VII)?
Motor innervation and sensory function
51
How can you assess the motor innervation of the Facial Nerve?
Have the patient smile and wrinkle their forehead; note asymmetry or weakness
52
What should you observe when the patient attempts to maintain eyelid closure? * testing CN VII
Note any weakness when resisting clinician's attempts to open eyelids
53
Which substances are used to assess the sensory function of the Facial Nerve?
Salt, sugar, citric acid, and quinine (bitter) *salty, sweet, sour and bitter*
54
What is the procedure for testing the sensory function on the patient's tongue?
Place crystals of substances on the anterior portion and identify taste
55
When testing taste, what must the patient do between each sample?
Rinse thoroughly
56
Fill in the blank: The Facial Nerve is also known as _______.
Cranial Nerve VII
57
True or False: The assessment of the Facial Nerve includes both motor and sensory evaluations.
True
58
What is the function of Cranial Nerve VIII (CN VIII)?
Sensory in function ## Footnote CN VIII is also known as the Vestibulocochlear Nerve.
59
Where is the nucleus of Cranial Nerve VIII located?
In the pons
60
What functions are associated with Cranial Nerve VIII?
Responsible for hearing, balance, proprioception, and orientation in space
61
What is the purpose of the cochlear testing?
To determine the distance at which the patient first hears the sound
62
Describe the procedure for cochlear testing.
Clinician rubs fingers together at least 40 cm from the patient's ear, noting when the patient first hears the sound, repeated for the other ear
63
What is a normal response in cochlear testing?
The distance at which the patient first noticed the sound should be symmetrical
64
What is Weber's test used for?
To distinguish between conductive or sensorineural hearing loss
65
How is Weber's test performed?
A vibrating tuning fork is placed at the top of the patient's skull
66
What indicates a normal response in Weber's test?
Equal perception between the ears
67
If the patient locates the sound with the ear with poorer hearing, what type of loss is indicated?
Conductive loss
68
If the sound is located with the ear with better hearing, what type of loss is indicated?
Sensorineural loss
69
What is the function of Cranial Nerve IX (CN IX)?
Sensory and motor in function
70
Where is the nucleus of Cranial Nerve IX located?
In the medulla
71
What muscle do the motor fibers of Cranial Nerve IX innervate?
Stylopharyngeus muscle
72
What areas do the sensory fibers of Cranial Nerve IX supply?
Pharynx, posterior 1/3rd of the tongue, soft palate, eustachian tube, tonsils, tympanic cavity
73
What is the function of Cranial Nerve IX (CN IX)?
Sensory and motor functions ## Footnote Also known as the Glossopharyngeal Nerve.
74
What is tested when a patient is asked to pronounce the vowels A, E, I, O, and U?
Hoarseness of the voice or any abnormalities ## Footnote This assesses the function of CN IX.
75
What does the clinician monitor when a patient drinks water?
The swallowing reflex ## Footnote Any abnormalities or regurgitation are considered atypical. *testing CN IX (glossopharyngeal nerve)
76
How is the gag reflex tested?
By lightly touching the posterior pharyngeal wall or tonsillar pillars ## Footnote This may be diminished or absent in the elderly.
77
What is observed during the gross observation of the soft palate?
Asymmetries or deviations ## Footnote The patient opens their mouth for inspection.
78
What is the primary function of Cranial Nerve X (CN X)?
Sensory and motor functions ## Footnote Also known as the Vagus Nerve.
79
Where is the nucleus of Cranial Nerve X located?
In the medulla ## Footnote This is where the motor fibers originate.
80
What areas does CN X convey indirect sensory information from?
* Auditory meatus * Portion of the ear * Thoracic viscera * Abdominal viscera * Pharynx * Larynx * Esophagus * Trachea ## Footnote This highlights the extensive sensory role of CN X.
81
Is the testing for Cranial Nerve X different from that of Cranial Nerve IX?
No, testing is identical ## Footnote Both nerves are tested similarly.
82
What is the function of Cranial Nerve XI (CN XI)?
Motor function ## Footnote Known as the Accessory Nerve.
83
Where is the nucleus of Cranial Nerve XI located?
In the medulla ## Footnote This is responsible for its motor output.
84
Which muscles are supplied by Cranial Nerve XI?
* Sternocleidomastoid * Trapezius ## Footnote These muscles are crucial for neck and shoulder movement.
85
What is the function of Cranial Nerve XI (Accessory Nerve)?
Motor function ## Footnote CN XI is primarily responsible for shoulder shrugging and head turning.
86
How is the strength of shoulder shrug tested in Cranial Nerve XI?
The patient is asked to shrug shoulders against clinician's downward pressure ## Footnote This tests the trapezius muscle, which is innervated by CN XI.
87
What muscle is palpated during the head-turning test for Cranial Nerve XI?
Sternocleidomastoid muscle ## Footnote The clinician observes for atrophy or abnormalities.
88
What indicates paralysis during the head tilt test for Cranial Nerve XI?
Chin turns towards the side of paralysis ## Footnote This reflects weakness in the affected side's muscle.
89
What is the primary function of Cranial Nerve XII (Hypoglossal Nerve)?
Motor function ## Footnote CN XII innervates the muscles of the tongue.
90
Where is the nucleus of Cranial Nerve XII located?
In the medulla ## Footnote This is part of the brainstem.
91
What is one way to assess the integrity of Cranial Nerve XII?
Patient repeats a tongue twister (T and D words will be impaired) Can also have patient stick out their tongue and asses for deviation, atrophy, fasciculations. ## Footnote This helps identify pronunciation difficulties. CN XII: hypoglossal nerve
92
What should be inspected when the patient opens their mouth during CN XII testing?
Deformities or abnormalities ## Footnote This can indicate issues with tongue function.
93
What is noted when a patient sticks out their tongue during testing of CN XII?
Any deviations from straight ## Footnote A straight tongue indicates normal function.
94
What is the procedure to test for weakness in the tongue during CN XII assessment?
Push tongue against inside of cheek while clinician pushes outside ## Footnote This is done for both cheeks.
95
What are some lesions that affect the cavernous sinus?
Arteriovenous fistulas, craniopharyngioma, pituitary tumors, granulomatous inflammation ## Footnote These lesions can lead to cranial nerve involvement.
96
Which cranial nerve is closely associated with the cavernous sinus lesions?
Oculomotor nerve ## Footnote It is in close proximity to the fourth, sixth, and first division of the fifth cranial nerve.
97
What symptoms might indicate an oculosympathetic migraine in young children?
Drooping of the eyelid, double vision, pain, dilated pupil ## Footnote These symptoms should prompt consideration of an oculosympathetic migraine as a potential diagnosis.
98
True or False: Cranial nerve involvement is uncommon in lesions affecting the cavernous sinus.
False ## Footnote Lesions typically produce additional cranial nerve involvement.
99
Fill in the blank: An oculosympathetic migraine should be considered as a potential diagnosis in young children presenting with _______.
drooping of the eyelid, double vision, pain, dilated pupil
100
Most common cause of a pupil-involving third nerve palsy
Aneurysm of posterior communicating artery at the junction of the internal carotid
101
What is aberrant regeneration in the context of third cranial nerve palsy?
Misdirection of a portion of the third nerve fibers to alternate muscles innervated by the third nerve.
102
Which muscles are controlled by the oculomotor nerve?
* Medial rectus * Superior rectus * Inferior rectus * Inferior oblique * Iris dilator muscle
103
What are common signs of aberrant third nerve regeneration?
* Eyelid-gaze dyskinesis * Elevation of involved eyelid on downgaze or adduction (pseudo-Graefe sign) * Pupil-gaze dyskinesis * Constriction of the pupil on downgaze or adduction
104
What are less common signs of aberrant third nerve regeneration?
* Limitation of elevation or depression of the eye * Adduction on attempted elevation or depression * Absent optokinetic nystagmus response
105
In which patients is aberrancy from acquired third nerve palsies most often observed?
Patients recovering from third nerve damage secondary to trauma or compression by an aneurysm.
106
What percentage of congenital third nerve palsy patients may experience aberrant regeneration?
Up to 2/3 of these patients.
107
Do ischemic third nerve palsies produce aberrancy?
No, ischemic third nerve palsies do not produce aberrancy.
108
What should be performed if aberrant regeneration develops in a patient with suspected ischemic palsy?
Immediate neuroimaging must be performed.
109
When can aberrant regeneration occur after a third nerve palsy?
Months to years after, but not typically less than 8 weeks after onset.
110
What is the treatment for aberrant regeneration?
Monitoring of the underlying condition; strabismus surgery may be considered for significant symptoms.
111
Does aberrant regeneration resolve spontaneously?
No, it is a permanent change in the innervation of the muscles.
112
True or false Ischemic third nerve palsies rarely, if ever produce aberrancy
True *but may occur in congenital or trauma related third nerve palsies
113
Etiology for CN 3 non-pupil involving palsy
Micro vascular disease
114
CN 3 palsy pupil involving etiology
Aneurysm of posterior communicating artery * pupil will be blown, eye is down and out *emergency!

NBEO Part 2 (23 decks)

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