Exam 1 Flashcards
(139 cards)
1
Q
How is CN 1 tested?
A
One would have the patient close one naris at a time and have them exhale, then inhale deeply.
2
Q
When testing CN 1, what two things are you as an examiner looking for?
A
- Identify some type of scent
2. Specifically ID the scent
3
Q
What should not be used as an odorant for the patient? (CN 1)
A
Alcohol or Mint, these will cool the mucosa and give false responses
4
Q
What are the three basic examples of scents to use? (CN 1)
A
Coffee
Cinnamon
Cloves
5
Q
What two nerves never become peripheral nerves?
A
CN 1 (olfactory) and CN 2 (optic)
6
Q
When smelling an odorant, where does the information go and get processed?
A
Ipsilateral cortex (telencephalon)
7
Q
What is the absence of the sense of smell?
A
Anosmia
8
Q
What is the diminished olfactory sensitivity?
A
Hyposmia
9
Q
What is considered an alteration or distortion of smell?
A
Dysosmia
10
Q
What is the distortion in the perception of an odorant? (aka. “this smells differently than I remember it”)
A
Parosmia
11
Q
What is the perception that an odor is present, when there actually is nothing there?
A
Phantosmia
12
Q
What is termed as the inability to classify, contrast, or ID odor sensations verbally, even though one can differentiate between smells…
A
Agnosia
13
Q
What is the cause of agnosia?
A
Cortical abnormality
14
Q
When an individual loses their sense of smell, what is their next most likely complaint?
A
Loss of taste
15
Q
Where are the odor receptors located in the nose?
A
Sphenopalatine recess
16
Q
Thinking about loss of smell, where does the GREATEST loss of smell come from? [aka when someone loses their smell, within what structure(s) is it normally lost within?]
A
Transport within the nose is severely decreased (major cause of loss of smell)
17
Q
Where type of chart does the physician test distant visual acuity on?
A
Snellen Chart
18
Q
What type of chart does the physician test near visual acuity on?
A
Rosenbaum Chart
19
Q
How far away does the patient have to stand when testing distant visual acuity?
A
20 ft away
20
Q
How is the patient tested on the Snellen chart? What are the steps?
A
- Read smallest line pt. can while covering one eye reading RIGHT to LEFT
- Pt. will then cover the other eye and read the smallest line they can from RIGHT to LEFT
21
Q
What distance is the Rosenbaum chart held from the patient?
A
14 inches (usually about a forearm length away from the patients face)
22
Q
When doing vision tests, and the patient is wearing corrective lenses, do they first use the lenses or the naked eye?
A
Test without corrective lenses first!
23
Q
What line on the Snellen chart is the pt. considered legally bling if they cannot read it?
A
Top line
24
Q
There are optic elements when dealing with an eye problem of Diagnostic Dilema, what are the 5 elements?
A
- Cornea
- Tear film
- Lens
- Vitreous
- Retina
25
There is also a pathway lesion that can be associated with Diagnostic Delema, what is this lesion?
Lesion in the OPTIC NERVE between the EYE and the VISUAL CORTEX
26
Where is the lesion in a Left Anopia?
- Lesion in L Optic N.
27
What are two pathologies/structural anomalies that can cause a L anopia? [Note: these can also cause a R anopia but must be on the R SIDE]
- Meningioma
| - Orbital tumor
28
What Brodmann area is considered the primary visual cortex?
Area 17
29
Where would the lesion be, if a patient had a Left Nasal Hemianopia?
The Left Lateral Chiasm [left side of the optic chiasm]
30
If there was a pathology in the left lateral optic chiasm, what would it be to cause this deficit? [L Nasal Hemianopia]
An aneurysm of the internal carotid a.
31
Where would the lesion be in a bitemporal hemianopua?
In the Optic Chiasm, BUT ONLY AFFECTING THE DECUSSATING FIBERS [very medial]
32
What pathology would be responsible for causing a bitemporal hemianopia?
- Pituitary tumor
| - aka. CRANIOPHARYNGEOMA, Rathke's pouch tumor, hypophysial duct tumor
33
If a patient is suffering from a Left Homonymous Hemianopia, where is the lesion?
In the R Optic Tract [The lesion will always be opposite to the field of vision lost]
34
If a patient is suffering from a Right Homonymous Hemianopia, what pathology could cause this visual field loss?
Tumor [NOTE: not confined to one side, can also occur in the L optic tract]
35
What events will transpire in the Lateral Geniculate Nucleus of the Thalamus?
This is where the superior and inferior fields of view are differentiated.
36
The fibers that carry visual information from the Lateral Geniculate Nucleus end up in which parts of the brain?
- Superior visual field goes through the TEMPORAL LOBE
| - Inferior visual field goes through the PARIETAL LOBE
37
If a patient is suffering from a Right Homonomous Quadrantonopia, where is the lesion?
Lesion is in the Left Temporal Lobe [Meyers loop is located here and is most likely what is being affected; optic radiation]
38
Where would one see a lesion if the patient suffers from a Right Inferior Homonymous Quadrantanopia?
Lesion is in the Left Parietal Lobe [parietal optic radiation]
39
What is central sparing [aka macular sparing], when referring to visual loss?
Central sparing refers to a lesion that is closed to the visual cortex. The percentage of fibers going to this area from the superior/inferior visual fields are much increased from macular vision. This occurs as a result of the lesion happening where there are a lot of fibers meeting in the occipital lobe so it makes it "harder to lesion everything" - thus living up to it's name of central or macular sparing...
40
When testing the patient for pupil size, accomodation, direct and consensual response to light, what cranial nerve is the physician elliciting?
CN 3 Oculomotor
41
When the physician measures pupil size, a pupil that is <2 mm in diameter is considered what kind of pupil? Coupled with this pupil size, what autonomic nervous systems are increased/decreased?
- Mitotic Pupil
- Increased Parasympathetic
- Decreased Sympathetic
42
When the physician measures pupil size in a pt. who has a pupil that is >6 mm in diameter it is said that the pt. has what kind of pupil? What autonomic nervous systems are increased/decreased in association with the pupil size?
- Mydriatic pupil
- Decreased Parasympathetic
- Increased Sympathetic
43
Which nucleus provides parasympathetic innervation to the eye? [autonomic functions only, oculomotor nucleus provides motor innervation for this CN]
Edinger Westphal Nucleus
44
Where do the sympathetics to the eye come from? [Obviously T1-L2, but specifically on what do they enter the skull?]
Carotid Plexus
45
How would a physician test for accomodation, and what is the physician looking for? [hint: 3 things]
- The physician would have the patient look at a distant object, then at a test object directly in front of them (4-6") from the bridge of the nose
- [Doc is observing for CONVERGENCE, CONSTRICTION, and NEAR VISUAL ACUITY]
46
How does one test for near vision? [hint: 2 things]
- Convergence
- Constriction
[NV - CC]
47
What can an abnormal pupillary reflex (either fast or slow) lead to?
Decreased visual acuity
48
When testing direct visual acuity, what eye does the doctor look in?
The eye the light is being shined in [ex. light in L eye, look at L eye for pupil response]
49
When testing consensual visual acuity, what eye does the doctor look in?
The eye the light is not being shined in [ex. light in L eye, look at R eye for pupil response]
50
Direct pupillary light reflex in L eye, which CN are being tested?
L II and L III
51
Direct pupillary light reflex in the R eye, which CN are being tested?
R II and R III
52
Consensual pupillary light reflex in the R eye, which CN are being tested?
L II and R III
53
Consensual pupillary light reflex in the L eye, which CN are being tested?
R II and L III
54
The R direct pupillary light reflex is not responsive. The L direct and L consensual are responsive. Where is the lesion?
R III
| [Slide 24 in Lecture 1 for chart!]
55
How would someone test for the H pattern of gaze?
Hold finger 12-18" away from patients face and move slowly through an H pattern looking for weakness or nystagmus
56
What does nystagmus mean?
Lagging or ticking of eye to follow finger
57
When the L eye is looking out and up, what muscle is being used?
Superior rectus
58
When the R eye is looking out and down, what muscle is being used?
Inferior rectus
59
When the R eye is looking up and in, what muscle is being used?
Inferior oblique
60
When the R eye is looking down and in, what muscle is being used?
Superior oblique
61
What are the 5 muscles that are innervated by CN III?
LR6SO4...3
- MR
- IO
- IR
- SR
- Levator Palpebrae Superioris
62
When moving the finger upwards, for instance, in the H pattern, what two things are you particularly looking at?
- Elevation of the eyelids
| - Elevation of the globes
63
What muscle does the Trochlear N CN IV innervate?
Superior oblique
64
What are the primary, secondary, tertiary actions of the superior oblique?
- AID
- Abduction
- Intorsion
- Depression
65
What eye muscle does the Abducens N CN VI innervate?
Lateral Rectus
66
What does diplopia mean?
double vision
67
When you only have double vision in one eye what does that mean?
Issues with the brain, not peripheral n.
68
What does ptosis mean?
Drooping of the eye
69
When a patient presents with diplopia and ptosis, what is suspected until proven otherwise? [pathology]
- Myesthenia gravis
70
In Myesthenia Gravis, what is normal during a CN III exam?
Pupillary light reflexes
71
What muscle type is used in a pupillary light reflex?
Smooth muscle
72
What is in the cavernous sinus that can cause vision loss/issues? [hint: 6 things]
1. internal carotid a.
2. CN III
3. CN IV
4. CN VI
5. V1
6. V2
73
What are the muscles of mastication?
- Med/Lat Pterygoids
- Temporalis
- Masseter
74
How do you test motor function of CN V?
Observe face for...
- Jaw mm. atrophy
- Jaw deviation
- Patient to clench teeth as doc palpates mm.
75
How do you test the sensory function of CN V?
- Touch V1, V2, V3 to see if patient can feel sharp/dull in each area
76
Corneal reflex tests which cranial nerve?
CN V [have patient look up and away]
77
When performing the corneal reflex, what should happen to the eyes if all findings are normal? [WNL]
Both eyes should blink simultaneously and symetrically
78
If there is diminished blinking when performing the corneal reflex, which patient population might this be NORMAL in?
patients who wear contact lenses
79
If there is only one eye blinking during the corneal reflex, what is not working?
- Afferent limb
80
What is sharp, stabbing pain that lasts seconds within the boundaries of V1,2,3?
Trigeminal neuraligia or Tic Doloroux [suicide pain]
81
In which branches of CN V is trigeminal neuralgia most common in?
V2 or V3, 10-12% is BILATERAL
82
Which sex is TGN most commonly present in?
Females
83
What age group is TGN most common in?
> 50 y/o
84
What could be two possible causes of TGN that were mentioned in class?
1. Abberant superior cerebellar artery
| 2. Cerebellar pontine angle tumor
85
How is motor function to the face evaluated by a clinician?
Have the patient perform facial expressions...
1. Raise eyebrows
2. Squeeze eyes shut
3. Frown
4. Smile
5. Wrinkle forehead
6. Show teeth
7. Purse lips to whistle
8. Puff cheeks [doc can push on cheeks to see if mouth will stay closed]
86
What is commonly seen in patients with Facial N. muscle weakness?
Drooping mouth, flattened nasolabial fold, lower eyelid sagging
87
When there is a cerebellar lesion what side is affected?
SAME SIDE
88
When there is a lesion in the cortex what side is affected?
OPPOSITE SIDE
89
Upper facial muscles are controlled by what?
BOTH CORTICES
90
What are the lower facial muscles controlled by?
CONTRALATERAL CORTEX ONLY
91
Which fibers run to the lower facial muscles from the contralateral cortex?
Corticobulbar fibers
92
What can a pontine lesion lead to, in the development of issues with CN VII?
Asymmetry of facial expression
93
The fibers for facial nerve in the pons goes around which structure in the brainstem?
Abducens nucleus
94
What is a neuroma?
Schwann cell tumor
95
Where is an acoustic neuroma found?
On the vestibular portion of VIII in the facial canal
96
A patient presents with ipsilateral facial weakness, hypoguesia, hypoacusis, decreased lacrimation... what condition is this patient likely to have?
Simple Facial Palsy (Bell's Palsy)
97
Expansion of an acoustic neuroma compresses what structure(s)?
Fibers of the chochlear and vestibular portions of VIII and VII
98
A person with acoustic neuroma has what type of hearing?
Hypoacusis
99
10-15% of patient with Acoustic neuroma have what?
Dysequilibrium
100
A person with Acoustic Neuroma will have facial palsy with decreased what? and increased what?
- Decreased tearing, taste, facial expression
| - Increased hearing
101
Why does someone with Acoustic Neuroma have increased hearing?
Loss of stapedius function
102
What is a corticobulbar tract lesion involved with?
Weakness of lower facial muscles of the contralateral face
103
A 4th ventricle tumor shows what symptoms...
- Ipsi face weakness
| - Ipsi LR palsy
104
Taste on the anterior 2/3 of the tongue senses what tastes?
Salty and Sweet
| [apply to each lateral side of the tongue]
105
Taste on the posterior 1/3 of tongue is done by which CN?
CN IX
106
What is known as the scratch test? What CN is being tested with this test?
- Make rubbing noises with thumb and index finger. Make sure pt. can hear then move fingers out till they can't hear anymore. Both sounds should be symmetrical.
- CN VIII is being tested
107
Roughly how far out should the hands be from the ears to be considered normal hearing?
1-2'
108
How does a doctor perform a hearing screen?
- Strike 512Hz tuning fork
- Hold in front of each ear
- Ask if heard
- Ask if it is symmetrical
109
How does a doctor perform the Weber test?
- Place 256 Hz tuning fork to midline of skull
| - Ask if it is heard equally each side
110
If the sound is louder on the right side according to the patient, what does this mean?
- Conductive loss on the Right
OR
- Sensorineural deficit in the Left
111
How does a doctor perform the Rinne test?
- Place 256Hz tuning fork on mastoid
- Ask pt. if they hear it and to state when they don't anymore [BONE CONDUCTION]
- Then hold the fork 1" away auditory canal, ask if pt. still can hear it [AIR CONDUCTION]
- Then have pt. state when they cannot hear it anymore
112
What does air conduction need to be to be sensory neuro problem on the other side?
2x bone conduction
113
Normal hearing is considered what using the RInne test?
Air conduction >> Bone conduction [2x greater]
114
If Weber's test does not lateralize, what is the finding?
Normal hearing in both ears
| [SLIDE 9 in PPT for tuning fork test CHART]
115
When cleaning out one's ear canal, what reflex can be perceived by the brain?
Gag reflex
116
What does CN IX Glossopharyngeal N. give sensation to? [hint: 4 things]
- Oropharynx
- Nasopharynx
- Auditory tube and middle ear
- Portion of ext ear canal and tympanic membrane
117
CN IX serves as the sensory limb [afferent] to what reflex?
Gag reflex
118
What CN serves as the motor limb [efferent] to the gag reflex?
CN X
119
What else does CN X serve as the motor function for in the oral cavity?
Swallowing
120
How to test the gag reflex?
- Tell patient, I'm testing gag reflex
- Pt. look up, tilt head up, open mouth, stick out tongue
- touch posterior wall of pharynx with applicator, observe upward movement of palate and contraction of the pharyngeal mm.
- soft palate should ELEVATE EQUALLY BOTH SIDES
121
What does a weakness of palatal elevation result in?
Nasally voice
122
How does the doc assess the symmetry of the soft palate?
have patient stick out tongue and say "Ah"
| [observe movement of soft palate and uvula for asymmetry]
123
If there is no or weak palatal elevation, which CN is most likely the culprit?
CN X Vagus
124
How would the doc test for the motor function of swallowing and if it is intact?
- Have patient sip and swallow water
| - There should be NO RETROGRADE passage of H2O through the nose
125
When thinking about the Vagus N, where do the parasympathetic fibers project on the heart?
The SA node of the R Atria
126
If there is an increase in the parasympathetic activity, what does this do to the HR?
Decreases HR
127
If there is decreased parasympathetic activity, what will this result in with respect to the heart?
Tachycardia (HR that exceeds the normal rate)
128
If there is increased parasympathetics to the GI tract, what would this cause?
- Increased peristalsis
- release digestive enzymes
- decrease transit time [CORN, BEETS](17-20 HRS NORM)
- abdominal cramping
- Diarrhea
129
If there is decreased parasympathetics to the GI tract, what would this cause?
- Bloating
- Flatulence
- Constipation
[decrease/ NO P/S function = no control over internal sphincters, no erection, no sexual function]
130
What does increased sympathetics do to the hands?
The feeling of cold hands
131
What nerve provides motor to the Trapezius and SCM?
CN XI spinal acessory n
132
When testing CN XII Hypoglossal, if the tongue protrudes to the weak side what is this a sign of?
Lower motor neuron lesion
133
With atrophy of CN XII, what would you notice with the tongue?
Atrophy/wrinkling of the mucosa on the side of the lesion
134
How does a clinician test the motor function of the tongue?
- Stick tongue out, should be midline
| - Move tongue from one side to other
135
What CN is involved if you can't open your eyes?
CN III
136
What CN involved if you can't close your eyes
CN VII
137
What is a myotome?
MM. innervated by motor fibers from the root
138
What is a motor root?
Alpha motor neuron and what it goes to
139
If you see a crescent shadow, what does this indicate?
Chronic glaucoma
