Neuro - CN Flashcards

1
Q

Name the cranial nerves (CN I - XII)

A
  • I olfactory
  • II optic
  • III oculomotor
  • IV trochlear
  • V trigeminal
  • VI abducens
  • VII facial
  • VIII vestibulocochlear
  • IX glossopharyngeal
  • X vagus
  • XI accessory
  • XII hypoglossal
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2
Q

Which are the visual cranial nerves?

A
  • II optic
  • III oculomotor
  • IV trochlear
  • VI abducens
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3
Q

Which are the bulbar cranial nerves?

A
  • IX glossopharngeal
  • X vagus
  • XII hypoglossal
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4
Q

What is the exposure requried for a cranial nerve exam?

A

clavicle up

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5
Q

what might be observed on general inspection during a cranial nerve exam?

A
  • unilateral neck muscle wasting neck (XI)
  • facial droop/asymmetry (VII)
  • articulation of words (V, VII, X, XII)
  • ptosis (III)
  • strabismus e.g. ambylopia (III, IV, VI)
  • abnormal/asymmetric pupils (II, III)
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6
Q

How do you test CN II?

A

Inspection, AFRO

  • Acuity
    1. distant vision - Snellen test
    2. near vision
    3. colour vision - Ishihara plates
  • Fields
    1. inattention
    2. fields
    3. blind spots
  • Reflexes
    1. accommodation
    2. direct & consensual
    3. swinging light - normal reaction = slight constriction, then slight dilation ​
  • Ophthalmoscopy
    1. ‘to visualise optic disc’
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7
Q

a) What is Horner’s syndrome?
b) What are the signs of Horner’s syndrome?

A

a) range of symptoms when sympathetic trunk is damaged
b) ipsilateral: miosis, partial ptosis, anhydrosis, enophthalmus

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8
Q

How do you test CN I?

A

‘have you noticed any changes in your sense of smell?’

offer to test with UPen smell identification test

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9
Q

How do you test CN III, VI, VI?

A

CN III = optic ; CN IV = trochlear ; CN VI = abducens

Inspect

  1. H Test
  2. saccades test
  3. convergence test (bring finger towards nose, pupil shrinks)
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10
Q

What is the pathology if there is

a) partial ptosis
b) complete ptosis

A

a) Horner’s syndrome
b) CN III lesion

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11
Q

What are the afferent and efferent nerves for the accommodation reflex?

A

afferent = CN II

efferent = CN III

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12
Q

What are the afferent and efferent nerves for the

a) direct pupillary reflex
b) consensual pupillary reflex

A

a) afferent = CN II ipsilateral ; efferent = CN III ipsilateral

b) afferent = CN II contralateral ; efferent = CN III ipsilateral

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13
Q

What are the afferent and efferent nerves for the swinging light reflex?

A

????

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14
Q
  1. What is a Marcus-Gunn pupil?
  2. What does a Marcus-Gunn pupil suggest?
A

1) when pupils dilate (to some degree) when a bright light is swung from the unaffected eye to the affected eye;
* as opposed to normal reaction = slight constriction, then slight dilation*
2) optic nerve lesion e.g. due to glaucoma, MS

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15
Q

How do you test CN V?

A

inspect (wasting: masseter, temporalis, lateral pterygoids)

  • sensory:
    • any areas of pins and needles or numbness?’
    • sharp & dull sensation testing over 3 branches (temporal, maxillary and mandibular) ‘does it feel the same on both sides?’
  • motor
    • from behind: clench jaw, feel masseters, temporalis & lateral pterygoids
  • reflexes:
    • offer: corneal reflex
    • offer: jaw jerk reflex
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16
Q

When testing CN V, what would you do if there are any sensory abnormalities found?

A

test the 3 branches again for:

  • temp sensation: cold tuning fork
  • light touch sensation: cotton wool
17
Q

What are the afferent and efferent nerves for the corneal reflex?

A

afferent = CN V: nasociliary branch of ophthalmic division

efferent = CN VII

18
Q

How do you test CN VII?

A

inspect

Motor:

  • Raise eyebrows
  • Scrunch up eyes + try to prise each open in turn with your thumbs
  • Purse lips together + try to prise each open in turn with your thumbs
  • Show teeth
  • Puff out cheeks + try to push air out
19
Q

How does

a) UMN present when raising eyebrows (CN VII)?
b) LMN present when raising eyebrows (CN VII)?

A

a) forehead spared, bilateral eyebrow raise
b) unilateral eyebrow raise

20
Q

How do you test CN VIII?

A

‘any changes in hearing?’

  • Crude hearing test: rub fingers in one ear
  • Weber test -
    • 512Hz
    • forehead ‘which side is louder?’
  • Rinnes test -
    • 512Hz
    • mastoid process ‘tell me when it stops’
    • by ear ‘can you hear it again?’

offer: vertigo tests e.g. Dill-Hallpike test

21
Q

What would be the results of Weber & Rinne’s in

a) sensorineural hearing loss
b) conductive hearing loss

A
22
Q

How do you test CN IX & X?

A
  • Inspect: open mouth say, ahhh
    • look for palate symmetry (CN IX)
    • look for uvula deviation (CN X)
  • Motor:
    1. speech - ‘say ahh & British constitution’
    2. cough
    3. swallow
  • Reflex:
    • offer: gag reflex
23
Q

How do you test CN XI?

A

Inspect: SCM, trapezius wasting

Motor: against resistance - turn head & shrug shoulders

24
Q

How do you test CN XII?

A

‘have you noticed any changes/slurring in your speech?’

Inspect

  • tongue wasting or fasciculations

Motor

  • stick out tongue - deviation?
  • against resist. press tongue inside cheek
25
Q

CHow could you complete your cranial nerve examination?

A
  • Full Hx
  • Upper & lower limb neuro examination
  • fundoscopy (if hearing impaired)
  • nerve conduction study
  • CT head
26
Q

What is

a) bulbar palsy
b) pseudobulbar palsy

A

a) LMN lesion
b) UMN lesion

27
Q

How could you differentiate between bulbar palsy and pseudobulbar palsy?

A