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Finals Elliot > PACES - CN > Flashcards

PACES - CN Flashcards

1
Q

TEST CN I

A

Olfactory

Ask about change in smell, offer smelling salts

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2
Q

TEST CN II

A

Optic (AFRO)

Acuity - Snellen Chart, Ishihara Plates

Fields - 1m apart, no glasses. Neglect = Which finger is wiggling. Fields = 4 corners, bring wiggling finger in form outside FOV. Offer red pin central vision & blind spot

Reflexes - Inspect pupil size, shape, symmetry. Direct reflex (constrict with light). Consensual reflex (constrict with light in other eye). Swinging (RAPD). Accommodation, ask to look at wall then finger, assess for constriction.

Opthalmoscopy - Check red reflex and optic disk

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3
Q

TEST CN III

A

Oculomotor

Dipolopia/Pain on H movement pattern. Check for nystagmus.

Lesion = Down and out pupil, ptotsis, mydriasis

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4
Q

TEST CN IV

A

Trochlear

Diplopia/Pain on H movement pattern. Check for nystagmus

Lesion = Vertical diplopia when looking downwards

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5
Q

TEST CN VI

A

Abducens

Lesion = Convergent squint, Horizontal diplopia worse when looking towards the affected side

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6
Q
A

Convergent squint, Abducens palsy

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7
Q
A

CN III lesion

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8
Q

TEST CN V

A

Trigeminal

Motor - Clench teeth (masseter), Open jaw against resistance

Sensory - V1, V2, V3

Reflexes (Offer corneal), Jaw jerk

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9
Q

TEST CN VII

A

Facial

Motor - Can you raise your eyebrows, Scrunch your eyes, Puff cheeks out, show me your teeth.

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10
Q

TEST CNVIII

A

Vestibulochochlear

Whisper number in each ear, can you repeat. If no, offer Rinne’s and Weber’s and formal audiometry testing

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11
Q

TEST CN IX, X

A

Glossopharyngeal, Vagus

Voice quality
Say ahh, check for symmetry and deviation of uvula.
Offer to test gag reflex.

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12
Q

TEST CN XI

A

Accessory

Ask the pt to shrug their shoulders and turn their head to the side against resistance on the cheek

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13
Q

Test CN XII

A

Hypoglossal
Ask pt to stick tongue out.
Deviation/Fasciculations.

Press tongue against finger resting on cheek to assess motor

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14
Q

How would you test the jaw jerk reflex?

A

Ask the pt to open their mouth
Place finger horizontally across pt’s chin
Tap finger lightly with tendon hammer
Observe slight closing of jaw.

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15
Q
A

Hypoglossal nerve palsy (Left)

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16
Q
A

Bell’s Palsy

17
Q
A

Ptosis

18
Q

How does the swinging light test work?

A

Swing from eye to eye.
Light in normal eye = both constrict
Light in affected eye = Less constriction

= Marcus Gunn pupil = Relative Afferent Pupillary Defect = partial CN II lesion (can be seen in optic neuritis)

19
Q

What can cause Horner’s Syndrome?

A

Central = MS, Syrigngeomyelia

Preganglionic = Pancoast tumour, Trauma from Central Venous Line insertion

Post-Ganglionic = Cavernous sinus thrombosis, carotid artery dissection

20
Q

What might cause unequal pupils?

A

Horner’s
CN 3 palsy
Migraine
Drugs

21
Q

What can cause an rapd?

A

MS
Glaucoma

22
Q

What is an argyll-robertson pupil?

A

Small irregular pupil
Accommodate but not reactive to light
DM, Syphylis

23
Q

What is a holmes-Adie pupil?

A

Dilated pupil with no response to light

Benign

24
Q

What can cause a homonymous hemianopia?

A

SOL
MCA Stroke, with hemiparesis
PCA stroke, macula sparing and cerebellar signs

25
Q

What can cause a bitemporal hemianopia

A

Chiasmatic Lesion
Check for endo disease

26
Q

Muscles of the eyes?

A

Superior Rectus
Superior Oblique
Inferior Rectus
Inferior Oblique
Medial Rectus
Lateral Rectus

Superior + Inferior rectus = CN III

Lateral Rectus = CN VI

Superior Oblique = CN IV

27
Q
A

Oculomotor Palsy

Ptosis, Down and out pupil, mydriasis, reduced direct and consensual constriction

28
Q
A

Trochlear Palsy

Double vision when looking down

29
Q
A

Abducens palsy

30
Q

Generic causes of cn nerve lesions?

A

DM
HTN
MS
Raised ICP

31
Q
A

Bell’s Palsy (CN VII)

32
Q

Add ons to CN exam?

A

Full Neuro exam and history

Urine dip
Fundoscopy
EMG, Nerve conduction
MRI spine/Brain

Finals Elliot (12 decks)

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