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NMS - pcc
NMS quiz 2
| Question | Answer |
|---|---|
| what is responsible for cervicogenic headaches? | The relationship between the vestibular cranila nuclei, cerivcally innervated muscles, joint proprioceptors and CN5 |
| Movements such as swallowing and moving the forehead are ____ innervated | Bilaterally |
| The ___ cranial nerves originate from a collection of cells outside the brain stem. | Sensory |
| The nerves which have ___ function originate deep within the brain stem and are analogous to the ____ of the spinal cord. | 1. Motor 2. Anterior horn cells |
| Reasons why you would have CN abnormalitie | 1. specific lesion to the nerve 2. Lesion to the nucleus 3. Lesion to the communication pathway 4. Generalized problems of nerve or muscle |
| In general examination of the eyes this allows for the examination of of tract running from the eye to where? | The occipital lobe which also crosses the midline |
| Unilateral CN 5, 7 and 8 = what? | Cerebellopontine angle lesion |
| Unilateral CN 3, 4, 5 and 6 = ? | Cavernous sinus lesion |
| Combined unilateral CN 9, 10 and 11 = ? | Jugular foramen syndrome |
| Combined bilateral 10, 11 and 12 = ? | LMN = bulbar palsy, UMN = pseudobulbar palsy |
| Prominant involvement of eye muscles and facila weakness usually suggests what? | Myasthenic syndrome (myoneural junction) |
| MC cause of intrinsic brain stem lesion in the young? Old? | 1. MS 2. Vascular disease |
| The sensory nuclei develop where? Motor? | 1. Dorsal or alar plate of the neuro tube 2. Basal plate |
| Motor nuclei nerve and location: Edinger Westphal: | Cn 3, superior colliculus |
| Motor nuclei nerve and location: trochlear | Cn 4, mid brain at level of sup colliculus |
| Motor nuclei nerve and location: trigeminal | CN 5, mid pons |
| Motor nuclei nerve and location: Abducens | CN 6, dorsal pons |
| Motor nuclei nerve and location: facial | CN 7, near caudal border of pons |
| Motor nuclei nerve and location: Salivatorius superior | CN 7, border of pons and medulla |
| Motor nuclei nerve and location: salivatorius inf | Cn 9, border of pons and medulla |
| Motor nuclei nerve and location: dorsal motor nucleus | CN 10, dorsal medulla |
| Motor nuclei nerve and location: Ambiguus | CN 9 , 10, 11 in dorsal medulla |
| Motor nuclei nerve and location: hypoglossal | CN 12 in medualla beneath 4th ventricle |
| Sensory nuclei nerve and location: mesencephalic | CN 5, mid brain |
| Sensory nuclei nerve and location: main sensory to trigeminal | CN 5 in pons |
| Sensory nuclei nerve and location: Vestibulochoclear nuclei | CN 8, pons and medulla |
| Sensory nuclei nerve and location: tractus solitarius | CN 7, CN 9, dorsal medulla |
| Sensory nuclei nerve and location: spinal tract of trigeminal | CN 5 in dorsal lateral medualla |
| AKA for testing gross visual field | Confrontation |
| Pupillary light reflex may be what or what? | 2 or 3 |
| Corneal light reflex: which nerves | 3, 4 or 6 |
| 6 cardinal field of gaze: which nerves? | 3, 4 or 6 |
| corneal blink reflex | 5 |
| Jaw jerk reflex | 5 |
| CN 7 tests | Musculature of the face and taste (ant 2 thirds of tongue |
| Weird named tests for CN 8 | Rinne, Weber, Finger Rustle, Schwabach and Watch tic tests |
| corneal blink reflex | 5 |
| Jaw jerk reflex | 5 |
| CN 7 tests | Musculature of the face and taste (ant 2 thirds of tongue |
| Weird named tests for CN 8 | Rinne, Weber, Finger Rustle, Schwabach and Watch tic tests |
| CN 9 tests | 1. say ahhhh 2. gag reflex 3. Check phonation : K-L-M test |
| Cn 10 tests | 1. Shoulder shrug 2. Muscle strenght of SCM and Trap |
| CN 12 tests | 1. Stick out tongue 2. Tongue in cheek test |
| Cortical lesion affecting CN 1 will cause what type of symptoms | Perversion, hallucination and diminished smell (hyposmia) |
| Complete loss of smell is due to what? | Viral infection, allergic rhinits, aging, head trauma causing a basilar skull fracture or fracture to cribriform plate |
| Lesions to the uncinate gyrus of the anterior temporal lobe may cause what? | hallucinations of smell associated with a strong feeling of deja vue |
| What are these called? | Uncinate fits or seizures |
| Parosmia | Perversion of smell |
| Cacosmia | Abnormal degree of smell |
| Common causes of anosmia | Blocked nasal passage, common cold, aging |
| Explain olfactory pathway | nasal mucosa to cribriform plate to olfactory bulb (1): olfactory tract to olfactory cortex (periamygdaloid area and prepiriform area) (2): Primary olfactory cortex to entorhinal cortex (area 28), lateral preoptic area, amygdaloid body and medial |
| forbrain bundle (3) | |
| Nerves that are not true nerves | CN 2 |
| 1st order neurons of CN 2 | Rods and cones |
| 2nd order neurons of CN2 | Bipolar cells of the retina |
| 3 order neurons of CN 32 | Ganglion cells |
| 4th order neuron of CN2 | Geniculocalcarine tract |
| The central connections of the optic nerve include what? | 1. From precentral region to the EW nucleus via posterior commisure 2. From sup colliculi via teactobulbar and spinal tracts 3. From occipital cortex to other cortical areas |
| Fibers that are responsible for the simple and consensual light reflexes come from where? | Pretectal region |
| Where do connections for involuntary oculoskeletal refeflxed come from? | superior colliculi |
| What is concerned with visual perception? | The lateral genuculocalcarine tract which comes from the lateral geniculate body |
| ____ is concerned with light reflexes and ___ is concerned with refelx movement | 1. Pretectal area 2. Sup colliculi |
| What is the retinal area for central vision? | Macula |
| The inner layers of the retina in the macular area are pushed appart to form what? | Fovea centralis |
| Where is vision at it's sharpest and color the most acute? | Fovea centralis |
| More rods equals what? | Better night vision |
| Involves the optic nerve or tract, the MC is MS | Retrobulbar neuritis |
| Includes various forms of retinitis | Optic or bulbar neuritis |
| Is commonly a sympton of increase intracranial pressure due to brain tumor, abscess. hemrrhage, hypertension, etc. Aka what? | Papilledema aka choked disc |
| Is associated with decreased visual acuity and a change in color of the optic disc to light pink, white or gray | Optic atrophy |
| Is caused by processes that involve the optic nerve and do not produce papilledema | Primary optic atrophy |
| Is a sequel of papilledema | Secondary optic atrophy |
| May be due to tabes dorsalis, MS or heridity | Primary (simple) optic atrophy |
| Corneal scars and arterioclerotic changes in the retina may occur | Opacities of the lens |
| May interrupt optic pathway | Tumors |
| May be caused by tumor at the base of the frontal lobe and is characterized by ipsilateral blindess, anosima and contralateral papilledema | Foster Kennedy syndrome |
| Cerebramacular degeneration, jewish, blindness, optic atrophy, dark cherry spot... aka what | Amaurotic familila idiocy aka tay-sachs |
| Tonic pupilary reaction and the abscence of one or more tendon relfec | Holmes adie syndrome |
| Heterotropias | deviation of bilateral eye alignement |
| Exptropia | Outward and lateral movement |
| Esotropia | Inward and medial movement |
| Hypertropia | Up |
| Hypotropia | Down |
| What is the purpose of the medial longitudinal fasciculus? (MLF) | Coordinate eye movements |
| The disease of interconnecting pathways may produce what? | a characteristic internuclear ophthalmoplegia |
| Unable to laterally gaze requires which cranial nerves | 3 and 6 |
| Unable to converge? | 3 bilaterally |
| There are 2 seprate super nuclear pathways for eye movements. The first is from the ___ lobe and controls ___ movements while the second is from the ___ lobe and controls ___ movements. | 1. Frontal 2. saccadic 3. Occipital 4. smooth |
| Involuntary eye oscilations | Nystagmus |
| Loss of coordination between the saccadic and smooth movements | nystagmus |
| Eyelid ptosis and corectasia | CN 3 |
| Patient unable to laterally deviate the eye from side to side on the side ipsilateral to the lesion | CN 6 |
| Causes difficulty for the patient to look down and in : which CN lesion | 4 |
| Disease of CN 2 will cause diminished _____ with bilateral symetry. | Pupilloconstriction |
| Pathological involvement of the motor portion of the eye light reflex will manifest how? | Decreased ability for puppiloconstriction in the ipsylateral eye |
| if you have no pupil light reflex, what may have happened | Loss of diencephelon or midbrain function |
| A pupil that reacts to light very slowly, MC in young woman, begign | Holmes-asie syndrome |
| pupil reacts only to accomodation: tabes dorsales, diabetics | Argyll robertson pupil |
| Clinical testing for peripheral vision is accomplished via a technique called what? | Confrontation |
| What is accommodation? | Reflex that occurs when one focusses on an object coming nearer |
| 2 main objectives when assessing extraoccular movements | 1. full, concomitant movement of both eyes 2. no nystagmus |
| Clinical finding with recent nystagmus | nausia, vertigo, vomitting, ataxia |
| Where should the reflexion from the light source be when doing the corneal light reflex? | slightly medial to the corneal center |
| Simple and sensitive method of testing equal pupilloconstriction | swinging flashlight test |
| The apparent puppilodilation with light introduced is known as what? | Marcus-Gunn phenomenon |
| A decreased marcus gunn phenomenon indicates what? | CN 2 lesion |
| The red reflex is not a | reflex |
| What are we evaluating in the fundiscopic eval? | Blood vessels |
| The margin between the optic disc should be ___ temporally and less medially | sharp |
| Findings that would indicate papilledema | 1. blurred nerve fibers and cup 2. Torturous, engorged veins and loss of venous pulsations at disc margin 3. Obliteration of physiological cup 4. disc elevation and edema |
| In primary optic atrophy, what color has the optic disc | dead white |
| In secondary optic atrophy. what color is the optic disc | gray and it's ragged |
| optic neuritis can predate the onset of what? | MS |
| Collection of degenerative deposits that often appear in the elderly | Drusen |
| Sensory nerve of the face and has motor fibers the muscles of mastication | CN 5 |
| A lesion in the peripheral CN 5 will cause loss of sensation over the face but not at this spot | The area over the angle of the jaw |
| The mandibular nerve of CN 5 has a recurrent meningeal branch that innervates what? | Dura of the middle and anterior cranial fossa |
| the lesion has to be where to completely paralyze the jaw? | Bilateral corticobulbar lesion |
| Sunken or hollowing out of the temples and zygomatic arch | peripheral nerve or brain stem diseases affecting CN 5 |
| How does one tests the integrity of CN 5 | Jaw deviation on opening, palpation of masseter and temporalis while patient clenches teeth |
| ____ leasions of CN 5 will result in paralysis and denervation atrophy of the mastication muscles | LMNL |
| CN 5 carries the sensory arc reflex of what? | Corneal reflex |
| Abscence of corneal reflex strongly suggests pathology of what? | CN 5 |
| Nerve of facial expression | CN 7 |
| Taste for CN 7 | Anterior 2 thirds of tongue |
| Will you still be able to move your forehead in a unilateral lesion of CN 7 | yes, thank god |
| 2 divisions of CN 7 as it slices through the parotid | 1. temporofacial 2. cervicofacial |
| which other cool muscle does CN 7 innervate? | Our friend, the stapedius |
| What is prosopoplegia? | peripheral facial paralysis |
| Bells palsy: lesion where? | peripheral to the geniculate ganglion |
| All lesion to CN 7 have what in common? | Flaccid paralysis that is ipsy to the lesion |
| Loss of taste aka | ageusia |
| Peripheral lesions to CN 7, proximal to the ____, will cause what? | 1. stylomastoid formen 2. loss of taste ipsy |
| Confirm bells-palsy | Complete hemifacial paralysis without loss of taste on ipsy ant 2 thirds on tongue |
| 2 divisions of CN 8 | 1. Cochlear 2. Vestibular |
| Where are the receptors located for the vestibular part | Semi-circular canals, the utricle and saccule |
| Where are the receptor for the cochlear part? | Organ of corti |
| Loss of hearing aka | Hypoacusis |
| Loss of hearing most likely due to ? | 1. conduction loss 2. Receptor disease 3. Lesion |
| A short circuit where can result in nystagmus? | CN 3, 4, 6 or 8 |
| Central lesions to CN 8 are associated with what? | hallucinations of hearing |
| Increased intensity of hearing aka what? due to what? | 1. Hyperacusis 2. CN 7 (stapedius) or central lesion in CN 8 |
| 2 major varieties of hearing loss | 1. conductive 2. sensrineural |
| Common etiologies for conduction loss | 1. Obstruction of canal 2. trauma to tympanic membrane 3. trauma to ossicles or aging 4. Accumulation of fluid in middle ear (RARELY chronic middle ear infection) |
| Sensorineural loss of hearing is usually due to what | damage to the organ of corti |
| 2 tests to evaluate choclear division | 1. finger rustle test (6 inches from ear) 2. Watch tic test |
| More refined tests for choclear | Rinne, Weber and Schwabach |
| vibrating tunning fork on mastoid | Rinne |
| Buzzing tunning fork on vertex | Weber |
| Buzzing tuning fork in front of auditory meatus | Schwabach |
| What is the auditopalpebral reflex | Loud noise makes you blink |
| Vestibular disease is always accompanied by what? | vertigo |
| Vestibular disease can also have this which is what? | Oscillopsia: visual perception of rapid to and fro movements accompanying nystagmus |
| What is caloric irrigation? | Shooting cold or warm water in auditory canal |
| What are we trying to find? | Nystagmus : COWS |
| Cervicogentic vertigo aka | Cervicospinal proprioceptive disease |
| How do you test for this? | Place patient in swivel chair, immobilize head and have patient rock side to side |
| Disorder to CN __ are very uncommon | 9 |
| Associated with CN 9 and 10 disease | Aphonia, dysarthria, anarthria, dysphagia, aphagia, hypernasal, hyponasal |
| Tests for CN 10 | 1. say ahhhh 2. KML test 3. gag relfex |
| Motor function of CN 11 | Trap and SCM |
| Lower trap innervation | Cervical nerves 3 and 4 |
| SCM functions | 1. tilt head to same side 2. Turns chin to opposite side 3. Flexes head when contracted bilaterally |
| Trap actions | same excepts raises shoulders when contracted bilaterally |
| CN 12 disease | Paralysis of tongue |
| How do you test for CN 12 lesions | Stick tongue out... if deviates to right = right side lesion or press the tongue against cheek with resistance |
Created by:
LrB
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