Neuro Exam 4: Review Questions for CNs

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brau2308
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216152
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Neuro Exam 4: Review Questions for CNs
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2013-04-30 15:36:30
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neurology neuroscience neuroanatomy
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review of syllabus page for exam 4
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  1. The pt's L eyelid was drooping and partially closed
    • L CN III
    • oculomotor nucleus (midbrain)
  2. Pt had flaccid paralysis of tongue mm and it pointed to the R when the pt tried to stick it out
    • R CN XII
    • nucleus XII (medulla)
  3. Pt could not see either right or left visual fields from the R eye
    • R CN II
    • cell bodies in ganglion cell of retina (rods/cones)
  4. Pt could no longer perceive taste from the posterior 1/3 of the R side of the tongue
    • R CN IX
    • inferior ganglion of IX
  5. pt could no longer perceive taste from the anterior 2/3 of the L side of the tongue
    • L CN VII
    • solitary Nucl/geniculate ganglion
  6. pt did not respond to auditory and equilibrium stimulation of the L ear
    • L CN VIII (ipsilateral) both vestibular and cochlear
    • spiral ganglion/cochlear nucleus and vestibular ganglion/nucleus
  7. when light was placed directly in front of pt's L eye, there was not a direct pupillary light reflex
    • L CN II (afferent)
    • ganglion cell of retina (rods/cones)
    • OR
    • L CN III (efferent)
    • Edinger-Westphal nucleus (midbrain)
  8. pt displayed flaccid paralysis of the L sternomastoid m.
    • L CN XI
    • mesencephalic nucleus of V
  9. R side of tongue became atrophied and wrinkled
    • R CN XII
    • nucleus of XII (medulla)
  10. pt's L eye became dry
    • L CN VII
    • salivatory nucleus
  11. R corner of pt's mouth sagged when he tried to smile; R side of forehead was immobile; and saliva dripped from the corner of the mouth which was sagging
    • R CN VII
    • motor nucl. of VII (pons)
  12. R scapula of pt depressed downward and rotated outward (lateral).  Muscle involved displayed flaccid paralysis
    • R CN XI
    • mesencephalic nucleus of V
  13. upon examination by physician, it was noted that the pt had decreased carotid sinus reflex on L side
    • L CN IX
    • inferior ganglion IX/solitary nucleus
  14. pt stated that the R side of mouth was dryer than usual.  Physician found that R parotid gland was no longer functioning due to a lesion of which nerve?
    • R CN IX
    • salivatory nucleus (medulla)
  15. after an accident the exam revealed that the pt could no longer perceive general sensation (anesthesia) from R side of face
    • R CN V
    • trigeminal ganglia/spinal nucleus of V/Chief sensory nucleus
  16. following a severe traumatic accident on the R side of neck, pt developed dysphonia
    • R CN X
    • nucleus ambiguus (medulla)
  17. when physician touched R side of soft palate w/ a tongue depressor, there was loss of gag reflex.  It had already been established that there was no motor involvement
    • CN IX (not CN X b/c there's no motor involvement)
    • nucleus ambiguus (medulla)
  18. R eye of pt deviated laterally (abducted)
    • R CN III
    • oculomotor nucleus (midbrain)
  19. pt could no longer perceive odors from L nostril
    • L CN I
    • olfactory epithelial cells
  20. after accident, pt could no longer perceive pressure and vibratory sensation from L mandibular region
    • L CN V
    • mesencephalic nucleus of V (pons)
  21. ophthalmologist told pt that she had diplopia (double vision) and strabismus
    • CN III, IV, VI
    • mesencephalic nucleus of V (midbrain)
  22. computerized axial tomography (CAT scan) revealed a small benign neoplasm associated w/ brain stem.  Physical exam revealed loss of salivation from R submandibular gland.  Which CN was involved?
    • R CN VII
    • salivatory nucleus
  23. ophthalmologist noted that the R cornea was sensitive to touch, however; there was loss of direct corneal reflex.  Under this limited set of circumstances, could this pt demonstrate a consensual corneal reflex?
    CN VI ipsilateral (could get a consensual reflex -- opposite eye will constrict)
  24. pt's L eye adducted an there was loss of direct pupillary light reflex in the L eye while the R eye demonstrated a consensual pupillary light reflex.  Which two nn had lesions?
    L CN VI and L CN III
  25. Pt lost (theoretical) L side carotid body reflexes
    • CN IX
    • inferior ganglion IX/Solitary nucleus
  26. pt demonstrated dysphagia on L side.  Which 2 nn would be involved?
    L CNs IX and X
  27. exam showed no involvement of sensory systems, but there was bilateral loss of gag reflex
    • CN X (not CN XI because sensory system isn't involved)
    • nucleus ambiguus (medulla)
  28. ophthalmologist found mydriasis of the L eye.  Which CN or nucleus was involved?
    • L CN III
    • Edinger-Westphal Nucleus (midbrain)
  29. if pt history indicated anisocoria, what physical sign would you expect to find and why?
    • CN III
    • mecencephalic nucleus of V (midbrain)
  30. pt had loss of jaw jerk reflex on L side as well as atrophy of L mm of mastication on L.  Which nerve was involved?
    • L CN V (V3 b/c mixed)
    • motor nucleus of V (pons)
    • mesencephalic nucleus of V
  31. trauma to neck from a car wreck resulted in multiple symptoms to include tachycardia.  Which CN was involved?  Very theoretical.
    • CN X (loss parasympathetic innervation to heart)
    • ganglion X/solitary nucleus
  32. pt lost left direct corneal reflex b/c of motor problems but had a functional R consensual corneal reflex
    L CN III
  33. Pt had L sided anosmia and flaccid paralysis of majority of extrinsic eye mm of L
    CN I and CN III
  34. pt lost L direct corneal reflex but had the consensual reflex.  he also had mydriasis of L eye
    L CN III
  35. pt had diplopia, abduction of R eye, and loss of pain sensations (analgesia) from R side of face
    R CN III and V
  36. pt could not hear high-pitched sounds from L ear, and found his tongue protruded to the L when asked to stick it out
    L CN VIII and XII
  37. physical exam revealed flaccid L sternomastoid muscle, and impaired palatal and uvular reflexes on the L
    L CN XI and X
  38. pt could not whistle well, lost facial sulci on left side, had saliva dripping from L corner of her mouth, and had flaccid paralysis of mm of mastication on L
    CN VII, V3 of CN V
  39. pt had dysphagia due to dryness of mouth.  Which 2 nn would be involved?  What nucleus do they share in relation to this function?
    CN IX and X
  40. pt had impaired gag reflex due to a motor problem
    CN X (sensory problem would be CN IX)
  41. pt had impaired gag reflex due to a sensory problem
    CN IX
  42. loss of taste perception from R side of anterior 2/3 of tongue and loss of vibratory sense from teeth in R mandible would involve which 2 nn?
    R CN V and VII
  43. eaxm revealed strabismus and ptosis of R eyelid as well as loss of direct corneal reflex of R eye due to a sensory deft
    R CN III
  44. pt had diplopia due to loss of function of L superior oblique m. and flaccid paralysis of L masseter muscle
    L CN IV and V
  45. pt did not have a consensual pupillary eye reflex when light was directed toward both L and R eyes.  Pt also had strabismus of both eyes.  Which CN was involved and was it unilateral or bilateral?
    CN III bilateral?
  46. anosmia
    loss of smell (lesion of CN I only if bilateral)
  47. flaccid paralysis
    LMN causing structure not to move
  48. ptosis
    drooping of upper eyelid due to dysfunction of possibly levator palpebrae sup. m (CN III)
  49. diplopia
    double vision (CN III, IV, VI)
  50. abduction of eye
    • CN III
    • pupil directed laterally away from nose due to inability of eye to move medially, upward, and downward (lateral rectus and sup. oblique are unopposed)
  51. strabismus
    • eyes are crossed and not synchronized during movement
    • occurs when extrinsic eye mm are not properly innervated or mm themselves are damaged
    • CN III
  52. mydriasis
    • dilated pupil
    • due to loss of preganglionic parasympathetic fibers in N
    • CN III
  53. anisocoria
    • pupils of unequal size due to one iris being innervated and one not due to loss of preganglionic parasympathetic fibers in affected N
    • CN III
  54. direct pupillary light reflex
    pupil responds to light shined in eye
  55. consensual corneal reflex
    cornea reacts when touched
  56. adduction of eye
    • CN VI
    • pointing toward nose due to unopposed action of innervated med. rectus muscle
  57. palatal and uvular reflexes
    • respond when touched
    • CN IX (sensory) and X (motor)
  58. carotid sinus and carotid body reflexes
    • carotid sinus (blood pressure)
    • carotid body (CO2/O2 and pH)
    • CN IX
  59. dysphagia
    • difficulty in swallowing
    • CN IX (sensory), X (motor), XII
  60. dysphonia
    • LMN paralysis of ipsilateral intrinsic laryngeal mm results in vocal cord becoming fixed and partially adducted
    • voice is hoarse and reduced to a whisper
    • CN X
  61. gag (pharyngeal) reflex
    • CN IX (sensory)
    • CN X (motor)
  62. transient tachycardia
    • increased heart rate due to reduced parasympathetic input to heart
    • CN X
  63. anesthesia
    loss of all general sensations
  64. analgesia
    absence of sense of pain w/o loss of consciousness
  65. If pt lost proprioception from L side of body and also experienced adduction of R eye ball, where might the lsion exist?
    R pons
  66. If pt lost pain and temp sensations from L side of the body and experienced flaccid paralysis of the facial mm on the R side where might there be a lesion?
    R pons
  67. Spinothalamic pathway -> spinal lemniscus -> end up in thalamus to synapse with:
    3rd orders (pain, temp, crude touch)
  68. Flaccid paralysis =
    • LMN
    • SO: somewhere in R pons it will be damaged; accounts from the same side facial paralysis but contralteral loss of temp and pain in body

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