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- Review cranial nerves, identify their function, and testing for each (study guide bullet)
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| Cranial Nerve pneumonic: name the numbers. |
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Olf Options Occasionally (I.olfactory II.optic III.oculomotor)
Trojan Tries About Facially (IV.trochlear V.trigeminal VI.abducent VII.facial)
Accosting Glossophair (VIII.acoustic IX.glossopharyngeal)
Vaguely Spinning Hypoglare (X.vagus XI.spinal XII.hypoglossal)
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Cranial "both", as in Nerves that are both motor and sensory: pick all you can stand...
A) Facial
B) Glossopharyngeal
C) Trigeminal
D) Vagus
E) Abducens |
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Definition
Only E) Abducens (VI; motor only for lateral movement of eye) is incorrect.
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Sensory (only) Cranial Nerves: pick all you can stand...
A) Trochlear
B) Vagus
C) Acoustic
D) Optic
E) Olfactory
Before you turn to the other side, name the number and what does each do? |
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Definition
| C) VIII - hearing, D) II - sight, and E) I - smell are correct. Vagus nerve, X, is motor (pharynx [swallowing] & larynx [talking]), sensory (general sensation for carotid [body & sinus], pharynx & viscera), and -just for complification- parasympathetic carotid reflex (co-mediated with CN IX glossopharyngeal). Trochlear is motor only for eyes down and in. |
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Get your motor running: which cranial nerves are motor only? Pick all you can stand.
A) Oculomotor
B) Trochlear
C) Abducens
D) Spinal
E) Hypoglossal
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| Only A) is incorrect; oculomotor (III) is motor for most EOM (extraocular muscle) movement, plus opening of eyelids. But it gets downright parasympathetic about pupil constriction and lens shape, too. Trochlear (IV) is for down & in eye movement. Abducens is for lateral eye movement (think "abductor"). Spinal is for trapezius & sternomastoid motoring. Hypoglossal is tongue movement. |
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Eye spy: let's test Cranial Nerve II: pick all you can stand...
A) Confrontation tests the optic nerve via peripheral vision and acuity
B) 20/40 means seeing at 40 feet what is normally seen at 20.
C) 20/40 means seeing at 20 feet what is normally seen at 40.
D) The Snellen test evaluates the ocular fundus
E) Palpabral fissures should be equal in width
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| A) & C) are correct. Confrontation (see Fig. 14-11) uses a pencil, 2' of distance and one eye covered to check peripheral vision. The Snellen test is an alternative method to confrontation to check peripheral vision; can also check acuity. Equal palpabral fissures are for CN III, IV & VI, along with checking cardinal positions of gaze and PERRLA (pupils equal, round, reactive to light & accommodation) |
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Eyeball soup: pick all you can stand...
A) III, IV, and VI have sensory and motor, not parasympathetic
B) Lateral movement is VI; vision is II.
C) EOM & opening eyelids motor, along with parasympathetic pupil constriction and lens shape is trochlear.
D) Abducens & trochlear are motor only.
E) VII closes the eye
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| Only B), D) & E) are correct. For A), CN III (oculomotor) has both sensory and parasympathetic functions as described in C). For both A) and D): CN VI (abducens) is motor only (lateral eye movement); and CN IV (trochlear) is motor only (down & in eye movement). For B) The abducens is IV, optic is II. C) describes Oculomoter III, NOT trochlear. VII facial is motor facial muscles, for closing (eye & mouth), and for labial (lip use) speech; sensory for taste (S,S,S & bitter); parasympathetic for salivation & tears. |
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Test the minimal of the trigeminal. Be grand with all you can stand...
A) The corneal reflex for bilateral blinking is a normal reaction test
B) Nystagmus documents decreased or unequal sensation.
C) Have the patient clench their teeth while you palpate the temporal and masseter muscles for bilaterally equal motor function.
D) Test all 3 trigeminal branches of sensory function by touching a cotton wisp to the forhead, check and chin to see if felt by patient.
E) With patient teeth clenched, try to separate the jaws by pushing down on the chin as test of motor function.
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| C), D) and E) are correct. Corneal reflex is only done for abnormal facial movement/sensation. Nystagmus reflects problems with the III, IV & VI motor nerves of the eye, not trigeminal. |
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Get seminal with trigeminal: try all that fly...
A) has motor, sensory, and parasympathetic functions
B) mastication motor, sensation scalp sensory
C) down and inward movement of eyes
D) sensory mucous mouth & nose membranes
E) is CN V has three branches |
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Definition
B), D), and E) are correct. Trigeminal V is motor for mastication, sensory for scalp; has no parasympathetic involvement. Down and inward movement of the eyes is IV Trochlear; a motor nerve only. |
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Spacial facial VII: let me count the ways: pick all you can stand...
A) Check nerve by asking patient to smile, frown, keep eyes shut against your efforts to open them.
B) A taste test is usually done only when injury is suspected.
C) Touch the forehead, cheek, and chin bilaterally with a cotton wisp to check for PNS lesions, such as Bell's palsy which only affects one side of the face.
D) Test motor function by providing resistance to a patient trying to turn their head.
E) Inspect the tongue for tremors or wasting and midline forward thrust; listen to the patient say, "light, tight, dynamite" (lingual speech) to check for Facial V motor function.
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Definition
| A) and B) are correct. Bell's palsy is a facial nerve issue, but the test described in C) is a sensory function test for trigeminal V. D) is for the spinal accessory XI, not facial. E) checks hypoglossal XII, not facial. Spinal & hypoglossal are motor only. |
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Face time for Facial Cranial Nerve: pick all you can stand...
A) Smiling and frowning indicate functional Facial VII
B) Salivation and tears are a facial CN parasympathetic function
C) Vocal chords and swallowing are a VII motor function
D) The facial nerve only addresses taste on the anterior 2/3 of the tongue
E) Muscles of mastication are a motor function of Facial VII.
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Definition
| A), B) & D) are correct. C) describes the motor function part of glossopharyngeal IX, which also has posterior 1/3 of tongue taste and pharynx gag reflex sensory; plus parasympathetic parotid (salivary) gland and carotid reflex. E) is describing the trigeminal V motor function, which goes with the sensation sensory functions of the face, scalp, cornea & mucous membranes (mouth & nose). Facial VII is motor for facial muscles, close (eye & mouth) & labial (use of lips) speech; sensory for taste (anterior 2/3 of tongue for sweet, sour, salty, bitter); and just to spice up your day, parasympathetic saliva & tear secretion. |
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Acousticate with CN 8: choose all that's great.
A) VIII (acoustic) is a motor nerve only for hearing.
B) Weber tests hearing balance, and Rinne tests for air conduction (AC) > bone conduction (BC).
C) VIII (acoustic) is a sensory nerve only for hearing and equilibrium.
D) Test vestibular apparatus inner ear ability to maintain balance with the gait, heel-to-toe tandem walking & Romberg test.
E) With shielded lips whisper 2-syllable words 30 to 60 cm from an ear, while the patient triggers the tragus of the other ear.
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| B), C) & E) are correct. B) Pneumonic: Weber for Which side; Rinne bone like Rhino horn; Figs. 15-10 to 15-12. D) is true, but those are tests of cerebellar not acoustic nerve function [Figs. 23-16 & -17]. E) is describing the Whispered Voice test [Ch 15] of the acoustic nerve VIII. |
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Hey, it's vegus, let's mix it up. Play the hand for all you can stand:
A) Glossopharyngeal IX co-mediates carotid reflex with vagus X
B) Parasympathetic CN include vagus, oculomotor, facial & glossopharyngeal.
C) IX has pharynx on both motor and sensory functions
D) X has pharynx on both motor and sensory functions
E) glossopharyngeal IX includes phonation & swallowing |
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Definition
| All answers are correct. Glossopharyngeal IX is motor for pharynx (phonation [vocal chord] & swallowing); sensory for taste (posterior 1/3 or tongue) & gag reflex (pharynx); plus parasympathetic carotid reflex (co-mediated w/ Vagus X) & parotid (salivary) gland. Vagus X is motor for pharynx & larynx (talking & swallowing); sensory for general sensation from carotid (body & sinus), pharynx, viscera; parasympathetic for carotid reflex. Pneumonic: glossso is tongue (back 1/3 sensory taste), which takes you to swallowing (motor) and the pharynx, as in "ph" for phonation + "p" as in parasym'c stim of the parotid and carotid. |
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When you do do neuro checks, do you do-do, too? Construe all that's true...
A) Integrate the neurologic exam with other respective parts of the body
B) Well people get a neurologic recheck
C) Headache, weakness, and / or loss of coordination is cause for the whole enchilada: the complete neurologic exam.
D) Screen check persons with a demonstrated neurologic deficit with an aromatic test.
E) Persons who appear well and have no subjective findings need no neurologic screening
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| Only A) & C) are correct [Ch 23, start of objective data]. B) & D) are absurdities: neurologic rechecks [Figs. 23-54 to 59] are for people who have a demonstrated neurologic deficity. E) is false: people who appear well and have no subjective findings get a screening neurologic examination [after Fig. 23-59] |
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Superficial only initial Cutaneous instantaeous: pick all that are...
A) Palmar
B) Tympanic
C) Pyramidal
D) Rooting
E) Babinski
Define them before turning the card over. |
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| A), D) & E) are all superficial cutaneous reflexes [Figs. 23-44 to 47]. Strong palmar grasp of all fingers eqaual bilaterally when ulnar side of hand is fingered ( birth to 3 or 4 mo.; firmest @ 1-2 mo.); absence = brain / muscle / nerve damage; persistence after 4 mo. = frontal lobe lesion. Rooting is cheek touch receiving a turned head to suck response; birth to 3-4 mo. Babinski reflex is J motion from heel up lateral side across ball of foot causing a fanning of toes; birth to 2-2.5 yr; persistence = pyramidal tract disease. 2 not listed: sucking reflex when lips touched (birth - 10 or 12 mo.); Plantar grasp is touching heel; birth to 8-10 mo. |
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Neurologic Recheck (LOC, motor function, pupils, VS, & Glasgow Coma Scale) (study guide bullet)
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What is important in a neuro re-check? Pick all you can stand...
A) Level of Consciousness
B) Motor function
C) Demonstrated neurologic deficity
D) Pupillary response
E) Lateral eye movement, blood pressure, & heart rate.
Explain each procedure before turning over card. |
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A), B), C) & D) are correct. A) Level of consciousness procedure: oriented as to name, place, & time. B) Motor function is checked by comands (lift eybrows, frown, bare teeth; note symmetry & bilateral nasolabial folds [CN VII], 2-finger grasp, arms sustained level out front, straight leg raises [1 @ a time]. C) Neurologic rechecks [Figs. 23-54 to 59] are for people who have a demonstrated neurologic deficity. D) Pupillary response is brisk direct & consensual constriction from light. Lateral eye movement is a test of abducens CN but not part of re-check exam. Vital Signs (VS) are another part of Re-checks, but BP & HR are notoriously unreliable parameters of CNS deficit.
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Been to Glassgow lately? Tell me all you can test...
A) Verbal response
B) Mental status
C) Is a quantitative tool not provided by LOC tests; normal is 15, coma is 7.
D) Motor response
E) Eye opening
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| B) is incorrect; all others are correct [Fig. 23-59]. The Glasgow Coma Scale (GCS) assesses the brain as a whole: scores for A), D) & E) are added to get the score; is reliable / repeatable. |
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Reflex correx: pick all the correct Cranial Nerve reflex tests that apply...
A) Reinforcement
B) Biceps & triceps
C) Brachioulnar
D) Quadriceps
E) Ankle jerk
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| B), D) & E) are correct [Figs. 23-29 to -39]. A) Reinforcement is not a reflex, it is a technique to distract the patient with an extraneous isometric so the reflex area being tested stays relaxed. There is a brachioradialis reflex, but C) is an absurdity. D) Ankle jerk is another name for the Achilles Reflex. |
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Cerebellar function: pick all CNS balance tests that apply...
A) Gait & Romberg
B) Tandem walking
C) Hop in place
D) Heel to shin
E) Rapid alternating movements
Describe them before turning the card over. |
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| A), B) & C) are correct [Figs. 23-16 to -18]. Gait is a 10 - 20 foot smooth rhythmic effortless walk w/ coordinated arm swing. Romberg is feet together standing for 20 seconds w/ eyes closed. Tandem walking is heel-to-toe. Hop in place is 1st on 1 foot, then the other. D) Heel to shin and E) RAM are cerebellar tests for coordination & skilled movements, not for balance. RAM is alternating supine & prone hands on knees and then increased pace. |
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Coordination and Skilled Movements (C&SM) tests of cerebellar movement are which? Pick all you can stand...
A) Finger by thumb
B) Finger to finger
C) Finger to butt
D) Finger to nose
E) Finger to navel
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| A), B) & D) are correct [Figs. 23-16 to -18]. C) & E) are absurdities. A) is touching each finger with thumb and then reversing the order; each hand. B) is your finger by their index finger. NOTE: heel-to-shin and RAM are C&SM tests described on another card. |
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- Table 23-1 (study guide bullet) 685
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Infant Cranial Nerve testing: select all that are correct.
A) Test olfactory with cinnamin for a Moro response
B) Bilaterally equal wrinkling of forehead / nasolabial folds, crying, or smiling
C) Trigeminal is tested with rooting or sucking reflex
D) Rapid closure of eyes from light in eyes
E) Abducens is tested with the root reflex.
Name the CN#'s before turning card over |
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B) is the facial VII movements. For C): the rooting reflex is CN V; infant turning toward stimulus of touched cheek. D) is the optical blink reflex test of CN's II, III, IV + VI; another reflex of these is size, shape, equality of pupils.
A) & E) are supposed to be fabricated absurdities. |
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Infant Cranial Nerves testing again: pick those that win...
A) Pinch nose: infant mouth opens , tongue rises in midline
B) Loud noise causes startled infant to temporarily extend all limbs, fan fingers, form C out of index finger & thumb.
C) Stereotype movements in jaw, lips or tongue that may accompany tremors.
D) Swallowing, gag reflex; or coordinated sucking & swallowing
E) Eyes follow movement, or regards face or close object
Before you turn the card over, name the CN that applies to each. |
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Only C) is incorrect. A) is XII hypoglossal. B) is called Moro reflex; when sound is used, it is testing VIII acoustic CN. Alternate is blink reflex from noise (eg, hand clap). D) is CN IX glossopharyngeal + X vagus. E) is CN II optic + III oculomotor + IV trochlear + VI abducens.
C) is dyskenesias, an elderly neuro problem; not an infant reflex. |
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- Other than CN names, Table 23-2 is not in this set!! (study guide bullet) 701
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