Term
1) aging
2) cribiform plate fractures(car accident)
3) minor brain anomalies
4) colds/allergies |
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Definition
| how can the sense of smell become impaired? |
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Term
| left and right are tested separately by closing their eyes and 1 nostril and the patient is asked if they can smell, and if they can recognize a strong scent (coffee, lemon, mint) |
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Definition
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Term
1) eye chart with glasses/contacts in place
2) asking them to count fingers in different parts of their visual field
-test eyes separate, a specialist can make more specific diagnoses than this to determine (corneal/retinal/CN2/CNS) problems |
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Definition
| how is visual acuity tested? |
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Term
1) tell patient to gaze straight ahead
2) clinician can move a finger into the periphery and asks when it is seen
visual field problems are also better diagnosed by a specialist |
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Definition
| how do you test the extents of the visual fields? |
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Term
| superior oblique paralysis from a lesion to CN IV (Trochlear) |
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Definition
| what nerve lesion can be mistaken for torticollis? |
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Term
sup. rectus: elevate and abducted eye
med rectus: adduct from resting position
inf rectus: depress an abducted eye
inf oblique: elevate and adducted eye |
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Definition
| what muscles are innervated by CN 3 and how do you test them? |
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Term
| just superior oblique: depress an adducted eye |
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Definition
| what muscle(s) are innervated by CN 4 and how do you test them? |
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Term
| just lateral rectus, have patient abduct their eye |
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Definition
| what muscles are innervated by CN VI and how are they tested? |
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Term
| head tilt to unaffected side |
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Definition
| if you paralyze superior oblique (CN 4), how does the patient tilt their head? |
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Term
| get medial strabismus, turn head to side of lesion to restore vision |
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Definition
| how do you restore vision if lateral rectus is paralyzed? what eye movement will you have |
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Term
CN 3 para innervates the ciliary muscles and constrictor pupillae
a light shined in 1 eye would cause both pupils to constrict
this is the pupillary light reflex |
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Definition
| how are the parsympathetic components of CN III tested? (What reflex is this) |
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Term
if a finger is brought toward the patients nose, the pupils should constrict a little, also the somatic motor part will adduct both eyes
this is the accomodation/convergence reflex |
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Definition
| constrictor pupillae acts in accomodation, so how can this be tested? what reflex is it? |
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Term
| some CNS disorders (like syphillis) can cause this response which is when the pupil constricts with accommodation, but not when a light is shined in the eye |
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Definition
| what is the Argyll Robertson response? |
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Term
1)clench their teeth and palpate the superficial muscles of mastication
2) then clench while the chin is pulled down to try to open the mouth
3) bite down on a tongue depressor across the premolars
look for strength and symmetry
4) then open the mouth with/without resistance to check lateral pterygoid |
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Definition
| how is the motor component of CN V tested? |
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Term
| chin deviates toward the affected side |
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Definition
| if there is weakness/paralysis of lateral pterygoid(or its innervation CN V), what direction does the chin deviate to with opening the mouth? |
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Term
| you have to test each component because they all go to different nuclei in the brain |
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Definition
| how do you test sensory of CN V in general? |
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Term
| have patient close their eyes and touch the skin with a cotton swab and say "touch" when something is felt |
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Definition
| how do you test light touch of CN V? |
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Term
| have the patient close their eyes and touch them with the head or the tip of the pin saying dull or sharp |
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Definition
| how is pain tested for CN V? |
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Term
| touch the patient with test tubes of hot and cold water and distinguish them |
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Definition
| how is temperature tested for CN V? |
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Term
V1: above the eyebrow away from the midline (Test both sides)
V2: below the lower eyelid away from the nose and above the lower lip
V3: lateral to the chin on each side |
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Definition
| where is V1 tested for sensory? V2? V3? (the dermatomes) |
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Term
look at upper face for strength and symmetery in the exercises and nasolabial folds, wrinkles, smiling, and blinking
1) show teeth (lower face)
2) raise eyebrows (upper face)
3) tightly shut eyes (upper face)
4) puff out cheeks with air (lower face) |
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Definition
| how is somatic motor tested for CN VII? |
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Term
corneal reflex CNV sense and CN VII motor
touch one eye with a cotton swab, both should blink |
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Definition
| how do you test the relationship between the facial and trigeminal nerves? |
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Term
V1, nasociliary nerve does cornea sensation
VII closes the eye with orbicularis oculi |
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Definition
| what nerve caries sensation from the cornea? what muscle closes the eye and what nerve? |
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Term
CN 8, the eyes will close with a loud noise
CN 2, or with bright light |
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Definition
| what else forms a reflex loop with CN V besides the facial n? |
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Term
| strong flavored paper strips on the sides of the tongue with the tongue sticking out |
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Definition
| how is the taste component of CN VII Tested? |
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Term
| check if the lacrimal gland is secreting with special paper strips |
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Definition
| how is the parasymptathetic component of CN VII tested? |
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Term
| not really, they all open into the same space |
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Definition
| is it possible to taste individual salivary glands? |
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Term
| via a specialist (hearing/balance/equilibrium) |
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Definition
| how is most testing for CN VIII done? |
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Term
| Weber and Rinne tests, rely on the fact that bone conducts sound well, bone conduction can stimulate the inner ear by bypassing the tympanic membrane and middle ear |
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Definition
| what are the preliminary hearing tests? what do they rely on? |
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Term
a tuning fork is struck and placed on the vertex of the skull, if CN VIII is intact on both sides, equal volume should be heard via bone conduction
test symmetry |
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Definition
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Term
this tests bone conduction and middle ear function
1)strike the fork and place on the mastoid process
2) then place by the ear to hear air conduction and test MIDDLE EAR FUNCTION |
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Definition
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Term
| middle ear - bones bypass the middle ear |
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Definition
| if the Weber test is passed( hearing via bone conduction) and the patient still cannot hear, where is the problem likely located? |
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Term
you can't really, but MAYBE
1) loss of sensation to the middle ear and pharynx
2) paralysis of stylopharyngeus
3) loss of taste/somatic sensation to the posterior 1/3 of the tongue
4) loss of secretion from the parotid
5) problems with chemoreception and baroreception (visceral afferents)
these symptoms are all usually compensated for by other things |
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Definition
| how can you test isolated unilateral lesions of CN IX? |
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Term
the GAG reflex
CN IX is sensory, CN X is the motor part |
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Definition
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Term
levator palati: look at the uvula at rest then say AHHH, weakness will cause the uvula to deviate to the INTACT side
other signs are hoarseness, stridor, and difficulty breathing with exercise |
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Definition
| how is somatic motor for CN X tested? |
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Term
| not really, too much stuff overlaps with parasympathetics and such |
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Definition
| can you test the function of the vagus nerve besides motor? |
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Term
it only innervates SCM and trapezius, so
SCM: have the patient run their head with resistance, weakness turning the head to one side indicates a problem with the opposite side muscle(SCM turns head to opposite side)
TRAPEZIUS: is tested by abducting and elevating the arm with/without resistance and shrugging the shoulders |
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Definition
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Term
stick out the tongue
UMN has no atrophy and fasiculations, tongue always goes toward the paralyzed muscle, so the opposite side the UMN is on will be where the tongue deviates
LMN has flaccid paralysis and atrophy, tongue goes toward the muscle (and the nerve) |
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Definition
| how is a hypoglossal nerve lesion tested? |
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