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99 Cards in this Set
- Front
- Back
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Which scale is used to asses the muscle strength (power) |
Medical research counsilgrad |
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Grade 0 |
No contractions are seen |
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Grade 1 |
Flicker or trace of contraction |
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Grade 2 or 2/5 |
Active movement only with gravity eliminated (patient move limbs to the sides) |
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Grade 3 |
Active movement against gravity but no resistance (patient should lift limbs) |
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Grade 4 |
Active movement against gravity and some resistance (create resistance and ask patient to move against it ) |
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Grade 5 |
Normal power or strength (active movement against gravity and full resistance) |
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For tone it is mainly passive . The patient is not involved. True or false ? |
True |
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What are the cranial nerves ? |
Olfactory nerve Optic nerve Oculomotor nerve Trochlear nerve Trigeminal nerve Abducent nerve Facial nerve Vestibulocochlear nerve Glossopharyngeal Vagus nerve Accessory nerve Hypoglossal nerve |
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Cranial nerve 1 |
Olfactory nerve Exit cranium from cribriform plate of the ethmoid bone Sensory Not parasympathetic or sympathetic For sense of smell Nuclei is not in the brain stem but in the cerebral cortex |
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Cranial nerve 2 |
Optic nerve Exit cranium from the the optic canal It is a sensory nerve No parasympathetic or sympathetic For sense of vision Nuclei is not found in the brain stem but in the cerebral cortex |
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Cranial nerve 3 |
Oculomotor nerve Exits cranium from the superior orbital fissure It is a motor nerve Parasympathetic (edinger -westphar nucleus ) Innervates extraocular muscles (superior rectus: upward movement of the eyes . Medial rectus :adduction of the eyes (moves the eye medically) Inferior rectus (downward movement of the eye) Innervates the papillary sphincter(what closes the sphincter) Innervates the levator palpebrae superioris |
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What are the extraocular muscles? |
Rectus (superior rectus , inferior rectus, medial rectus, lateral rectus) Oblique (superior oblique , inferior oblique ) Levator palpebrae superioris |
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What are the extraocular muscles? |
Rectus (superior rectus , inferior rectus, medial rectus, lateral rectus) Oblique (superior oblique , inferior oblique ) Levator palpebrae superioris |
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Cranial nerve 4 |
Trochlear nerve Exits the cranium from the superior orbital fissure Motor neuron Innervates the superior oblique muscles downwards and medically |
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Cranial nerve 5 |
Trigeminal Responsible for pain and temperature sensation Involves the ophthalmic, maxillary, mandibular. Ophthalmic(V1) exits from superior orbital fissure Maxillary(V2) exits from foremen rotondum Mandibular(V3) exits from foramen ovale Trigeminal is both sensory and motor neuron Sympathetic Innervates the lacrimal gland Sensory innervation of the forehead, scalp, upper eyelid(V1) Lower eyelid , mucosa , cheeks, upper jaw , upper lip, sensory innervation to the palate (V2) Lower jaw pain and temperature sensation of the tongue (lingual nerve which is a branch of the mandibular nerve) V3 Motor: Innervates muscles of mastication (masseter, medial pterrygoid, temporalis) |
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Cranial nerve 5 |
Trigeminal Responsible for pain and temperature sensation Involves the ophthalmic, maxillary, mandibular. Ophthalmic(V1) exits from superior orbital fissure Maxillary(V2) exits from foremen rotondum Mandibular(V3) exits from foramen ovale Trigeminal is both sensory and motor neuron Sympathetic Innervates the lacrimal gland Sensory innervation of the forehead, scalp, upper eyelid(V1) Lower eyelid , mucosa , cheeks, upper jaw , upper lip, sensory innervation to the palate (V2) Lower jaw pain and temperature sensation of the tongue (lingual nerve which is a branch of the mandibular nerve) V3 Motor: Innervates muscles of mastication (masseter, medial pterrygoid, temporalis) |
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Which cranial nerve is responsible for pain and temperature sensation ? |
Trigeminal nerve due to lingual nerve which is a branch of the mandibular nerve |
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Which cranial nerve is for taste sensation of anterior 2/3rd of the tongue |
Facial nerve .
Posterior 1/3 is the glossopharyngeal nerve |
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Which cranial nerve is for taste sensation of anterior 2/3rd of the tongue |
Facial nerve .
Posterior 1/3 is the glossopharyngeal nerve |
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Cranial nerve 6 |
Abducent nerve Exits from superior orbital fissure Motor nerve Innervates lateral rectus which is for the abduction of the eye. Moves eye laterally |
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Which cranial nerve is for taste sensation of anterior 2/3rd of the tongue |
Facial nerve .
Posterior 1/3 is the glossopharyngeal nerve |
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Cranial nerve 6 |
Abducent nerve Exits from superior orbital fissure Motor nerve Innervates lateral rectus which is for the abduction of the eye. Moves eye laterally |
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Cranial nerve 7 |
Facial nerve Exits from the internal acoustic meatus> stylomastoid foramen Both sensory and motor Parasympathetic Taste sensation to the anterior 2/3rd of the tongue Sensory innervation to the external auditory meatus(middle ear) Innervates muscles of the face Innervates stapedus muscle of the middle ear Innervates orbicularis Otis muscle Innervates the submandibular and sublingual salivary glands Nasal palatine and pharyngeal mucous glands Lacrimsl gland too |
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Which cranial nerve is for taste sensation of anterior 2/3rd of the tongue |
Facial nerve .
Posterior 1/3 is the glossopharyngeal nerve |
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Cranial nerve 6 |
Abducent nerve Exits from superior orbital fissure Motor nerve Innervates lateral rectus which is for the abduction of the eye. Moves eye laterally |
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Cranial nerve 7 |
Facial nerve Exits from the internal acoustic meatus> stylomastoid foramen Both sensory and motor Parasympathetic Taste sensation to the anterior 2/3rd of the tongue Sensory innervation to the external auditory meatus(middle ear) Innervates muscles of the face Innervates stapedus muscle of the middle ear Innervates orbicularis Otis muscle Innervates the submandibular and sublingual salivary glands Nasal palatine and pharyngeal mucous glands Lacrimsl gland too |
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What is the smallest muscle in the body |
Stupedius muscle |
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Some facts about the stapedus muscles |
Smallest muscle in body Attached to neck of stapes Regulate intensity of sound entering inner ear For facial nerve palsy , low sound will sound high ( hyperacousis) Regulates intensity of sounds entering inner ear |
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Some facts about the stapedus muscles |
Smallest muscle in body Attached to neck of stapes Regulate intensity of sound entering inner ear For facial nerve palsy , low sound will sound high ( hyperacousis) Regulates intensity of sounds entering inner ear |
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Cranial nerve 8 |
Vestibulocochlear Exits from internal acoustic meatus Sensory Hearing(cochlear) and balance (vestibular) |
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Some facts about the stapedus muscles |
Smallest muscle in body Attached to neck of stapes Regulate intensity of sound entering inner ear For facial nerve palsy , low sound will sound high ( hyperacousis) Regulates intensity of sounds entering inner ear |
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Cranial nerve 8 |
Vestibulocochlear Exits from internal acoustic meatus Sensory Hearing(cochlear) and balance (vestibular) |
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Cranial nerve 9 |
Glossopharyngeal Exits from jugular foramen Both sensory and motor Parasympathetic Taste Sensation of the posterior 1/3rd of the tongue Supplies the middle ear , Eustachian tube Pain and temperature sensation to the posterior 1/3 of tongue Innervates the stylopharyngial muscle Carotid sinus and carotid body , parotid gland |
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Some facts about the stapedus muscles |
Smallest muscle in body Attached to neck of stapes Regulate intensity of sound entering inner ear For facial nerve palsy , low sound will sound high ( hyperacousis) Regulates intensity of sounds entering inner ear |
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Cranial nerve 8 |
Vestibulocochlear Exits from internal acoustic meatus Sensory Hearing(cochlear) and balance (vestibular) |
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Cranial nerve 9 |
Glossopharyngeal Exits from jugular foramen Both sensory and motor Parasympathetic Taste Sensation of the posterior 1/3rd of the tongue Supplies the middle ear , Eustachian tube Pain and temperature sensation to the posterior 1/3 of tongue Innervates the stylopharyngial muscle Carotid sinus and carotid body , parotid gland |
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Which nerve share a lot in common |
9 and 10 |
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Some facts about the stapedus muscles |
Smallest muscle in body Attached to neck of stapes Regulate intensity of sound entering inner ear For facial nerve palsy , low sound will sound high ( hyperacousis) Regulates intensity of sounds entering inner ear |
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Cranial nerve 8 |
Vestibulocochlear Exits from internal acoustic meatus Sensory Hearing(cochlear) and balance (vestibular) |
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Cranial nerve 9 |
Glossopharyngeal Exits from jugular foramen Both sensory and motor Parasympathetic Taste Sensation of the posterior 1/3rd of the tongue Supplies the middle ear , Eustachian tube Pain and temperature sensation to the posterior 1/3 of tongue Innervates the stylopharyngial muscle Carotid sinus and carotid body , parotid gland |
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Which nerve share a lot in common |
9 and 10 |
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Cranial nerve 10 |
Vagus Exits from Jugular foramen Motor and sensory nerve Both sympathetic and parasympathetic (more) Innervates the palate , palatoglossus, smooth muscles of the larynx and GIT External auditory meatus, sensory innervation to the pharynx and larynx |
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Some facts about the stapedus muscles |
Smallest muscle in body Attached to neck of stapes Regulate intensity of sound entering inner ear For facial nerve palsy , low sound will sound high ( hyperacousis) Regulates intensity of sounds entering inner ear |
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Cranial nerve 8 |
Vestibulocochlear Exits from internal acoustic meatus Sensory Hearing(cochlear) and balance (vestibular) |
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Cranial nerve 9 |
Glossopharyngeal Exits from jugular foramen Both sensory and motor Parasympathetic Taste Sensation of the posterior 1/3rd of the tongue Supplies the middle ear , Eustachian tube Pain and temperature sensation to the posterior 1/3 of tongue Innervates the stylopharyngial muscle Carotid sinus and carotid body , parotid gland |
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Which nerve share a lot in common |
9 and 10 |
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Cranial nerve 10 |
Vagus Exits from Jugular foramen Motor and sensory nerve Both sympathetic and parasympathetic (more) Innervates the palate , palatoglossus, smooth muscles of the larynx and GIT External auditory meatus, sensory innervation to the pharynx and larynx |
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Cranial nerve 11 |
Exit from jugular foramen |
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Cranial nerve 11 |
Accessory nerve /spinoaccessory nerve Exit from jugular foramen Motor neuron Innervates the sternocleidomastoid and trapezius muscles |
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Cranial nerve 11 |
Accessory nerve /spinoaccessory nerve Exit from jugular foramen Motor neuron Innervates the sternocleidomastoid and trapezius muscles |
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Cranial nerve 12 |
Hypoglossal nerve Exit from the Hypoglossal canal Motor nerve Innervates both intrinsic and extrinsic muscles of the tongue except the palatoglossus(Innervated by vagus nerve ) |
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Differences between superior rectus and inferior rectus |
Superior - elevation -incydotorsion -adduction
Inferior -depression -excyclotorsion -adduction |
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Cranial nerve 11 |
Accessory nerve /spinoaccessory nerve Exit from jugular foramen Motor neuron Innervates the sternocleidomastoid and trapezius muscles |
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Cranial nerve 12 |
Hypoglossal nerve Exit from the Hypoglossal canal Motor nerve Innervates both intrinsic and extrinsic muscles of the tongue except the palatoglossus(Innervated by vagus nerve ) |
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Differences between superior rectus and inferior rectus |
Superior - elevation -incydotorsion -adduction
Inferior -depression -excyclotorsion -adduction |
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Differences superior oblique an inferior oblique |
Superior -incyclotorsion -depression -abduction Inferior -exyclotorsion -elevation -abduction |
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Which nerve gives sensory to the soft and hard palate |
Facial nerve |
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Which nerve gives sensory to the soft and hard palate |
Facial nerve |
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Which nerves give motor neuron to the soft and hard palate ? |
Vagus and Glossopharyngeal |
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Setting the tray |
Reflex hammer (tendon hammer) Pen torch Snellen chart Lemon or sweet scented soaps Tuning fork 512Hz Neurotip Cotton wool Mydriatic eye drop Glass of water Ishihara plate Ophthalmoscope Spatula |
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Two uses of the patella hammer |
Tendon reflexes and jaw reflexes Chest persuasion |
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Pen torch uses |
Assess papillary reflex Trans illumination of swelling Locating upper level of jugular venous pressure To inspect visible apex beat To inspect oral nucleus To inspect external meatus for lesions To examine wounds To locate patients in dark ward Clinically diagnose death |
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Steps for physical examination of cranial nerves (Intro) |
Wash hands Introduce self Patient details Explain examination procedure to patient and gain consent Position patient at eye level |
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Steps for physical examination of cranial nerves (Intro) |
Wash hands Introduce self Patient details Explain examination procedure to patient and gain consent Position patient at eye level |
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physical examination of cranial nerve 1 |
Ask patient to close eyes and close 1 nostril Introduce sweet scented soap at inch from unclosed nostril Ask patient to identify Repeat with other nostril |
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Steps for physical examination of cranial nerves (Intro) |
Wash hands Introduce self Patient details Explain examination procedure to patient and gain consent Position patient at eye level |
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physical examination of cranial nerve 1 |
Ask patient to close eyes and close 1 nostril Introduce sweet scented soap at inch from unclosed nostril Ask patient to identify Repeat with other nostril |
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Physical exam of cranial nerve 2 |
Inspection: Inspect size of pupils (r/o anisocoria) Shape and symmetry PERLA(pupils are equally round and reactive to light and accommodation) Observe pupillary reflex (direct , consensual) Swinging light test Visual acuity Accommodation Visual field Color vision Fundoscopy
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Bones of the middle ear |
Malleus(hammer) Incus(anvil) Stapes(stirrup) They’re known as ossicles |
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The stapedius muscle is innervated by |
Cranial nerve 7 (facial nerve ) |
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What does the stapedius muscle do |
Attaches to the neck of the stapes and reduced the intensity of sound |
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What does the stapedius muscle do |
Attaches to the neck of the stapes and reduced the intensity of sound |
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A cranial nerve 7 palsy could cause |
Hyperacusis |
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Argyll- Robertson pupil |
Abnormally small pupils seen in neurosyphillis(sluggishly reacts to light ) |
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Argyll- Robertson pupil |
Abnormally small pupils seen in neurosyphillis(sluggishly reacts to light ) |
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Horner’s syndrome |
Miosis(unilateral) Ptosis(partial) Anhydrosis +/- Enophthalmos
When there hs a lesion at T1 above the bifurcation of the sympathetic trunk |
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Argyll- Robertson pupil |
Abnormally small pupils seen in neurosyphillis(sluggishly reacts to light ) |
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Horner’s syndrome |
Miosis(unilateral) Ptosis(partial) Anhydrosis +/- Enophthalmos
When there hs a lesion at T1 above the bifurcation of the sympathetic trunk |
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Holmes-Adie pupil |
A large pupil which fails to react to light but reacts on accommodation |
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Cranial nerve 12 physical exam |
-inspect the tongue at rest for any fasciculations - ask the patient to protrude tongue and look for deviations -ask patient to push against a resistance applied on the cheek with the tongue (acceding power of tongue |
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Cranial nerve 11 physical exam |
Ask patient to shrug shoulder against resistance (trapezius build test) Ask patient to turn head to one side against resistance |
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Cranial nerve 9 and 10 physical exam |
Gag reflex Assess symmetry of uvula Try to elicit bovine cough by telling patient to cough Ask patient to swallow water and not if any difficulty |
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Cranial nerve 3,4,6 physical exam |
Eye movement Cover test |
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Cranial nerve 3,4,6 physical exam |
Eye movement Cover test |
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Convergent squint (Esotropia) |
Eye moves nasally |
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Cranial nerve 3,4,6 physical exam |
Eye movement Cover test |
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Convergent squint (Esotropia) |
Eye moves nasally |
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Divergent squint (exotropia) |
Eye moves laterally |
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Differentials of small pupil |
Drugs - pethidine, morphine Acetylcoline Horner’s syndrome Argyll-robertson Holmes-Adie pupil Pseudo argyll-robertson Glaucoma |
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Differentials of small pupil |
Drugs - pethidine, morphine Acetylcoline Horner’s syndrome Argyll-robertson Holmes-Adie pupil Pseudo argyll-robertson Glaucoma |
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Differential diagnoses of large pupil |
Drugs -atropine Holmes-aldie pupil (chronic phase) Cranial nerve 3 palsy |
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Differentials of small pupil |
Drugs - pethidine, morphine Acetylcoline Horner’s syndrome Argyll-robertson Holmes-Adie pupil Pseudo argyll-robertson Glaucoma |
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Differential diagnoses of large pupil |
Drugs -atropine Holmes-aldie pupil (chronic phase) Cranial nerve 3 palsy |
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How to confirm death |
GCS 3/15 Respiratory system assessment (absent breath sounds ) Cardiovascular (absent heart sounds , apex beat absent ) Peripheries cold Fixed and dilated pupils |
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Causes of decreased visual acuity |
Age related Cranial nerve 2 pathology eg optic neuritis Ocular media opacities |
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Physical examination of sensory nerve 5 |
Sensory exam Motor exam Reflexes (jaw and corneal ) |
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Muscles of mastication |
Medial pterygoid Lateral pterygoid Masseter Temporalis |
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Physical exam of cranial nerve 7 |
Sensory Symmetry of forehead wrinkles , cheeks , angle of mouth Motor Check notes |
