32 Questions
What should be avoided when testing the sense of smell for cranial nerve I?
Noxious odors like ammonia that might stimulate CN V
How is the sense of smell tested for cranial nerve I?
By occluding one nostril and testing smell in the other with familiar nonirritating odors
What is anisocoria?
A difference of >0.4 mm in the diameter of one pupil compared to the other
Why should visual fields be tested by confrontation for cranial nerve II?
To reveal a visual field defect, an abnormality in peripheral vision such as homonymous hemianopsia
What should be inspected with an ophthalmoscope to test cranial nerve II?
The optic fundi paying special attention to the optic discs
What is missed when testing only one eye for visual fields for cranial nerve II?
"Homonymous hemianopsia" which describes a visual field defect
Which of the following does the near response test assess?
Pupillary constriction, convergence, and lens accommodation
What may be indicated by a large pupil reacting poorly to light and worsening anisocoria in light?
Normal pupillary constriction
In which condition may both pupils react to light and anisocoria worsen in darkness?
Horner syndrome
What is indicated by prechiasmal defects seen in glaucoma, retinal emboli, and optic neuritis?
Visual acuity poor
What is an indication of postchiasmal lesions in the occipital or parietal lobe?
Homonymous hemianopsias or quadrantanopsias
What may be suggested by a large pupil with abnormal pupillary constriction and the presence of ptosis and ophthalmoplegia?
Intracranial aneurysm
What are the common causes of loss of smell as mentioned in the text?
Smoking and aging
What does the examination of the optic fundi using an ophthalmoscope specifically look for?
Papilledema, optic atrophy, and cup enlargement
What are the associated findings of stroke in relation to visual acuity?
Visual acuity poor
What should be inspected carefully when examining each optic disc with an ophthalmoscope?
Bulging and blurred margins
What involuntary jerking movement of the eyes should the examiner identify, noting the direction of gaze, the plane of the movement, and the direction of the quick and slow components?
Nystagmus
What should be identified if diplopia is determined to be monocular or binocular by asking the patient to cover one eye, then the other?
The cause of diplopia
In testing extraocular movements, what causes diplopia and loss of conjugate movements in any of the six directions?
Nystagmus
When asking the patient to firmly clench the teeth, which cranial nerve and motor function is being assessed?
Cranial Nerve V - Trigeminal Motor
What normal variant is observed in approximately one third of patients when examining for ptosis?
Slight difference in the width of the palpebral fissures
During examination, what should be observed to determine if ptosis is present?
Slight difference in the width of the palpebral fissures
What is the most likely cause of monocular diplopia?
Glasses or contact lenses
What is a common cause of ptosis?
CN III palsy
Which condition is associated with binocular diplopia?
Myasthenia gravis
What might be indicated by difficulty clenching the jaw or moving it to the opposite side?
Massetter and lateral pterygoid weakness
In brainstem lesions, what type of sensory loss is observed?
Contralateral facial and body sensory loss
What motor function is being assessed when the patient is asked to firmly clench their teeth?
Facial muscle weakness
What might be indicated by a large pupil reacting poorly to light and worsening anisocoria in light?
Horner syndrome
What is the likely cause of bilateral hemispheric disease?
Cortical lesions
In which condition is nystagmus commonly observed?
Cerebellar disease
What might be indicated by a large pupil with abnormal pupillary constriction and the presence of ptosis and ophthalmoplegia?
Myasthenia gravis
Test the sense of smell using familiar nonirritating odors. Ensure nasal passages are patent, then ask the patient to identify odors after occluding one nostril. This quiz covers the procedure for testing the olfactory nerve (CN I).
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