Cranial Nerves Assessment Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the name of cranial nerve I?

Olfactory nerve

How do you assess cranial nerve I?

To test the sense of smell, the examiner will ask the patient to smell while occlusion of the opposite nostril, using scents like coffee, peppermint, or cinnamon.

How do you assess cranial nerves III, IV, and VI?

Have the patient follow a penlight or object with their eyes, without moving their head, in the six cardinal fields of gaze (cat whiskers). 2. Dim the light and have the patient stare into the distance. Shine a penlight at the side of the eye to see how the pupil constricts. 3. Checking for accommodation: with the light back on, have the patient stare at a distant object. Then take the pen or object and move it inward towards the nose to see if the eyes constrict, pupils dilate, and cross while looking at the penlight. If normal, eyes are reactive to light and accommodate with no nystagmus. This is known as PERRLA (pupils equal, round, reactive to light and accommodation).

What is a coma?

A state of impaired arousal and awareness, signaling a potentially life-threatening event affecting the two hemispheres, the brainstem, or both. Signup and view all the answers

How do you assess a comatose patient?

<ol> <li>First, assess and stabilize the ABCs (airway, breathing, and circulation). 2. Assess the patient's level of consciousness. 3. Perform a neurological examination. Identify any focal or asymmetric findings and determine if the cause of impaired consciousness is structural or metabolic. Obtain information from relatives, friends, or witnesses to establish the speed of onset and duration of unconsciousness, any warning symptoms, precipitating factors or previous episodes, and the premorbid appearance and behavior of the patient. Any history of past medical and mental disorders are also important. Tests used to assess a comatose patient include the Glasgow Coma Scale (patients with a score of 3-8 are usually considered to be in a coma); metabolic and structural coma tests; and pupil assessment in a comatose patient.</li> </ol> Signup and view all the answers

What is the Glasgow Coma Scale (GCS)?

A scale used to assess the consciousness of a patient upon physical examination, typically in patients with neurological concerns or complaints. Signup and view all the answers

What are the two main categories of coma?

Metabolic and Structural Signup and view all the answers

Which category of coma is associated with lesions that destroy or compress brainstem arousal areas?

Structural Signup and view all the answers

Which category of coma is associated with toxins poisoning arousal centers or depletion of critical substrates?

Metabolic Signup and view all the answers

Which of the following is NOT a cause of structural coma?

Epidermal Signup and view all the answers

Which of the following is NOT a cause of metabolic coma?

Brain Stem Infarct Signup and view all the answers

What is the significance of pupil size in a comatose patient?

Pupillary size, equality, and light reactions are important signs in assessing the cause of coma and the region of the brain that is impaired. Remember that unrelated pupillary abnormalities may precede coma, from optic drops for glaucoma or mydriatic drops for viewing the ocular fundi. Signup and view all the answers

What is the common cause of small or pinpoint pupils (bilateral small pupils) in a comatose patient?

Bilateral small pupils (1-2.5 mm) suggest damage to the sympathetic pathways in the hypothalamus or metabolic encephalopathy, a diffuse failure of cerebral function that has many causes, including drugs. Light reactions are usually normal. Signup and view all the answers

Pinpoint pupils are always a sign of opioid overdose.

False Signup and view all the answers

What are some of the signs and symptoms of opioid overdose?

Pinpoint pupils, drowsiness, slow breathing, confusion, nausea, vomiting, constipation, and loss of consciousness. Signup and view all the answers

What is the term for loss of consciousness caused by a sudden drop in blood pressure?

Syncope Signup and view all the answers

Which type of syncope is often associated with standing up or standing up after hemorrhage or dehydration?

Orthostatic hypotension syncope Signup and view all the answers

Which type of syncope is often associated with severe paroxysms of coughing?

Cough syncope Signup and view all the answers

Which type of syncope is often associated with emptying the bladder after getting out of bed to void?

Micturition syncope Signup and view all the answers

What is the Apgar score?

The Apgar score is an assessment of the newborn immediately after birth. Its five components classify the newborn's neurological recovery from the stress of birth and immediate cardiopulmonary adaptation to extrauterine life. Signup and view all the answers

What are the five components of the Apgar score?

Heart rate, Respiratory effort, Muscle tone, Reflex irritability, and Color. Signup and view all the answers

What is the significance of a 1-minute Apgar score of 8-10?

Normal. Signup and view all the answers

Study Notes

Cranial Nerves Assessment

Cranial Nerve I (Olfactory): Tested by asking the patient to smell different scents (coffee, peppermint, cinnamon) while occluding the opposite nostril.
Cranial Nerve II (Optic): Assessed by testing visual acuity (Snellen chart) and confrontation visual fields. For confrontation visual fields, the patient closes one eye and indicates the number of fingers the examiner is holding in the upper, lower, and middle visual fields while the patient stares straight ahead. Repeat with the opposite eye.
Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Assessed by having the patient follow a penlight or object with their eyes in six cardinal fields of gaze (think "cat whiskers"). Also, assess pupillary responses to light and accommodation (constriction when a near object is moved closer to the nose). Normal findings include pupils being equal, round, reactive to light and accommodating (PERRLA).
Cranial Nerve V (Trigeminal): Tested by having the patient clench their teeth (feel masseter and temporal muscles), and try to open their mouth against resistance. Important to examine the ophthalmic, maxillary, and mandibular branches.
Cranial Nerve VII (Facial): Tested by observing facial expressions (closing eyes tightly, smiling, frowning, puffing out cheeks).
Cranial Nerve VIII (Vestibulocochlear): Assess by having the patient repeat a whispered word or sound with one ear occluded at a time. The Rinne and Weber tests are used to distinguish between possible conduction and sensorineural hearing loss.
Cranial Nerve IX (Glossopharyngeal): Tested by having the patient say "ahh" (observe uvula position) and test the gag reflex using a tongue depressor.
Cranial Nerve X (Vagus): Assess for hoarseness and swallowing ability.
Cranial Nerve XI (Accessory): Test shoulder shrug and head turning against resistance.
Cranial Nerve XII (Hypoglossal): Instruct the patient to stick out their tongue and move it from side to side. Ensure the tongue is positioned centrally.

Coma Assessment

Coma: Impaired arousal and awareness, often a serious, potentially life-threatening condition.
Arousal: Wakefulness, determined by the brain stem's ascending reticular activating system.
Coma Assessment: First, stabilize ABCs (airway, breathing, circulation). Next, assess level of consciousness using something like the Glasgow Coma Scale (GCS). Assess neurological function for focal or asymmetric findings. Obtain background info from relatives, noting history and pre-morbid behavior.
Metabolic Coma: Pathophysiology involves toxic effects or depleted substrates in arousal centers. Respiratory patterns may be normal/hyperventilating or irregular (Cheyne-Stokes). Pupillary size may vary depending on the cause, but level of consciousness changes after pupil changes. Possible causes include uremia, liver failure, hyperglycemia, hypoglycemia, alcohol, drugs, hypothyroidism, or infections (meningitis, encephalitis).
Structural Coma: The damage directly or indirectly compromises brain stem arousal areas. Respiratory patterns are often irregular (Cheyne-Stokes, ataxic, apneustic, central hyperventilation). Pupillary changes are generally unequal or unreactive to light (fixed) and level of consciousness changes before pupil changes. Possible causes include hemorrhage, infarction, tumors, or abscesses.
Pupils in Coma: Pupil size, equality, and light reactions are important indicators regarding the cause and location of brain damage. Unilateral or bilateral unequal pupils (or fixed and dilated pupils) suggest structural lesions in the brain stem but remember that these symptoms can be associated with other conditions.

Syncope and Other Disorders

Vasovagal Syncope: Caused by neurologically-mediated vasodepressor/bradycardia. Often occurs after prolonged standing, supine hypertension is common.
Orthostatic Hypotension Syncope: Gravitational redistribution of blood, leading to decreased blood pressure after standing. Hypovolemia is also involved which is a decreased blood volume
Cough Syncope: Neuromuscular response to severe coughing episodes leading to hypotension.
Micturition Syncope: Sudden hypotension due to vasovagal reflex during urination after standing up.
Cardiovascular Syncope: Arrhythmias (bradycardia, tachycardia), aortic stenosis, or myocardial infarction; can trigger decreased cardiac output or cerebral hypoperfusion.
Massive Pulmonary Embolism Syncope: Sudden hypoxia or decreased cardiac output as a result of blood clots in lung arteries; usually occurs after periods on bed rest
Disorders Resembling Syncope: Hypocapnia from hyperventilation, hypoglycemia, and functional neurological symptoms disorder (conversion disorder)

Apgar Score

Apgar Score: Assessment of a newborn's status immediately after birth. Evaluates five components: heart rate, respiratory effort, muscle tone, reflex irritability, and skin color. Scores for each component (0–2) are summed to quantify the newborn's condition, immediately after childbirth

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on the assessment techniques for cranial nerves. This quiz covers the testing methods for olfactory, optic, oculomotor, trochlear, and abducens nerves, along with methodologies for evaluating other cranial nerves. Understand the normal findings and clinical significance associated with these assessments.