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221 Cards in this Set
- Front
- Back
The brainstem sits between which 2 junctions? |
midbrain-diencephalic junction and cervicomedullary junction |
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The tectum (roof) of the midbrain is formed by ... |
superior and inferior colliculi |
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The interpeduncular fossa sits on which surface of the midbrain (ventral, dorsal, rostral, caudal etc.) |
ventral surface of midbrain has the cerebral peduncles |
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Major anatomical difference between the rostral and caudal medulla |
In the rostal medulla, the inferior olivary nuclei can be seen just lateral to te pyramids. In the caudal medulla, the inferior olivary nuclei can no longer be seen, but the posterior columns and posterior column nuclei are visicle on the dorsal surface |
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What is the obex? |
the lower limit of the 4th ventricle; marks entry into the spinal cord central canal (normally closed in adults) |
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CN 2 transmits light from the retina to the ... |
lateral geniculate body of thalamus |
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CN 4 arises from ... |
dorsal midbrain |
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CN 5 arises from ... |
pons |
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CN 1 enters the skull through which foramen? |
cribriform plate of ethmoid bone |
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CN 2 enters the skull through which foramen? |
optic canal |
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CN V2 exits the skull via which foramen? |
foramen rotundum |
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CN V3 exits the skull via which foramen? |
foramen ovale |
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CN 7 and 8 exit the cranial cavity via which foramen? |
internal auditory meatus |
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CN 7 exits the skull via which foramen? |
stylomastoid foramen |
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CN 9, 10, 11 exit the skull via which foramen? |
jugular foramen |
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CN 12 exits the skull via which foramen? |
hypoglossal canal |
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CN 3, 4, V1, 6 exit the skull via which foramen? |
superior orbital fissure |
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CN 11 cervical branches enter the skull via which foramen? |
foramen magnum |
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3 motor columns of cranial nerves |
Branchial (SVE), parasympathetic (GVE) and somatic (GSE) motor columns |
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3 sensory columns of cranial nerves |
Special somatic (SSA), general somatic (GSA), Visceral (SVA) sensory columns |
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Which cranial nerves are found in the Somatic motor column? |
3, 4, 6, 12 |
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Which cranial nerves are found in the Branchial motor column? |
5, 7, 9, 10, 11 |
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Which cranial nerves are found in the Parasympathetic motor column? |
3, 7, 9, 10 |
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Which cranial nerves are found in the General somatic sensory column? |
5, 7, 9, 10 (trigeminal nucleus) |
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The trigeminal nucleus has which cranial nerve fibers |
5, 7, 9, 10 sensory fibers |
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Which cranial nerves are found in the Visceral sensory column? |
7, 9, 10 (taste and visceral afferents)- nucleus solitarus |
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Which cranial nerves are found in the Special somatic sensory column? |
CN 8 for hearing (cochlear and vestibular nuclei) |
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Nucleus ambiguous contains what cranial nerve fibers? |
9, 10 motor fibers |
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Nucleus solitarus contains what cranial nerve fibers? |
7, 9, 10 sensory |
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Trigeminal Nucleus contains what cranial nerve fibers? |
5, 7, 9, 10 sensory |
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The somatic motor nuclei are derived embryologically from ________ |
occiptal somites |
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Brainstem Exit: CN I |
Telencephalon |
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Brainstem Exit: CN II |
Diencephalon |
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Brainstem Exit: CN III |
ventrally from interpenduncular fossa |
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Brainstem Exit: CN IV |
dorsal midbrain from the inferior tectum |
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Brainstem Exit: CN V |
ventrolateral pons |
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Brainstem Exit: CN VI |
ventrally at pontomedullary junction |
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Brainstem Exit: CN VII |
cerebellopontine angle |
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Brainstem Exit: CN VIII |
cerebellopontine angle |
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Brainstem Exit: CN IX |
cerebellopontine angle |
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Brainstem Exit: CN X |
Medulla (posterior to inferior olive) |
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Brainstem Exit: CN XI |
Medulla; arises laterally from multiple rootlets in the cervical spine |
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Brainstem Exit: CN XII |
Medulla (between pyramids and inferior olivary nuclei) |
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Function: Ciliary ganglion |
parasympathetic to iris and ciliary muscle (CN III) |
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Function: Trigeminal ganglion (semilunar or gasserian ganglion) |
Primary sensory neuron cell bodies for sensation in the face, mouth, sinuses, and supratentorial meninges (CN V) |
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Function: Sphenopalatine (pterygopalatine) ganglion: |
Parasympathetics to lacrimal glands and nasal mucosa (CN VII) |
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Function: Submandibular ganglion |
Parasympathetic to submandibular and sublingual salivary glands (CN VII) |
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Function: Geniculate ganglion |
Primary sensory neuron cell bodies for taste sensation in the anterior 2/3 of tongue, and for sensation near outer ear (CN VII) |
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Function: Spiral ganglion |
Primary sensory neuron cell bodies for hearing (CN VIII) |
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Function: Scarpa's vestibular ganglion |
Primary sensory neuron cell bodies for vestibular sensation (CN VIII) |
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Function: Otic ganglion |
Parasympathetics to parotid gland (CN IX |
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Function: Superior (jugular) glossopharyngeal ganglion |
Primary sesory neuron cell bodies for sensation from middle ear, external auditory meatus, pharynx, and posterior 1/3 tongue (CN IX) |
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Function: Inferior (petrosal) glossopharyngeal ganglion |
Primary sensory neuron cell bodies for sensation from middle ear, external auditory meatus, pharynx, posterior 1/3 of tongue, for taste posterior tongue, and for carotid inputs (CN IX) |
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Function: Parasympathetic ganglia in end organs |
parasympathetics to heart, lungs, digestive tract to level of splenic flexure (CN X) |
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Function: Superior (jugular) vagal ganglion |
Primary sensory neuron cell bodies for sensation from pharynx, outer ear, and infratentorial meninges (CN X) |
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Function: Inferior (nodose) vagal ganglion |
Primary sensory neuron cell bodies for laryngeal sensation, for taste from epiglottis, and for reflex inputs from aortic arch receptors and other thoracoabdominal viscera (CN X) |
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Function CN I |
olfaction |
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Function CN II |
vision |
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Function CN III |
-levator palpebrae superior and all extraocular muscles, excpet for superior oblique and lateral rectus |
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Function CN IV |
Superior oblique muscle; causes depression and intorsion of the eye |
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Function CN V |
-Sensations of pain, touch, temperature, joint position, and vibration for the face, mouth, anterior 2/3 tongue, nasal sinuses, and meninges |
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Function CN VI |
Lateral rectus muscle; causes abduction of the eye |
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Function CN VII |
-Muscles of facial expression, stapedius muscle, and part of digastric muscle |
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Function CN VIII |
Hearing and vestibular sensation |
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Function CN IX |
-Stylopharyngeus muscle |
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Function CN X |
-Pharyngeal muscles (swallowing) and laryngeal muscles (voice box) |
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Function CN XI |
Sternomastoid and upper part of trapezius muscle |
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Function CN XII |
Intrinsic muscle tongue |
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What is anosmia? |
inability to smell, CN1 damage |
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Unilateral vs. bilateral anosmia |
Patients are ofte unaware of unilateral because olfaction in the contralateral nostril can compensate; patients are aware of bilateral anosmia and often after a decreased sense of taste |
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Causes of anosmia |
head trauma, viral infections, obstruction of the nasal pathway, neurodegenerative diseases (Parkinson's, Alzheimer's); intracranial lesions that occur at the base of frontal lobes (meningioma, metastases, basal meningitis, sarcoidosis) |
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Foster Kennedry Syndrome |
anosmia together with optic atrophy in one eye (caused by ipsilateral tumor compression) and papilledema in the other eye (caused by elevated intracranial pressure) |
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A patient presents with a blown pupil. Which cranial nerve tract is most likely blown? |
parasympathetic motor tract containing CN3 parasympathetic from Edinger-Westfall nucleus |
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Location: CN III nuclei |
midbrain |
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Location: CN IV nuclei |
midbrain |
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Location: CN VI nucei |
pons |
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Once CN3, 4, 6 leave their origins, how do they all get to the extra-occular eye muscles? |
cavernous sinus, then exit superior orbital fissure |
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Describe the path of the parasympathetic from CN3 to the eye. |
From the Edinger-Westfall nucleus > out interpeduncular fossa> through superior orbital fissure> parasympathetic to the ciliary ganglion where they synapse on postganglionic neurons > pupillary constrictor muscles and ciliary muscle |
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CN 3 parasympathetic preganglionics are located ... |
in the Edinger-Westfall nucleus of the superior colliculi |
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CN 3 sympathetic preganglionics are located ... |
in the IML of T1-T4 spinal cord |
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CN 3 sympathetic postganglionics are located ... |
in the superior cervical ganglion of the paravertebral column |
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Three divisions of trigeminal |
V1: opthalmic |
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Pathway trigeminal nerve: |
exits the brainstem from the ventrolateral pons --> enters a small fossa just posterior and inferolateral to the cavernous sinus called Meckel's cave (location of trigeminal nucleus) --> division into V1, V2, and V3 |
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Where is the trigeminal ganglion located? |
Meckel's cave |
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The trigeminal nucleus relays sensory information to what part of the thalamus? |
VPM |
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Tensor tympani is innervated by which CN? |
V3 |
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Sensory Modalities: Mesencephalic Trigeminal Nucleus |
Proprioception |
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Sensory Modalities: Chief trigeminal sensory nucleus |
fine touch; dental pressure |
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Sensory Modalities: Spinal trigeminal nucleus |
crude touch; pain; temperature |
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Location: Cheif trigeminal sensory nucleus |
lateral pons |
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Location: Spinal trigeminal nucleus |
lateral pons and medulla, extending down to the upper cervical spine |
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The Spinal Trigeminal Tract is analogous to |
Lissauer's Tract |
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The trieminothalamic tract is analogous to |
Spinothalamic tract |
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Somatotropic organization of spinal trigeminal tract |
mandibular division dorsally, the opthalmic division ventrally, and the maxillary division in between |
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Location: mesencephalic nucleus and tract |
runs along the lateral edge of the periaqueductal gray matter in the midbrain |
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What is the only case in which the primary sensory neurons lie within the CNS instead of the peripheral ganglia? |
Mesencephalic trigeminal nucleus |
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A unilateral upper motor lesion of the corticobulbar tract leads to what deficits? |
none, upper motor control is bilateral to the trigeminal motor nucleus |
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What is trigeminal neuralgia? |
tic douloureux; severe pain from non-painful stimuli |
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A lesion in the trigeminal sensory nucleus leads to sensation loss where? |
ipsilateral pain and temperature sensation loss; the trigeminal nuclei have not crossed |
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Lesions of the trigeminal nucleus in the pons often cause damage to what other tract? |
spinothalamic (anterolateral) |
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Parasympathetics from the facial nerve travel to the geniculate ganglion via what nerve? |
nervus intermedius |
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Where is the facial nucleus located? |
in the branchial motor column, more caudally in the pons than the trigeminal motor nucleus |
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Facial colliculus |
elevated area located on the dorsal pons in the floor of the 4th ventricle. It is formed by fibers from the motor nucleus of the facial nerve as they loop over the abducens nucleus. |
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Upper motor neuron lesions of the corticobulbar tract lead to what deficits? |
loss of contralateral face movement; forehead spared |
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The facial nerve enters the internal auditory meatus with what other nerve? |
CN VIII |
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Geniculate ganglion |
lies in the genu and contains primary sensory neurons for taste sensation in the anterior 2/3 of the tongue, and for general somatic sensation in a region near the external auditory meatus |
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Innervation: Tensor Tympani |
Trigeminal |
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Innervation: Stapedius |
Facial Nerve |
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The chorda tympani joins the ____ nerve to reach the ____ ganglion, where postganglionic parasympathetics arise to supply the submandibular and sublingual salivary glands |
lingual nerve; submandibular ganglion |
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The majority of saliva production is in which glands? |
submandibular |
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Facial nerve parasympathetic pre-ganglionics are found where? |
superior salivatory nucleus |
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After the geniculate ganglion, CN7 pre-ganglionic parasympathetics travel via which nerve? |
greater petrossal nerve |
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Facial nerve parasympathetic post-ganglionics are found where? |
(pterygopalatine) sphenopalatine ganglion |
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Facial nerve exits the skull through the ... |
stylomastoid foramen |
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Nerve to stapedius is innervated by which cranial nerve? |
CN7 |
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A patient with hyperacusis and decreased tear production most likely has a lesion within which cranial nerve? |
CN7 (facial) controls the lacrimal gland with parasympathetics and the nerve to stapedius to prevent hyperacusis; perhaps this is a Bell's Palsy |
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How does the facial nerve sense taste? |
chorda tympani/lingual nerve transmit taste to the VPM of thalamus |
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The submandibular ganglion receives pre-ganglionic parasympathetics from which nerve? |
facial nerve > lingual nerve |
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Cranial nerve parasympathetics travel with what fibers in the brain? |
branches of the trigeminal nerve (V1, V2, V3) |
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Lingual nerve is a branch of which cranial nerve? |
V3 |
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A patient presents with full right sided face paralysis. Where is the lesion? |
left upper motor neuron/lateral motor cortex |
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The presence of hand weakness, sensory loss, dysarthria, or aphasia suggest an (upper/lower) motor neuron lesion |
upper |
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Crocodile tears |
Aberrent regeneration of parasympathetic fibers in which patients experience lacrimation instead of salivation |
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Corneal reflex afferent limb ... |
CN V1 (ophthalmic) |
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Corneal reflex efferent limb ... |
CN 7 |
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Eye blink reflex afferent limb... |
CN 2 |
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Eye blink reflex efferent limb... |
CN 3 |
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jaw jerk reflex |
monosynaptic pathway - mesencephalic trigeminal nucleus |
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How does sound get processed. Start with the tympanic membrane. |
Tympanic membrane > malleus > incus > stapes > oval window > cochlea > scala tympani/vestibuli > round window > spiral ganglion > cochlear nuclei > inferior colliculi > medial geniculate nucleus of thalamus > auditory cortex (Heschel's gyrus) |
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The superior olivary nucleus receives neurons from ... |
ventral cochlear nuclei |
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Where is the primary auditory complex found? |
Heschl's transverse gyrus |
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In the cochlea, hair cells are found in (endolymph or perilymph)? |
endolymph |
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The hair cells nearest the oval window hear (high or low frequencies)? |
high frequencies are heard in the early cochlea |
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Hair cells in the vestibular system are found in what structure? |
crista ampullaris |
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The medial longitudinal fasciculus connects which 4 cranial nerve nuclei? |
3, 4, 6, 8 |
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Brodman's Area 41 |
primary auditory cortex (Heschl's transverse gyri) |
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Testing conduction of sound through bone and air is called the ____ test. |
RInne |
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Testing conduction of sound through to each ear simultaneously is called the ____ test. |
Weber |
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Sound is heard better through (air or bone) conduction? |
air |
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An acoustic neuroma is a tumor what cells? |
Schwann cells on CN8 > leads to hearing loss, tinnitus and unsteadiness |
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What is true vertigo? |
room spinning due to vestibular problems (PNS or CNS) |
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Vertigo caused by CNS problems will show what result in a Dix-Hallpike test? |
immediate vertigo when semicircular canal is stimulated |
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Vertigo caused by PNS problems will show what result in a Dix-Hallpike test? |
delayed vertigo when semicircular canal is stimulated |
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what fills the body labyrinth |
perilymph |
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what fills the membranous labyrinth |
endolymph |
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what comprises the membranous labyrinth |
cochlear duct, utricle, saccule, semicircular canals |
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path of vibration in the ear |
oval window-scalavestibuli-cochlea/cochlear duct (scala media)-scala tympani-round window |
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where mechanoreceptor cilia on hair cells are activated by movement of the basilar membrane relative to the stiff tectorial membrane.... these neurons have their cel bodies in the spiral ganglion |
cochlear duct (scala media( |
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hair cells of cochlea + supporting cells = |
organ of corti |
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detects angular acceleration |
ampullae of the semicircular canals |
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detects linear acceleration |
maculae of the otolith organs (utricle and saccule) |
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receives input from the posterior saccule and posterior semicircular canal |
inferior vestibular ganglion |
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receives input from the utricle, anterior saccule, and anterior and lateral semicircular canals |
superior vestibular ganglion |
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where do the four vestibular nuclei lie |
lateral floor of 4th ventricle in pons and rostral medulla |
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which vestibular spinal tract extends throughout the length of the spinal cord and is important in maintaining balance and extensor tone |
lateral vestibular nucleus |
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which vestibular spinal tract extends to only the cervical spine and is important for head and neck position |
medial vestibular nucleus |
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what does the inferior vestibular nucleus look like on myelin stain |
checkerboard |
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what is the pathway that connects the nuclei involved in eye movements to each other and to the vestibular nuclei |
medial longitudinal fasciculus |
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hearing loss caused by disorders of the cochlea or CNVIII |
sensorineural hearing loss |
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hearing loss caused by abnormalities of the external auditory canal or middle ear |
conductive hearing loss |
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in this type of hearing loss, bone conduction is greater than air conduction |
conductive hearing loss |
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in this type of hearing loss, air conduction is greater than bone conduction, however, hearing is decreased in the affected ear |
sensorineural hearing lost |
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tuning fork is placed on vertex of skull in midline, pt is asked which side the tone sounds louder |
weber test; sensorineural hearing lost: tone is quieter on affected side |
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can be caused by lesions anywhere in the vestibular pathway from labyrinth, to vestibular nerve, to vestibular nuclei and cerebellum, to parietal cortex |
vertigo |
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dix-hallpike positional testing: onset of nystagmus is delayed, there is adaptation, there is horizontal or rotary nystagmus but not vertical |
peripheral (inner ear) lesion |
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dix-hallpike positional testing: onset of nystagmus is immediate, there is no habituation, there is horizontal, rotary, and vertical nystagmus, and nystagmus may occur in absence of vertigo |
central (brainstem or cerebellum) lesion |
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pt has recurrent episodes of vertigo, accompanied by fluctuating and sometimes stepwise, progressive hearing loss and tinnitus. pt also can complain of a feeling of fullness in the ear |
meniere's disease |
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What is the onset of nystagmus in a peripheral (inner ear) lesion? |
delayed |
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What is the onset of nystagmus in a central (brainstem or cerebellum) lesion? |
can be immediate or delayed |
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Is there adaptation (habituation) in a peripheral (inner ear) lesion? |
yes |
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Is there adaptation (habituation) in central (brainstem or cerebellum) lesion) |
no |
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What are the characteristics of nystagmus and vertigo in a peripheral (inner ear) lesion? |
Horizontal or rotatory, not vertical; does not change directions; prominent nystagmus only if vertigo is present as well |
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What are the characteristics of nysagmus and vertifo in a central (brainstem or cerebellum) lesion affecting CN VIII? |
Horizontal, rotatory, or vertical; may change directions; prominent nysagmus may occur in the absence of vertigo |
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Benign paroxysmal positional vertigo |
most common cause of true vertigo; patients experience brief episodes of vertigo lasting a few seconds and changing with position; proposed mechanism = otoconia (otholtihic debris in the semicircular canals) |
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CN 9 Motor fibers arise from what nucleus? |
nucleus ambiguous |
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CN 9 Pre-ganglionic parasympathetic fibers arise from what nucleus? |
inferior salivatory nucleus |
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CN 9 Post-ganglionic parasympathetic fibers arise from what ganglion? |
otic ganglion |
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Parotid gland innervation comes from which nerve? |
CN 9 > lesser petrossal > auriculotemporal (V3) |
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The carotid sinus and carotid body send sensory information via which nerve? |
CN 9 |
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afferents IX which conveys inputs from baroreceptors and chemic receptors from the carotid body synapse in what nucleus |
caudal nucleus solitarius of the medulla |
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taste from IX which does the posterior 1/3 of the tongue synapses in what nucleus |
rostral nucleus solitarius (gustatory nucleus) |
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what muscle does the branchial motor portion of CNIX supply |
stylopharyngeus (elevates pharynx during talking and swallowing and contributes with XNX to gag reflex) |
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where do parasympathetic preganglionic fibers in the glossopharyngeal nerve originate and what do they exit as |
inferior salivatory nucleus in the pons..they leave the glossopharyngeal nerve via the tympanic nerve and then join the lesser petrosal nerve to synapse in the otic ganglion-->providing postganglionic parasympathetics to the parotid gland |
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afferents IX which conveys inputs from baroreceptors and chemic receptors from the carotid body synapse in what nucleus |
caudal nucleus solitarius of the medulla |
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Parasympathetic pre-ganglionic fibers of CN10 are found where? |
Dorsal motor nucleus of CN10 |
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The taste nucleus is part of what larger nucleus? What Cranial nerves send sensation to it? |
nucleus solitarus; CN 7, 9, 10 |
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Contraction of the left SCM muscle turns the head which direction? Left SCM tilts the head to which side? |
turns it right; tilts it left |
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A lesion in the left tongue motor cortex will produce weakness on which side? |
contralateral, right |
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A lesion in the left tongue hypoglossal nucleus will produce weakness on which side? |
ipsilateral, left |
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A lesion in the left tongue motor cortex will cause the tongue to deviate to which side when protruded? |
right. left motor cortex = right sided hypoglossal nerve damage = tongue protrusion deviates it to the right since the left pushes forward more |
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A lesion of the left hypoglossal nerve will cause the tongue to deviate to which side when protruded? |
left. the right hypoglossal will protrude more and push the tongue left |
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Larynx muscles are innervated by ... |
CN10 |
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Hoarse voice suggests damage to which cranial nerve? |
CN 10 |
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Difficulty swallowing can be caused by damage to which cranial nerves? |
9, 10 &12 |
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Gag reflex afferent limb |
CN 9 |
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Gag reflex efferent limb |
CN 10 |
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A patient's uvula deviates to the left. Which nerve is damaged? |
right CN 10 |
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A patient's soft palate is lower on the left. Which nerve is damaged? |
left CN 10; curtain sign"" |
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what nucleus supplies the motor component of CNX |
nucleus ambiguus |
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nerve that loops back upward from the thoracic cavity to control all intrinsic laryngeal muscles except for the cricothyroid |
recurrent laryngeal nerve |
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innervation of cricothyroid |
superior laryngeal nerve |
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lower part of traps are innervated by |
C3 and C4 |
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where does CNXII exit |
between the pyramid and inferior olivary nucleus |
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lesions in the primary motor cortex or internal capsule will cause ______ tongue weakness...lesions of the hypoglossal nucleus or nerve will cause ____ tongue weakness |
lesions in the primary motor cortex or internal capsule will cause contralateral tongue weakness...lesions of the hypoglossal nucleus or nerve will cause ipsilateral tongue weakness |
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unilateral tongue weakness will cause the tongue to deviate toward the weak side when it is protruded. Therefore a lesion of the hypoglossal nerve will cause the tongue to deviate away/toward the side of the lesion |
toward the side of the lesion |
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glomus tumors |
result in compression of IX, X, XI in the jugular foramen |
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abnormal articulation of speech |
dysarthria.. it should be distinguished from aphasia |
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difference between dysarthria and aphasia |
dysarthria: motor articulatory disorder; aphasia: disorder or higher cognitive function in which language formulation or comprehension is abnormal |
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impaired swallowing |
dysphagia |
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gag reflex afferent and efferent |
afferent; mostly ix --- efferent; mostly x |
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what causes this: when the uvula and soft palate deviate to the normal side and the abnormal soft palate hangs low |
unilateral lesions of CNX or the nucleus ambiguus (stage curtain sign) |
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lesions in what cranial nerves will cause random laughter or crying without feeling the usual associated emotions |
CN VII, IX, X, XII...lesions of the corticobulbar pathways (pseudobulbar affect) |
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difference in sensory innervation of middle and outer ear |
middle ear: IX; outer ear: V3, VII, IX, X |
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muscles of the soft palate are supplied by...except... |
muscles of the soft palate are supplied by X except for tensor veli palatini (V3) |
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sensation from the supratentorial dura mater is carried by.. |
CNV |
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while dura of the posterior cranial fossa is supplied by... |
CNX |
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To walk down stairs, one has to have the ability to move the eyes down when they are in the medial position. This involves the use of cranial nerve _______, which innervates the superior oblique muscle (whose action is to pull the eye downward when in the medial position). |
If there is damage to this nerve on one side, the eyes will not be able |
|
to focus on the same visual field, thus producing double vision. |
IV (trochlear nerve) |
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patient has a stroke and is rigid aftewards. Where is the lesion and what produces the rigidity |
pons... unopposed action of the lateral vestibulospinal tract; The central pathways mediating taste include the following: primary afferent |
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synapse in the _____ nucleus. |
the solitary nucleus |
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CNIX supplies the stylopharyngeous muscle (elevation of pharynx in speech)... what nucleus supplies its efferents |
nucleus ambiguus |