Neuro 12 Brainstem 1

Front 1

the two pairs of bumps on the dorsal midbrain are?

Back 1

superior and inferior colliculi

Front 2

what structures lie dorsal to the pons?

Back 2

4th ventricle, cerebellum

Front 3

what are the bumps on the floor of the 4th ventricle?

Back 3

facial colliculi (abducens nuclei and fibers of CN VII)

Front 4

which cranial nerves do not emerge from the brainstem?

Back 4

CN I and II

Front 5

where do the optic nerves enter the brain?

Back 5

wrap around midbrain to enter LGN of the thalamus

Front 6

which CN's exit the brainstem dorsally?

Back 6

only CN IV (dorsal midbrain)

Front 7

origin of CN III?

structures around it?

Back 7

ventral midbrain interpeduncular fossa

passes btwn PCA and Sup Cerebellar A.

Front 8

which nerve protrudes from the ventral surface of the pons?

Back 8

CN V

Front 9

which nerves exit at the pontomedullary jctn?

Back 9

CN VI, VII, VIII, IX

Front 10

what's the region where CN VII, VIII and IX exit the brainstem called?

Back 10

cerebellopontine angle

Front 11

only nerve to exit brainstem anterior to inf olive?

Back 11

CN XII

Front 12

foramen for optic nerve

Back 12

optic canal

Front 13

nerves that traverse sup orbital fissure?

Back 13

CN III, IV, V1, VI

Front 14

foramina for branches of trigem?

Back 14

V1 = sup orbital fissure
V2 = foramen rotundum
V3 = foramen ovale

Front 15

how does facial nerve leave the skull?

how does CN8 leave?

Back 15

int auditory meatus -> stylomastoid foramen

int auditory meatus

Front 16

how do CN IX, X, and XI leave the skull?

X1 reenters via?

Back 16

jugular foramen

foramen magnum

Front 17

in general, motor CN nuclei are located more _____, sensory CN nuclei are located more _____.

Back 17

ventrally, dorsally

Front 18

furthest medial motor column of cranial nerve nuclei (GSE) includes which nuclei?

functions?

derived from?

Back 18

oculomotor (sup colliculus), trochlear (inf colliculus), abducens, hypoglossal (3, 4, 6, 12)

extraocular muscles, intrinsic tongue muslces

occipital somites

Front 19

what CN nuclei are part of the parasympathetic GVE column?

functions?

Back 19

Edinger-Westphal (III), Sup salivatory (VII), Inf salivatory (IX), Dorsal motor nucleus of CN X (3, 7, 9, 10)

PNS of head and thoracoabdominal viscera above splenic flexure

Front 20

what CN nuclei are part of the SVE column?

functions?

Derived from?

Back 20

Trigem motor nucleus, Facial nucleus, Nucleus ambiguus (IX, X), Spinal acc. nucleus (5, 7, 9, 10, 11)

mm. mastication, facial expression, middle ear, pharynx/larynx, SCM, upper traps

branchial arches

Front 21

what CN nuclei are in the visceral sensory column?

functions?

Back 21

nucleus solitarius (7, 9, 10)

gustatory (rostral, VII, IX, X) = TASTE
cardiorespiratory (caudal, IX, X) = receives INPUTS for regulation of cardiac, resp, and GI fxn

Front 22

what nuclei are in the general somatic sensory column?

functions?

Back 22

Trigeminal nuclei (V, VII, IX, X) (5, 7, 9, 10)

general sensation for face, sinuses and meninges

(touch, pn, temp, position, vibration)

Front 23

what nuclei are in the special somatic sensory column?

functions?

Back 23

cochlear, vestibular (VIII)

hearing, balance/orientation

Front 24

which muscles of the head/neck are derived from the occipital somites?

Back 24

extraocular and intrinsic tongue mm.
(somatic motor CN nuclei) = "GENERAL somatic efferent"

innervate striated m

Front 25

which muscles of head/neck are derived from branchial arches?

Back 25

muscles of mastication, facial expression, middle ear, pharynx/larynx, SCM, upper traps

(basically if it is not eye muscles or tongue muscles, it is special visceral efferent muscles)

innervate striated m

Front 26

which nuclei in the brainstem receive input from multiple nerves?

Back 26

SAT= solitarius, ambiguus, trigeminal

Front 27

which CN have both motor and sensory fxn?

Back 27

V, VII, IX, X

Front 28

Foster-Kennedy syndrome?

Back 28

meningiomas in olfactory sulcus region cause anosmia + I/L optic atrophy + C/L papilledema

Front 29

action of trochlear nerve? path of trochlear nerve?

Back 29

pull top of the eye medially and downward

exits dorsally from INFERIOR TECTUM

Front 30

CN III carries parasympathetics to what structures?

preganglionics are where? synapses where?

Back 30

pupillary constrictor and ciliary muscle of the lens

preganglionic parasympatherics are located in the Edinger Westphal nucleus

synapose in the ciliary ganglion of the orbit

Front 31

trigeminal nerve exits from? to enter? where is the sensory ganglion?

Back 31

trigeminal leaves from the ventrolateral pons to enter meckel's cave where the sensory ganglion lies

Front 32

innervation of dura mater?

Back 32

supratentorial = CN V
infratentorial = CN X & upper cerv

Front 33

innervation of nasal sinuses and inside of nose?

Back 33

CN V

Front 34

general sensation of tongue?

Back 34

ant 2/3 = CN V
post 1/3 = CN IX

Front 35

trigeminal sensory systems synapse on the ____; spinal sensory systems synapse on the ___ of the thalamus

Back 35

VPM; VPL
Trigeminal Sensory systems include the trigeminal lemniscus and the trigeminothalamic tract

Spinal Sensory systems include the MEDIAL lemniscus and the spinothalamic tract

Front 36

Mesencephalic trigeminal nucleus senses ______.

Back 36

propioception

Front 37

Chief trigeminal sensory nucleus senses ______. It travels to the thalamus via _____ and synapses on the ____

Back 37

fine touch, dental pressure; trigeminal lemniscus; VPM

Front 38

Spinal trigeminal nucleus senses __________. It travels to the thalamus via _________ and synapses on the ____

Back 38

crude touch, pain, temperature; trigeminothalmic tract

Front 39

in the spinal trigeminal tract and nucleus, which cutaneous areas are represented most rostrally in the tract? which division of CN V is represented most dorsally?

Back 39

rostral to caudal = perioral areas > eyes, cheeks > chin, ears, scalp

dorsal to ventral = mandibular > maxillary > ophthalmic

Front 40

the mesencephalic trigeminal tract runs lateral to what structure in the midbrain? mediates what sense?

Back 40

periaqueductal gray matter; propioception of MASTICATION, TONGUE, and EXTRAOCULAR M.

* mesencephalic nucleus is the only one where the primary sensory neurons lie within the CNS instead of a peripheral ganglia

Front 41

where does the branchial motor root of CN V exit the skull?

muscles innervated by it?

can deficits of jaw movement be caused by a unilateral UMN lesion?

Back 41

V3 to exit via foramen ovale

masseter, temporalis, medial/lateral pterygoids, tensor tympani, tensor veli palatini, mylohyoid, ant belly digastric

no because the UMN control is bilateral

Front 42

multiple sclerosis is sometimes assoc'd with what nerve disorder?

Back 42

trigem neuralgia

Front 43

DOC for trigem neuralgia?

Back 43

carbamazepine or baclofen

Front 44

lesions of trigem nuclei in brainstem cause ____ loss of facial sensation

so if you see a question where they have a pt w loss of facial sensation (pn/temp) on the R and loss of body sensation (pn/temp) of the L, think ____

Back 44

ipsilateral

lesion of trigeminal nuclei on the R

Front 45

what nerve regulates PNS for lacrimation and salivation as well as taste and general sensation to a small area around the ear?

Back 45

nervus intermedius (CN VII)

Front 46

the bodies of primary sensory neurons for taste to the ant 2/3 of the tongue lie in what ganglion?

with which nerves do the fibers travel?

where do they synapse in the brainstem?

Back 46

geniculate ganglion (CN VII)

lingual nerve (V3) and chorda tympani (VII)

gustatory nucleus (nuc solitarius)

Front 47

what goes through foramen lacerum?

Back 47

int carotid a., a. of pterygoid canal, n. of pterygoid canal

Front 48

what comes from sup salivatory nucleus and where does it go?

Back 48

pregang parasympath nerves of the facial nerve
At genu, it splits into GREATER PETROSAL (which goes to SPENOPALATINE ganglion to lacrimal gland and nasal mucosa) and CHORDATYMPANI (which exits at petrotympanic fissure, joins LINGUAL N to submandibular ganglion to submandibular and submaxillary glands)
*chorda tympani and lingual n also carry taste sensation but they go to GENICULATE ganglion

Front 49

what type of neuron injury spares the muscle innervation to the forehead?

Back 49

U/L UMN lesion of CN VII; LMN affects the whole face

Front 50

innervation of corneal reflex?

innervation of threat blink reflex?

Back 50

afferent = CN V1 to chief sensory and spinal trigem nucleus; efferent = CN VII to orbicularis oculi mm.

afferent = CN II, efferent = CN VII

Front 51

innervation of jaw jerk reflex?

when is it seen?

Back 51

sensory neurons in mesencephalic trigem nucleus send axons to pons to synapse in motor trigem nucleus

BL UMN lesions (e.g. ALS) or diffuse white matter disease

Front 52

the bony labyrinth is filled with ___, while the membranous labyrinth is filled with ____.

Back 52

perilymph
endolymph

Front 53

fibers from ____ pass through the trapezoid body, skip the sup olivary nucleus to travel through the ____ to the inferior colliculus

Back 53

dorsal cochlear nuclei
lateral lemniscus

Front 54

what area is specialized to localize sounds horizontally in space?

Back 54

superior olivary nuclear complex of the pons

Front 55

the ____ is traversed at right angles by the medial lemniscus

Back 55

trapezoid body

Front 56

which vestibular nuclei are important in maintaining balance and extensor tone throughout the length of the SC?

Back 56

lateral

Front 57

which vestibular nuclei are important in controlling head/neck position?

Back 57

medial and inferior

Front 58

which vestibular nucleus has a checkerboard appearance on myelin stained section?

Back 58

inferior

Front 59

purpose of MLF?

Back 59

connect oculomotor, trochlear, abducens nuclei to each other and to medial and superior vestibular nuclei

Front 60

which hearing test evaluates conductive hearing loss?

Back 60

Rinne
(normal = air > bone; conductive hearing loss = bone > air)

Front 61

which hearing test evaluates sensorineural hearing loss?

Back 61

Weber
(normal = tone equal on both sides; sensorineural loss = tone louder on unaffected side)

Front 62

TxOC for pt c/o recurrent vertigo w/ fluctuating and/or step-wise progressive hearing loss?

Back 62

salt restriction and diuretics (Meniere's dz)

Front 63

muscles innervated by CN IX?

Back 63

stylopharyngeus

Front 64

inferior salivatory nucleus...what arises from here?

Back 64

PNS fibers run with CN IX to tympanic n to lesser petrosal n., synapse in otic ganglion to the parotid gland

Front 65

what special sensory functions does CN IX mediate?

Back 65

taste post 1/3 tongue
chemo-/baroreceptors of carotid body

Front 66

what nerve controls almost all the pharyngeal and laryngeal muscles?

Back 66

branchial motor component of CN X

Front 67

where do the parasympath pregang fibers of CN10 arise from?

Back 67

dorsal MOTOR nucleus of CN10 (the dorsal motor nucleus forms the vagal trigone on the floor of the 4th ventricle)

Front 68

innervation of cricothyroid m.?

Back 68

sup laryngeal n. (all other intrinsic laryngeal mm. = recurrent laryngeal n)

Front 69

somatosensory areas of CN X?

special sensory?

Back 69

pharynx, larynx, infratentorial meninges, ext auditory meatus

taste from epiglottis and post pharynx

Front 70

manifestation of LMN lesion of CN XI?

Back 70

IL shoulder shrug or arm elevation weakness

weakness turning head AWAY from lesion

Front 71

weakness of head turning in UMN lesion of CN XI?

Back 71

weak turning AWAY from lesion
(same as LMN lesion)

Front 72

CN XII innervates what muscles?

Back 72

intrinsic and extrinsic tongue mm EXCEPT palatoglossus (CN X)

Front 73

dx: weak shoulder shrug, weak head turning, dysphagia for solids & liquids, hoarseness, fluctuant BP, fleshy vascular mass in middle ear

Back 73

glomus tumor compressing CN IX, X, XI

Front 74

appearance of soft palate/uvula with UL lesions of CN X or nuc ambiguus?

Back 74

uvula deviates toward normal side, soft palate hangs low on affected side

Front 75

dx: uncontrollable bouts of laughter or crying w/o associated emotions

Back 75

pseudobulbar affect
(UMN-like disorder of CN VII, IX, X, XII leads to abnml reflex activation of laugh/cry circuits in brainstem)

Front 76

dx: episodes of inappropriate laughter (2)

Back 76

gelastic epilepsy (hypothalamic hamartoma)
temporal lobe seizures

Front 77

optic nerve carries visual information to what nucleus of the thalamus?

Back 77

LATERAL GENICULATE

Front 78

lesions of the facial nucleus causes?

Back 78

ipsilateral facial weakness

Front 79

lesions of the cortex or corticobulbar tracts of CN7 causes?

Back 79

contralateral facial weakness that spares the forehead

Front 80

when does CN7 branch into it's 5 motor branches?

what are the 5 branches?

Back 80

after piercing through parotid

temporal, zygomatic, buccal, mandibular, cervical

Front 81

what is the path of the preganglionic parasympathetics of CN7

Back 81

preganglions start in the superior salivatory nucleus and are carried by 2 small branches off the main trunk of the facial nerve.
1 branch is the greater petrosal nerve (leaves at genu) which continues to the sphenopalantine/pterygopalatine ganglion then to lacrimal glands and nasal mucosa
2 branch is the chorda tympani (leaves at inner ear) which joins the lingual n to get to the submandibular ganglion to the salviary glands

Front 82

greater petrosal nerve is to the ___ ganglion as the chorda tympani (and lingual n) is to the _____ ganglion

Back 82

pterygopalantine; submandibular

Front 83

Where are the cell bodies for taste? who specifically carries taste for the ant 2/3 of the tongue? and go back to which nucleus of the midbrain?

Back 83

Geniculate ganlion. Lingual n and chorda tympani. nucleus soltarius

Front 84

Bell's Palsy has 4 syx; LMN or UMN?

Back 84

1- unilateral facial weakness
2- retroauricular pain
3- hyperaccusis
4- dry eye

LMN because it is the entire half of the face

Front 85

recovery from bell's palsy can cause crocodile tears

Back 85

so they may cry instead of salvate when they see food

Front 86

what is synkinesis?

Back 86

abnormal bilateral movement

ask pt to close one eye and they close both

Front 87

Sound waves are transmitted by the ______ and amplified by the middle ear ossicles -- ___, ___, ___ to reach the ________ then the vibrations reach the inner ear, which consists of the cochlea, vestibule, and semicircular canals

Back 87

tympanic membrane; malleus, incus, stapes; oval window;

Front 88

malleus is dampened by ____ and stapes is dampened by ____

Back 88

tensor tympani; stapedius

Front 89

What is the most common tumor of the cerebllopontine angle?

Back 89

acoustic neuroma/schwannoma

Front 90

Acoustic Neuroma arises from____? Syx?

Back 90

arises from vestibular division of CN8. unilateral hearing loss, tinnitus and undsteadiness. then it may affect the neraby trigeminal nerve causing facial pain and sensory loss (subtle decrease in corneal reflex)

Front 91

Are most cases of vertigo caused by peripheral disorders or central disorders?

Back 91

peripheral

Front 92

Dix Hallpike positional testing causes maximal stimulation of the _____ of the ear that is down

Back 92

posterior semicircular canal

Front 93

During a Dix Hallpike manuever, if the nystagmus and vertigo take 2-5 s to begin, the lesion is most likely peripheral or central

Back 93

peripheral

Front 94

vertical nystagmus, nystagmus that changes directions while remaining in the sme position, are only seen in ___ lesions

Back 94

central

Front 95

what is the most common cause of true vertigo?

Back 95

BPPV- otoconia in semicircular canals

Front 96

what 3 movements trigger BPPV?

Back 96

when the affected side's ear is down, turning away from affeced side, or sitting up

Front 97

Pt has recurrent episodes of vertigo with fluctuating or stepwise, progressive hearing loss, and tinnitus. pt complaints of "full feeling" in ear- what is it?

Back 97

menieres dz

Front 98

what is menieres dz caused by?

Back 98

excess fluid and pressure in endolymphatic system

Front 99

pt complains of hearing loss and tinnitus, but really they are just unsteady and dont have true vertigo- what do they have?

Back 99

acoustic neuroma

Front 100

anemia and thyroid disorders can also produce dizziness and should be tested for in all pts complaining of vertigo where etiology is unclear

Back 100

ok

Front 101

tell me the pathway of the parasympathetics of CN9- what nucleus? what nerves? what ganglion? what effector?

Back 101

Inferior Salivatory nucleus carries the the pregang parasympath to the tympanic n then to the lesser petrosal n to synapse in the OTIC ganglion to providing postgang to PAROTID

Front 102

What is the general visceral sensory portion of CN9?

Back 102

baro and chemoreceptors in the carotid body that travel to the causal n. solitarius

Front 103

what nerves supplies the general visceral sensation from chemo and baroreceptors of the aortic arch

Back 103

CN10 reaching the caudal nucleus solitarius

Front 104

where are the primary sensory neuron cell bodies for CN10 general and special visceral sensation?

Back 104

inferior vagal ganlgion located just below the jugular foramen

Front 105

tongue deviates to the R, where is the lesion?

Back 105

L cortex or R hypoglossal nucleus

*lesions in the motor cortex or internal capsule will cause contralateral tongue weakness, but wheakness in the hypoglossal nucleus will cause ipislateral weakness

Front 106

epsidoes of severe throat and ear pn = _______neuralgia

Back 106

glossopharyngeal

Front 107

unilateral vocal cord paraliss and hoarsness is a result of injury to what nerve?

Back 107

recurrent laryngeal n

Front 108

glomus tumors affect which nerves? and are richly innervated by what nerce?

Back 108

9, 10, 11; 9

Front 109

what is the most common lesion of the medulla affecting the nucleus ambiguus?

Back 109

lateral meduallary infarct

Front 110

what is responsible for spasmodic dysphonia?

Back 110

dysfxn of the basal ganglia circuitry; seen in Parkinson's

Front 111

what is dysarthria?

Back 111

abnormal articulation of speech

Front 112

Dysphagia can be caused by dysfxn of which 3 CN?

Back 112

9, 10, 12

Front 113

gag reflex is elicited by stroking the posterior pharynx w a cotton swab- sensory of _ and motor of _

Back 113

sensory of 9, and motor of 10

Front 114

unilateral lesion of CN10 or of nucleus ambiguus, the uvula and soft palate will deviate toward the normal side, while the soft palate on the abnormal side hangs low producing the _______________

Back 114

stage curtain sign

Front 115

if you have a pt w a lesion of 7, 9, 10, 12- what peculiar behavioral problem may they have?

Back 115

psudeobulbar affect- uncontrollable bouts of laughing or crying

Front 116

hypothalamic hamartomas or temporal lobe seizures may also ellict...

Back 116

inappropriate laughter

Front 117

what nerve provides facial sensation? facial movement?

Back 117

5, 7

Front 118

what nerves provide taste for the ant 2/3 of the tongue? general somatic sensation?

Back 118

facial nerve, chorda typmani; v3

Front 119

taste for pos 1/3

Back 119

9- taste and sensation; 10- epigottis and pos pharynx taste

Front 120

sensation for teeth, nasal sinuses, inside of mouth?

Back 120

10

Front 121

somatic sensation for middle ear and TM?

Back 121

9

Front 122

sensation for ext ear and outside of TM?

Back 122

V3, 7, 9, 10