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196 Cards in this Set
- Front
- Back
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what does the cerebellum attach to
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dorsal surface of pons and upper medulla
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what is on the dorsal surface of the midbrain
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two pairs of bumps: superior and inferior colliculi - form tectum aka roof of midbrain
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what is the ventral surface of the midbrain formed by
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cerebral peduncles
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what is between the cerebral peduncles
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interpeduncular fossa
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what is the pons limited dorsally by
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fourth ventrical
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what attaches the pons to the cerebellum dorsolaterally
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large white matter tracts called superior, middle, and inferior peduncles
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what divides the medulla into rostral and caudal portions
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pyramidal decussation
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what forma the focial colliculi in the floor of the fourth ventricle
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abducens nuclei and fibers of the facial nerve
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what are the hypoglossal trigone and vagal trigones formed by in the floor of the fourth ventricle
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hypoglossal nucleus and dorsal motor nucleus of CN X
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what does the cerebral aqueduct run through
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midbrain
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what does the 4th ventricle drain into caudally
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foramina of Luschka and Magendie into the subarachnoid space
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Where does the 4th ventricle end caudally
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obex - entry of spinal cord central canal which is normally closed in adults
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what is the pathway of the optic nerves
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wrap around midbrain and enter the lateral geniculate nuclei of the thalamus
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what CN exits dorsally
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CN IV (trochlear); the fibers also cross over as they emerge
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What CNs exit near midline
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III, VI, and XII
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where do the oculomotor nerve (CN III) emerge
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ventrally from interpeduncular fossa of midbrain
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what does CN III generally pass between
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posterior cerebral artery and superior cerebellar artery
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where does trigeminal emerge (CN V)
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ventrolateral pons
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where does abducens emerge (CN VI)
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ventrally at pontomedullary jxn
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where do CNs 7-10 emerge
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ventrolaterally from pontomedullary jxn and rostral medulla
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spinal accessory ner (CN XI) emerge
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laterally from multiple rootlets along upper cervical spinal cord
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hypoglossal nerve (CN XII) emerges
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medulla ventrally btwn pyramids and inferior olivary nuclei
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where does CN1 exit
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cribiform plate
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where does CN2 exit
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optic canal
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what exits via the superior orbital fissure
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CN III, IV, VI, and V1
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what CNs mediate eye movement
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III, IV, and VI
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What conveys sensation for the eye and upper face
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opthalmic division (V1)
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what exits via foramen rotundum
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V2 (maxillary)
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what exits via foramen ovale
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V3 (mandibular)
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What CNs exit via internal auditory meatus
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VII and VIII
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what CN travels through the stylomastoid foramen
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CN VII
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What CNs exit via jugular foramen
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CN IX, X, and XI
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Where does CN XII exit
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hypoglossal canal in front of foramen magnum
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somatic motor nuclei of CNs
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oculomotor (III), trochlear (IV), abducens (VI), hypoglossal (XII); all nuclei are adjacent to midline
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what are extraocular and intrinsic tongue muscles derived from embryologically
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occipital somites
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two colums of visceral motor nuclei
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branchial motor nuclei and parasympathetic nuclei
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branchial motor nuclei
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V, VII, nucleus ambiguus (IX, and X), XI nuclei; innervate striated muscle
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what are muscles of branchial motor nuclei derived from
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branchial arches
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parasympathetic nuclei
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Edinger-Westphal nucleus (III), superior (VII) and inferior (IX) salvitory nuclei, dorsal motor nucleus of vagus
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visceral sensory column nucleus
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nucleus solitaris
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two parts of nucleus solitaris
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rostral/gustatory nucleus and caudal nucleus solitaris
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what does the rostral/gustatory nucleus receive
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taste inputs from VII, and also IX and X
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caudal nucleus solitaris fxn
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cardiorespiratory nucleus; input for regulation of cardiac, respiratory, and GI fxn from IX and X; sleep regulation
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general somatosensory nuclei (trigeminal nuclei) fxns
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mediate touch, pain, temperature, position, and vibration sense for face, sinuses, and meninges
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what do the trigeminal sensory nuclei receive smaller sensory inputs from
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VII, IX, and X
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what 2 special senses do not have nuclei in the brainstem
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olfaction and vision
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brainstem special somatic sensory nuclei
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cochlear nuclei, vestibular nuclei (taste included in visceral sensory column in nucleus solitarus)
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What 3 nuclei do not receive inputs from predominately one CN
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SAT - Soltarius, Ambiguus, Trigeminal; all are long nuclei extending into the medulla
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purely motor CNs
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III, IV, VI, XI, and XII
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purely sensory CNs
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I, II, VIII
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mixed motor and sensory CNs
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V, VII, IX, and X
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where do the olfactory tracts run
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in the olfactory sulcus btwn gyrus rectus and orbital frontal gyri to reach the olfactory processing areas
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are the olfactory bulbs and tracts really nerves
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no, they are part of the CNS
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anosmia
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olfactory loss
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What intracranial lesions can occur at the base of the frontal lobes near the olfactory sulci
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meningioma, metastases, basal meningitis, sarcoidosis
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Foster-Kennedy syndrome
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anosmia with optic atrophy in one eye and pailledema in the other eye; large lesions can produce
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What CN abducts the eye laterally
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VI (abducens)
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What CN carries parasympathetics to the pupillary constrictor and to the ciliary muscle of the lens
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CN III
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Which branch of CN V has a motor root and what does it do
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mandibular division (V3); muscles of mastication and some other small muscles
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Meckel's cave
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small fossa just posterior and inferolateral to the cavernous sinus that CN V ganglion resides in
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Superior room occupancy (SRO)
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mnemonic for exiting of V1,2, and 3: superior, rotundum, ovale
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what does the trigeminal nerve provide touch and pain sensation for
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face, nasal sinuses, inside of nose, mouth, and anterior 2/3 of tongue
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Pain sensation for the supratentorial dura mater is supplied by
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CN V
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dura of the posterior fossa is innervated by
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CN X and cervical nerve roots
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trigeminal nuclear complex location and components
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midbrain to upper cervical spine and consists of 3 nuclei: mesencephalic, chief sensory, spinal trigeminal
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chief trigeminal sensory and spinal trigeminal provide sensory systems for
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face and head (analogous to posterior columns and anterolateral systems)
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trigeminal lemniscus crosses to
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opposite side of brainstem to ascend with the medial lemniscus toward the thalamus, goes to the ventral posterior medial nucleus (VPM)
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where does the smaller pathway of the dorsal trigeminal tract travel
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from chief trigeminal sensory nucleus to ipsilateral VPM - conveys touch and P from oral cavity
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spinal trigeminal nucleus is the rostral extension of the
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dorsal horn; analagous to Lissauer's tract
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what ascend as the trigeminothalamic tract
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secondary sensory neurons from the spinal trigeminal nucleus; analagous to spinnothalamic tract
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where do trigeminothalamic tract fibers synapse
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thalamic ventral posterior medial nucleus (VPM)
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how is the spinal trigeminal tract organized
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mandibular dorsally, opthalmic ventrally, and maxillary in between
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what does the mesencephalic trigeminal nucleus and tract mediate
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proprioception
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What is special about the neuron of the mesencephalic trigeminal nucleus
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only case where primary sensory neurons liw within the CNS instead of peripheral ganglia
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where is the trigeminal motor nucleus located
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upper-to-mid pons near the trigeminal exit from brainstem
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muscles of mastication
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masseter, temporalis, medial and lateral pterygoid
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what other small muscles does V3 innervate
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tensor tympani, tensor veli palatini, mylohyoid, anterior belly of digastric
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why don't unilateral lesions in motor cortex or corticobulbar tract usually cause deficits in jaw movement
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UMN reaching the trigeminal motor nucleus is predominately bilateral
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trigeminal neuralgia
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recurrent episodes of bried severe pain lasting from seconds to minutes; unknown cause
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lesions of trigeminal nuclei in the brainstem cause same or opposite side effects
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ipsilateral
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combination of spinal trigeminal and spinothalamic involvement in lateral brainstem
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sensory loss ipsilateral to lesion and contralateral body
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nervus intermedius
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facial branch VII carring fibers for parasympathetic (tears and salivation), visceral sensory (taste), and general somatosensory fxns
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Where is the facial nucleus located
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branchial motor column, more caudal in the pons than the trigeminal motor nucleus
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lesions in the cortex or corticobulbar tracts cause what kind of face weakness
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contralateral that spares the forehead
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lesions of the facial nucleus, nerve fasicles in the brainstem or peripheral nerve cause what kind of face weakness
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ilsilateral of the whole face
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where does the geniculate ganglion lie and what does it contain
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in the genu; primary sensory neurons for taste sensation in the anterior 2/3 tongue and general somatic sensation in a region near the external auditory meatus
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Where does the facial nerve divide and into what branches
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in parotid gland into temporal, zygomatic, buccal, mandibular, and cervical branches
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what small muscles does the facial nerve innervate
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stapedius, occipitalis, posterior belly digastric, stylohyoid
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mnemonic for middle ear muscles
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trigeminal for Tensor Tympani and Seventh for Stapedius
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where do preganglionic parasympathetic fibers of the facial nerve originate
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superior salivary nucleus
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Where does the greater petrosal nerve branch off from the main facial nerve
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at the genu, goes on to sphenopalatine (pterygopalantine) ganglion
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what comes from the pterygopalatine ganglion
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postganglionic parasympathetics for lacrimal glands and nasal mucosa
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where does the chorda tympani leave the facial nerve
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just before the stylomastoid foramen and travels back upward to traverse the middle ear cavity before leaving the skull at the petrotympanic fissure
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what does the chorda tympani join
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lingual nerve to reach submandibular ganglion
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what comes from the submandibular ganglion
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postganglionic parasympathetics for submandibular and submaxillary salivary glands
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what do the lingual nerves and chorda tympani also carry
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special visceral sensory fibers for taste sensation of anterior 2/3 tongue
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where are the primary sensory taste fiber cell bodies
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geniculate ganglion
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where do taste fibers in geniculate ganglion go on to synapse
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rostral nucleus solitarius (gustatory nucleus)
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where is the cortical taste area
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inferior margin of postcentral gyrus adjacent tongue somatosensory area and extends into parietal operculum and insula
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where does the general somatic sensation from the facial nerve synapse
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trigeminal nuclei
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Most common facial nerve disorder and cause
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Bell's palsy; generally unknown-may be viral or inflammatory
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recovery from Bell's palsy
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80% fully recover within 3 weeks
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crocodile tears cause
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regenerating facial nerves go to innervate wrong area causing lacrimation instead of salivation with food
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synkinesis
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abnormal movement together
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when should MRI be done with facial nerve issues
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recurrent episode
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corneal reflex involves
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trigeminal sensation and facial for reaction
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eye blink response involves
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optic for sensation (vision) and facial for reaction
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when is jaw jerk reflex brisk
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bilateral UMN lesions - amyotrophic lateral sclerosis or diffuse white matter disease
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what is the bony labyrinth filled with
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fluid called perilymph-suspends structures of membraneous labyrinth
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what is the membraneous labyrinth filled with
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endolymph
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what is included in the membraneous labyrinth
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cochlear duct, utricle, saccule, and semicircular canals
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where are P waves relieved
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round window
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pathway of P wave
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oval window to scala vestibuli to scala tympani to round window
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where are the cell bodies of primary sensory neurons of hearing
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spiral ganglion along the central rim of the cochlea
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tonotopic representation along length of organ of corti
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higher frequency near oval window and lower frequency at apex of cochlea
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pathway of auditory information starting from spiral ganglion
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axons go to cochlear CN VIII to dorsal/ventral cochlear nuclei, ascend brainstem to inferior colliculi, medial geniculate nuclei, and ultimately the auditory cortex
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why isn't unilateral hearing loss seen in lesions proximal to the cochlea nuclei
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decussations occur at multiple levels while ascending to auditory cortex
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where are the dorsal and ventral cochlear nuclei
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wrapped around lateral aspect of inferior cerebellar peduncle at pontomedullary jxn
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where do fibers from dorsal cochlear nucleus go
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pass dorsal to inferior cerebellar peduncle, cross pontine tegmentum, and ascend in contralateral lemniscus
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fibers of the ventral cochlear nucleus go
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ventral to inferior cerebellar peduncle to synapse bilaterally in superior olivary nuclear complex of pons
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fxn of superior olivary nuclei
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localize sounds in horizontal space
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fxn of lateral lemniscus
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important ascending pathway in pons and lower midbrain that terminates in inferior colliculus
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maculae in he utricle and saccule measure
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linear acceleration and head tilt
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cristae ampullaris measures
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angular acceleration
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otoliths
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calcified crystals that sit in gelatinous layer in macula
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what ganglion receives input from the utricle, anterior saccule, and anterior/lateral semicircular canals
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superior vestibular ganglion
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What does the inferior vestibular ganglion receive input from
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posterior saccule and posterior semicircular canal
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where are the four vestibular nuclei in the brainstem
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lateral floor of 4th ventricle, in pons, and rostral medulla
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what nucleus is part of vestibular medial descending pathways
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lateral vestibular nucleus
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how far does the lateral vestibulospinal tract extend
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throughout the length of the spinal cord - for maintaining balance and extensor tone
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medial vestibulospinal tract extension and fxn
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extends to cervical spine and controls neck and head position
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importance of medial longitudinal fasciculus
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connects nuclei involved in eye movements with vestibular nuclei
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location of medial longitudinal fasciculus
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near midline on each side under oculomotor and trochlear nuclei in midbrain
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conductive hearing loss
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abnormalities of external auditory canal or middle war
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sensoineural hearing loss
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disorders of cochlea or 8th nerve
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Rinne test
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air conduction compared to bone conduction
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Weber test results
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sound louder in normal ear for sensorineural hearing loss and sound louder in affected side for conductive hearing loss
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what is an acoustic neuroma
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schwannoma
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what other CN becomes involed in larger acoustic neuromas
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generally trigeminal…eventually facial
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most causes of vertigo stem from
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peripheral disorders involving inner ear
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symptoms of posterior fossa disease
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diplopia, visual changes, somatosensory changes, weakness, dysarthria, incoordination, impaired consciousness
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delay in peripheral lesions of inner ear
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2-5 seconds before onset of nystagmus and vertigo; often become more brief with repeated stimulation
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central lesion delay
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immediate and no adaptation
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Benign paroxysmal positional vertigo
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most common; brief; may be caused by debris in semicircular canals
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vestibular neuritis
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monophasic illness due to viral infections or idiopathic inflammation
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meniere's disease
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recurrent episodes of vertigo along with hearing loss; may be due to excess pP in endolymphatic system
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central causes of vertigo
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vertebrobasilar ischemia or infarct
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what should be checked for in a patient with unexplained vertigo
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anemia, thyroid disorders
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brachial motor portion of CN IX supplies
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stylopharyngeus (elevates pharynx during talking/swallowing, gag reflex)
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branchial motor component of CN IX is from
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nucleus ambiguus in medulla
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where are parasympathetic preganglionic fibers in CN IX from
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inferior salivatory nucleus in pons
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where do the parasympathetic fibers leave CN IX
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lesser petrosal nerve and synapse with otic ganglion (parotid gland)
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where does the general visceral sensory of CN IX go
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baroreceptors and chemoreceptors in carotid body
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where do afferents from carotid body go
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caudal nucleus soltarius of medulla (cardiorespiratory nucleus)
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CN IX special visceral sensation mediates
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taste posterior 1/3 tongue
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path for CN IX taste fibers
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rostral nucleus solitarius (gustatory nucleus)
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general somatic sensory fxns of CN IX
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touch, pain, temp from posterior 1/3 tongue, pharynx, middle ear, region near exteral auditory meatus
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parasympathetic preganglionic fibers of vagus come from
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dorsal motor nucleus of CN X
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what does the branchial motor component of vagus innervate
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nearly all pharyngeal muscles (swallowing and gag) and muscles of larynx
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cricothyroid innervation
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superior laryngeal, all other larynx is via recurrent laryngeal
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general somatic sensory from CN X
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pharynx, larynx, meninges of posterior fossa, small region near external auditory meatus
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special visceral sensory fibers of CN X
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taste sensation from epiglottis and posterior pharynx to rostral nucleus solitarius
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what does CN XI supply
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sternomastoid and upper portions of trapezius
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where is the spinal accessory nucleus
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protrudes laterally btwn dorsal and ventral horns of the spinal cord central gray matter
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where do the recurrent laryngeal nerve fibers begin
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caudal nucleus ambiguus and exit lateral medulla adjacent the vagus nerve
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what does the hypoglossal nerve XII innervate
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all intrinsic and extrinsic tongue muscles except palatoglossus (CN X)
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where is the hypoglossal nucleus located
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near midline on floor of 4th ventricle in medulla forming hypoglossal trigone medial to dorsal nucleus of CN X
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glossopharyneal neuralgia symptoms
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episodes of severe throat and ear pain
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what does recurrent laryngeal nerve injury produce
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unilateral voal cord paralysis and hoarseness
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glosmus bodies
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normal small epitheliod structures that resemble the carotid bodies histologically, but fxn is unknown
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what innervates the carotid bodeies and glosmus bodies
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CN IX
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what does hoarseness result from
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asynchronous vibratory patterns - swelling, nodules, polyps, or neoplasm can cause
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what does breathiness result from
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paralysis or paresis of vocal cords - incomplete adduction of one or both vocal cords
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What nerve/CNS disorders can cause voice disorders
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lesions of CN X - glomus jugulare, nucleus ambiguus in medulla
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most common lesion of medulla affecting nucleus ambiguus
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lateral medullary infarct
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dysarthria
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abnormal articulation of speech - motor articulary disorder
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aphasia
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disorder of higher cognitive fxn in which language formulation or comprehension is abnormal
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lesions in what areas can cause dysarthria
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NM jxn, peripheral or central portions of CN V, VII, IX, X, or XII, also dysfxn in motor cortex , cerebellum, basal ganglia, descending corticobulbar pathways to brainstem
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disease causes of dysarthria
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infarcts, MS, lesions of corticobulbar pathways, toxins (alcohol), etc
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dysphagia
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impaired swallowing
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4 phases of swallowing
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oral prep phase, oral phase, pharyngeal phase, and esophageal phase
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swallowing can be impaired by lesions of what CNs
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IX, X, and XII
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other lesions that can cause swallowing impairment
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NM jxn dysfxn, descending corticobulbar pathways
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what mediates the gag reflex
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sensory and motor in CNs IX and X, IX more important afferent, X efferent
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brainstem nuclei involved in laughing and crying
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CN VII, IX, X, and XII
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pseudobulbar affect
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uncontrollable bouts of laughter or crying without feeling the usual associated feelings
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what lesions can cuase the pseudobulbar affect
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corticobulbar pathways in subcortical white matter or brainstem
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gelastic epilepsy cause
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hypothalamic lesions and occasionally temporal lobe seizures (inappropriate laughter may occur)
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anterior 2/3 tongue sensation and taste
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V sensation, VII taste
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posterior 1/3 tongue sensation and taste
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IX (glossopharyngeal)
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epiglottis and posterior pharynx taste
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X
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sensation for teeth, nasal sinuses, inside of mouth, above pharynx and above posterior 1.3 tongue
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V
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somatic sensation for middle ear and inner tympanic membrane
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IX
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sensation external ear and outer surface of tympanic membrane
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V3 (mandibular), VII, IX, X
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sensation supratentorial dura mater
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V
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dura of posterior cranial fossa
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X and upper cervial roots
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