Nbeo Part 1

Front 1

What two bones comprise the lateral wall of the orbit?

Greater Wing of the Sphenoid
Lesser Wing of the Sphenoid
Frontal Bone
Zygomatic Bone

Back 1

Correct Answers = Greater Wing of the Sphenoid Bone and Zygomatic Bone

Some remember the two bones that comprise the lateral wall as "Great-Z"

Front 2

Which of the following muscles causes intorsion, abduction, and depression?

Superior oblique
Superior rectus
Inferior rectus
Inferior oblique

Back 2

Correct Answer = SUPERIOR OBLIQUE

Front 3

When are the oblique muscles responsible for for elevation and depression?

Back 3

When the eye is pointed towards the nose (adducted 51-55 degrees).The recti muscles are isolated for elevation and depression when abducting 23 degrees.

Front 4

What about in clinic when you have a patient look straight up. What muscle(s) are performing this action?

Back 4

superior rectus and inferior oblique.
The obliques are isolated during adduction and the recti are isolated during abduction is very clinically significant!

Front 5

Which of the following is correct?

1.Upon adduction 23 degrees the superior rectus is the primary elevator
2.Upon abduction 51 degrees the inferior oblique is the primary elevator
3.Upon abduction 23 degrees the inferior rectus is the primary depressor

Back 5

Correct Answer = Upon abduction 23 degrees the inferior rectus is the primary depressor

This concept is very important and has value in your quest to be an outstanding clinician. Now, don't get me wrong, I do not take out my protractor in clinic, but you should definitely have a solid understanding of this concept

Front 6

The optic nerve courses to all of the following destinations except:

Superior Colliculus
Inferior Colliculus
LGN (and onto the visual cortex)
Pretectal nucleus

Back 6

Correct Answer = Inferior Colliculus just prior to entering the LGN, gives off 1/3 of its fibers to the pretectal nucleus. You know what happens next.... the fibers leave the pretectal nucleus to innervate both Edinger-Westphal nuclei.

Front 7

Where do preganglionic parasympathetic fibers that course to the pupil originate at in the eye?

Back 7

Correct Answer = EW nucleus. Do not put the pretectal nucleus if asked on the exam

Front 8

Where do postganglionic parasympathetic fibers that course to the pupil originate at in the eye?

Back 8

Correct Answer = Ciliary Ganglion
CN 2 (optic nerve) performs the sensory loop (e.g. takes information back to the pretectal nucleus), while CN 3 (which begins at EW nucleus) performs the motor loop (e.g. takes information from EW nucleus to Ciliary Ganglion and onto ciliary muscle (for accommodation) and sphincter muscle (for miosis)

Front 9

Which of the following cranial nerves is used for shoulder shrugging?

X
XI
XII
IX

Back 9

Correct Answer = Cranial nerve XI

Think of CN XI as the "student nerve." Sometimes when I ask my students questions they will shrug their shoulders and turn their head from side to side (horizontally) to express their lack of knowledge of the topic (or disdain of my question).

CN XI = "student nerve" = HEAD TURNING and SHOULDER SHRUGGING

Front 10

What condition results from a lesion at the location of the ciliary ganglion?

Back 10

Correct Answer = Adie's tonic pupil

Recall that .125% pilocarpine is used for diagnosis.

Front 11

A lesion to the superior division of CN III would result in which of the following?

An eye that sits down and out
Ptosis
Loss of accomodation

Back 11

Correct Answer = Ptosis

Remember that the superior division of CN III innervates superior things.... the superior levator muscle (opens the eye) and the superior rectus (elevates the eye).

Front 12

Inability for your patient to look up and out is most likely a result of a:

Lesion of the contralateral SR nucleus
Lesion of the ipsilateral SO nucleus
Lesion of the ipsilateral SR nucleus

Back 12

Correct Answer = lesion of the contralateral SR nucleus

The SR fibers decussate - it is in the notes but not something I stressed very much in lecture. Within CN III, the SR fibers are the only ones to decussate. Recall that in CN IV the entire nerve decussates.... not just portions of the nerve (e.g. only SR fibers) as in CN III.

Front 13

CN VII innervates all of the following except?

Frontalis muscle
Corrugator
Platysma
Masseter

Back 13

Correct Answer = Masseter

Remember, this is a muscle of mastication (masseter = mastication) that is innervated by V3. Some students will miss this concept if asked on the exam, but you will NOT. The reason this would be easy to confuse is because most students know that CN VII is responsible for facial expression and other motor activity within the facial region (e.g. closing the eyes) and they incorrectly assume that mastication is performed by CN VII as well.

Remember V3 = mastication. VII = facial expression, closing eyes, lacrimation, dampening of sound.

Front 14

Which of the following has a different anatomical and physiological origin?

Inferior Oblique
Superior Oblique
Lateral Rectus

Back 14

Correct Answer = Superior Oblique

Anatomical Origin = Lesser Wing of the Sphenoid Bone and Common Tendinous Ring (CTR)
Physiological Origin = Trochlea
Recall that the CTR is also referred to as the Annulus of Zinn.

Front 15

A palsy of which of the following muscles will cause the patient to tilt their head to the side opposite the palsy?

IV
III
VI
II

Back 15

Correct Answer = CN 4

Recall that the entire CN IV decussates. Thus, the right superior oblique muscle is controlled by the left superior oblique nucleus. If a patient has a right superior oblique palsy, they will tilt their head to the left. Thus, a patient will always tilt their head in the direction of the side where the nuclear lesion is located but opposite the side of the palsy.

Front 16

What nerve innervates the lateral conjunctiva and lateral part of the upper eyelid?

Back 16

Correct Answer = Lacrimal Nerve
Recall that after innervating the lacrimal gland, the lacrimal nerve then supplies the lateral conjunctiva and lateral part of the UPPER EYELID. You probably remember that V1 provides for the forehead and upper eyelid, correct? Well, remember that V1 consists of the NFL, with the "L" being the Lacrimal nerve, which again, provides for the lateral portion of the upper eyelid.

Front 17

What nerve provides for the lateral part of the lower eyelid?

Back 17

Correct Answer = Zygomatic Nerve
Recall that the infraorbital and zygomatic nerve comprise V2, which provide for the cheek and lower eyelid. If this is confusing to you, remember to picture V1 above the eye, V2 below the eye, and V3 within the mandibular region.

For V2 don't make it difficult. The infraorbital ('below orbit') is right below the orbit and the zygomatic innervates the lateral structures, including the lateral part of the LOWER EYELID.

Front 18

Which of the following cranial nerves is most likely to be affected in a patient with papilledema?

CN IV
CN VI
CN III

Back 18

Correct Answer = CN VI. When there is too much pressure in the brain, CN VI is by far the most likely nerve affected with palsy.

What if a patient presents in your office with vertical diplopia (they see two separate objects with one above the other); what is the the most common nerve affected?
Correct Answer = CN IV.

Front 19

A lesion of the Facial Nerve would elicit all of the following symptoms except?

Loss of Reflex tearing
Inability to close eyelids tightly
Loss of taste from the front of the tongue
Decreased hearing

Back 19

Correct Answer = Decreased hearing / Recall that CN VII dampens sound.

I would expect the questions to center more around the 3 major functions of CN VII (below). As you think about CN VII, first recall that it is MOTOR, MOTOR, MOTOR, with a minor sensory compenent (see textbook if you need more context). Then know that it is the "studly nerve" because it's functions include sensory, voluntary motor and involuntary motor roles:

Sensory: anterior 2/3 taste
Voluntary motor: facial expression (but not mastication)
Involuntary motor: lacrimation and dampening of sound

Front 20

A patient with a pupil involving CN III palsy should be highly suspected of an aneurysm at the junction of which of following two arteries?

Posterior communicating artery / Internal Carotid Artery
Posterior cerebral artery / Internal Carotid Artery
Posterior cerebral artery / Vertebral artery

Back 20

Correct Answer = Posterior Communicating artery and Internal Carotid. Again, this is the most likely location of a PUPIL-INVOLVING CN 3 palsy.Remember, a PUPIL-SPARING CN III palsy is typically from HTN and/or diabetes.These patients will have double vision (from the eye sitting down and out eye), so even though you are excited that they likely do not have an aneurysm - they are antsy because they want the double vision gone. In the majority of cases, the EOM's regain oxygen and the diplopia is resolved within 3 months.

Front 21

Which of the following statements is true?

Strokes are supranuclear lesions that result in ipsilateral muscle paralysis
Bell`s palsy is a lower motor neuron lesion that results in contralateral muscle paralysis to the entire side of the face.
Strokes are lower motor neuron lesions that result in contralateral paralysis
Bell`s palsy is a lower motor neuron lesion that results in ipsilateral damage to the entire side of the face.

Back 21

Correct Answer = 4.

Clinical Context: If a patient comes into your office with a right homonymous hemianopsia from a stroke, the stroke occurred on the left side of the brain. Or, if a patient reports a recent history of stroke and can't move their left arm, you know the stroke occurred on the right side of the brain. Remember, strokes cause CONTRALATERAL issues. Bell's is the opposite; because it damages lower motor neurons (neurons that have already crossed the brainstem), it results in IPSILATERAL issues.

Remember, our main concern with Bell's palsy is EXPOSURE KERATOPATHY. Why?
Correct Answer = Bell's palsy is a type of CN 7 palsy. Recall that CN 7 closes the eye. Lack of CN 7 innervation results in ectropion and subsequent corneal exposure.