Cranial Nerve Critical Thinking Indicate which of the 12 cranial nerves (using R
ID: 240905 • Letter: C
Question
Cranial Nerve Critical Thinking Indicate which of the 12 cranial nerves (using Roman numerals) may be involved in the abnormal signs or symptoms described in each patient below. Cranial nerve choices may be used once, more than once, or not at all. One best answer per item. Patient complains of difficulty in swallowing and movingOffactory food around mouth with tongue Optic You note that your patient's voice sounds unusual and he complains of inability to "yawn within his throat He also complains of some difficulity in rotating and send- bending his head on his neck, as well as in extension of the neck and elevating the shoulders Your patient complains of altered gastrointestinal function that is unexplained by any tests you have run She also has unpredictable and unexplained fluctuations in her blood sugar levels. oculomotor IV Trochlear V Trigeminal VI 4 VIII Patient complains of a ringing in their ears Patient describes visual disturbances in right eye Abducens Patient seems to have speaking difficulties related to what they describe as a "wooden (stiff) tongue VIl Facial The left side of the patient's face appears expressionless. He seems to have lost the ability to close his left eye and the left comer of his mouth "sags and his wet with saliva. Patient has numbness around his right eye, across the VIll Vestibulocochlear right cheek, and extending inferiorly onto the right jaw- ine 9 Your patient describes difficulty in chewing toughfoods Ix Glossopharyngeal 1,apples like apples and steak-the movements seem labored and weak. You note that your patient's left pupil stays facing forward when she is asked to visually track a pen light to the left a pen light x v 11i xI Accessory You note that your patient seems to have balance issues when entering the exam room Patient complains of smeling a constant odor of yeast XIl Hypoglossal Mr. Jones has unexplained problems with heart rate and blood pressure regulation 13 14medially, down You note that your patient has lost the ability to look up, medially, down and to rotate their right eyeball superolaterally Upon testing you note that the patient has lost the sensation of taste on the anterior 2/3's of her tongue 15 | | Created by Lisa K Conley. PhO. September 2009. Use only with permission.Explanation / Answer
XII Hypoglossal. This nerve supplies to the tongue. it is responsible for tongue movements in speech and swallowing. Here the patient is having difficulty in swallowing and movement of tongue. XI Accessory. It consists of two parts, that is cranial and spinal parts. Cranial part: controls swallowing movements, supplies the internal laryngeal muscles. Spinal part: movement of the head and shoulders, supplies sternocleidomastoid and trapezius muscles. The patient has difficulty in yarning and difficulty in bending head and extension of head. X Vagus (Motor fibers). There are two fibers, motor and sensory fibers. The motor fibers stimulates voluntary muscles that effect swallowing, coughing and speech, stimulates the contraction and relaxation of smooth muscle in the gastrointestinal tract, can trigger reduction of heart-rate and stimulates secretion of digestive fluids. Sensory Fibres: Monitors blood pressure, monitors levels of oxygen and carbon dioxide in blood, sensations of touch, pain and temperature from thoat area and sensations from visceral organs in thorax and abdomen. Here the patient has altered GI function and fluctuations in blood sugar levels. VIII Vestibulocochlear (Cochlear nerve). Two branches: Vestibular nerve senses posture, movement equilibrium and cochlear nerve aids in hearing. Patient complains of ringing in the ear. II Optic. This nerve is responsible for vision, also called eyesight. Patient has visual disturbances. XII Hypoglossal. It supplies the muscles of the tongue that is responsible for the tongue movements involved in speech and swallowing. Patient has speaking difficulty and stiff tongue. VII Facial. The sensory fibres are concerned with taste via the taste buds at the front of the tongue. Motor fibres control secretion of tears via the lacrimal glands and saliva via the sublingual salivary glands as well as facial expressions via some of the muscles of facial expression. The patient seems to be expressionless. V Trigeminal. This is largest cranial nerve and splits into the following 3 divisions, each of which includes both motor and sensory fibres. they are ophthalmic nerve, maxillary nerve and mandibular nerve. The sensory fibres convey sensations of touch, pain and temperature from the front of the head including the mouth and also from the meninges. The patient has numbness of face which is because of sensory fibres. V Trigeminal. The motor fibres of all 3 divisions control the facial muscles involved in chewing. The patient has difficulty in chewing. VI Abducens. Moves the eyeballs outwards by sending nerve impulses to the lateral rectus muscles. The patient cannot track the light and move eyes. VIII Vestibulocochlear (Vestibular nerve). It aids in equilibrium by carrying impulses from the semicircular canals - providing info about posture, movement and balance. The patient has balance issues. I Olfactory. It is responsible for smell. Patient complains of smelling a constant odour of yeast. X Vagus (Sensory fibers). Sensory fiberes monitors blood pressure, monitors levels of oxygen and carbon dioxide in blood, sensations of touch, pain and temperature from thoat area and sensations from visceral organs in thorax and abdomen. Motor Fibres: Stimulates voluntary muscles that effect swallowing, coughing and speech. it stimulates the contraction and relaxation of smooth muscle in the gastrointestinal tract, can trigger reduction (slowing) of heart-rate and stimulates secretion of digestive fluids. The patient has unexplained problems with heart rate and blood pressure. III Oculomotor. It moves the eyeball and eyelid, adjusts the lens of the eye for near vision and also constricts the pupil of the eye via motor fibres distributed to muscles located in and around the eye. The patient cannot move the eyes. VII Facial. Sensory fibres are concerned with taste via the taste buds at the front of the tongue. Motor fibres control secretion of tears via the lacrimal glands and saliva via the sublingual salivary glands. The patient lost sensation of taste.