Cranial nerve anatomy and reflexes

This link directory works to subvert the aims of Section K1(i) from the 2023 CICM Primary Syllabus, which asks the exam candidate to "describe the anatomy of cranial nerves relevant to brainstem reflexes". It is literally the first item in the syllabus, and it remains completely forgotten by the CICM First Part examiners, with absolutely no questions about it in any of the past exam papers. On the other hand, the Second Part Exam is practically lousy with them. An incomplete list of representative questions is as follows:

The topic of cranial nerve anatomy and reflex examination is a complicated one, which requires the reader to memorise all sorts of tabulated material. The material itself also resists being learned because of the fact that it is completely illogical, i.e. it is impossible to learn some sort of theory and then apply it to all cases - instead, each bit of information needs to be memorised, because there is no unifying principle describing them.  From this, a heretical statement follows: that this part of the CICM syllabus document can be safely ignored until after the primary exam. No one is saying that the cranial nerves are unimportant, but pragmatic self-preservation instincts of the learner should direct them to leave them alone, focusing instead on topics like the production of the CSF, which for some reason seems to come up in almost every second paper.

Still, not wanting to  leave the trainee without some direction, the following chapters from the Second Part preparation section will be of interest:


J.A. Simpson, W. Fitch, "Chapter 17 - Reflex activity". Applied Neurophysiology, Butterworth-Heinemann, 1988,

Chen, Hsiao-Huei, et al. "Development of the monosynaptic stretch reflex circuit." Current opinion in neurobiology 13.1 (2003): 96-102.

Simpson, J. A. "REFLEX ACTIVITY OF THE SPINAL CORD." Journal of Neurology, Neurosurgery, and Psychiatry 38.2 (1975): 202.

Bussel, B., C. Morin, and E. Pierrot-Deseilligny. "Mechanism of monosynaptic reflex reinforcement during Jendrassik manoeuvre in man." Journal of Neurology, Neurosurgery & Psychiatry 41.1 (1978): 40-44.

Gregory, J., S. Wood, and U. Proske. "An investigation into mechanisms of reflex reinforcement by the Jendrassik manoeuvre." Experimental Brain Research 138.3 (2001): 366-374.

Boyraz, Ismail, et al. "Clonus: definition, mechanism, treatment." Med Glas (Zenica) 12.1 (2015): 19-26.

Yates, C., et al. "Novel mechanism for hyperreflexia and spasticity." Progress in brain research 188 (2011): 167-180.

Hultborn, Hans. "Spinal reflexes, mechanisms and concepts: from Eccles to Lundberg and beyond." Progress in neurobiology 78.3-5 (2006): 215-232.

Hultborn, Hans. "Spinal reflexes, mechanisms and concepts: from Eccles to Lundberg and beyond." Progress in neurobiology 78.3-5 (2006): 215-232.

Schiller, Francis. "The reflex hammer. In memoriam Robert Wartenberg (1887–1956)." Medical history 11.1 (1967): 75-85.

Bynum, Bill, and Helen Bynum. "Reflex hammer." The Lancet 390.10095 (2017): 641.

Pinto, Francisco. "A short history of the reflex hammer." Practical Neurology 3.6 (2003): 366-371.

Schwartz, R. S., et al. "A comparison of two methods of eliciting the ankle jerk." Australian and New Zealand journal of medicine 20.2 (1990): 116-119.