CN examination

Question 1

CN I

Answer 1

test each nostril separately with non-irritating substance (coffee, cinnamon, etc)
often omitted from exam, unless pt. has suspected frontal damage, reports loss of taste/smell

Question 2

CN II

Answer 2

visual acuity - snellen chart
visual fields and confrontation
pupillary dilation

Question 3

CN III

Answer 3

pupillary reflexes (reactivity to light, convergence with constriction of pupils)
EOMS = oculomotor muscles (up, down, in, elevation of eyelids)
Observe for ptosis

Question 4

CN IV

Answer 4

Test with EOMS (depression and adduction)

voluntary eye mvmnts, smooth pursuits, saccades

Question 5

CN V

Answer 5

cranial sensation (cotton swab for sensory testing to face and scalp)
corneal reflex (cotton swab to cornea)
Jaw mvmnts (palpation of temporalis and masseter, strength test jaw opening/closure)

Question 6

CN VI

Answer 6

EOM (abduction)

Question 7

CN VII

Answer 7

taste (anterior 2/3 of tongue)
sensation (cotton swap to ear)
facial mvmnts (observe facial symmetry and expression)

Question 8

What are the prompts to assess CN VII facial mvmnts?

Answer 8

Have patient tightly close eyelids, observe for buried lashes and symmetry
Instruct patient to grimace, smile, purse lips, puff out cheeks, wrinkle forehead, raise eyebrows and close eyelids.

Question 9

CN VIII

Answer 9

auditory (tuning fork, rubbing fingers together, watch)

vestibular (gaze fixation, balance, analysis of dizziness)

Question 10

CN IX

Answer 10

gag reflex (stimulate pharyngeal wall)
look for elevation of palate B with symmetrical uvula mvmnts during "ah"

Question 11

CN X

Answer 11

touch to ear
gag reflex (with CN IX) / listen to speech
Exam of soft palate (with CN IX)
Not tested but look for signs of autonomic imbalance

Question 12

CN XI

Answer 12

Test SCM and upper trap strength

Question 13

CN XII

Answer 13

protrude tongue (symmetry?)