CNS II Flashcards
12 cranial nerves assessment
CN I assessment procedure
present props (coffee & soap) to one of the nostril & another one being occluded
CN I assessment abnormal result
inability to identify correct scent > loss of smell > inability to smell
CN I assessment normal result
correctly identify scent
CN II assessment 4 areas
- pupillary reaction
- vision acuity
- vision field
- optic fundi
CN II vision acuity assessment procedure
Snellen chart: 20 feet distance away
Newspaper: 35 cm away
CN II visual field assessment procedure
confrontation test in 4 visual qaurdrants
CN II optic fundi assessment procedure
use ophthalmoscope to assess retina & optic disc
CN II pupillary reaction assessment procedure
direct & concensual test
(react to direct light source on one side & another side also react by constriction)
CN II vision acuity assessment normal result
Snellen chart: test with one eye covered
Documentation: 20/20 vision (=able to see what an average person can see 20 feet away)
CN II optic fundi assessment normal result
- round red reflex is presented
- retina is pink
- optic disc: 1.5mm, round & oval shape, clear margin, creamy pink & paler physiologic cup
CN II vision acuity assessment abnormal result
Snellen chart: difficulty in reading, squinting eye
newspaper: closer > 35 cm/ farther (persbyopia, occur when aging)
CN II vision field assessment abnormal result
loss of vision field: retina damage/ detachment; parietal cortex lesion; optic nerve lesion
CN II & III assessment procedure & documentation
use penlight for direct & concensual response
Documention: PERRLA
pupil equal, round, react to light, accomodation
CN II & III assessment normal result
- bilateral illuminated pupils constrict simltaneously
- benign anisocoria: differ >0.5mm & reaction
CN II & III assessment abnormal result
- dilated pupils (6-7mm): oculootor paralysis
- Argyll Roberston pupils: neurosyphilis, alcoholism
- constrited/ fized pupils: narcotic abuse
- unilateral pupil unresponsive to loght/ no accomodation: CN III (oculomotor) damage
- Constricted pupils unresponsive to light/ accomodation: synpathetic nervous system lesion
CN II & III assessment abnormal result: signs of Argyll Roberston
- small pupils
- non-reactive to light
- do accomodate
CN III & IV & V assessment procedure
observe pt’s eyes movement by requiring pt to follow a moving target to detect nystagmus
CN III & IV & V assessment normal result
- PERRLA: pupil equal, round, reactive to light, accomodation
- smooth & coordinated movement in all directions
- eyelid cover 2mm of the iris
CN III & IV & V assessment 3 area
- margins of the eyelids
- extraoculor movement
- pupillary reaction
CN III & IV & V assessment 4 abnormal result
- abnormal pupillary reaction
- limited eye movement in the 4 area
- strabismus
- Nystagmus (rhythmic ocillation of the eyes)
CN VI chewing function assessment procedure
ask pt to clentch and palpate temporal & messester muscle contraction
CN VI sensation of 3
divisions (ophthalmic,
maxillary, mandibular) assessment procedure
- pt close eyes > use dull simulus (paper clip) to touch 3 divisions
- pt look up & away from examiner > use fine wisp cotton paper to approach pt’s cornea from out of his line of vision
CN VI 3 areas of assessment
- cornea reflex
- motor: messester & temporal
- sensation: pain, temperature & tactile sensation
CN VI assessment normal result
bilateral contraction of temporal & messester
CN VI assessment abnormal result
- unilateral/ bilateral sides muscle weakness
- pain when clentching
- decrease contraction on one/ both sides
- asymmetrical strength in moving jaw
CN VIII assessment procedure
- Weber, Rinne & Whisper test
- ask pt to close their eyes & stand for 20s & inspect their stability
CN VIII assessment normal result
- Weber: Vibration should be heard by both sides of the ears
- Rinnie: Air Conduction > Bone conduction
- Whisper: hear whispered words clearly from 1-2 feet away
CN VIII assessment abnormal result
- Air conduction is not as twice longer than bone conduction
- Vibratory sounds is lateralized in good ears
CN IX& X assessment proedure
- ask patient to say ‘ahh’
- bilateral & symmetrical arise of soft palete & uvula, without hoarse
- take a sip of water to see ability to swallow
- use tongue depressor to lightly touch posterior part of the tongue to see gag reflex
CN IX& X assessment 3 areas
- motor function of pharyn larynx, soft palete
- gag reflex
- ability to swallow
CN IX & X assessment normal result
- soft palete & uvula arise bilaterally & symmetrically while phonation
- Swallow without difficulties & without hoarseness
- gag reflex present
CN IX & X assessment 3 abnormal result
- hoarseness present
- absent of gag reflex
- soft palete do not arise bilaterally
CN XI assessment procedure
- inspect symmetry of scapula & neck & shoulder muscle
- apply counterforce when ask pt to turn their head to left/ right > test sternocleidomastoid strength against force
- apply countreforce when ask pt to shrug their shoulders > test trapezius
CN XI assessment normal result
- strong contraction of sternocleimastoid oppposite the side where the face turn to
- symmetrical & strong contraction of trapezius
CN XI assessment abnormal result
- muscle weakness
- muscle atrophy/ fasciculaton
- asymmetrical muscle contraction
CN XII assessment procedure
- ask pt to stick out his tongue & move from side to side
- ask pt to say ‘light’ & ‘tight’, notice their pronunciation
CN XII assessment normal result
smooth & symmetric tongue movement
bilateral strength
CN XII assessment abnormal result
- tongue atrophy/ fasciculation
- tongue deviation
Motor & cerebellum system: how to test condition & movement of muscle
observe gait
weight should be evenly distribued
stand on toes & heels
Motor & cerebellum system: Romberg test
To test balance
ask patient to stand up & oserve any unsteadiness & imblanace
ask patient to close eyes for 20s, observe imbalance & swaying
Motor & cerebellum system: 5 tests for coordination
- tandem walking: walk on straight heels & toes
- tandem stand: stand on one foot, do a shallow knee bend/ hop
- rapid hand alternation movement
- finger to nose
- heel slide test
What is the sequence of sensation test?
light touch> pain> temperature
from dital to proximal each limb
what instrument is use for vibration sensation test?
tunning fork
from distal to proximal each limb
2 tests for testing tacile discrimmination
- test position sense
- stereognosis: recognize objects by touching
point localization test
breifly touch patient> ask to identify which point is being touched
What is graphesthesia?
use intrument to write number on patient’s hand, a kthem to identify the numbers written
two point discrimmination test
patient cloed eye> identify number of points being touched with EKG calibers> when patient no longer separate 2 point: measure the distance of the two points
How to test extinction
simultaneously touch the same area of the both side of the body, ask patient to identify the area touched
Kernig’s signs & Brudzinski’s sign & testing neck’s mobility is for?
meningeal irritation/ inflammation
