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OSCE - examinations > Cranial nerve exam > Flashcards

Cranial nerve exam Flashcards

1
Q

How would you test CN-I (olfactory)?

A

Have you noticed any changes in smell recently?

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2
Q

How would you test CN-II (optic)?

A
  1. Visual acuity
  2. Visual fields
  3. Pupillary reflexes
  4. Fundus
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3
Q

How would you test visual acuity?

A

“Do you wear glasses or contacts?”

“Have you had any problems with your vision lately?”

Snellen chart, ask pt to read sth covering one eye at a time

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4
Q

How would you test visual fields?

A
  1. Inattention: look at may nose, put your arms at both sides and wiggle one or two fingers (stroke)
  2. Visual field (ideally with a white hat pin)
    “look at my nose, can you see my whole face”

Cover one eye at a time while also covering own opposite eye. Test all four corners for both eyes

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5
Q

How would you test pupillary reflexes?

A

Ask pt to concentrate on spot on the wall

Look for direct and consensual response

Swinging torch test !

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6
Q

What is RAPD?

A

Rapid afferent pupillary defect

Often due to optic neuritis secondary to MS

investigate with swinging torch test

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7
Q

How would you test the fundus?

A

“I would ideally like to examine the funds by ophthalmoscopy”

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8
Q

How would you test CN-III, CN-IV and CN-VI (oculomotor, trochlear, abducens)?

A
  1. Eye movements

2. Accommodation

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9
Q

What would abnormal position of eye indicate?

A

Oculomotor lesion

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10
Q

How would you test eye movements?

A

“Keep your head still and follow my finger”

“Let me know if you see double at any point”

H movement

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11
Q

What is ophthalmoplegia?

A

Paralysis of the extraocular muscles that control the movements of the eye

Can be seen when doing eye movement test

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12
Q

If there is diplopia during eye movement tests, what would you ask?

A
  1. Ask if image is separated horizontally or vertically
  2. Cover each eye in turn, which image disappears?
  3. Looking to the side: lateral image from affected side
  4. Looking down: lower image from affected side
  5. Looking up: upper image from affected side
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13
Q

How would you test for accommodation?

A

‘Keep looking at my finger”

Bring finger to nose of patient, pupils should constrict

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14
Q

How would you categorise the tests for CN-V (trigeminal)?

A
  1. Sensory
  2. Motor
  3. Reflexes
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15
Q

How would you test for sensory in CN-V (trigeminal)?

A

Ask patient to close eyes and say yes when you touch them

Go over:

  1. Ophthalmic division: above eyebrows
  2. Maxillary division: over zygoma
  3. Mandibular division: jaw

Do both sides feel the same?

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16
Q

How would you test for motor in CN-V (trigeminal)?

A
  1. Jaw opening against resistance

2. Jaw clenching: feel masseter and feel frontalis

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17
Q

How would you test for reflexes in CN-V (trigeminal)?

A
  1. Mention corneal rerflex (or cotton wool in nostril)

2. Jaw jerk

18
Q

What is a minimal or absent jaw jerk indicative of? And a brisk one?

A

Minimal: normal

Brisk: UMN, stroke, tumour, MS

19
Q

How would you categorise the tests for CN-VII (facial)?

A
  1. Facial tone
  2. Motor
  3. Sensory
20
Q

How would you test for facial tone in CN-VII (facial)?

A

Look for reduced facial tone:

  1. Reduced wrinkling of forehead (LMN)
  2. Drooping of corner of mouth
  3. Flattening of nasolabial fold
21
Q

How would you test for motor in CN-VII (facial)?

A

Raise eyebrows
Screw up eyes, and don’t let me open them
Puff out cheeks
Teethy smile

22
Q

How would you test for sensory in CN-VII (facial)?

A

“Have you noticed any changes in taste (anterior 2/3 of tongue; chordates tympani)

“Are you troubled by loud noises?” (branch to stapedius)

23
Q

How would you test for CN-VIII (vestibulocochlear)?

A
  1. Hearing: stroke tragus and look at ear. Whisper numbers on both sides
  2. Rinne and Weber test
24
Q

How would you test for CN-IX, CN-X and CN-XII (glossopharyngeal, vagus, hypoglossal)?

A
  1. Bulbar function: say aaa and look at movement of uvula, speech, water swallowing
  2. Tongue: appearance and movement
25
Q

What does choking or spluttering of water indicate?

A

Possible bulbar deficit

26
Q

What does a flaccid, wasted or fasciculating tongue indicate?

A

Bulbar palsy

27
Q

What does a spastic and contracted tongue indicate?

A

Pseudobulbar palsy

28
Q

How would you test for CN-XI (Accessory)?

A

Trapezius - shrug against shoulder resistance

Sternocleidomastoids - turn head against resistance

29
Q

What tests would you recommend after a cranial nerve examination?

A

Fundoscopy
MRI/CT
Formal hearing test

30
Q

What is the cause of unilateral versus bilateral ptosis?

A

Uni: CN III palsy, Horner’s, congenital

Bi: MG, myotonic dystrophy, congenital

31
Q

What are features of CN III palsy?

A

Eyes deviated down and out

Ptosis

32
Q

What are the causes of optic nerve palsy?

A

Trauma
Frontal lobe tumour
Meningitis

33
Q

What are the causes of olfactory nerve palsy?

A

Monocular blindness: MS, giant cell arteritis

Bitemporal hemianopia; pituitary adenoma, internal carotid aneurysm

Homonymous hemianopia: anything behind chiasm, stroke/tumour/abscess

34
Q

What are the causes of oculomotor nerve palsy?

A

Pupil spared: diabetes

Complete: PCA aneurysm, raised iCP

35
Q

What are the causes of trochlear nerve palsy?

A

Rare! Orbit trauma

36
Q

What are the causes of trigeminal nerve palsy?

A

Idiopathic: trigeminal neuralgia
Acoustic neuroma
Herpes zoster

37
Q

What are the causes of abducens nerve palsy?

A

Skull fracture including petrous temporal bone
nasopharyngeal carcinoma
Raised ICP

38
Q

What are the causes of facial nerve palsy?

A

Forehead affected (LMN): Bell’s, malignant parotid tumour, herpes zoster, sarcoid

Forehead spared (UMN): stroke/tumour

39
Q

What are the causes of vestibulocochlear nerve palsy?

A

Excessive noise levels
Jenieke’s
Furosemide
Gentamicin

40
Q

What are the causes of CN-IX/X/XII nerve palsy?

A

LMN: MND, diphtheria, polio, MG, GB-syndrome

UMN: MND, bilateral strokes, MS

41
Q

What cranial nerves are affected in Paget’s disease of bone?

A

Bony impingement on nerves: V, VII, VIII

42
Q

What cranial nerves are affected in cavernous sinus thrombosis?

A

III, IV, VI (ophthalmic pani)

OSCE - examinations (13 decks)

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