Cranial nerve exam Flashcards
Cranial nerve 1
olfactory
1) have patient block 1 nostril
2) use a strong smell like cofee or mint
3) ask if them smell and to identify it
4) change nostrils and repeat
only unilateral olfactory loss is of importance
Cranial nerve II
Optic nerve
1)visual acuity= snellen chart
- patient wears glasses
- test each eye separately
–> want to get down to the most ability to see= if they cant read the letters check if they can see hand movement–> if they can’t see hand movement check for light perception
2)visual fields= confrontation
- test each eye separately
- they look into your opposite eye
- ask them when they can see a pen or wiggling finger coming from diagonal into their centrte of vision
3)fundoscopy
4)inspect the pupils
size
shape
symmetry
regularity
5)pupilary response
-test each eye separately looking for
a)direct response–> pupil constricts when light shined on eye
b)consensual response–> other pupil constricts when light shined in eye
a)RAPD–> shine light into one eye, both pupils should constrict
–> rapidly move the other pupil–> look to see if pupil expands and does not react to light but other one does
6)accomodation
- patient looks into the distance
- focus on pen or finger held 30cm from their face
NORMAL = BOTH PUPILS SHOULD CONSTRICT
Cranial nerve III
Oculomotor
1)check pupils for (repeat from CN 2)
size
shape
regularity
symmetry (> 3mm difference is pathological)
2)inspect eyelids for ptosis
3)pupillary response ( this is a repeat from CN 2)
4)extra occular movements
- cardinal eye movements
- nystagmus
- diplopia at extremes of ROM
Cranial nerve IV
Trochlear
controls the superior oblique muscle
–> this depresses, intorts and abducts the eye
superior oblique lesion leads to
1)eye being up and out
ask about vertical diplopia ( can also be oblique)
Cranial nerve V
Trigeminal nerve
-sensation to the face and muscles of the massetter
compare side to side pinprick and light touch (warn patient before you touch them)
V1= opthalmic
corneal reflex
V2=maxilary
V3=mandibular
- patient should bite down –> feel tension in tempralis and masseters muscles
- jaw jerk
Cranial nerve VI
Abducens
SO4 LR6
= can’t abduct eye
-often compensatory head turn
Cranial nerve VII
Facial
- muscles of facial expression
- tast to anterior 2/3 of tonge
1)inspect face
- symmetry
- sagging of eyelids
- smoothing of wrinkles and folds of face
2)listen to patient speech listening for B, M, P
3)Test motor function
- wrinkle forehead
- squeeze eyes shut (try to keep them closed while I try to open them)
- show teeth
- puff out cheeks
- purse the lips to whistle
- contract platysma ( pull down the corners of your mouth)
4)tast to anterior 2/3 of tonge
Cranial nerve VIII
Vestibulo-cochlear nerve
- hearing and balance
- hearing tested without hearing aid
1)inspect eardrum
- obstructions
- inflammation
- perforation
2)whispered test
rub fingers next to one ear while whispering 60cm from the other
if suspect partial deafness ( whispered test is abnormal) then do
3)Rinne’s test
- 256 or 512 Hz tuning fork on mastoid process
- ask when they can no longer hear the the tuning fork
- put the tuning fork to the external meatus
–> if sensory hearing loss= they will hear it at external meatus
–> if conductive hearing loss= they will not hear it at external meatus
4)Webers test
256 or 512 Hz tuning fork on patients forehead
- sound should be heard in both ears
- Patient with sensory hearing loss the sound should be louder in the normal ear
- patient with conductive hearing loss the sound should be louder in the affected ear
4)romberg test
Cranial nerve IX
Glossopharyngeal
1) location of uvula
2) paient says “ah”–> look for symmetrical movement of soft palate and uvula
3) swallow some water ( also CN X)
4) gag reflex
5) posterior 1/3 of tonge for taste
Cranial nerve X
Vagus
1)voice hoarseness
overlap from CN IX
2) inspect and ah for uvula and soft palate
3) swallow water
4) gag reflex
Cranial nerve XI
Accessory nerve
innervates trapezius and sternocleidomastoid
1) inspect for muscle bulk
2) Push down on patients shrugged shoulders
3) Ask patient to turn head side to side and you push against
Cranial nerve XII
Hypoglossal nerve
motor nerve for tonge
1) inspect tonge looking for wasting and fasciculations
2) ask patient to stick tonge out
look for deviation ( deviates towards side of lesion)
3) muscle strength (push on tonge through cheek)
4) lingual sounds on speech L, T, D,N
