Cranial nerve exam

Question 1

Cranial nerve 1- olfactory

Answer 1

have you noticed any change in your sense of smell?

have you had a cold or a head injury?

Question 2

nerve 2- optic

Answer 2

do you ever get double vision?
Do you have difficulty seeing the stairs when you walk downstairs?
Do you wear glasses?

resting position of eyes, eyelid and pupil abnormality,
nystagmus

take your time

Snellen chart with one eye occluded (6m)

visual fields by confrontation

fundoscopy

light reflexes

accommodation reflex

Question 3

Eye movements (2, 3, 4, 6)
-optic, oculomotor, trochlear, abducens

Answer 3

H test

slowly

Question 4

nerve 5 (trigeminal)

Answer 4

light touch comparing side to side

offer pin prick

muscles of mastication:
clench teeth and palpate for masseter and temporalis

protraction and side to side movement

open jaw against resistance

jaw jerk

Question 5

nerve 7 (facial)

Answer 5

inspect for asymetry

test muscle power:
grimace and show me your teeth
say me-me-me
puff out your cheeks
screw your eyes up 
look upwards 

corneal reflex

Question 6

bells palsy

Answer 6

lower motor neurone lesion- forehead and face paralysed

Question 7

stroke

Answer 7

UMN lesion, forehead spared while face is paralysed

Question 8

taste and salivation (facial nerve)

Answer 8

have you had a change in taste

have you had a dry mouth or dry eyes

Question 9

Ears

Answer 9

ask about hearing problems
inspect ears- look for hearing aid, pinnae, scalp, ear canals

perform auroscopy

Question 10

Cn 8 - vestibulocochlear

Answer 10

whisper test

weber’s test
rinne’s test

audiometry

ask about vertigo

Question 11

glossopharyngeal (9) and vagus (10)

Answer 11

inspect palate and pharynx with a pen torch
say ahh
ask patient to cough 
say kuh kuh kuh
gag reflex
swallow water

Question 12

accessory nerve- 11

Answer 12

head movement- side to side and forwards

shrug shoulders against resistance

Question 13

hypoglossal- 12

Answer 13

inspect the tongue
stick out tongue
movements of tongue (side to side)
power of tongue (push into cheek)

speech- say a tongue twister (yellow lorry, baby hippopotamus)

Question 14

Uvula moves to one side

Answer 14

suggests a lesion of vagus.

Question 15

uvula does not move

Answer 15

bilateral palatal muscle paresis

Question 16

gag reflex

Answer 16

must be done before asking patient to swallow water

Question 17

weber and rinne’s

Answer 17

offer if whisper test is reduced

Question 18

corneal reflex branches

Answer 18

5- afferent

7 efferent

Question 19

pathological jaw jerk

Answer 19

brisk reflex- bilateral UML

Question 20

light touch

Answer 20

demonstrate on sternum first

Question 21

ocular paresis of cn 3

Answer 21

ptosis, eye is lateral and slightly downwards, pupil may be dilated and unresponsivec

Question 22

ocular paresis of cn 4

Answer 22

impaired depression of fully adducted eye, head may be tilted to the opposite side

Question 23

ocular paresis of cn 6

Answer 23

impaired abduction

Question 24

what nerves are tested in the corneal reflex

Answer 24

5 and 7

Question 25

what could cause an oculomotor nerve lesion

Answer 25

raised intracranial pressure and downward depression of the brain compressing the third nerve against the free edge of the tentorium cerebelli.

Question 26

what does a 3rd cn lesion present as

Answer 26

Ptosis, eye deviated laterally and slightly downwards, pupil may be dilated and unresponsive.

Question 27

what does a 4th cn lesion present as

Answer 27

impaired depression of the fully adducted eye, head tilted to the other side
double vision

Question 28

what does a 6th cn lesion present as

Answer 28

impaired abduction

Question 29

what are the causes of nystagmus

Answer 29

abnormalities of the vestibular system

abnormalities of the cerebellum or central vestibular connections

damage to the retina

Question 30

what part of the brain controls persuit eye movements

Answer 30

occipital lobe

Question 31

what eye muscles are controlled by occulomotor

Answer 31

levator palpebrae
medial rectus
superior rectus and inferior oblique
inferior rectus

Question 32

what nerve supplies superior oblique

Answer 32

trochlea

Question 33

what controls accommodation reflex

Answer 33

cn2 and cn3