Cranial nerve exam

Question 1

How do you test CN I?

Answer 1

Ask patient about changes in their sense of smell

Question 2

How do you test CN II?

Answer 2

1. Inspect pupils
2. Visual acuity
3. Direct and consensual pupillary light reflexes
4. Accommodation reflex
5. Colour vision (Ishihara chart)
6. Visual inattention and visual fields (peripheral)

Question 3

How do you test CN III, IV and VI?

Answer 3

Assess eye movements by drawing a big H, ask about double vision

Question 4

How do you test CN V?

Answer 4

1. Cotton wool / neuro-tip on each branch
2. Assess muscle bulk of temporalis and masseter (clench jaw + open mouth against resistance)
3. Jaw jerk reflex
   (4. Corneal reflex)

Question 5

How do you test CN VII?

Answer 5

1. Facial expression (raise eyebrows, close eyes, bare teeth, purse lips, puff cheeks)
2. Change in taste?
3. Hearing louder than usual? (occurs in stapedius muscle paralysis)
4. Inspect external ear

Question 6

How do you test CN VIII?

Answer 6

1. March on spot with eyes closed
2. Whisper a word at changing distances
3. Rinne’s test - tuning fork on mastoid process
4. Weber’s test - tuning fork on centre of forehead

Question 7

How do you test CN IX and X?

Answer 7

1. Inspect uvula / soft palate as patient says “ah”
2. Gag reflex
3. Cough
4. Swallow water and assess for delay

Question 8

How do you test CN XI?

Answer 8

Assess trapezius (shrug shoulders) and sternocleidomastoid (turn head)

Question 9

How do you test CN XII?

Answer 9

1. Assess tongue appearance (fasciculations?)
2. Protrude tongue (deviation?)
3. Assess tongue strength (against cheek and press)