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OSCE 2 > Cranial Nerve Exam > Flashcards

Cranial Nerve Exam Flashcards

1
Q

What is CN VIII (8)?

A

Vestibulocochlear nerve

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2
Q

What is CN IX (9)?

A

Glossopharyngeal Nerve

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3
Q

What is CN XI (11)?

A

Spinal accessory nerve

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4
Q

What is CN XII (12)?

A

Hypoglossal nerve

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5
Q

What is the pathology?

A

Bell’s Palsy (unilateral facial nerve weakness)

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6
Q

What is the pathology?

A

Stroke (UMN lesion affecting the facial muscles)

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7
Q

How can Bell’s be differentiated from a facial stroke?

A

Forehead sparing in stroke

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8
Q

Why is there forehead sparing in stroke?

A

Bilateral UMN supply to the superior part of the facial nerve nucleus

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9
Q

What is this sign?

A

Ptosis

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10
Q

What is this sign?

(Not the ptosis)

A

Miosis (pupil constricted)

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11
Q

What is this sign?

A

Mydriasis (pupil dilation)

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12
Q

How can you distinguish unilateral miosis from unilateral mydriasis?

A

The normal pupil should be more constricted in brighter light

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13
Q

What abnormality of speech is relevant to a cranial nerve exam?

A

Dysarthria (problems with articulation)

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14
Q

What are the aspects of a full optic nerve assessment?

(Doing all of these in an exam is excessive unless specifically asked to)

A
  • Pupil inspection
  • Visual acuity
  • Pupillary reflexes
  • Colour vision
  • Visual fields
  • Fundoscopy
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15
Q

What are the essential aspects of an optic nerve assessment?

A
  • Pupil inspection
  • Visual acuity (brief tests of ability to read/see)
  • Visual fields
  • Fundoscopy (may not be needed)
  • Pupillary reflexes (also CN III)
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16
Q

What is the type of anisocoria and what is the likely cause?

A

Mydriasis - CN III lesion

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17
Q

What is the type of anisocoria and what is the likely cause?

A

Miosis - Horner’s syndrome

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18
Q

If performing fundoscopy as part of a cranial nerve exam, what aspects should be included?

A
  • Red reflex
  • Retinal visualisation
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19
Q

What is the name of and what can cause this sort of visual field defect?

A
  • Monocular blindness
  • Optic nerve or retinal lesion
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20
Q

What is the name of and what can cause this sort of visual field defect?

A
  • Bitemporal hemianopia
  • Lesion at the optic chiasm
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21
Q

What can cause a lesion at the optic chiasm?

A

Pituitary tumour

22
Q

What is the name of and what can cause this sort of visual field defect?

A
  • Right homonymous hemianopia
  • Lesion of the optic tract
23
Q

What is shown here?

A

Nystagmus

24
Q

Palsy of which nerve is seen here?

A

Abducens

25
Q

Palsy of which nerve is seen here?

A

Oculomotor nerve

26
Q

Palsy of which nerve is seen here?

A

Trochlear nerve

27
Q

What are the tests of pupillary reflexes?

A
  • Accommodation reflex
  • Direct pupillary reflex
  • Consensual pupillary reflex
  • Swinging light test
28
Q

Which nerves are involved in the light reflexes?

A

2 and 3

29
Q

If there is absence of direct reflex but presence of consensual, which nerve is affected?

A

2

30
Q

If there is absence of direct and consensual reflexes in one eye, which nerve is affected?

A

3

31
Q

If there is loss of consensual reflex only which nerve is affected?

A

The contralateral 2nd nerve

32
Q

How can the vestibulocochlear nerve be tested?

A
  • Whisper a number in the paitent’s ear and ask them to repeat it
  • Weber’s test
  • Rinne’s test
33
Q

What is Weber’s test?

A
  • Place a tuning fork on the patient’s forehead
  • Ask them which ear it localises to if any
34
Q

What does localisation of Weber’s test suggest?

A

Asymmetrical hearing loss

35
Q

Where does the sound localise to in an asymmetrical sensorineural hearing loss in Weber’s test?

A

The unaffected ear

36
Q

Where does the sound localise to in an asymmetrical conductive hearing loss in Weber’s test?

A

Affected ear

37
Q

What is Rinne’s test?

A
  • Place the tuning fork on the mastoid process and ask them to tell you when it stops
  • Move fork to in front of ear and ask if they can still hear it
38
Q

What result of Rinne’s suggests conductive hearing loss?

A

Unable to hear once moved from mastoid

39
Q

What suggests sensorineural loss in Rinne’s test?

A

Able to hear sound when moved from mastoid process (in the ear that sound localised away from in Weber’s test - will show the same Rinne result in normal ear)

40
Q

What are the Bulbar cranial nerves?

A

9, 10, 12

41
Q

How should the bulbar nerves be tested?

A
  • Cough
  • Articulation
  • Examine pharynx
  • Tongue movements
42
Q

What cranial nerve is tested by asking the patient to cough?

A

10 (vagus)

43
Q

What nerves are involved in articulation?

A
  • (7)
  • 10
  • 12
44
Q

How is the pharynx examined?

A
  • Use a tongue depressor and pen torch
  • Ask the patient to say ahh and observe uvula
  • Remove tongue depressor
  • Ask to swallow
45
Q

Where does the uvula deviate in a CN IX or X lesion?

A

Away from the lesion on saying ahh

46
Q

What is not normally tested in a conscious patient?

A

Gag reflex

47
Q

How is CN 12 tested?

A
  • Ask the patient to stick their tongue out
  • Observe for wasting
  • Move side to side
  • Push tongue into side of cheek and apply resistance
48
Q

What indicates a CN 12 lesion?

A

Deviation towards the lesion

49
Q

Which muscle provides shoulder shrugging?

A

Trapezius

50
Q

What additional tests can be considered after a cranial nerve exam?

A
  • Neuro exam of the limbs
  • Gait and balance
  • CT/MRI head
51
Q

What is shown here?

A

Left CN XII lesion

52
Q

What is shown here?

A

Left CN IX or X lesion

OSCE 2 (15 decks)

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