Cranial Nerve Exam Order

Question 1

What are the 13 steps?

Answer 1

1. Introduction
2. Position and exposure
3. General inspection (mentions 2)
4. Olfactory (I)
5. Optic (II)
6. Oculomotor (III), Trochlear (IV), Abducens (VI)
7. Trigeminal (V)
8. Facial (VII)
9. Vestibulocochlear (VIII)
10. Glossopharyngeal (IX), vagus (X)
11. Accessory (XI)
12. Hypoglossal
13. End

Question 2

What is included in introduction?

Answer 2

1. Checks patients name and states role
2. Obtains consent for examination
3. Washes hands

Question 3

What is in position and exposure?

Answer 3

1. Appropriate exposure

2. Checks patient is comfortable and in an adequate position

Question 4

What are you looking for in general inspection?

Answer 4

1. squint
2. ptosis
3. facial droop
4. asymmetric or abnormal eye position and pupils

Question 5

How do you test for the olfactory nerve (I)?

Answer 5

1. Asks about any change in sense of smell

2. Offers to use scented bottles testing each nostril separately

Question 6

What are the steps to test the optic (II) nerve?

Answer 6

1. Asks about corrective lenses
2. Describes pupils
3. Offers to assess the acuity of each eye with Snellen’s chart
4. Tests visual fields
5. Tests visual inattention
6. Tests accommodation reflex
7. Tests pupillary reflex with pen-torch: swinging light reflex
8. Offers to asses Colour vision with Ishihara Colour plates and to test for blind spot
9. Offers to perform fundoscopy

Question 7

How do you test for the oculomotor (III), Trochlear (IV) and abducens (VI) nerve?

Answer 7

1. Tests movements of the eyes with the patient’s head still
2. Asks about blurring or diplopia
3. Assess for nystagmus

Question 8

What are the 3 categories for the trigeminal nerve (V)?

Answer 8

• sensation
• motor
• reflex

Question 9

How do you test the sensation of the trigeminal (V) nerve?

Answer 9

light touch in ophthalmic maxillary and mandibular divisions on both sides

Question 10

How do you test motor part of trigeminal nerve (V)?

Answer 10

1. Ask patient to clench teeth whilst feeling masseter and temporalis
2. Asks patient to open jaw against resistance

Question 11

How do you test the reflex of the trigeminal nerve?

Answer 11

1. offers to do jaw jerk

2. offers to do corneal reflex

Question 12

What are the two parts of the facial nerve?

Answer 12

1. motor

2. sensory

Question 13

How do you rest for the motor part of the facial nerve (VII)?

Answer 13

1. raising eyebrows
2. closing eyes
3. puff out cheeks
4. show teeth/smile

Question 14

How do you test the sensory part of the facial nerve (VII)?

Answer 14

offers to check anterior 2/3 of tongue for taste sensation

Question 15

How do you test for the vestibulocochlear nerve (VIII)?

Answer 15

1. Asks about hearing and balance
2. Gross assessment with rubbing fingers or whispering a number
3. Offers to do Rinne’s and Weber (512Hz Tuning Fork)

Question 16

How do you test for the glossopharyngeal (IX) and vagus (X) nerve?

Answer 16

1. checks for uvula deviation

2. offers to test coughing, swallowing and gag reflex

Question 17

How do you test for accessory (XI) nerve?

Answer 17

1. Asks patient to raise shoulder and applies resistance

2. Asks patient to turn head against hand

Question 18

How do you test for hypoglossal nerve?

Answer 18

stick out tongue

Question 19

What are you looking for on the tongue?

Answer 19

wasting, fasciculation and deviation

Question 20

What else do you ask to test for the hypoglossal nerve?

Answer 20

• Ask one or both of the following:
  1. Asks patient to move tongue (side to side or push against inside of check)
  2. Asks patient to say “british constitution” or “baby hippoptamus” or “yellow Lorry”

Question 21

How do you end the exam?

Answer 21

1. thanks patient
2. helps cover up
3. washes hands
4. how would complete examination

Question 22

What do you need to complete exam?

Answer 22

1. carry out a full neurological examination of the upper and lower limbs
2. mini mental examination
3. assess gait and balance