Cranial Nerve Exam Order Flashcards
What are the 13 steps?
- Introduction
- Position and exposure
- General inspection (mentions 2)
- Olfactory (I)
- Optic (II)
- Oculomotor (III), Trochlear (IV), Abducens (VI)
- Trigeminal (V)
- Facial (VII)
- Vestibulocochlear (VIII)
- Glossopharyngeal (IX), vagus (X)
- Accessory (XI)
- Hypoglossal
- End
What is included in introduction?
- Checks patients name and states role
- Obtains consent for examination
- Washes hands
What is in position and exposure?
- Appropriate exposure
2. Checks patient is comfortable and in an adequate position
What are you looking for in general inspection?
- squint
- ptosis
- facial droop
- asymmetric or abnormal eye position and pupils
How do you test for the olfactory nerve (I)?
- Asks about any change in sense of smell
2. Offers to use scented bottles testing each nostril separately
What are the steps to test the optic (II) nerve?
- Asks about corrective lenses
- Describes pupils
- Offers to assess the acuity of each eye with Snellen’s chart
- Tests visual fields
- Tests visual inattention
- Tests accommodation reflex
- Tests pupillary reflex with pen-torch: swinging light reflex
- Offers to asses Colour vision with Ishihara Colour plates and to test for blind spot
- Offers to perform fundoscopy
How do you test for the oculomotor (III), Trochlear (IV) and abducens (VI) nerve?
- Tests movements of the eyes with the patient’s head still
- Asks about blurring or diplopia
- Assess for nystagmus
What are the 3 categories for the trigeminal nerve (V)?
- sensation
- motor
- reflex
How do you test the sensation of the trigeminal (V) nerve?
light touch in ophthalmic maxillary and mandibular divisions on both sides
How do you test motor part of trigeminal nerve (V)?
- Ask patient to clench teeth whilst feeling masseter and temporalis
- Asks patient to open jaw against resistance
How do you test the reflex of the trigeminal nerve?
- offers to do jaw jerk
2. offers to do corneal reflex
What are the two parts of the facial nerve?
- motor
2. sensory
How do you rest for the motor part of the facial nerve (VII)?
- raising eyebrows
- closing eyes
- puff out cheeks
- show teeth/smile
How do you test the sensory part of the facial nerve (VII)?
offers to check anterior 2/3 of tongue for taste sensation
How do you test for the vestibulocochlear nerve (VIII)?
- Asks about hearing and balance
- Gross assessment with rubbing fingers or whispering a number
- Offers to do Rinne’s and Weber (512Hz Tuning Fork)
How do you test for the glossopharyngeal (IX) and vagus (X) nerve?
- checks for uvula deviation
2. offers to test coughing, swallowing and gag reflex
How do you test for accessory (XI) nerve?
- Asks patient to raise shoulder and applies resistance
2. Asks patient to turn head against hand
How do you test for hypoglossal nerve?
stick out tongue
What are you looking for on the tongue?
wasting, fasciculation and deviation
What else do you ask to test for the hypoglossal nerve?
- 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”
How do you end the exam?
- thanks patient
- helps cover up
- washes hands
- how would complete examination
What do you need to complete exam?
- carry out a full neurological examination of the upper and lower limbs
- mini mental examination
- assess gait and balance
