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Medicine: Clinical Skills > Cranial Nerve Examination > Flashcards

Cranial Nerve Examination Flashcards

1
Q

how to remember the cranial nerves

A

Oh
Oh
Oh
To
Touch
And
Feel
Virgin
Girl’s
Vagina
Ah Such
Heaven

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2
Q

cranial nerves in order

A

olfactory
optic
oculomotor
trochlear
trigeminal
abducens
facial
vestibulocochlear
glossopharyngeal
vagus
accessory spinal
hypoglossal

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3
Q

which nerve combinations can be tested together in year one

A

2,3, 4 and 6
5 and 7
9, 10, 11 ,12

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4
Q

what is the 1st cranial nerve

A

olfactory

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5
Q

what is the 2nd cranial nerve

A

optic

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6
Q

what is the 3rd cranial nerve

A

oculomotor

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7
Q

what is the 4th cranial nerve

A

trochlear

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8
Q

what is the 5th cranial nerve

A

trigeminal

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9
Q

what is the 6th cranial nerve

A

abducens

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10
Q

what is the 7th cranial nerve

A

facial

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11
Q

what is the 8th cranial nerve

A

vestibulocochlear

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12
Q

what is the 9th cranial nerve

A

glossopharyngeal

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13
Q

what is the 10th cranial nerve

A

vagus

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14
Q

what is the 11th cranial nerve

A

accessory spinal

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15
Q

what is the 12th cranial nerve

A

hypoglossal

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16
Q

general points to consider within the examination

A

Introduce yourself to the patient
Ask for consent to examine them and explain what you are going to do Check the patient is in no pain
Use alcohol gel / wash hands
Test each component of a nerve (motor, sensory, autonomic)
Some tests may involve asking questions
Test both sides (remember the nerves are paired, only the trochlear nerve truly decussates)
Explain what you are doing and what you expect the result to be

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17
Q

olfactory nerve test

A

sensory= smell

ask if they have noticed a change in their sense of smell
can test sense of smell with non-irritating stimulant
smell yourself first to check
occlude one nostril at a time and then test one nostril at a time

18
Q

how to remember testing sensory for optic nerve

A

ARIVO

19
Q

A in optic nerve testing

A

a for acuity
test the best corrected vision so leave glasses on
use snellen chart
take each eye in turn, ask patient to cover other eye with palm of their hand

colour Vision can also be assessed using Ishihara plates

20
Q

R in optic nerve testing

A

r for reflexes
test in dimly lit environment
ask patient to look at a fixed point
approach laterally with a pen light to observe direct and consensual responses
swinging light test may reveal a relative afferent pupillary defect
test accommodation reflex by asking patient to focus from distant point to a near object, should see constriction with convergence

21
Q

I in optic nerve testing

A

I for inattention
test for sensory inattention by sitting directly opposite the patient and with both hands up and slightly wide of the patient
ask them to focus on my nose
move one finger at a time and ask them to point at the finger that they see moving

22
Q

v in optic nerve testing

A

sit directly opposite the patient, 1m away
ask patient to keep looking at my eyes
ask patient to cover one eye and cover my eye on the corresponding side
ask patient to keep looking at my open eye
test each quadrant separately
hold finger equidistant between myself and the patient, start peripherally and wiggle end of finger and bring to patient until they can see it
comparing patients visual field with my own
repeat for each quadrant then for the other eye
use red hat pin for more detailed assessment

23
Q

o in optic nerve testing

A

ophthalmoscopy

24
Q

testing oculomotor nerve

A

motor: testing the extra ocular muscles
autonomic tests the pupillary reflexes which have already been tested

25
Q

how do you test the 3 nerves supplying the extra ocular muscles

A

use the H test
“I’d like to assess the movements of your eyes, have you got any double vision at the moment? let me know if you have any double vision throughout the exam”

ask patient to follow your finger or pen or torch with their eyes, keeping their head still
move finger smoothly to one side, up and down then to the other side in a “H” pattern
watch for any restriction of movement of for any nystagmus

26
Q

testing for trochlear

A

motor: extra ocular muscle for eye movements

27
Q

sensory testing for trigeminal nerve

A

light touch and pin-prick
test the sensory modality on the suprasternal notch and ask “does this feel normal”
ask the patient then to close their eyes
ask the patient to say yes when they feel the modality tested
firstly test using cotton wool
test forehead both sides, cheek both sides and just off the chin both sides
ask if it felt the same on both sides
repeat with a pin prick

28
Q

motor testing for trigeminal nerve

A

feel patients temple and ask them to clench jaw
unclench
feel patients cheeks and ask them to clench their jaw
ask patient then to try and open their mouth, I will resist the movement to test for power and deviation
then ask patient to let jaw hand open and place finger just above patients chin, tap finger gently with tendon hammer and an absent reflex is normal

29
Q

trigeminal nerve testing, what is not usually required in an OSCE

A

corneal reflex and nasal tickle
use cotton wool in corner of eye and under nose

30
Q

testing abducens

A

motor: extraocular, lateral rectus

31
Q

testing facial nerve, motor

A

inspect whole face looking for asymmetry
ask patients to blink and observe any unilateral eye closure
watch for spontaneous or involuntary movements and ask if anyone has noticed asymmetry
ask patient to raise their eyebrows
test their power by “screw your eyes tightly shut and stop me from trying to open them”
and then “puff out your cheeks, don’t let me push them in”
ask patient to purse lips
ask patient to pare teeth
have you noticed that your hearing sounds louder than normal

32
Q

testing sensory for facial nerve

A

ask if their taste is currently okay, doesn’t taste loudly or gone off

33
Q

testing autonomic of facial nerve

A

ask the patient if they have a dry mouth/eyes

34
Q

testing hearing with vestibocochlear nerve

A

mask or cover one ear and stand behind the patient, whisper a number close and then slightly further away, ask patient to report
Rinne’s test: press 512 Hz or 256 Hz tuning fork on mastoid process and when no longer audible bring to front of ear. ask if patient can hear, tell them to say when it stops, ask if they can hear again when moved front
if they can’t hear when moved front then conduct webers test: press tuning fork in centre of forehead and ask if they can hear it loudest in one ear or the other or in the centre

35
Q

testing balance for vestibulocochlear nerve

A

ask patient to close their eyes and march on the spot
patient may turn towards the side of this nerve lesion

35
Q

testing balance for vestibulocochlear nerve

A

ask patient to close their eyes and march on the spot
patient may turn towards the side of this nerve lesion

36
Q

testing sensory with glossopharyngeal

A

tests posterior 1/3 of the tongue
check tastes are ok
would test the gag reflex but not in OSCE setting

37
Q

testing motor with glossopharyngeal

A

has motor supply to the sytlopharyngeus only which elevates the larynx and pharynx
not seen in isolation
patient needs to swallow large bolus of food

38
Q

autonomic testing glossophrayngea l

A

parotid gland
ask patient about dryness in mouth

39
Q

motor testing of vagus nerve

A

assess the soft palate and uvula for symmetry and movement
is there any hoarseness in the patients voice
would ask to cough but not now due to covid risk
ask patient to sip water to check for normal swallowing
gag reflex but not routinely tested

40
Q

autonomic testing of vagus nerve

A

has patient experienced any problems with gut motility or heart palpitations

41
Q

accessory spinal testing motor

A

trapezius, ask patient to shrug and then repeat but against resistance
sternocleidomastoid, as patient to turn head against resistance, test both sides

Medicine: Clinical Skills (5 decks)

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