Cranial Nerve Examination Flashcards
Describe examination of Cranial Nerve I
Ask;
- changes in sense of smell, if present unilateral/bilateral
Test;
- each nostril separately using strong smelling substance i.e. coffee/toothpaste (not routinely performed, only if clinically indicated)
Describe examination of Cranial Nerve II
Visual Acuity;
- ask if patient can see equally well with each eye
- use Snellen chart at about 60cm (wearing visual correction) one eye at a time
Pupillary responses;
- Inspect size and shape of pupil, checking for symmetry
- Pupil response tested by moving pen torch in from side, looking for both the direct and indirect response in both eyes
Visual Fields;
- Ask patient to cover one eye and look at your nose
- cover your opposite eye and bring your finger from furthest periphery toward centre, asking patient to say yes when they can see your finger
- test each quadrant in turn
Visual Inattention
- hold both hands within field of vision
- ask patient to point to the hand that has the finger moving
- once established that patient can see on both sides, move both together
Accommodation
- Ask patient to focus on a pen held at a distance and keep focusing on it as you move it closer to them
- pupils should constrict as eyes converge
Fundoscopy (would occur here normally but not in OSCE)
Describe examination of Cranial Nerve III, IV, VI
Inspection; look for drooping lid (ptosis), pupil abnormality or gaze abnormality
- Ask patient to keep their head still and follow you finger as you move it in a slow ‘H’
- start in midline directly in front of patient
- Ask patient to tell you if they get any double vision
- Note if their eyes always move in parallel
- Look for any nystagmus
Describe examination of Cranial Nerve V
Sensation
- cotton wool (eyes closed), then sharp end of neurotip (eyes can be open)
- Over ophthalmic, maxillary and mandibular areas
Motor
- palpate bulk of masseter muscle and then ask patient to clench their teeth
- ask patient to open their jaw against resistance to test pterygoid muscles
Corneal Reflex
- ask if they wear contact lenses
- warn may be uncomfortable
- ask patient to look up to the left, touch cornea on right side with wisp cotton wool
- look for a blink response (should be bilateral)
- repeat for other eye
Jaw Jerk reflex
- place a finger on lower jaw, just below lips
- mouth should be slightly open
- tap finger in downward direction with tendon hammer (or finger)
- watch for masseter muscle jerking jaw upward
- usually absent reflex
Describe examination of Cranial Nerve VII
Inspect face for any asymmetry
Motor;
- look at facial movement
- ask patient to wrinkle their forehead, then screw up their eyes, then smile/show their teeth
- ask them to puff out their cheeks, then press gently on them to try and expel air
Taste;
- rarely tested
Describe examination of Cranial Nerve VIII
Vestibular;
- check for nystagmus (done when testing eye movements)
- check balance (usually when testing gait)
Hearing;
- Whisper test
- Tuning fork; Rinne’s and Webber’s
Describe examination of Cranial Nerve IX
Inspection; ask patient to open mouth and say ‘ah’
- look to see if palate moves symmetrically
- uvula should remain central
Cough
- ask patient to cough and see if this sounds normal
(remember to ask them to turn to the side)
Gag Reflex
- Warn patient uncomfortable
- touch side of throat on each side, one at a time
Describe examination of Cranial Nerve XI
Trapezius
- place hands on patients shoulders from behind
- ask them to shrug
Sternocleidomastoid
- ask patient to turn their head to one side
- then ask them to push against the side of your fist with their face
Describe examination of Cranial Nerve XII
Inspect tongue for fasciculation, wasting or deviation
Motor; ask patient to stick out their tongue and wiggle it side to side
Speech; Ask them to say the days of the week
