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Year 3 Examinations > Cranial Nerve Examination > Flashcards

Cranial Nerve Examination Flashcards

1
Q

What does WIPPPPE stand for

A 
Wash hands
Introduce yourself (shake hands)
Indentity of patient
Permission (consent/explanation)
Pain?
Position
Privacy
Exposure
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2
Q

Upon general inspection, what monitoring devices could you expect in a cranial nerve examination? (2)

A

ECG, bedside spirometry

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3
Q

Upon general inspection, what treatments could you expect in a cranial nerve examination? (5)

A

eye patch, oxygen, IV infusions (e.g. ivig), NG tube, TPN

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4
Q

Upon general inspection, what paraphernalia could you expect in a cranial nerve examination? (6)

A

Nil-by-mouth signs, fluid thickener, walking aids, wheelchair, glasses, hearing aid

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5
Q

Upon general inspection, what signs in the patient should you look out for in a cranial nerve examination? (4)

A

Well or unwell?
Speech difficulties?
Facial droop? Ptosis? Wasting? Abnormal posturing?

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6
Q

What are the 12 cranial nerves?

A

Olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, spinal accessory and hypoglossal

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7
Q

CN1?

A

Olfactory

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8
Q

CN2?

A

Optic

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9
Q

CN3?

A

Oculomotor

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10
Q

CN4?

A

Trochlear

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11
Q

CN5?

A

Trigeminal

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12
Q

CN6?

A

Abducens

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13
Q

CN7?

A

Facial

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14
Q

CN8?

A

Vestibulocochlear

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15
Q

CN9?

A

Glossopharyngeal

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16
Q

CN10?

A

Vagus

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17
Q

CN11?

A

Spinal Accessory

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18
Q

CN12?

A

Hypoglossal

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19
Q

What do you ask to assess the olfactory nerve? 1 Q and 2 follow-up Q’s

A

Ask the patient if they have noticed any change in sense of taste/smell. If yes, check the nostrils aren’t blocked and that the patient hasn’t recently had a cold

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20
Q

What is anosmia an early sign of?

A

Parkinson’s

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21
Q

Which CN does AFRO correspond to testing?

A

CNII Optic

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22
Q

What does AFRO stand for in testing CNII?

A

Acuity, Fields, Reflexes, Opthalmoscopy

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23
Q

When introducing yourself, what should you observe the face for? (6)

A 
Ptosis
Strabismus
Facial droop or asymmetry
Articulation of words
Abnormal eye position
Abnormal or asymmetrical pupils
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24
Q

What is ptosis?

A

Drooping of eyelid

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25
Q

What is drooping of eyelid known as?

A

Ptosis

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26
Q

What is strabismus?

A

When the eyes do not align

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27
Q

What is misalignment of the eyes known as?

A

Strabismus

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28
Q

Which cranial nerve(s) is/are affected in: ptosis

A

CNIII

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29
Q

Which cranial nerve(s) is/are affected in: facial droop or asymmetry

A

CNVII

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30
Q

Which cranial nerve(s) is/are affected in: poor articulation of words

A

V, VII, X, XII

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31
Q

Which cranial nerve(s) is/are affected in: abnormal eye position

A

II, IV, VI

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32
Q

Which cranial nerve(s) is/are affected in: abnormal or asymmetrical pupils

A

II, III

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33
Q

What is ideal for testing if a patient can read?

A

Snellen chart

34
Q

What does acuity affect?

A

Ability to read letters

35
Q

How do you test visual fields?

A

Make sure your eyes are at the same level as the patient, ask the patient to cover one eye and whilst they look at you wiggle your finger a foot to the side of the patients head and ask when they can see it. Repeat to the top and bottom as well.
Make sure to test both nasal and temporal fields of each eye.

36
Q

What do you use to do a fundal assessment of a patient?

A

Opthalmoscope

37
Q

What environment do you need to do a fundal examination?

A

Dark as possible

38
Q

How do you assess a pupillary response?

A

Shine a light into one eye and see if the pupil shrinks, then the other eye and see if the same pupil shrinks (consensual response).

39
Q

What does relative afferent pupillary defect mean?

A

That the patient is relatively blind in one eye

40
Q

How do you assess a relative afferent pupillary defect?

A

Swinging torch to see pupil size

41
Q

What is a positive response to the swinging torch test?

A

The relatively blind eye will grow in size as the torch goes to it

42
Q

What does the swinging torch tests assess?

A

Relative afferent pupillary defect

43
Q

What is a Marcus Gunn pupil?

A

Pupil which has a relative afferent pupillary defect

44
Q

What is a pupil with a relative afferent pupillary defect also known as?

A

Marcus Gunn pupil

45
Q

How do you check for nystagmus when checking eye movement?

A

Hold finger at the extremes of the cardinal directions of the eye

46
Q

What does holding fingers at the extremes of the cardinal directions of the eye check for?

A

Nystagmus

47
Q

How do you test for convergence (eye movements)?

A

Ask the patient to look at your finger whilst you bring it to the bridge of their nose

48
Q

What muscles do you test when testing the motor root of the trigeminal? (3)

A

Pterygoids, temporalis and masseters.

49
Q

How do you test the motor root of the trigeminal?

A

Ask patient to open mouth against resistance and clench jaw - palpate the masseter and temporalis as they clench.

50
Q

How to test the three divisions of the sensory root of the temporalis and what are they?

A

Ophthalmic, maxillary and mandibular

Poke with something sharp on forehead, cheek and haw on both sides.

51
Q

What should you do if you find an abnormality when testing the three divisions of the sensory root of the temporalis?

A

Test the three divisions for temperature sensation with a tuning fork and light touch using cotton

52
Q

How do you test the corneal reflex?

A

Ask the patient to look to the side and touch the cornea with cotton

53
Q

What can decrease the corneal reflex?

A

Contact lenses

54
Q

What 6 movements should you ask the patient to perform to test CNVII?

A 
Raise eyebrows
Close both eyes to resistance
Smile
Frown
Show teeth
Puff out cheeks
55
Q

How will an UMN/LMN lesion affect CNVII testing?

A

UMN lesions mean patients can raise both eyebrows but LMN lesions the patient will do it asymmetrically

56
Q

How do you test hearing (not Weber/Rinne)?

A

Hold both hands against both ears of the patient, rub fingers together on one side and ask which side it’s coming from

57
Q

What tests are used to test hearing?

A

Weber and Rinne

58
Q

Weber’s test tests what?

A

Hearing

59
Q

Rinne’s test tests what?

A

Air and bone conduction (hearing)

60
Q

How do you perform a Weber test?

A

Hit a tuning fork and place it on the patients forehead, then ask where the sound is coming from

61
Q

How do you perform a Rinne’s test?

A

Hit a tuning fork, then place it on the mastoid process, and ask when the patient can no longer hear it.
Then turn it over and ask when the patient can no longer hear it.
They should still be able to hear it upon turning as air conduction is better and ears amplify sound.

62
Q

What is the result of the Webers, Left Rinne’s and Right Rinne’s tests in: normal people

A

Weber’s: midline
LR: air > bone (normal)
RR: air > bone (normal)

63
Q

What is the result of the Webers, Left Rinne’s and Right Rinne’s tests in: left sensorineural deafness

A

Weber’s: louder on right
LR: air > bone (normal)
RR: air > bone (normal)

64
Q

What is the result of the Webers, Left Rinne’s and Right Rinne’s tests in: left conductive deafness

A

Weber’s: louder on left
LR: bone > air (abnormal)
RR: air > bone (normal)

65
Q

What is the result of the Webers, Left Rinne’s and Right Rinne’s tests in: right sensorineural deafness

A

Weber’s: louder on left
LR: air > bone (normal)
RR: air > bone (normal)

66
Q

What is the result of the Webers, Left Rinne’s and Right Rinne’s tests in: right conductive deafness

A

Weber’s: louder on right
LR: air > bone (normal)
RR: bone > air (abnormal)

67
Q

What do these Webers, Left Rinne’s and Right Rinne’s tests indicate:
Weber’s: louder on right
LR: air > bone (normal)
RR: air > bone (normal)

A

Left sensorineural deafness

68
Q

What do these Webers, Left Rinne’s and Right Rinne’s tests indicate:
Weber’s: louder on left
LR: bone > air (abnormal)
RR: air > bone (normal)

A

Left conductive deafness

69
Q

What do these Webers, Left Rinne’s and Right Rinne’s tests indicate:
Weber’s: louder on left
LR: air > bone (normal)
RR: air > bone (normal)

A

Right sensorineural deafness

70
Q

What do these Webers, Left Rinne’s and Right Rinne’s tests indicate:
Weber’s: louder on right
LR: air > bone (normal)
RR: bone > air (abnormal)

A

Left sensorineural deafness

71
Q

3 steps to test CNIX and X?

A

Listen to patients voice (hoarse/nasal?)
Ask patient to swallow and watch movement of the soft palate and the pharynx
Ask patient to say ahh and watch the uvula

72
Q

If lesion in present in the vagus nerve what happens to the uvula upon saying ahh?

A

It will swing away from the side of the lesion (unlike tongue)

73
Q

What nerve innervates the uvula?

A

Pharyngeal branch of the Vagus

74
Q

How to test the accessory nerve? (include what you do before movement)

A

Look for atrophy or asymmetry of the trapezius and ask patient to shrug shoulders against resistance.
Then ask the patient to turn head against resistance and check SCM.

75
Q

What would happen on protruding the tongue if there is a lesion in the hypoglossal nerve?

A

It will deviate towards the side of the lesion.

76
Q

Causes of central scotoma?

A

MS

77
Q

What is central scotoma?

A

An area of depressed vision that corresponds with the point of fixation and interferes with central vision

78
Q

What are the 2 formal tests of visual fields?

A

Goldmann kinetic perimetry and Humphrey visual fields testing

79
Q

What is optic neuritis?

A

Optic neuritis is an inflammation that damages the optic nerve, a bundle of nerve fibers that transmits visual information from your eye to your brain

80
Q

What causes poor central visual field assessment with red hat pin?

A

Optic neuritis

81
Q

What is papilloedema?

A

Expansion of blindspot

Year 3 Examinations (5 decks)

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