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
2
Q
Upon general inspection, what monitoring devices could you expect in a cranial nerve examination? (2)
A
ECG, bedside spirometry
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
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
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?
6
Q
What are the 12 cranial nerves?
A
Olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, spinal accessory and hypoglossal
7
Q
CN1?
A
Olfactory
8
Q
CN2?
A
Optic
9
Q
CN3?
A
Oculomotor
10
Q
CN4?
A
Trochlear
11
Q
CN5?
A
Trigeminal
12
Q
CN6?
A
Abducens
13
Q
CN7?
A
Facial
14
Q
CN8?
A
Vestibulocochlear
15
Q
CN9?
A
Glossopharyngeal
16
Q
CN10?
A
Vagus
17
Q
CN11?
A
Spinal Accessory
18
Q
CN12?
A
Hypoglossal
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
20
Q
What is anosmia an early sign of?
A
Parkinson’s
21
Q
Which CN does AFRO correspond to testing?
A
CNII Optic
22
Q
What does AFRO stand for in testing CNII?
A
Acuity, Fields, Reflexes, Opthalmoscopy
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
24
Q
What is ptosis?
A
Drooping of eyelid
25
What is drooping of eyelid known as?
Ptosis
26
What is strabismus?
When the eyes do not align
27
What is misalignment of the eyes known as?
Strabismus
28
Which cranial nerve(s) is/are affected in: ptosis
CNIII
29
Which cranial nerve(s) is/are affected in: facial droop or asymmetry
CNVII
30
Which cranial nerve(s) is/are affected in: poor articulation of words
V, VII, X, XII
31
Which cranial nerve(s) is/are affected in: abnormal eye position
II, IV, VI
32
Which cranial nerve(s) is/are affected in: abnormal or asymmetrical pupils
II, III
33
What is ideal for testing if a patient can read?
Snellen chart
34
What does acuity affect?
Ability to read letters
35
How do you test visual fields?
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
What do you use to do a fundal assessment of a patient?
Opthalmoscope
37
What environment do you need to do a fundal examination?
Dark as possible
38
How do you assess a pupillary response?
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
What does relative afferent pupillary defect mean?
That the patient is relatively blind in one eye
40
How do you assess a relative afferent pupillary defect?
Swinging torch to see pupil size
41
What is a positive response to the swinging torch test?
The relatively blind eye will grow in size as the torch goes to it
42
What does the swinging torch tests assess?
Relative afferent pupillary defect
43
What is a Marcus Gunn pupil?
Pupil which has a relative afferent pupillary defect
44
What is a pupil with a relative afferent pupillary defect also known as?
Marcus Gunn pupil
45
How do you check for nystagmus when checking eye movement?
Hold finger at the extremes of the cardinal directions of the eye
46
What does holding fingers at the extremes of the cardinal directions of the eye check for?
Nystagmus
47
How do you test for convergence (eye movements)?
Ask the patient to look at your finger whilst you bring it to the bridge of their nose
48
What muscles do you test when testing the motor root of the trigeminal? (3)
Pterygoids, temporalis and masseters.
49
How do you test the motor root of the trigeminal?
Ask patient to open mouth against resistance and clench jaw - palpate the masseter and temporalis as they clench.
50
How to test the three divisions of the sensory root of the temporalis and what are they?
Ophthalmic, maxillary and mandibular
| Poke with something sharp on forehead, cheek and haw on both sides.
51
What should you do if you find an abnormality when testing the three divisions of the sensory root of the temporalis?
Test the three divisions for temperature sensation with a tuning fork and light touch using cotton
52
How do you test the corneal reflex?
Ask the patient to look to the side and touch the cornea with cotton
53
What can decrease the corneal reflex?
Contact lenses
54
What 6 movements should you ask the patient to perform to test CNVII?
```
Raise eyebrows
Close both eyes to resistance
Smile
Frown
Show teeth
Puff out cheeks
```
55
How will an UMN/LMN lesion affect CNVII testing?
UMN lesions mean patients can raise both eyebrows but LMN lesions the patient will do it asymmetrically
56
How do you test hearing (not Weber/Rinne)?
Hold both hands against both ears of the patient, rub fingers together on one side and ask which side it's coming from
57
What tests are used to test hearing?
Weber and Rinne
58
Weber's test tests what?
Hearing
59
Rinne's test tests what?
Air and bone conduction (hearing)
60
How do you perform a Weber test?
Hit a tuning fork and place it on the patients forehead, then ask where the sound is coming from
61
How do you perform a Rinne's test?
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
What is the result of the Webers, Left Rinne's and Right Rinne's tests in: normal people
Weber's: midline
LR: air > bone (normal)
RR: air > bone (normal)
63
What is the result of the Webers, Left Rinne's and Right Rinne's tests in: left sensorineural deafness
Weber's: louder on right
LR: air > bone (normal)
RR: air > bone (normal)
64
What is the result of the Webers, Left Rinne's and Right Rinne's tests in: left conductive deafness
Weber's: louder on left
LR: bone > air (abnormal)
RR: air > bone (normal)
65
What is the result of the Webers, Left Rinne's and Right Rinne's tests in: right sensorineural deafness
Weber's: louder on left
LR: air > bone (normal)
RR: air > bone (normal)
66
What is the result of the Webers, Left Rinne's and Right Rinne's tests in: right conductive deafness
Weber's: louder on right
LR: air > bone (normal)
RR: bone > air (abnormal)
67
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)
Left sensorineural deafness
68
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)
Left conductive deafness
69
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)
Right sensorineural deafness
70
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)
Left sensorineural deafness
71
3 steps to test CNIX and X?
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
If lesion in present in the vagus nerve what happens to the uvula upon saying ahh?
It will swing away from the side of the lesion (unlike tongue)
73
What nerve innervates the uvula?
Pharyngeal branch of the Vagus
74
How to test the accessory nerve? (include what you do before movement)
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
What would happen on protruding the tongue if there is a lesion in the hypoglossal nerve?
It will deviate towards the side of the lesion.
76
Causes of central scotoma?
MS
77
What is central scotoma?
An area of depressed vision that corresponds with the point of fixation and interferes with central vision
78
What are the 2 formal tests of visual fields?
Goldmann kinetic perimetry and Humphrey visual fields testing
79
What is optic neuritis?
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
What causes poor central visual field assessment with red hat pin?
Optic neuritis
81
What is papilloedema?
Expansion of blindspot
