Cranial Nerve Examination Flashcards
1
Q
List the initial observations looked for in general inspection
A
Introduce yourself and watch the face for
- Ptosis (III)
- Strabismus (squint)
- Facial droop or asymmetry (VII)
- Articulation of words (V, VII, X, XII)
- Abnormal eye position (III, IV, VI)
- Abnormal or asymmetrical pupils (II, III)
- Hearing aid, walking stick and glasses
2
Q
Describe examination of the 1st cranial nerve
A
- Olfactory
- Determine whether patient can smell by offering an item of fruit
- If no item is available, ask whether they have noticed any change in their sense of smell
- Alternatively, a testing kit with a variety of smells can be obtained
3
Q
Describe testing of the second cranial nerve
A
- Optic nerve
- Inspect pupils (size, shape and symmetry)
- Check acuity, fields, fundi and pupils
- Check the patient can read with each eye
- If available a snellen chart is ideal
- Screen visual fields by confrontation
4
Q
Describe the process of the fundal examination
A
- Darken the room
- Adjust the opthamoscope so the light is no brighter than necessary. Adkust the aperture to a large plain white circle. Set the diopter dial to zero unless a beter setting determined
- Use left hand and left eye to examine patients left eye, and right for right eye. Place your free hand on the patients shoulder for better control
- Ask the patient to stare at a point in the wall or corner of the room
- Look through the opthalmoscope and shine the light into the patients eye from about 2 feet away. You should see the retina as a red reflex
- Adjust the diopter dial to bring the retina into focus. Find a blood vesssel and follow to the optic disk, and use this as a reference
- Inspect outward from the optic disk in at least four quadrants
5
Q
Describe pupil responses
A
- Optic and oculomotor
- Test pupilary reactions to light
- Dim the room lights as necessary
- Ask the patient to look in the distance
- Shine a bright light obliquely into each pupil in turn
- Look for both the direct and consentual reactions
- Move the torch from eye to eye to detect relative afferent pupillary defect
6
Q
Describe testing accommodation
A
- Ask patient to look into the distance
- Observe pupil size
- Ask patient to look at an object close to their face
- Note whether pupil gets smaller and eyes converge
7
Q
What is a relative afferent pupillary defect?
A
- Patient is relatively blind in one eye
- When the light is swung into the good eye, both pupils contract.
- When the light arrives at the blind eye both pupils will dilate
- Marcus Gunn pupil
8
Q
Describe testing of extraocular movements
A
- Oculomotor, trochlear and abducens
- Observe normal eye position at rest, look for nystagmus
- Ask patient for follow your finger with their eyes without moving their head
- Ask patient how many fingers they can see in each position (any double vision, pain or restriction of eye movement)
- Check gaze in 6 directions using a H pattern
- Oculomotor nerve down and out in damage (also causes ptosis if damaged)
- Trochlear nerve normally moves eye down and in, if damaged difficulty looking down (superior oblique)
- Abducens failure to move laterally in damage (lateral rectus)
9
Q
Describe testing of the 5th cranial nerve
A
- Trigeminal
- Test pterygoids, temporal and masseater muscle strength (ask patient to open mouth and clench teeth, palpate muscles). First inspect for wasting
- Ask patient to open jaw against resistance
- Test 3 divisions for touch sensation with cotton wool, and pain sensation with a sharp object on the forehead, cheeks and jaw on both sides
- Substitute a blunt object occasionally
- If an abnormality found test with tuning fork and light touch using cotton
- Jaw jerk and corneal reflex (touch corneum with cotton ball)
10
Q
Describe testing of corneal reflex
A
- Ask patient to look away
- Touch cornea lightly with a fine whisk of cotton
- Look for blink reaction
- Repeat on both sides
- Nerves trigeminal (afferent) and facial (efferent)
11
Q
Describe testing of facial nerve
A
- Observe any facial droop or asymmetry
- Raise eyebrows, close both eyes to resistance, smile, frown, show teeth, puff out cheeks
- Ask if any changes in sense of taste (anterior 2/3)
12
Q
Describe screening hearing
A
- Vestibulococchlear nerve
- Ask about changes to hearing and balance
- Face patient and hold out arms with fingers near each ear.
- Rub fingers together on one side while moving noiselessly on the other
- Ask patient to tell you when and which ear they hear rubbing
- Increase intensity and note any asymmetry
- If abnormal, use Weber and Rinne tests
13
Q
Describe test for ossicles
A
- Rinnes test
- Compare air and bone conduction
- Place base of tuning fork against mastoid bone behind ear
- When patient no longer hears the sound, hold the end of the fork near patients ear and see test air conduction
- Patient should be able to hear the sound (air conduction should be louder)
- Bone louder than air in abnormal result (rennes negative - conductive hearing loss)
- Rennes positive means air louder than bone. Sensorineural or normal result
- In sensorineural air still more than bone
- Do webers test
14
Q
Describe testing of glossopharyngeal and vagus nevres
A
- Ask about any swallowing problems or changes to voice or cough
- Listen to voice (horse or nasal)
- Ask to swallow (sip of water - look for change in voice qualty)
- Ask to say ah
- Watch movements of soft palate and pharynx
- Uvula will deviate away from midline if lesion present
- Ask to test gag reflex (don’t actually)
15
Q
Describe testing of the accessory nerve
A
- From behind look for atrophy or asymmetry of the trapezius muscle
- Ask patient to shrug shoulders against resistance
- Ask patient to turn their head against resistance. Watch and palpate the sternomastoid muscle on the opposite side
