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Clinical 4a > Cranial Nerve Examinations > Flashcards

Cranial Nerve Examinations Flashcards

1
Q

What are the indications for a cranial nerve examination?

A

Recent onset of new type of HA, accompanied with
- Dizziness or balance alterations
- Changes in sense of hearing/sight/smell/taste
- Slurred speech or altered speech patterns
- Facial muscle wasting or paraesthesia

Cerebellar related symptoms
- Altered or poor coordination
- Hx of falling

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2
Q

What is cranial nerve 1 testing?

A

Olfactory nerve = Smell

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3
Q

How do you perform the test for cranial nerve 1?

A

Bring a scent to the patients nose 10cm away while blocking 1 nostril and have the patient identify the smell

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4
Q

What is an abnormal finding for CN1?

A

Cannot smell or identify the scent (Anosmia)

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5
Q

What is cranial nerve 2 testing?

A

Optic nerve = sight
- visual accuity (snellen chart)
- Peripheral
- Opthalmascope

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6
Q

Describe the visual accuity test

A

Accessing the fovea and retina
Have the patient read the lowest line on the chart with one eye covered
Repeat by the patient reading the same line backwards

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7
Q

How is the accuity test measured?

A

The patients vision is 6/(Line that was read)

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8
Q

Describe the peripheral vision test

A

Have the patient cover one eye while looking into the practitioners eye
Move wiggling finger from low, to middle, to high from lateral to medial
Note the patients visual fields and if they can see your fingers
Watch for physiological nystagmus

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9
Q

Describe the opthalmascope test

A

Using the opthalmascope for the optic nerve
Looking inside the eye for abnormalities, vesiculations, discolouration

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10
Q

What abnormalities are we noting

A

Abnormalities in fundus (papillary dysplasia, congenital optic disc pit)

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11
Q

What is cranial nerve 2 and 3 testing for?

A

Sight and eye movements = Optic and oculomotor nerve

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12
Q

Describe the test for the optic and oculomotor nerves

A

Have patient seperate their eye with their hand
Shine a light in each eye to compare size and contraction of their pupil
Shine light into one eye and watch the other to see if it contracts

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13
Q

What abnormalities can be found in the optic nerve and oculomotor test?

A

If the pupils have no light response and dont contract
If a consensual contraction doesnt occur
Pupillary miosis (muscles of your iris contract tightly around your pupil)

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14
Q

What is cranial nerve 3, 4, and 6 testing?

A

Eye movements = Oculomotor, trochlear and abducence nerves

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15
Q

What is involved in the cranial nerve 3, 4, and 6 tests?

A

Have the patient go through the 6 cardinal directions of gaze (H-test)

Convergence test - Have pt stare at something in the distance and then get them to focus on your finger up close to their face (note pupil contraction change)

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16
Q

What abnormalities can be found in cranial nerve 3, 4, and 6 testing?

A

Double vision (diplopia)
Drooping eyelid (ptosis)
Pathalogical nystagmus
Eye movement during directional gaze and convergence not together (same time)

17
Q

What is cranial nerve 5 testing for?

A

Face sensation and motor supply to the muscles of mastication = Trigeminal nerve

18
Q

Describe the test for cranial nerve 5

A

Light touch/pain sensation in the 3 regions of cutaneous supply
Test each region individually (left then right), ask if patient feels the same sensation on both sides

Motor testing
Have the pt clench their teeth while palpating masseter, as well as temporalis
Resist patients jaw movement to one side, and test for the other

19
Q

What abnormalities can be found in cranial nerve 5 testing?

A

Different sensation in light touch or pain on either sides
Lack of sensation in light touch/pain

Weak/lack of of muscular contraction
Asymmetrical contraction of muscles/jaw movement

20
Q

What is cranial nerve 7 testing for?

A

Muscles of facial expression - Facial nerve

21
Q

What is involved in cranial nerve 7 testing?

A

Active facial expression
- Raise eyebrows
- Frown
- Close eyes tight and ask patient to resist you opening them
- Puff cheeks and ask them to resist you pushing them in
- Make a whistle motion with their lips
- Smile and show their teeth
- Tense their neck muscles

22
Q

What abnormalities can be found in cranial nerve 7 testing?

A

Asymmetry in face at rest
Involuntary muscle movements during facial expressions
Difficulty performing movements and asymmetrical
Closed eyes and puffed cheeks can be easily changed

23
Q

What is cranial nerve 8 testing for?

A

Hearing - Vestibulocochlear

24
Q

What is involved in cranial nerve 8 testing?

A

Whisper test (block opposing ear and whisper in patients ear)

IF HEARING LOSS IS PRESENT, MOVE ON TO DETERMINE IF ITS CONDUCTIVE OR SENSORINEURAL

Webber test (place tuning fork on vertex of head, ask patient if they can hear it equally bilaterally)

Rinne test (Place tuning for on mastoid process until they cant hear the vibration, then move the fork to their ear and they should be able to still hear)

25
Q

What abnormalities are found in the cranial nerve 8 tests?

A

Hearing loss in the whisper test
If one ear hears it louder it may indicate conductive or sensorineural hearing loss
If bone conduction is better than air conduction it suggest that conductive hearing loss is present

26
Q

What is cranial nerves 9 and 10 testing for?

A

Soft palate elevation = Glossopharyngeal and vagus nerve

27
Q

What is involved in the cranial nerve 9 and 10 assessments

A

Ask patient to say ‘ahhh’
Use a tongue depressor, with a torch examine the soft palate and uvula

28
Q

What is a normal finding of cranial nerve 9, 10?

A

The soft palate rises equally and the uvula stays in midline

29
Q

What happens if one of the cranial nerve 10’s is weak?

A

The muscles on the good side PULL the soft palate towards the normal side, the uvula is displaced to the good side

30
Q

What is cranial nerve 11 testing?

A

Movements of the SCM and trapezius = Accessory nerve

31
Q

What is involved in cranial nerve 11 testing?

A

Resisted isometric contraction of the traps and SCM

32
Q

What are abnormal findings of CN11 testing?

A

Contractions are not symmetrical, or weak

33
Q

What is cranial nerve 12 testing?

A

Movements of the tongue = Hypoglossal nerve

34
Q

What is involved in the CN12 testing?

A

Listening to the patients articulation of words
Ask patient to open their mouth and assess resting tongue for hypertrophy/atrophy
Ask patient to stick tongue out and access for deviations

35
Q

What are some abnormal findings of CN12 testing?

A

Slurred speech
Tongue atrophy/hypertrophy
Asymmetrical tongue movements
If one CN12 is weak, the muscles on the good side push the tongue towards the weak side. (Tongue deviates to the bad side)

Clinical 4a (7 decks)

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