Cranial Nerve Screening Tests

Question 1

CN II ==> optic n. (S)

Answer 1

Snellen eye chart - read lines that get smaller each time

penlight - shine obliquely into eye –> constriction of CONTRALATERAL pupil, but ipsilateral pupil should constrict too

Question 2

CN III ==> oculomotor n. (M)

Answer 2

ability to elevate both eyelids
ability of both eyes to follow PT’s moving finger (in H pattern) w/o moving head
penlight ==> shine obliquely into eye –> constriction of IPSILATERAL pupil (can also be assessed while assessing CN II)

Question 3

CN IV ==> trochlear n. (M)

Answer 3

assessed during H motion test of CN III

after making H, bring finger toward Pt.’s nose so that both eyes should converge (move downward and inward)

Question 4

CN V ==> trigeminal n. (B)

Answer 4

eyes closed
cotton ball or pad of index finger to lightly touch face on forehead, cheeks, and L jaw ==> should feel same on both sides
palpate masseter and temporalis bilaterally ==> clench jaw
hold jaw slightly open and provide R to mandibular closing or L dev - should be able to hold against mod F

Question 5

CN VI ==> abducens n. (M)

Answer 5

assessed during H test of CN III L abd

Question 6

CN VII ==> facial n. (B)

Answer 6

motor: smile, frown, elevate or depress eyebrows, and puff out cheeks ==> look for symmetry
close eyes and stick out tongue to assess taste - sweet on A portion ==> identify taste

Question 7

CN VIII ==> vestibulocochlear n. (S)

Answer 7

eyes closed

hearing: rub pads of thumb and index finger together next to an ear ==> when rubbing is heard look for symmetry in time to hear and test one ear at a time
vestibular: stand unsupported (but guarded) w/ eyes closed for up to 30 seconds

Question 8

CN IX ==> glossopharyngeal n. (B) and CN X ==> vagus n. (B)

Answer 8

taste: flavor should be sour or bitter an placed on P 1/3 of tongue
open mouth and say “ahh” ==> uvula should not L dev; listen for loss of phonation
swallow several times ==> look for and ask for difficulties
gag reflex: carefully move tongue depressor toward back of throat until reflex elicited

Question 9

CN XI ==> spinal accessory n. (M)

Answer 9

shoulder shrug and provide R ==> test bilaterally

look for trapezius or SCM atrophy - observe bilaterally

Question 10

CN XII ==> hypoglossal n. (M)

Answer 10

stick tongue out - look for side-to-side dev or atrophy

move tongue from side to side - look for smooth motions

Question 11

CN I ==> olfactory n. (S)

Answer 11

eyes closed
distinctive-smelling items
smell one at a time each nostril separately
identify odor
strength of odor should be equal on each side