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CPA > Cranial Nerves > Flashcards

Cranial Nerves Flashcards

1
Q

CN I exam?

A

History of chance in sensation of smell
Use odourants known to patient (OFFER scented bottles)

OLFACTORY

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2
Q

CN II exam?

A

Do you have glasses or contacts? Any changes in vision?
OFFER - Stellen’s chart (for acuity), Ishiharo plate (for colour), Fundoscopy.
Visual field confirmation test
Direct and consensual pupillary reflex

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3
Q

CN III, IV + VI exam?

A
  1. Motor - (CN III, IV + VI) H test for eye movements

(2. Parasympathetic - assessed by pupillary reflexes - for CN III)

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4
Q

CN V exam?

A
  1. Sensory - assess light touch (V1, V2 + V3 areas of face; opthalmic, maxillary, mandibular)
  2. Motor - assess the muscles of mastication

(3. Corneal reflex and jaw jerk reflexes - OFFER)

TRIGEMINAL

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5
Q

CN VII exam?

A

Any changes in taste?
1. Motor - facial muscles - assess facial muscle actions

OFFER (2. Taste - tongue anterior 2/3 - not tested)
OFFER (3. Parasympathetic - submandibular, sublingual and lacrimal glands - not tested)

FACIAL

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6
Q

CN VIII exam?

A

any changes in hearing or balance?

  1. Cochlear part - assess hearing (whisper, Rinne and Weber tests)

OFFER (2. Vestibular part - not tested)

VESTIBULO COCHLEAR

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7
Q

CN IX exam?

A

Change in taste? Offer salt water ideally
Open mouth, stick tongue out

OFFER (General sensory - post 1/3 of tongue - assessed by ‘gag’ reflex)

GLOSSOPHARYNGEAL

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8
Q

CN X exam?

A

Change in taste?
UVULA - say aaaa, should pull upwards. If deviates, will deviate away from side of lesion.
OFFER cough and swallow
1. Motor - assess action of soft palate

VAGUS

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9
Q

CN XI exam?

A
  1. Spinal accessory - motor - assess the strength of sternocleidomastoid and trapezius
  2. Cranial accessory - motor - pharyngeal and laryngeal muscles - assessed with vagus

Neck muscles - place hand on face, look towards hand.
Trapezius - push shoulders against hand.
ACCESSORY

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10
Q

CN XII exam?

A

Motor - tongue (test protrusion)
Stick tongue out. If deviates, will point towards side of lesion.
Place hand on cheek. Ask to push hand with tongue.
HYPOGLOSSAL

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11
Q

Special tests?

A
  1. Ophthalmoscopy
  2. Otoscopy
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12
Q

Movements exam?

A
  1. Head - atlanto-axial and atlanto-occipital joints
  2. Cervical and thoracocolumbar spine
  3. TM joint and mandible (lower jaw)
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13
Q

Palpation?

A
  1. Bone/cartilage in head, neck and spine
  2. TMJ, cricothyroid space
  3. Lymph nodes
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14
Q

Arterial pulses?

A

Carotid
Superficial temporal
Subclavian arteries

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15
Q

Assessing JVP?

A
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16
Q

V1, 2 + 3 areas?

A
17
Q

Muscles of mastication assessment?

A
18
Q

Facial muscle actions?

A

Raise eyebrows
Screw eyes - don’t let me open them
Puff out cheeks
Smile with teeth
Purse lips

19
Q

Whisper, Rinne and Weber test?

A

Whisper - rub fingers in one ear and say number in the other
Rinne - air vs bone - mastoid process and in front of ear
Weber - on forehead - is it same in both ears

20
Q

Sternocleidomastoid and trapezius assessment?

A

Shrug shoulders against force
Turn face against my hand each side

21
Q

Tongue protrusion assessment?

A

Look for deviation, wasting, fasciculation
Power - push tongue against cheek against force
Test words - “British Constitution”

22
Q

Weber test results?

A

Louder in affected ear - conductive hearing loss
Louder in healthy ear - sensorineural hearing loss

23
Q

Rinne’s test results?

A

Air>bone - normal
Bone>ear - conductive hearing loss

24
Q

What to offer for CN II?

A

Stellen’s chart
Ishiharo plate
Fundoscopy

25
Q

Visual field confirmation test?

A

Cover same eye, look at my nose, whittle fingers and say yes when see it move

26
Q

Direct and consensual pupillary reflexes?

A

Light, hold hand in between eyes, look for direct and consensual. Look at both eyes.
Make obvious which eye looking at.
Then do swinging light test

27
Q

H test?

A

For CN III, IV + VI

Let me know if you see any pain or blurring/double vision

test for nystagmus

28
Q

3rd nerve palsy?

A

Eye looks down and out

29
Q

4th nerve palsy?

A

Superior oblique bad, unable to look down and inwards

30
Q

6th nerve palsy?

A

Eye can’t abduct

31
Q

How to test motor CN V?

A

Maseter - hold jaw whilst they clench jaw
Hold jaw whilst touching temporalis muscles
Open mouth against resistance

32
Q

Offer for trigeminal?

A

Jaw jerk
Cornea reflex

33
Q

Facial nerve motor tests?

A

Raise eyebrows
Close eyes (against resistance)
Puff out cheeks (against resistance)
Smile with teeth
Grimace

34
Q

Offer for facial nerve?

A

Taste test - ideally with salt water

35
Q

Frequency of hearing fork?

A

512 hz

36
Q

Rinne test interpretation?

A

Conductive hearing loss - Rinne louder on bone than ear
Sensorineural - Rinne the same

37
Q

Weber test interpretation?

A

Conductive - amplifies Weber in bad ear than normal ear
Sensorineural - amplifies Weber in good ear

CPA (9 decks)

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