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Neuromuscular Exam and Rehab Exam 1 > Cranial Nerves > Flashcards

Cranial Nerves Flashcards

1
Q

How do you tests the olfactory nerve?

A

-Sense of smell in each nostril (close one nostril at a time
-Pt is blindfolded or closes their eyes
-Utilize familiar scent

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2
Q

What are abnormal findings when olfactory nerve?

A

-Anosmia – inability to select smells

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3
Q

How do you test the optic nerve?

A

-Visual acuity test with Snellen eye chart
-Visual field testing: Test temporal and vertical peripheral vison

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4
Q

How do you test the oculomotor nerve?

A

Shine light into eye — pupil constriction
-Eye accommodates to light
-Pupils move medial when viewing object at close range

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4
Q

What are abnormal findings when testing oculomotor nerve?

A

-Absence of pupillary constriction
-Lateral strabismus (exotropia)
-Anisocoria (unequal pupils)
-Horner’s Syndrome, CN III paralysis (ptosis)

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5
Q

How do you test oculomotor, trochlear, and abducens nerve?

A

-Test saccadic movements: ask Pt to look up, down, medial, and lateral
-Test purist eye movements: ask Pt to follow moving finger
-Test one eye at a time: other eye occluded

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6
Q

What are the abnormal findings when testing the oculomotor, trochlear, and abducens nerve?

A

-Lateral strabismus: eyeball turns lateral; can cause diplopia or nystagmus
-Impaired eye movements
-Ptosis
-Medial strabismus: eyeball turns inward; can cause diplopia or nystagmus

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7
Q

How do you test the trigeminal nerve V1 the opthalmic division?

A

-Test pain
-Light touch sensation
-Forehead, cheeks, inner oral cavity (occlude vision)

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8
Q

What are the abnormal findings when testing the trigeminal nerve V1 the opthalmic division?

A

Loss of facial sensation —– numbness with CN V lesion
Trigger area with trigeminal nerve

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9
Q

How do you test the trigeminal nerve V2 the maxillary division?

A

Test cornea reflex — Touch lightly with the wisp of a cotton

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10
Q

What are the abnormal findings when testing the trigeminal nerve V2 the maxillary division?

A

Loss of corneal reflex ipsilaterally (blinking in response to corneal touch)

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11
Q

How do you test the trigeminal nerve V3 the mandibular division?

A

-Palpate temporal and masseter muscle
-Observe spontaneous movements
-Have Pt open mouth, move jaw side to side, bite down on tongue dispenser, hold against resistance

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12
Q

What are the abnormal findings when testing the trigeminal nerve V3 the mandibular division?

A

-Weakness, wasting or muscle
-When opened, deviation of jaw to ipsilateral side
-Asymmetry of jaw
-Asymmetry of jaw strength

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13
Q

How do you test the facial nerve motor devision?

A

Test strength and symmetry of facial muscles: have patient elevate eyebrows and forehead, smile, frown, and pucker lips, close eyes tightly, puff out both cheeks

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14
Q

What are abnormal finding when testing the facial nerve motor devision?

A

-Paralysis
-Inability to close eye drooping corner of moth, difficulty with speech articulation
-Unilateral LMN: Bell’s Palsy (PN)
-Bilateral LMN: Guillain – Barré
-Unilateral UMN: stroke

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15
Q

How do you test the facial nerve sensory devision?

A

Apply salty, sweet, and sour solution to outer and lateral portions of anterior tongue using a cotton swab (occlude vision)

16
Q

What are abnormal finding when testing the facial nerve sensory devision?

A

Incorrectly identifies solution  decreased taste

17
Q

How do you test the vestibulochoclear nerve (vestibular function)?

A

Test balance and protective functions: vestibulospinal function (VSR)
Test eye-head coordination: vestibular ocular reflex (VOR)

18
Q

What are abnormal findings when testing the vestibulochoclear nerve (vertibular function)?

A

-Vertigo, decreased balance, decreases protective responses (disequilibrium)
-Gaze instability with head rotation, nystagmus (constant, involuntary cyclical movement of the eyeball)

19
Q

How do you test the vestibulochoclear nerve (cochlear function)?

A

-Test auditory acuity  finger rub test
-Weber test for lateralization: place vibrating tuning fork on top of head, mid-position; check if sound heard in one ear or equally in both
-Rinne test: Compares air bone conduction, place vibrating tuning fork on mastoid bone, then close to ear canal; sound head longer through air than bone

20
Q

What are abnormal findings when testing the vestibulochoclear nerve (cochlear function)?

A

-Deafness, impaired hearing, tinnitus
-Unilateral conductive loss: sound lateralized to impaired ear sensorineural loss: sound heard in good ear
-Conductive loss: sound heard through bone is equal to or longer than air
-Sensorineural loss: sound head longer than air

21
Q

How do you test the function for the glossopharyngeal nerve (sensory funtion)?

A

Apply sweet, salty, and sour solutions to posterior tongue

22
Q

What are the abnormal finding when testing the glospharyngeal nerve (sensory function)?

A

Incorrectly identifies solution — loss of taste on posterior tongue

23
Q

How do you test the glosopharyngeal and vagus nerve (phonation)?

A

Listen to voice quality

24
Q

What are the abnormal finding when testing glosopharyngeal and vagus nerve (phonation)?

A

Dysphonia: Hoarse voice; denotes vocal cord weakness, nasal quality denotes palatal weakness

25
Q

How do you test the glosopharyngeal and vagus nerve (swallowing)?

A

Examine for difficulty in swallowing: glass of water, different consistence of food

26
Q

What are the abnormal finding when testing glosopharyngeal and vagus nerve (swallowing)?

A

Dysphagia: Difficulty swallowing; loss of swallowing reflexes

27
Q

How do you test the glosopharyngeal and vagus nerve (Palatal, pharynx control)?

A

Have patient day “ah”, observe motion of soft palate (elevates) and position of uvula (remains midline)

28
Q

What are the abnormal finding when testing glosopharyngeal and vagus nerve (Palatal, pharynx control)?

A

-Dysarthria: difficulty articulating words clearly, slurs words
-Palate fails to elevate, (lesion of CN X); asymmetrical elevation with unilateral paralysis

29
Q

How do you test the glosopharyngeal and vagus nerve (gag reflex)?

A

Stimulate back of throat lightly on each side

30
Q

What are the abnormal finding when testing glosopharyngeal and vagus nerve (gag reflex)?

A

Loss of gag reflex lesion of CN IX; possibly CN

31
Q

How do you test the spinal accessory nerve (motor function, spinal nerve, trap muscle)?

A

-Examine bulk strength
-In sitting, ask pt to elevate shoulders upward against resistance applied in direction of depression

32
Q

What are the abnormal findings when testing the spinal accessory nerve (motor function, spinal nerve, trap muscle)?

A

LMN: atrophy, fasciculations, weakness
-Weakness, inability to approximate the acromion and the occiput

33
Q

How do you test the spinal accessory nerve (SCM)?

A

In supine, ask patient to flex head anterolaterally and rotate head to opposite side; resistance is applied in an obliquely posterior direction

34
Q

What are the abnormal findings when testing the spinal accessory nerve (SCM)?

A

Weakness, inability to flex head laterally and forward, rotate head contralateral side

35
Q

How do you test the spinal accessory nerve (cranial nerve root)?

A

Examine laryngeal elevation by placing index and middle finger over Pt’s Adams apple (laryngeal muscles); ask pt to swallow

36
Q

What are the abnormal findings when testing the spinal accessory nerve (cranial nerve root)?

A

Dysphagia due to decreased laryngeal elevation

37
Q

How do you test the hypoglossal nerve?

A

-Listen to Pt articulation
-Examine resting position tongue
-Ask patient to protrude tongue, move tongue side to side

38
Q

What are the abnormal findings when testing the hypoglossal nerve?

A

-Dysarthria (seen with lesion of CN X and CN XII, also V, VII)
-Atrophy or fasciculations of tongue (LMN, ALS)
-Impaired movements with deviation of tongue to weak side
-UMN lesion: tongue deviates away from weak side of cortical lesion
-Check for tongue movement tremors or involuntary tongue movements

Neuromuscular Exam and Rehab Exam 1 (11 decks)

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