Cranial nerves 2

Question 1

What is something to remember when examining CN2?

Answer 1

Its important to sit directly opposite and at the same level as the patient as it could affect your results

Question 2

What does finding a large blind spot upon examination of CN2 mean?

Answer 2

Papilloedema due to raised ICP

Question 3

How do you carry out a fundoscopy?

Answer 3

Darken the room, get patient to fixate on distant object
Assess red reflex - positioned 30cm from patient eyes and upon looking through fundoscope with light shining on pupil, expect to see a red/orange reflection (absence=cataract)
Examine eye - move closer, find a vessel on the fundus and follow it back to the optic disc, assess optic disc, retinal vessels and macula

Question 4

What are some causes of ptosis?

Answer 4

Oculomotor pathology, Horners syndrome, myasthenia gravis, congenital, age related

Question 5

How do you elicit a corneal and jaw jerk reflex?

Answer 5

Not routinely performed
Corneal - touch eye with cotton wool, should blink
Jaw - place finger on chin of patient with open and relaxed mouth and use tendon hammer, excessive closure = UMN lesion

Question 6

What are the causes of two different presentations of CN7/facial nerve damage?

Answer 6

UMN = forehead sparing ie post stroke (as all muscles of upper face have bilateral UMN supply, lower = unilateral)
LMN = all facial muscles on affected side ie Bell's palsy

Question 7

How do you test for meningism?

Answer 7

Manipulate their head forward and backward, look for pain

Kernig’s sign - lay patient down, flex their thigh at the hip and extend the leg, look for pain