Cranial Nerves

Question 1

Cranial Nerve I

Answer 1

olfactory, sensory- smell

test:
1. patency (occlude each nostril separately)
2. smell- close eyes and identify a familiar scent

Question 2

Cranial Nerve II

Answer 2

Optic, sensory- vision

test:
1. visual acuity- jager test
2. visual field - cover opposite eyes, say no when you see my finger in peripheral field.

Question 3

Cranial Nerve III
Cranial Nerve IV
Cranial Nerve VI

Answer 3

III- Oculomotor: mixed- EOM movements, opening eyes; parasympathetic- pupil constriction and lens shape
IV- Trochlear: motor - down and inward movement of eye
VI- Abducen: motor- outward and lateral movement of eye

Test:

1. Palpable fissures- equal width, no drooping, no strabismus or nystagmus
2. Pupil size - PERRLA (use light to check constriction of pupil, should have consensual constriction) (accommodation- stare at far object, now at my finger held 7 cm from nose- constriction and convergence of eye)
3. EOM movement- 6 point star, normal is tracking

Question 4

Cranial Nerve V

Answer 4

V- Trigeminal- mixed: motor- mastication muscles. sensory- scalp, face, cornea, mucous membrane of nose and mouth
Tests:
1. temporal and masseter muscle- palpate as pt clenches teeth - equal and strong both sides
2. lower jaw movement- try to separate while pushing down - shouldn’t be able to
3. light touch: 3 places with cotton ball on face, pt says now when they feel
4. corneal reflex: I would touch your cornea with this cotton ball and expect you to blink

Question 5

Cranial Nerve VII

Answer 5

VII Facial- mixed: sensory- 2/3 ant. taste on the tongue, motor- close mouth and eye, facial muscles, labial speech; para- tear and saliva
Test
smile, frown, lift eyebrows, show teeth, puff cheeks out (i push air out), close eyes tightly against me trying to open.
- should be equal, air should leave symmetrically

Question 6

Cranial Nerve VIII

Answer 6

VIII- Acoustic- sensory: hearing

1. Whisper: one ear at a time, pt occludes by pushing tragus. I whisper from 30-60 cm behind “tuesday, baseball)
   - patient should hear correctly
2. conversation - been following convo this whole exam

Question 7

Cranial Nerve IX and X

Answer 7

IX Glossopharyngeal: Mixed- Motor- pharynx, sensory- lateral 1/3 of tongue taste and gag reflex. Para- carotid reflex and partoid gland
X Vagus: Motor- pharynx and larynx; sensory- general viscera, carotid body and sinus, pharynx. Para- carotid reflex

Test:

1. pharyngeal movement: depress tongue with tongue blade, say “ahhh” - uvula raised at midline
2. gag reflex- i would touch your posterior pharyngeal wall with this tongue blade, and expected would be a gag reflex

Question 8

Cranial Nerve XI

Answer 8

XI spinal accessory- sternomastoid and trapezius

Test:

1. sternomastoid: hand on each cheek, turn towards hand - equal strength
2. trapezius: hand on shoulder, shrug against hand- should be equal strength

Question 9

Cranial nerve XII

Answer 9

XI Hypoglossal - tongue movement

Test:
1. “Light, Tight, Dynamite” - I can hear L, T, D clearly and distinct.