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Year 3 - OSCE Neuro > Cranial nerves > Flashcards

Cranial nerves Flashcards

1
Q

Which tra

A

2 3 4 6

9 and 10

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2
Q

How do you assess smell?

A

Ask patient whether they’ve noticed any changes to sense of smell

Ask them to

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3
Q

Causes of anosmia?

A 
Head trauma
Tumour
Viral URTI 
COVID-19
Meningitis
Parkinson's disease
Blocked nostril (mucous/nasal polyp)
Genetic (Kallman syndrome)
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4
Q

How do you inspect

A

Size
Shape
Symmetry

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5
Q

Asymmetry in pupil size is caused by

A

Anisocoria

Horner’s
Physiological
Third nerve palsy
Holmes-Adle syndrome

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6
Q

Describe how you’d assess which eye is abnormal

A

More pronounced in bright light, larger pupil is abnormal

In dull light????

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7
Q

Eye chart is called

A

Snellen chart

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8
Q

How far should the patient stand?

A

stand 6m away

pt should wear glasses

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9
Q

How do you record the results of the snellen test?

A

Like a fraction

Top number - distance teh chart should be read from

the bottom number is which line they can get to on the chart

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10
Q

If unable to read top line

A

Move patient closer (3m/1m)
Count fingers
Hand movements
Light perception

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11
Q

What is visual inattention or neglect?

A

Deficit in awareness of one side of visual field

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12
Q

Describe findings with pin hole

A

If improvement with pin hole, refractory problem - can be corrected with glasses/

Optic nerve pathology if no correction with pinhole

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13
Q

Describe a finding of visual inattention or neglect

A

Pt can see both of your hands individually, but when you move both at the same time, the pt can only see one hand

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14
Q

What do you call the visual field red pin thing?

A

Hap pin

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15
Q

What do you call the visual field red pin thing?

A

Hat pin

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16
Q

Pupillary light reflex (optic nerve 2)

A

Direct
Consensual
Swinging

17
Q

Describe the direct and consensual light reflex test

A

Shine light in eye and observe pupil constriction in THAT eye

Then shine the light in the same eye but observe the consensual light reflex in the opposite side

18
Q

Describe the direct and consensual light reflex test

A

Shine light in eye and observe pupil constriction in THAT eye

Then shine the light in the same eye but observe the consensual light reflex in the opposite side

19
Q

Swinging light reflex

A

Relative afferent pupillary defect - optic neuritis caused by MS

20
Q

See slide about causes of RAPD

A

Retinal damage

Optic neruoapthy

21
Q

Accommodation reflex

A

Hold finger out and ask pt to look at your finger
Eyes should converge and constrict

Lens is pulled thin and pupil is large when you look at somethign close by

????

22
Q

Describe how you’d test oculomotor nerve

A

Inspect ptosis

23
Q

Causes of a ptosis

A

Oculomotor nerve palsy
Neuromascular pathology - myasthenia gravis (bilateral ptosis)
Congenital
Horner’s

24
Q

Describe how you’d test for CN 3, 4 and 6

A

Inspect eyes - neutral position
Deviation
Nystagmus

25
Q

Describe how you’d assess eye movements

A

Ask pt to follow your finger with their eyes (H)

Ask them to tell you if they get double vision or pain
Restriction of eye movement

26
Q

Describe oculomotor nerve palsy

A

Inferiolaterally (down and out)
Ptosis (drooping of eye lid in that eye)
Pupil dilatation

27
Q

Causes of nystagmus

A

Congenital
Central e.g. mid brain or cerebellar lesion
Peripheral e.g. vestibular system
Physiological (normal)

28
Q

Rinner’s test

A

Sensorineural deafness - air is louder than bone conduction, but weber’s test - sound louder in normal ear
Conductive
Bone louder than air
Weber’s test - louder in affected air

Normally air should be louder than the bone

29
Q

Weber’s test

A

non vibrating end of tuning fork held to forehead

Pt should hear the sound both side

30
Q

CN 9 and 10

A

gag reflex

Inspect soft palate and uvula
Look for uvula deviation (away from affected side)
Soft palate - reduced elevation on affected side

Ask: have you experienced any swallowing difficulties or changes to your voice or cough? - ask patient to cough

Swallow
sip water

gag reflex ?

31
Q

CN 11

A

Inspect SCM and trapezius

Muscle wasting and fasciulations

Test power - ask patient to shrug against resistance

scm - ask pt to turn their head (opposite scm causes the head turn)

32
Q

CN 12

A

stick tongue out
wasting fasciculations
deviation (towards)

Power - ask pt to press their tongue against the cheek, whilst you feel and compare sides

33
Q

Further examinations

A

full neuro examination
mini mental exam
asssessmetn of gait and balance

34
Q

Facial nerve 7 palsy is called

A

Bell’s palsy

35
Q

Distinguish between a

A

Stroke - forehead sparing (can wrinkle both sides)

Facial nerve palsy, forehead is affected

Year 3 - OSCE Neuro (6 decks)

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