Cranial Nerves Exam

Question 1

how would you test for cranial nerve I (olfactory)?

Answer 1

“any recent change in smell?’
if so … test each nostril with coffee/soap

Question 2

how would you test for cranial nerve II (optic)

Answer 2

(AFIRO)
Acuity - snellen chart from 6m away, one eye at a time (no chart hold up fingers)
Fields - 1m apart each cover opposite eye, move index finger from outside your visual field towards centre of visual field
Inattention - hold hands up on periphery of visual field move each index finger one at a time and then both at the same time
Reflexes - direct + consensual (shine light source in from side 2x look at both pupils) + accomadation ( look at a distant point then focus on finger in front of their nose + pupils should constrict)
Offer - ophthalmoscopy, testing colour vision and assessing blind spot

Question 3

how would you test for cranial nerve III, IV, VI (Oculomotor, trochlear, abducens nerves)

Answer 3

ask patient to keep their head still and follow with their eyes as you draw a H and an I
‘any double vision?’

Question 4

how would you test for cranial nerve V (trigeminal)

Answer 4

sensation - fine touch (cotton wool), pinprick
tone - clench jaw and palpate masseter + temporalis muscle, then ask them to open their mouth against resistance
jaw jerk - mouth half oppened, finger over midline of lower jaw then tap with tendon hammer
offer corneal reflexes

Question 5

how would you test for cranial nerve VII (facial nerve)

Answer 5

screw up eyes (try and pull them apart), puff cheeks, raise eyebrows, purse their lips and show their teeth

Question 6

how would you test for cranial nerve VIII (vestibulocochlear)

Answer 6

cover opposite ear and whisper a number at 15cm then 60cm
if abnormality then perform special test
Rinne’s - tuning fork placed on mastoid then moved to external acoustic meatus (conductive hearing loss if louder on mastoid)
Weber’s - tuning fork held on forehead in midline, normal if vibrations are equal on both side, conductive deafness: louder in abnormal, sensineneuronal deafness: louder in normal

Question 7

how would you test for cranial nerve IX + X (glossopharyngeal + vagus)

Answer 7

say ahh - uvula will deviate away from side of IX palsy
ask to cough
any difficulty swallowing?
offer gag reflex

Question 8

how would you test for accessory nerve (XI)

Answer 8

shrug shoulders against resistance
turn head against resistance