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Examinations > Cranial Nerves Exam > Flashcards

Cranial Nerves Exam Flashcards

1
Q

What is the first step?

A

Introduce self
Confirm name and DOB
Ask for consent
Ask if they are in any pain

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2
Q

What do you do after the introduction?

A

General inspection

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3
Q

What kind of things are you looking for in a general inspection?

A

Walking aids
Hearing aids
Medication

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4
Q

What is the CN I ( Olfactory Nerve) Test

A

Ask if they have had any changes to their sense of smell recently

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5
Q

What is the order of the CN II ( Optic Nerve) Test?

A

Inspect pupils
Visual Acuity
Visual Fields
Accommodation reflex
Pupil reflexes ( direct and consensual)
Say you would perform fundoscopy and access blind spot

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6
Q

What are you accessing the pupils for?

A

Size
Shape
Symmetry

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7
Q

How do you assess visual acuity?

A

Ask if they normally use glasses
Using a Snellen chart
Get them to stand 6m away
One eye at a time
Ask them to read to the last line

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8
Q

What comes after the visual acuity test?

A

Pupillary Reflexes

Shine light into each eye , direct and consensual

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9
Q

What do you perform after the visual acuity test?

A

The accommodation reflex test

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10
Q

How do you do the accommodation reflex test?

A

Place an item about 30cm away their face and ask them to focus on it . Then slowly move it towards their face to assess their pupil response

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11
Q

What should you see of the pupils in the accommodation reflex?

A

Constriction
Convergence

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12
Q

What do you do after the accommodation reflex?

A

Visual Neglect

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13
Q

How do you test for visual neglect?

A

Ask patient to focus on your nose and place arms out . Wiggle one side and ask them to point at which side it was

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14
Q

What do you assess after visual neglect?

A

Visual fields

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15
Q

How do you assess visual fields?

A

Ask the patient to cover one eye with their hand, you cover the mirrored eye with your hand.
Ask them to focus into your eyes
Ask them to tell you when they see your finger wiggling, compare to your own visual field
Do each corner ( box shape )

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16
Q

What do you assess after visual fields?

A

Fundoscopy

17
Q

What are you looking for with a a fundoscope?

A

Any optic disc pathologies
E.g. Papilloedema

18
Q

How do you asses CN III, IV and VI?
(First step)

A

Inspect eyelids for ptosis

19
Q

What can ptosis be caused by?

A

Oculto motor nerve palsy
Horner’s Syndrome
Myasthenia Gravis

20
Q

What do you do after inspecting their eyelids?

A

Inspect their eye movements

21
Q

How do you inspect eye movements?

A

Be at eye level
Ask patient to keep their head still
Ask them to follow your finger with thier eyes
Make a H shape with your finger
Ask if they had any pain or double vision

22
Q

What are you looking for in an eye movement test?

A

Strabismus ( eyes not aligning )

23
Q

What do you access after CN III, IV and VI

A

CN V ( Trigeminal )

24
Q

How do you access CN V sensory component?

A

Light touch (cotton bud ) and pinprick sensation of the forehead (V1), cheek (V2) and lower jaw (V3)

25
Q

How do you assess CN V Motor Function?

A

Test the muscles of mastication

Inspect the temporalis and masseter for wasting
Palpate the master and ask patient to clench jaw
Ask patient to open their mouth whilst you apply resistance to the jaw
Ask them to swing their jaw side to side ( pterygoids )

26
Q

How do you assess CN VIII ( Facial Nerve ) special sensory function ?

A

Ask if they’ve had an changes to their sense of taste

27
Q

How do you assess the CN VII (Facial Nerve) motor function?

A

Ask patient to :

Raise thier eyebrows
Close eyes and don’t let me open them
Blow out cheeks
Smile and show teeth
Purse lips

28
Q

How do you assess CN VIII (vestibulocochlear nerve) motor function?

A

Ask if they have had any changes to their hearing recently

29
Q

What do you do after asking about changes to their smell?

A

Whisper test

Tell patient you are gonna whisper 3 words in their ear and ask them to repeat it back to you. Cover one of their ears , e.g. say “55, 75, 33 “

30
Q

What do you do after the whisper test?

A

Rinne’s Test

Apply vibrating fork to the patients mastoid process and ask them to say when they can no longer hear it.
Then move it off and ask if they can now hear it, they should be able to .

Air conduction > Bone conduction

31
Q

What do you do after Rinne’s Test?

A

Weber’s Test

Vibrate fork and place it on their forehead. Ask them if it is louder on one side

32
Q

How do you assess CN IX and X ( Glossopharyngeal + Vagus )?

A

Ask patient to open their mouth
Inspect thier soft palate and uvula
Ask them to say ‘ah’ should be no deviation
Ask them to cough
Say you would do gag reflex also

33
Q

How do you assess CN XI?

A

Assess SCM and trapezius for wasting
Ask them to raise shoulders (apply resistance)
Ask them to turn the head left (apply resistance)
Ask them to turn their head right ( apply resistance)

34
Q

How do you assess CN XII ( Hypoglossal Nerve) ?

A

Ask patient to open mouth
Assess tongue for wasting/fasciculations
Ask them to protrude tongue
Place your finger on each check and ask them to press against it

Examinations (11 decks)

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