Cranial Nerves Exam Flashcards
What is the first step?
Introduce self
Confirm name and DOB
Ask for consent
Ask if they are in any pain
What do you do after the introduction?
General inspection
What kind of things are you looking for in a general inspection?
Walking aids
Hearing aids
Medication
What is the CN I ( Olfactory Nerve) Test
Ask if they have had any changes to their sense of smell recently
What is the order of the CN II ( Optic Nerve) Test?
Inspect pupils
Visual Acuity
Visual Fields
Accommodation reflex
Pupil reflexes ( direct and consensual)
Say you would perform fundoscopy and access blind spot
What are you accessing the pupils for?
Size
Shape
Symmetry
How do you assess visual acuity?
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
What comes after the visual acuity test?
Pupillary Reflexes
Shine light into each eye , direct and consensual
What do you perform after the visual acuity test?
The accommodation reflex test
How do you do the accommodation reflex test?
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
What should you see of the pupils in the accommodation reflex?
Constriction
Convergence
What do you do after the accommodation reflex?
Visual Neglect
How do you test for visual neglect?
Ask patient to focus on your nose and place arms out . Wiggle one side and ask them to point at which side it was
What do you assess after visual neglect?
Visual fields
How do you assess visual fields?
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 )
What do you assess after visual fields?
Fundoscopy
What are you looking for with a a fundoscope?
Any optic disc pathologies
E.g. Papilloedema
How do you asses CN III, IV and VI?
(First step)
Inspect eyelids for ptosis
What can ptosis be caused by?
Oculto motor nerve palsy
Horner’s Syndrome
Myasthenia Gravis
What do you do after inspecting their eyelids?
Inspect their eye movements
How do you inspect eye movements?
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
What are you looking for in an eye movement test?
Strabismus ( eyes not aligning )
What do you access after CN III, IV and VI
CN V ( Trigeminal )
How do you access CN V sensory component?
Light touch (cotton bud ) and pinprick sensation of the forehead (V1), cheek (V2) and lower jaw (V3)
How do you assess CN V Motor Function?
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 )
How do you assess CN VIII ( Facial Nerve ) special sensory function ?
Ask if they’ve had an changes to their sense of taste
How do you assess the CN VII (Facial Nerve) motor function?
Ask patient to :
Raise thier eyebrows
Close eyes and don’t let me open them
Blow out cheeks
Smile and show teeth
Purse lips
How do you assess CN VIII (vestibulocochlear nerve) motor function?
Ask if they have had any changes to their hearing recently
What do you do after asking about changes to their smell?
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 “
What do you do after the whisper test?
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
What do you do after Rinne’s Test?
Weber’s Test
Vibrate fork and place it on their forehead. Ask them if it is louder on one side
How do you assess CN IX and X ( Glossopharyngeal + Vagus )?
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
How do you assess CN XI?
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)
How do you assess CN XII ( Hypoglossal Nerve) ?
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
