Cranial Nerves Exam

Question 1

Inspection for CN exam?

Answer 1

walking stick, scars, neurofibromas, facial symmetry, ptosis, proptosis (protrusion of eyeball), skew deviation of the eyes and inequality of pupils, resting tremor and muscle wasting

Question 2

Assess CN1 (olfactory)

Answer 2

Have you noticed any changes to your sense of smell recently? If thye have then test each nostril with eyes closed with a strong smelling thing e.g. coffee

Question 3

Assess CN2 (optic) for visual acuity

Answer 3

Snellen chart but if you dont have ione use fingers with one eyes closed at a time

Question 4

Assess CN2 (optic) for reflexes

Answer 4

Direct (shine light directly)
Consensual (check opposite eye to the one tested)
Swinging light test

Question 5

Assess CN2 (optic) for accommodation

Answer 5

Focus on object behind and then focus on finger in front of eyes

Question 6

Assess CN2 (optic) for visual inattention

Answer 6

Sit 1m apart and look directly into eyes and wiggle finger in periphery

Question 7

Assess CN2 (optic) for visual fields

Answer 7

Sit opposite and both cover the same side eye and identify finger in each quadrant

Question 8

Extra CN2 assessments

Answer 8

check for colour blindness, fundoscopy and blind spot

Question 9

How to assess CN3, 4 and 6

Answer 9

H shape, I shape, ask if they have any double vision, look for nystagmus

Question 10

How to test CN5 (trigeminal) sensation

Answer 10

Eyes closed for exam
Cotton wool on sternum
Cotton wool on forehead both sides on at a time
Then cheeks
Then chin

Question 11

How to test CN5 for Motor and Power

Answer 11

Clench teeth and then palpate the temples and the cheeks as they do it

Power - open mouth against resistance

Question 12

What would you offer for CN5 reflexes?

Answer 12

Jaw jerk and corneal

Question 13

How to assess CN7?

Answer 13

Raise eyebrows, Close eyes as tight as possible and dont let me pull them open, puff out your cheeks, purse your lips, show your teeth

Question 14

CN8 assessment

Answer 14

Cover opposite ear and whisper a number

Rinnes - 512Hz tuning fork, held on mastoid and then patient stops hearing it and then move to in front of their ear and ask if they can hear it

Webbers - hold on forehead and ask if they can hear it equally on both sides

Ask if they have experienced any dizziness

Question 15

CN9 and 10 Assessment

Answer 15

Open wide and say ‘aah’ and look for uvular deviation away from the affected side

Any difficulty swallowing

Could you cough for me

Offer gag reflex

Question 16

How to assess CN11 (Accessory)

Answer 16

Turn head against resistance and palpate sternocleidomastoid)

Shrug shoulders against resistance

Question 17

Assess Hypoglossal

Answer 17

Open mouth and observe tongue at rest

Stick out tongue and look for deviation

Ask them to move tongue side to side

Push tongue into cheek with resistance

Question 18

Present for normal CN exam

Answer 18

Today I examined patient X. On general inspection the patient appeared comfortable with no signs of peripheral neurological disease. Examination of the cranial nerves was unremarkable and so this was a normal cranial nerve examination