Cranial nerves examination Flashcards
What are the things to look out in inspection of patient and environment?
Patient:
- speech deformities
- facial deformities
- eyelid deformities
- pupillary deformities
Environment:
- walking aids
- hearing or visual aids
- medication
What are the things to test in olfactory nerve?
- Ask for any changes in smell
What are the things to test in optic nerve?
- inspect pupil-for assymetry; mydriasis or miosis
- check for visual acuity with snellen’s chart
- distance (6m)/ number of last line
- 6m-> 3m->1m (check with pinhole if cannot be seen)
- check for light reflex
- check for direct light reflex (pupil constriction when light is shone); consensual light reflex (other pupil constriction when light is shone)
- check for relative afferent pupillary defect when swinging light (abnormal if dilated when light is shone due to retinopathy defect)
- check for ability to accomodate-> ask to look at wall and then at finger (check for pupil constriction and convergence)
- check for colour vision with ishihara plate
- test for visual inattention-> with finger (test for contralateral parietal lobe)
- test for visual fields
- offer to check for blind spot/fundoscopy
What are the things to test for III/IV/VI?
- inspect eyelids for any ptosis or opthalmoplegia
- first ask for any pain in eye and double vision
- H-> check for any nystagmus and restriction of eye movement
What are the things to test for V?
- check for sensation and pain with cotton wool/pin prick in V1 and V2 and V3
- check for temporalis and masseter muscle wasting(ask them to clench)
- ask them to open their mouth and stop you from closing the mouth
- check for jaw jerk reflex by putting finger horizontally and then tapping it lightly (brisk reflex is abnormal)
What are the things to test for VII?
- have you noticed any changes in taste or hearing
- facial movement
Raised eyebrows: assesses frontalis – “Raise your eyebrows as if you’re surprised.”
Closed eyes: assesses orbicular oculi – “Scrunch up your eyes and don’t let me open them.”
Blown out cheeks: assesses orbicularis oris – “Blow out your cheeks and don’t let me deflate them.”
Smiling: assesses levator anguli oris and zygomaticus major – “Can you do a big smile for me?”
Pursed lips: assesses orbicularis oris and buccinator – “Can you try to whistle?”
- check for any change in the taste sensation
- check for any sensitivity to loud sounds
- look for vesciular rashes in external auditory meatus
What are the things to test for VIII?
- any changes in your hearing?
- check for gross hearing by whispering number at 60cm-> move to 15cm if they can’t hear you
- Rinne’s test
- bone conduction:place tuning fork at the mastoid process and tell them to tell you when they can’t hear it
- air conduction:then place tuning fork in front of ear and ask if they can hear it. If they can air conduction>bone conduction (Rinne’s positive which means normal or sensorineural deafness) If bone conduction>air (conductive hearing loss)
- Weber’s
- place it in middle of forehead. Hearing should be equal on both sides. Sensorineural hearing loss-> hear it better on unaffected side; conductive hearing loss-> hear it better on affected side
- ask them to march on the spot with their eyes closed (vestibular function, unterberger test-rotate to the side of lesion indicates labyrinthe lesion)
What are the things to test for IX and X?
- ask for any changes in their voice or swallowing or cough
- ask them to open their mouth and say ahh-> check for deviation of uvula and paralysis of palate
- ask them to cough
- ask them to swallow
- offer to check for gag reflex
What are the things to test for accessory nerve?
- inspect for SCM/trapezius for wasting
- ask them raise their shoulders and stop you from pushing them down
- ask them to turn their head to the side and stop you from turning the other away
What are the things to test for hypoglossal nerve?
- open the mouth and check for fasciculations
- ask patient to protrude their tongue-> check for hypoglossal lesion
- ask them to press their tongue against the cheek and place your finger on each cheek to assess tongue power
