Cranial Nerves Year 2 Flashcards

1
Q

Cranial nerve and there part of the examination

A

Olfactory
- have you noticed a change in your sense of smelll

Optic

  • get them to read something
  • visual fields test - finger should be halfway between you and the patient
  • pupillary light reflex, direct reflex, consueal reflex in each eye

Abducens, trochlear and oculomotor nerve
- movement of the eye H sign - ask them if they see double

trigeminal sensory aspect of the nerve
- sensation of the face - ask if they feel your touching it, if it is normal and the same both side

trigeminal nerve
- open your mouth and prevent me from closing it

facial nerve

  • muscle of facial expression
  • puff out your cheeks
  • toothy grin

vestibulocochlear?
- whisper 2 digit number and mask it on the other side

vagus/glossopharyngeal?
- visualise the soft palate and get them to say ahh

Hypoglossal Nerve
- ask them to stick the tongue out

Spinal accessory Nerve
- shurg there shoulders

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2
Q

What are you looking for in inspection

A
  • May reveal a facial palsy
    Ptosis
  • Ophthalmoplegia (eye patch)
  • Craniotomy scars (not usually obvious from an anterior inspection, can look behind the ear)
  • PEG/trachy - due to not being able to swallow properly
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3
Q

what can an introduction reveal

A

May reveal a dysphasia or dysphonia

May reveal a decreased conscious level

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4
Q

Name the cranial nerves and there number

A
I = Olfactory
II = Optic
III = Oculomotor
IV = Trochlear
V = Trigeminal
VI = Abducens
VII = Facial
VIII= Auditory (vestibulo cochlear)
IX = Glossopharyngeal
X = Vagus
XI = Accessory
XII= Hypoglossal
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5
Q

How do you test for olfactory

A

Have you noticed any change in your senses of taste or smell?

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6
Q

describe an example of acuity

A

– “6/36” means “I can see at 6m what an average person can see at 36m”

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7
Q

How do you test acuity

A

= ask them to read something
= ask them if they are wearing their glasses
= remember to examine each eye separately - cover one eye get them to read and cover the other eye and get them to read
- use a snellen chart in order to quantify it (won’t use one as you won’t have one and won’t have the distant marked on the floor)

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8
Q

How do you examine the visual fields

A

Fields – tested by confrontation

This allow you to compare the patients visual fields to your own (assumed normal)

In quadrants

One eye at a time

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9
Q

name some eye defects that can arise

A
1 Monocular blindness
2 Bitemporal hemianopia
3 Contralateral homonymous hemianopia
5 C. hom. inferior quadrantanopia
6 C. hom. superior quad
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10
Q

how do you examine the pupillary light reflex

A

using a pen torch

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11
Q

what are the 6 reflexes to test

A
  • direct
  • consensual
  • accommodation - bringing one finger in towards the patients nose and as there eyes converge their pupils constrict
    = these these in each eye
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12
Q

name some pupillary abnormalities

A
Small pupil (miosis) - opiate drugs can cause the pupils to constrict, tend to be smaller in older people as well
can be due to:  
= Drugs eg Opiates
= Pons
= Horner’s syndrome
= Old age
Dilated pupil (mydriasis) = sometimes done on purpose to get a better view 
can be due to:
- Drugs eg Atropine
- Oculomotor palsy
- Ocular trauma (irregular)
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13
Q

what does a fundoscopy allow you to do

A

– you can actually see the end of the second cranial nerve

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14
Q

How do you check for colour vision

A

Colour vision – Ishihara chart

= can check for colour blindness

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15
Q

what causes horizontal movements in the eye

A

medial rectus = moves inwards (adduction)

lateral recuts = moves outwards (abduction)

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16
Q

what nerve supplies the lateral rectus

A

abducens nerve

17
Q

describe what the eye muscles do

  • superior oblique
  • inferior oblique
  • superior rectus
  • inferior rectus
A
  • Superior oblique = inycloduction
  • inferior oblique = excyloduction

superior rectus

  • elevation
  • adduction

inferior rectus
- depression
adduction

18
Q

How do you test superior and inferior rectus

A

but with the eye abducted, the superior and inferior recti move the eye up and down

19
Q

How do you test superior and inferior oblique

A

with the eye adducted, the inferior and superior obliques move the eye up and down

20
Q

what does oculomotor palsy result in

A

An oculomotor palsy results in a dilated pupil and a depressed, abducted eye (down and out)

21
Q

How do you examine the trigeminal nerve

A

Examine facial sensation to fine touch in all 6 areas

Muscles of mastication “clench your teeth” “open your mouth”

Jaw jerk

22
Q

How do you examine the facial nerve

A

“Raise your eyebrows”
“Screw your eyes tight shut”
“Puff out your cheeks”
“Big smile”

23
Q

why does an UMN spares the forehead in the face

A
An UMN weakness 
of the face, spares 
the forehead.
Because the forehead
area of the facial
nucleus is innervated by
both motor cortices.
24
Q

Why might facial weakness develop

A

bells palsy - knocks out the whole side the face

stroke - only bottom half of the face as UMN

25
describe how the corneal reflex works
Stroking the cornea with a wisp of cotton wool, causes the eye to blink Vophth & VII Part of brain stem tests= maybe if they are brain dead Can cause corneal abrasion thus not routinely performed
26
How do you test the vestibule-cochlear nerve
A crude bedside test Mask one ear with tragal massage Whisper a number into the tested ear Ask the patient to repeat the number
27
what tuning fork do you use for weber and rhinne
512Hz tuning fork
28
describe how weber and rhinne test works
The basis for the tests is sensory adaptation – when there is a conduction defect in an ear, the hair cells receive less stimulation and so become hypersensitive. Acoustic conduction can be bypassed by placing a tuning fork on the skull – in which the cochlear is embedded (don't do in the exam)
29
describe how you form the weber and rhinne test
Weber - in which ear is the sound louder? Rinne – which is louder? Air or bone? In a R conductive deafness, Weber localises to R and bone stimulus is louder on Rinne In a R sensorineural deafness, Weber localises to L and air stimulus is louder on Rinne
30
How do you test for cranial nerves IX, X and XI
Open mouth, say “ah” The uvula will be seen to elevate. It will deviate away from the side of a bulbar palsy Gag reflex – when the posterior pharyngeal wall is stimulated with a cotton bud, the patient gags. This is an unpleasant thing to do to someone.
31
how do you examine spinal accessory nerve
Shrug you shoulders” | Tests trapezius
32
How do you examine XII
Stick out your tongue” Look for fasciculation and wasting Deviates towards side of palsy (the muscles of the tongue are pushing it out