Cranial Nervous Examination

Question 1

Cranial nerve I name and function

Answer 1

Olfactory nerve - smell

Question 2

Cranial nerve II name and function

Answer 2

Optic nerve - vision

Question 3

Cranial nerve III name and function

Answer 3

Oculomotor - eye movement

Question 4

Cranial nerve IV name and function

Answer 4

Trochlear - eye movement

Question 5

Cranial nerve V name and function

Answer 5

Trigeminal - facial sensation/chewing

Question 6

Cranial nerve VI name and function

Answer 6

Abducens - eye movement

Question 7

Cranial nerve VII name and function

Answer 7

Facial - facial expression

Question 8

Cranial nerve VIII name and function

Answer 8

Vestibulocochlear - hearing and balance

Question 9

Cranial nerve IX name and function

Answer 9

Glossopharyngeal - soft palette movement

Question 10

Cranial nerve X name and function

Answer 10

Vagus - swallowing

Question 11

Cranial nerve XI name and function

Answer 11

Accessory - shoulder elevation and head turning

Question 12

Cranial nerve XII name and function

Answer 12

Hypoglossal - tongue movement

Question 13

Which attributes of cranial nerve I do you assess

Answer 13

Ability to smell

Question 14

How do you assess ability to smell

Answer 14

Ask if the patient has noticed any change in their sense of smell

Question 15

Which attributes of cranial nerve II do you assess

Answer 15

Visual acuity
Visual fields
Pupillary reflexes
Fundus

Question 16

Which attributes of cranial nerves III, IV and VI do you assess

Answer 16

Eye movements

Accommodation

Question 17

How do you assess visual acuity

Answer 17

Ask the patient to read something out at a distance, covering one eye (wearing their glasses or contacts if they have them)

Question 18

How do you assess visual fields

Answer 18

Inattention (look at my nose and point to which side i make a gesture to)
Visual fields (one eye at a time, compare your own visual fields to the patients' using a pin)
Blind spot (compare your own blind spot to the patients')

Question 19

How do you assess pupillary reflexes

Answer 19

Shine a torch into patient’s eyes

Swinging torch test

Question 20

How do you assess the fundus

Answer 20

By ophthalmoscopy

Question 21

How do you assess eye movements

Answer 21

Note ptosis and abnormal position

Ask patient to follow finger side to side and then in an H pattern

Question 22

How do you assess accommodation

Answer 22

Ask patient to look at finger as you move it closer towards them and observe convergence

Question 23

Which attributes of cranial nerve V do you assess

Answer 23

Sensory
Motor
Reflexes

Question 24

How do you assess facial sensation (V)

Answer 24

Ask patient to close eyes and inform you when they feel you touch their forehead, cheek and jaw on both sides

Question 25

How do you assess facial motor function (V)

Answer 25

Ask patient to open jaw against resistance

Palpate jaw muscles while asking them to clench their jaw

Question 26

How do you assess facial reflexes (V)

Answer 26

Corneal reflex - can be assessed with cotton wool on the nostril (same nerve)
Jaw jerk reflex

Question 27

Which attributes of cranial nerve VII do you assess

Answer 27

Facial tone
Motor
Sensory

Question 28

How do you assess facial tone (VII)

Answer 28

Look for signs:
reduced wrinkling
drooping of mouth

Question 29

How do you assess facial motor function (VII)

Answer 29

Raise eyebrows
Screw up eyes
Puff out cheeks

Question 30

How do you assess facial sensory function (VII)

Answer 30

Ask:
Have you noticed any changes in taste
Have you become increasingly bothered by loud noises

Question 31

Which attributes of cranial nerve VIII do you assess

Answer 31

Hearing

Question 32

How do you assess hearing in cranial nerve exam

Answer 32

Occlude one ear and whisper to patient asking them to repeat. Repeat on other side.

Question 33

Which attributes of cranial nerve IX, X, XII do you assess

Answer 33

Palate function

Tongue function

Question 34

How do you assess palate function

Answer 34

Movement of uvula (ask patient to say ahhhh)
Speech
Swallowing water

Question 35

How do you assess tongue function

Answer 35

Appearance (wasting, fasciculating, spastic)

Movement (left to right, resistance against cheek)

Question 36

Which attributes of cranial nerve XI do you assess

Answer 36

Motor

Question 37

How do you assess motor function (XI)

Answer 37

Shrug shoulders

Turn head against resistance

Question 38

Further investigations after cranial exam

Answer 38

Peripheral neural exams
Formal hearing test
Nerve conduction study
Bloods
CT/MRI head