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ECR 2012 > ECR Cranial Nerve and Eye Exam > Flashcards

ECR Cranial Nerve and Eye Exam Flashcards

1
Q

What does HPI include

A

General physical exam

Visual loss/changes

Diplopia (double vision)

Discharge

Erythema/redness

Eye pain

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2
Q

Related Hx of

A 
Trauma
Employment exposure
Allergies
Corrective lenses
Medications
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3
Q

Common presentation of eye problems

A

vions loss (retina disease/stroke)

Visual distortion (macular degeneration, medication side effect

Itching/foreignbody sensation (foreign body, allergies)

Headache/dizziness (migrain/cerebllar disease)

Eye pain (glaucoa/ sinusitis)

Light sensitivity (coreanl abrasion/ meningities)

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4
Q

What eye chart is used for far vision

A

Snellen Chart

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5
Q

What eye chart is used for near vision

A

Rosenbaum card

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6
Q

What is the apporach to exam (3 parts)

A
  1. Vision assessment (always document vision PRIOR to and AFTEr exam)
  2. Inspectin ,palpation, and cranial nerve testing (external eye and ass. structures moving to more internal structures)
  3. Opthalmoscopic examination (internal eye)
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7
Q

What do you do for vision assessment?

A

Central Vision

  • distance visual acuity
  • near visual acuity

Visual fields

Color vision if warranted

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8
Q

What can DM, HTN, AIDs cause in ye?

A

Retinal changes

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9
Q

What can cause dry eye

A

Rheuatologic conditions

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10
Q

What can severe medication reaction/ Herpes Zoster cause

A

Red/eye conjunctivitis

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11
Q

Thyroid disease can cause

A

Proptosis/exopthalamos

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12
Q

Multiple sclerosis/ inc. intracranial pressure

A

Optic nerve changes/ body of eye; mc”

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13
Q

liver/biliary/pancreatic disease

A

scleral icterus

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14
Q

What is an Amsler Grid?

A

Used for central vision deficits like MACULAR DEGENERATION

stare at center dot to see if lines are croooked or bent

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15
Q

What does it mean if you see crooked lines or liens missing?

A

Macula degeneration!

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16
Q

What does the macula do?

A

macula of retina

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17
Q

How do you give external eye exam?

A

INspect surrounding areas
Eyebows for size, extension, hair texture
Orbial area for edema, exopthalamos (protudig troauma0
eyelids
lacrimal apparatus

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18
Q

How do you assess external pupil reaction ?

A

Direct
Consensual
Accomodation

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19
Q

What does it mean to do direct pupil exam

A

shine light to left eye–> left pupil constricts

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20
Q

Consensual pupil exam

A

Shind light to left eye, right pupil will contract

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21
Q

Accomodation

A

constriction of pupil and CHANGE OF SHAPE of lens to assist focusing on a lose object

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22
Q

Accomodation

A

constriction of pupil and CHANGE OF SHAPE of lens to assist focusing on a lose object

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23
Q

How do you test Extraocular muscles

A

muscle alignment/balance with penlight

movement using 6 cardinal fileds f gaze (H)

Conjugate (workign togehter) or dysconjugate

Assess convergence (follow fingers as you move it towards bridght of nose)

Observe for nystagmus

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24
Q

What is nystagmus

A

fine rhythmic oscillation of eyes

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25
Q

What is strabismus

A

misalignment of eyes

26
Q

Which EOM for right and up

A

Right superior rectus muscle

Left inferior oblique

27
Q

Which EOM for Left and up

A

Right inferior oblique

Left superior recturs

28
Q

Which EOM for Right

A

Right lateral rectus

Left medial rectus

29
Q

Which EOM for Left

A

Left lateral rectus

Right medial rectus

30
Q

Which EOM right and down

A

Right inferior rectus

Left superior oblique

31
Q

Which EOM for left and down

A

Right superior oblique

Left lateral rectus

32
Q

What are components of the fundus?

A

Optic nerve/optic disc

Retina

Arteries

Veins

Macula and Fovea

33
Q

What are common presentations of vision

A

change or loss of vision

Double vision (diplopia)

Facial weakness

difficulty speaking

Difficulty swallowing

Change or loss of hearing

Imbalance/vertigo

34
Q

How do you test CN I

A

Olfactory

occlude and let patient semll something with one nostril at atime
NO noxious stimuli such as smelling salts or ammonia

35
Q

How do you test CN II

A

Optic

Visual Acuity- eye chart

Visual Fields- Confrontation (2 wiggling fingers)

Visualization of the nerves (opthalamoscopic exam)

Pupillary response (afferent II, efferent III)

36
Q

How do you test CN III

A

Oculumotor

MOtor: 4/6 muscles (inferior rectus, inferior olique, medial rectus, supieror rectus)

Convergence (ask pt to follow finger as u bring it to bridge of nose)

Elevate eyelid (levator palpebrae superioris m)

Pupillary light (direct and consensual)

37
Q

Signs to look for if CN III is affected

A

Right CN III Palsy
Ptosis (eyelid drooping)
Eye is “down and out” at rest
Pupil more dilated than opposite eye

38
Q

How to test CN IV and VI

A

IV- Trochlear
VI- Abducens
(LR6,SO4)3

CN IV- superior oblique; moves eye down adn in

CN VI- Lateral rectus; moves eye into abduction

39
Q

Sings to look for if CN VI affected

A

right CN VI palsy
Excessive adduction at rest
Cannot adduct when gazing left

40
Q

HOw to test for CN V Motor

A

Trigeminal
Motor: muscles of mastication- masseters, pterygoids, temporalis
Palpate
Assess Strength

41
Q

How to test for CN V Sensory

A

Trigeminal

Sensory
-sensation to face (sharp or cold?_
-3 divisions 
V1- Opthalamic
V2- Maxiallary
V3- Mandibular

Touch to face

Corneal Reflex

42
Q

How do you test corneal reflex

A

CN V and VII

Use cotton and put to side of eye

Sensory input from surface of eye CN V
Motor response from CN VII (facial N)

In by V
Out by VII

42
Q

How to test sensory for CN VII

A

Facial

Sensory:
Taste to anterior 2/3

Sesnation to small area behind ear and ear canal

43
Q

How to test motor for CN VII

A

Facial

Muscles of facial expression
Close eyes tightly
Raise eyebrows
Puff out cheeks
Show me your teeth

Note asymetry, weakenss

43
Q

How to test CN VIII (acoustic)

A

Acoustic (vestibulocochlear)

Semicicrular cnals/vestibular apparatus

balance
warm/cold caloric testing
special diagnostic maneuvers
*not clinically useufl for us yet_

44
Q

How to test for CN VIII (cochlear)

A 
Cochlea
Hearing
Acutiy (whisper test)
Rinne Test
Weber Test
44
Q

If no hearing loss, is it louder in air or bone for Rinne test

A

Air > Bone

45
Q

If no hearing loss, what is result of Weber test

A

hear it midline

45
Q

If there is Sensorineural damage waht are results for Rinne and Weber

A

Rinee- Air > Bone

Weber : Louder in NORMAL EAR

46
Q

If there is Conducton damage what are results for Rinne and Weber tests

A

Rinne test- Bone >A ir

Weber: Louder in IMPAIRED ear

46
Q

CN IX

A

IX- Glossopharygeal

Sensory ; soft palate, pharynx, posterior tongue

Motor stylopharygenas

47
Q

CN X

A

Motor: movement of the uvula and soft palate with phonation and gag

48
Q

How to test CN IX and X

A

test together

let patient say “Ahhh”
Gag rellex
Swallow water

look for symmetric elevation of palate, midline uvula

Difficulty swallong ,poor phonation with speaking

49
Q

How to test CN XI

A

Accessory

AKA: Spinal accessory nerve

Motor Trapezius (shrug shoulders)/ sternocleidomastoids (resist face)

assess strenght/test against resistance

50
Q

How to est for CN XII

A

Hypoglossal

Motor- movement and protrusion of tongue

Assess position, movment and strength

Stick tongue straight out and move it side ot side

Look for fasciculations (involuntary muscle movement), atrophy, deviation from midline

51
Q

CN IX

A

IX- Glossopharygeal

Sensory ; soft palate, pharynx, posterior tongue

Motor stylopharygenas

52
Q

CN X

A

Motor: movement of the uvula and soft palate with phonation and gag

53
Q

How to test CN IX and X

A

test together

let patient say “Ahhh”
Gag rellex
Swallow water

look for symmetric elevation of palate, midline uvula

Difficulty swallong ,poor phonation with speaking

54
Q

How to test CN XI

A

Accessory

AKA: Spinal accessory nerve

Motor Trapezius (shrug shoulders)/ sternocleidomastoids (resist face)

assess strenght/test against resistance

55
Q

How to est for CN XII

A

Hypoglossal

Motor- movement and protrusion of tongue

Assess position, movment and strength

Stick tongue straight out and move it side ot side

Look for fasciculations (involuntary muscle movement), atrophy, deviation from midline

ECR 2012 (16 decks)

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