History and Examination

Question 1

What are the 12 cranial nerves?

Answer 1

Olfactory, Optic, Oculomotor, Trochlear, Abducens, Trigeminal, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal

Question 2

How do you test the olfactory nerve?

Answer 2

Olfactory - sense of smell
Ask the pt if sense of smell is altered
Test with aromatic substances

Question 3

How do you test the optic nerve?

Answer 3

Ask the patient about their sight
Check visual acuity

Question 4

How do you test the oculomotor nerve, trochlear nerve and abducens nerve?

Answer 4

Test eye movements in all directions

Question 5

How do you test the trigeminal nerve?

Answer 5

Trigeminal - sensory to facial skin and oral mucosa, motor to muscles of mastication
Test all 3 branches - ophthalmic, maxillary and mandibular
Is the sensations of the skin of the face normal over all these areas?
Does the pt have a corneal reflex?
Can the pt clench her jaw muscles?

Question 6

How do you test the facial nerve?

Answer 6

Motor to muscles of facial expression, sensory to the external auditory meatus, taste sensation to the tongue.

Can the pt pout, smile, wrinkle her forehead or raise her eyebrows?

Question 7

How do you test the vestibulocochlear nerve?

Answer 7

Hearing and balance
Can the pt hear normally?
Block one ear by pressing on the Tragus - whisper a number and get the patient to repeat it

Question 8

How do you test the Glossopharyngeal nerve?

Answer 8

Supplies the stylopharyngeus muscle and taste in posterior 1/3rd of tongue

Get patient to say ahh and look for any deviations of the uvula and movements of the soft palate

Question 9

How do you test the vagus nerve?

Answer 9

Supplies structures in neck, thorax and abdomen

Ask the patient to say “ahh” and look for deviation of the uvula

Tell the examiner that you will test the gag reflex

Question 10

How do you test the accessory nerve?

Answer 10

Innervates sternocleidomastoid muscle and trapezius

Can the patient shrug his shoulders?

Question 11

How do you test the hypoglossal nerve?

Answer 11

Motor to tongue muscles

Ask pt to protrude tongue. Is the tongue symmetrical in movement and bulk?

Question 12

How would you assess a lump in the neck?

Answer 12

Introduce yourself to patient
Neck observed from front
Ask patient to swallow
Stand behind pt and palpate thyroid gland
Percuss the manubrium (upper part of sternum) for retrosternal extension
Listen for any abnormal sound
Palpate triangles of the neck and supraclavicular fossae for lymph nodes

Question 13

How can lumps in the neck be classified?

Answer 13

Either location (anterior triangle of the neck or posterior) or by benign/malignant

Question 14

What are the important points to note when you are examining a lump in the neck?

Answer 14

Single or multiple lumps? - multiple lumps usually indicate lymph nodes

Where is the lump?

Is the lump solid or cystic?

Does it move with swallowing?

Question 15

How would you take a medical history from a patient?

Answer 15

Introduce yourself to the pt
Are they generally fit and healthy or currently receiving tx for a doctor, hospital or clinic?
Are they taking any regular medication?
Do they have any allergies to any substances or foods or medications?
Pregnant or breastfeeding?

Have they ever had any problems with their heart or blood pressure?
Any problems with lungs - asthma, COPD, bronchitis?
Any problems with epilepsy or fits/faints?
Any liver/kidney problems? - jaundice, hepatitis
Diabetes?
Ever had any infectious diseases HIV
or tuberculosis?
Any problems with bleeding post extraction or injury or aware of any bleeding disorders within the family?
Smoker or ex-smoker?
Drinker? - units
Have they ever been hospitalised for anything? - if so what have they been hospitalised for
Have they ever had a bad reaction to local or GA?

Question 16

A 24 year old male pt has suffered a punch to the side of the lower jaw at a party. It is now Monday morning and he is attending A&E, please take a history from the pt regarding his injury (There is not time to take a medical or social hx)

Answer 16

Introduce yourself to the pt
Pts complaint - ascertain their chief complaint and write in notes in their own words
HPC -
Exactly when was pt injured?
What was he hit with?
How many times was he hit?
What directions the blow(s) came from?
Did he lose consciousness - if so, how long for and how was this dealt with?
Was the alleged assault witnessed and if so by whom?
Are the police involved?
Was any tx sought initially?
Was the pt under the influence of any subjects when the injury occurred (e.g alcohol or drugs?)

You now need to find out about the symptoms that the pt is experiencing
- pain - SOCRATES
- loss or altered function related to - the mandible (movement, occlusion, speech, swallowing) nerve injury - paraesthesia/anaesthesia of the trigeminal nerve, bleeding from the ears

You also need to find out whether the pt has shown any signs of a head injury since the time the injury occurred

Question 17

How would you examine a patient in regards to a suspected fractured mandible?