Neuro: Cranial Nerves

Question 1

CN I: Olfactory PE ?

Answer 1

Test sense of smell

Check patency b/l ( occlude on nostril)

Close eyes

One nostril at a time

Nonirritating odor
-Cloves, vanilla, soap

Not often checked, “CN’s II – XII grossly intact”

not commonly a problem and not commonly checked

Question 2

CN II: Optic PE ?

Answer 2

Visual acuity - snellens

Funduscopic exam

Visual fields by confrontation - they are looking in your eyes as you move fingers, they tell you when they seat to see your fingers in their preperfera

Question 3

CN II and III: Optic and Oculomotor PE ?

Answer 3

Size and shape of pupils

Pupillary reaction

Near response - when they convert and constrict - assuming accommodation

**Near response– pupillary constriction, convergence and accommodation of the lens

shine light 4 times

anesacoria - different sized pupil ) more than 0.4)

3rd nerve palsy - abnormal pupil constriction

and check for ptosis **

Question 4

CN III, IV and VI: Oculomotor, Trochlear and Abducens PE ?

Answer 4

Extraocular movements – 6 cardinal directions
make an H

Nystagmus- horizontal, vertical, rotary, mixed

Ptosis

**little bit of ptosis is always opposite , double vision if they do not move together - the eyes **

Question 5

CN V: Trigeminal PE - motor ?

Answer 5

Clench jaw, palpate temporal and masseter

Move jaw side to side

Question 6

CN V: Trigeminal PE - Corneal reflex ?

Answer 6

Look up and away

Touch cornea with a wisp of cotton

not reliable if they were contact readily

Question 7

CN V: Trigeminal PE - Sensory ?

Answer 7

Sharp/dull in 3 areas bilaterally

If abnormal, check temperature

Light touch

**opthalmic, maxillary , mandibular **

Question 8

CN VII: Facial PE ?

Answer 8

Inspect face

Raise eyebrows

Frown

Close both eyes tightly

Show upper and lower teeth

Smile

Puff out both cheeks

Taste: Anterior 2/3 of tongue
Salty, sweet, sour and bitter

Question 9

CN VII: Facial PE- taste ?

Answer 9

Taste: Anterior 2/3 of tongue

Salty, sweet, sour and bitter

Question 10

CN VIII: Acoustic PE ?

Answer 10

Auditory acuity – whispered voice

Rinne - put on mastoid ( AC > BC)

Weber - should go to both ears symmetrically

Vestibular function rarely included

Question 11

CN IX and X: Glossopharyngeal and Vagus PE ?

Answer 11

Listen to voice

Swallowing

Rise and fall of soft palate with phonation

Midline uvula

Gag reflex

**hoarse voice

trouble swallowing?

say ahh - looking a pharynx or for drainiage or looking to see if the soft palpate lifts symmetrically on phonation - equally

uvula - should hang midline ( some are bend - this is okay) just dont want to see it markedly shifted to one side **

Question 12

CN XI: Spinal Accessory PE ?

Answer 12

Atrophy or fasciculations of trapezius

Shrug shoulders against resistance

Turn head against hand

Question 13

CN XII: Hypoglossal PE ?

Answer 13

Articulation of words

Atrophy or fasciculation ( fine tremor) of tongue

Tongue protrusion - look for deviation

Tongue against cheek

**ability to speak ( is it from no dentures)

deviates to right side if problem on the right
**

Question 14

CN I - Olfactory- function ?

Answer 14

Sensory

Olfaction - smell

Question 15

CN II - Optic- function ?

Answer 15

Sensory

vision

Question 16

CN III- Oculomotor- function ?

Answer 16

Both

serves muscles of the eye

Question 17

CN IV- Trochlear- function ?

Answer 17

Both

serves the superior oblique eye muscle

Question 18

CN V- Trigeminal- function ?

Answer 18

Both

sensory from face and mouth; motor to muscles of mastication - chewing

Question 19

CN VI- Abducens- function ?

Answer 19

Both

serves the laster rectus eye muscle

Question 20

CN VII- Facial- function ?

Answer 20

Both

serves the muscles of facial expression, lacrimal glands, and salivary glands

Question 21

CN VIII- Vestibulocochlear - function ?

Answer 21

sensory

equilibrium and hearing

Question 22

CN IX - Glossopharyngeal- function ?

Answer 22

Both

serves the pharynx ( throat) for swallowing, posterior 1/3 of tongue, parotid salivary gland

Question 23

CN X- Vagus- function ?

Answer 23

Both

sensation from visceral organs, and parasympathetic motor regulation of visceral organs

Question 24

CN XI- Spinal accessory- function ?

Answer 24

Both

serves muscles that move head, neck, and shoulders

Question 25

CN XII - hypoglossal - function ?

Answer 25

Both

serves muscles of the tongue

Question 26

CN function own notes ?

Answer 26

lid elevation problems = ptosis

LR6 SO4

facial -anyerior 2/3 of taste

VC - hearing mostly

GP - for swallowing, taste on posterior 1/3

V - more from visceral , lifting the palate
SA - head neck and shoulders