Neurology: Cranial Nerves

Question 1

Introduction
Assessment criteria

Answer 1

1. Introduction: Name, pronouns
2. Ask client: name, pronouns
3. Wash hands
4. Explain the assessment, inspection, palpation
5. Ask for consent
6. Inform client they can stop at any time
7. Verbalize general assessment - no signs of distress, positioning, posture, symmetry, safe to proceed

Question 2

CN1

Answer 2

• Olfactory nerve
• sensory nerve
• Test for nasal patency, both nostrils
• present with smell, eyes closed

Question 3

CN2

Answer 3

• Optic nerve
• sensory nerve

1. Visual acuity
   - snellen chart
   - hold at arms length
   - read the last visible line
2. Visual fields
   - covery opposite eye as patient
   - fingers in the peripheral field, looking forward
   - say “now” when you see them
3. Visual confrontation test
   - Finger moving close
   - focus on finger
   - pupil size, and convergence of the eyes

Question 4

CN3

Answer 4

• Occulomotor nerve

1. Upper eyelid inspection
   - no ptosis
   - symmetric palpebral fissures
2. Pupil size and shape
   - equal
   - round
3. Pupils reacting to light
   - Direct and consensual light reflex
4. Accomodation
   - stare at finger, stare at back wall
   - pupil changes size

Question 5

CN3,4,6

Answer 5

• Occulomotor
• trochlear
• abducens
• Eye movements

Inspect eyes
- symmetric
- no diplopia, blurred vision reported
- tracking together

1. Cardinal field of gaze
   - all 6 fields
   - smooth eye movements
   - nystagmus, sustained not present

Question 6

CN5

Answer 6

• Trigeminal nerve
• Sensory and motor (mixed)

1. Muscles of mastication
   - symmetry, contraction, tone
   - open jaw, move right and left
   - same movements with palpation (resistance)
2. testing the branches
   - sharp and dull stimuli
   - say “now” with eyes closed
   - equal symmetrically on both sides

Question 7

CN7

Answer 7

Facial nerve
- mixed nerve
- taste anterior 2/3 of the tongue
- motor

1. Facial expressions
   - smile, frown, raise eyebrows, keep eyes closed, puff cheeks
2. inspection for symmetry

Question 8

CN8

Answer 8

• Vestibulochochlear nerve
• balance and hearing
• sensory nerve

1. Whipser test
   - press tragus and whisper in alternate ear
2. Finger test
   - rub fingers infront of ear
3. Rinne Test
   - tuning fork
   - placed on mastoid process
   - now when hear, now when disappears
   - placed infront of ear
   - now when hear, now when disappears
   - air conduction > bone conduction
4. Weber test
   - tuning fork
   - placed in middle of forehead
   - equal in both ears ? lateralized?

Question 9

CN9 and 10

Answer 9

• glossopharyngeal nerve, vagus nerve
• sensory (taste posterior tongue) and motor

1. Voice quality
   - nasal, horse
2. Movement uvula, palate, tonsils
   - upward movement and medial movement
   - AHHH with tongue depressorCN

Question 10

CN11

Answer 10

• spinal accessory muscles

1. trapezius muscle
   - shrug shoulders
2. sternocleidomastoid muscle
   - look right and left

Question 11

CN12

Answer 11

• hypoglossal nerve

1. Voice intonation
   - light, tight, dynamite
2. tongue movement
   - stick out, to the sides, then while palpation