SPARC CN

Question 1

Inspection and exposure

Answer 1

Expose up to upper limbs, shoulders
Look at hands and fingers - wasting, Horners
Look at trapezius - spinal accessory nerve
Look behind the auricles and SPLIT the hairs - look at posterior cranial fossa scars

Question 2

Visual field

Answer 2

Screening
Can you see my whole face?
Use small numbers (1 to 3) - do not use 5

Better - use Snellen’s chart 3 metres away

Test colour - big red ball

Visual field
Close 1 eye with hand, look at my eye (we may or may not need to close our own eye)
From the side all the way to the centre
- let me know when it appears
- inform me if disapepars

Question 3

CN 2

Answer 3

Anisocoria
Shine from far away to look at both pupils

Pupillary constriction
Shine from the side then move closer, observe constriction

Consensual light reflex
Swing 1 second in oblique manner (do not do in front of patient’s eye)
RAPD is tested with 1 torch - real PACES only 1 torch provided
When swing to the next eye, eye will dilate first (from previous consensual constriction) then re-constrict back

If RAPD positive:
Affected eye - no constriction
Swinging eye to unaffected - no dilatation, only constriction
Swing back to affected eye - only dilatation (from consensual reflex constriction), no re-constriction
Must do fundoscopy on both sides

Question 4

CN 3 4 6

Answer 4

Adequate distance
Not too fast, pursuit will be broken
Hold to look for nystagmus before going up and down
Change hand when going the other side
Turn horizontal when testing centrally

Question 5

Saccades

Answer 5

Vertical saccade - PSP
Alternatively look at ball and nose

Horizontal saccade - INO

Question 6

CN muscles

Answer 6

Bend down a little then look up - wrinkles over frontalis

Close eyes tightly - orbicularis oculi
Use 1 finger over upper ridge and another finger over lower ridge - to open eyes

Open mouth until I can see tongue, do not stick out first
- Look for tongue fasciculation
- Shine torch, say ahh, look at palate and uvula symmetry
- Then stick out tongue

Slight flex head, turn head to the side and test SCM power

Shoulder shrug

Question 7

Sensation CN

Answer 7

Generally uses front touch
Except suspicious of Wallenberg/lateral medullary syndrome - loss of pain sensation

Avoid areas over lateral of face / front of ears - CN5 V2 nerve root over there

Test both foreheads
Lateral to nasal
Mandible

Question 8

CN8

Answer 8

Screen conductive defect
- If same then no need to proceed Webers

Rinne
Brush hair aside and place on bony prominence
Support contralateral side of head with hand

When doing Weber, need to tightly support back of head with hand

Question 9

Speech

Answer 9

Majulah Singapura - Singapore
British Constitution - UK
Perpustakaan - Malaysia

Question 10

Horner

Answer 10

Partial ptosis
- CN3
- CN5 V1

Miosis
re-Dilatation lag