Clinical skills: cranial nerve exam Flashcards
Initial approach?
Hand hygiene
Regular six steps
Ask patient if they are in any pain of discomfort
Steps?
General inspection
Vital signs
Cranial nerves
General inspection?
Scars + evidence of past intracranial surgery
Rash
Lesions
Facial asymmetry
Speech/voice issues
Cranial nerve I (olfactory)
Inspect the nose
Ask about smell
Test smell (don’t do)
Cranial nerves II (optic), III (oculomotor), IV (trochlear), VI (abducens)
- General inspection
Ptosis
Proptosis
Unequal pupils
Squint
Ask about visual aids
Cranial nerves II (optic), III (oculomotor), IV (trochlear), VI (abducens)
- 4 tests to look at CN II only?
Visual acuity (Snellen chart)
Colour vision (Isihara plates)
Visual field
Mapping the blind spot
Cranial nerves II (optic), III (oculomotor), IV (trochlear), VI (abducens)
- 2 tests to look at CN II (afferent) and CN III (efferent)?
- Accommodation
- Pupillary light reflex: direct, indirect, afferent defect
Cranial nerves II (optic), III (oculomotor), IV (trochlear), VI (abducens)
- Test for eye movement (nerves III, IV, VI)?
H shape
Look for nystagmus, ask about diplopia
Cranial nerves II (optic), III (oculomotor), IV (trochlear), VI (abducens)
- Additional test?
Ophthalmoscopy
Cranial nerve V:
- Inspection
Wasting and asymmetry of the masseter and temporalis
Cranial nerve V
- Sensory tests?
Corneal reflex (sensory 5, motor 7)
Light and sharp touch - across the opthalmic, maxillary, mandibular branches
Cranial nerve V
- Motor tests?
Palpation of the temporalis, pterygoid, masseter
Jaw jerk reflex
Cranial nerve VII
- Inspection
Facial asymmetry
Cranial nerve VII
- Sensory?
Taste - anterior 2/3 of the tongue
Cranial nerve VII
- Motor
Muscles of facial expression
