Cranial Nerve Exam

Question 1

Cranial Nerve Exam - General inspection

Answer 1

• Well/Unwell
• Orientation
• Scars
• Slurred Speech
• Adjuncts
• Facial symmetry
• Rashes

Question 2

Cranial Nevre Exam - Olfactory nerve

Answer 2

Ask if any changes in taste or smell
“Cranial Nerve I Intact”

Question 3

Cranial Nerve Exam - Optic Nerve

Answer 3

Visual Acuity
- Use Snellen Chart, report line, how many missed, bilateral/unilateral
Visual Fields
Corner test, “patient visual fields are equal to mine and intact”
** Visual Inattention, Blind Spot, Fundoscopy**
-in interest of time yada yadda yadda
Pupil Examination
“Pupils appear to be symmetrical, and are of equal size and shape”
- Test direct and consensual response with light and hand in between
“Direct and Consensual bilaterally”
- swinging flashlight test
- Accomodation
- convergence and construction of pupils, do one on either side

Question 4

Cranial Nevre Exam - Oculomotor, Trochlear, Abducens

Answer 4

Extraocular muscles
assess diplopia and nystagmus (sudden shaking of eyes) - H movement w red hat pin
- let me know if you have any double vision or pain
- ‘extraoccular movemets are regular, indicating that cranial nerves 3, 4 and 6 are intact”

Question 5

Cranial Nerve Exam - Trigeminal Nerve

Answer 5

Sensation - opthalmic, maxillary, mandibular regions + corneal reflex with cotton bud - ask if soft and felt
Motor function - masseter and temporalis muscles + jaw jerk - testing for symmetry and muscle bulk have to palpate and get to bite jaw
- “normal and symmetrical muscle bulk in masseter and temporalis muscle”
Jaw jerk “normal response to jaw jerk is slight/no closure of mouth”

Question 6

Cranial Nerve Exam - Facial Nerve

Answer 6

Assess facial movements - “going to be asking you to make some facial expressions

Raise eyebrows
Scrunch eyes
Blow cheeks
Grin
Do all against resistance
Report 5/5 power in all, suggesting cranial drive 7 is intact

Question 7

Cranial Nerve Exam - Vestibulocochlear Nerve

Answer 7

Hearing test
Whisper 66/99 in one ear while rubbing fingers together in other ear

Rinne’s test
Flick fork, 512 put ball on mastoid, ask when it stops, move ends infront of ear
“air conduction greater than bone conduction bilaterally”
Rinne’s positive = normal or sensorineural deafness = air > bone
Rinne’s negative = conduction deafness = bone > air

Weber’s test
Get patient to close eyes and place fork in middle of head
“Webers test is localised to the centre of the forehead”
Normal = sound localised to centre
Sensorineural deafness = sound heard louder in intact ear
Conduction deafness = sound heard louder in affected ear

Question 8

Cranial Nerve Exam - Glossopharyngeal and Vagus nerves + Hypoglassal

Answer 8

Glossopharyngeal and Vagus nerves
Inspect mouth - for uvula deviation and symmetrical rise of soft palate
Tongue will deviate to same side of brain as lesion - ‘lick you wounds’
Uvula will deviate to opposite side
test toung streth through cheek
Cranial nerves IX and X intact
Stick out tongue look far wasting, Fasciculations, deviation
cough reflex, drink water, mention gag
Cranial Nevre 12 intact

Question 9

Cranial Nerve exam - Accessory nerve

Answer 9

Assess power of:
Trapezius muscle - ask to shrug shoulders and resist pushing down
Sternocleidomastoid - ask to turn head against your palm
Cranial Nerve XI intact