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Phase 2b Medicine > Cranial Nerve Examination > Flashcards

Cranial Nerve Examination Flashcards

1
Q

What should be completed in the introduction of the examination?

A
  • Wash hands
  • Introduction
  • Identify patient
  • Explain the exam
  • Consent
  • Confirm well-being
  • Patient on chair at eye level
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2
Q

What should be noted on general inspection in a cranial nerve examination?

A
  • Facial asymmetry
  • Scars
  • Ptosis
  • Proptosis
  • Speech abnormalities
  • Eyelid & pupillary abnormalities
  • Strabismus
  • Arm & Leg Weakness
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3
Q

What is ptosis?

A

The drooping/falling of the upper eyelid

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4
Q

What is proptosis?

A

The protrusion of the eyeball

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5
Q

What is strabismus?

A

When the eyes don’t align properly when looking at an object

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6
Q

How is the Olfactory Nerve assessed (formally and informally)?

A
  • Informal - ask if there is any change in their sense of smell
  • Formal - using scratch and sniff cards, ask patient to close eyes & cover one nostril while other is tested
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7
Q

What is the name of the first cranial nerve?

A

Olfactory Nerve

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8
Q

What may be found in an abnormal olfactory nerve examination?

A
  • Hyposmia
  • Ansomnia
  • Parosmia
  • Phantosmia
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9
Q

What is hyposmia?

A

Reduced ability to smell

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10
Q

What is anosmia?

A

Inability to perceive odour

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11
Q

What may cause hyposmia & anosmia?

A
  • Disease/damage to olfactory filaments due to trauma, compression or invasion by basal skull tumours
  • Pre-symptomatic stages of Parkinson’s/Alzheimer’s
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12
Q

What is parosmia?

A

Pleasant smells are perceived as bad smells

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13
Q

What may cause parosmia?

A
  • Head trauma
  • Sinus infection
  • Adverse drug reactions
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14
Q

What is phantosmia?

A

Olfactory hallucinations

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15
Q

What may cause phantosmia?

A
  • Alzheimer’s disease

- Focal epilepsy

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16
Q

What 6 things are performed to inspect the optic nerve?

A
  • Inspect the size, shape and symmetry of the pupils
  • Use of the Snellen chart
  • Test direct & consensual pupillary reflexes using a pen torch
  • Visual inattention
  • Visual fields
  • Fundoscopy
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17
Q

What is the name of the second cranial nerve?

A

Optic nerve

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18
Q

What findings may there be when inspecting size, shape and symmetry of the pupils?

A
  • Anisocoria
  • Large & fixed pupils
  • Small & reactive pupils
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19
Q

What is anisocoria?

A
  • Pupil size asymmetry more than 0.4mm

- May be normal

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20
Q

What will the pupils look like in oculomotor nerve palsy?

A

Large & fixed

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21
Q

What will the pupils look like in Horner’s syndrome?

A

Small and reactive

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22
Q

What are the signs/symptoms of Horner’s syndrome?

A
  • Ptosis
  • Anhidrosis
  • Miosis
  • Inability to completely close or open the eyelid
  • Facial flushing
  • Headaches
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23
Q

What is ptosis?

A

Drooping of the upper eyelid

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24
Q

What is anhidrosis?

A

Decreased sweating

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25
Q

What is mitosis?

A

Constriction of the pupil

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26
Q

What is a Snellen chart used for?

A

To assess patient vision

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27
Q

What findings may be found on a Snellen chart?

A
  • Decreased visual acuity

- If it improves by asking patient to read through a pinhole, there is a refractive element to poor vision

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28
Q

What are some causes to poor visual acuity?

A
  • Refractive erros
  • Amblyopia
  • Cataracts/corneal scarring
  • Macular degeneration
  • Optic neuritis
  • Lesions higher in the visual pathways
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29
Q

What is amblyopia?

A

A ‘lazy’ eye

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30
Q

How do you test direct and consensual pupillary reflexes using a pen torch?

A
  • Bring the light source in from the side so that the patient doesn’t focus on it and accommodate
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31
Q

What is the direct pupillary reflex?

A

Shine a light into the pupil and observe constriction of that pupil

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32
Q

What is the consensual pupillary reflex?

A

Shine a light into the pupil and observe that pupil

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33
Q

What is the ‘normal’ result from a consensual pupillary reflex?

A

The eye without the light shone in should constrict

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34
Q

What is the swinging light test and how is it performed?

A
  • Ensure the patient is looking forward at a select point

- Swing the light in front of the patient

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35
Q

What may a swinging light test reveal?

A

A relative afferent pupillary defect

36
Q

What is a relative afferent pupillary defect?

A

When pupils respond differently to light stimuli shone in one eye at a time due to unilateral/asymmetrical disease of the optic nerve

37
Q

How do you test visual inattention?

A
  • Wiggle fingers from above and below & get patient to point at which one is moving
  • Make sure patients are looking into your eyes
38
Q

How do you test visual fields?

A
  • Doctor and patient cover eyes opposite each other
  • Move your finger in from the side
  • Get the patient to tell you when it’s coming in to view
39
Q

How are the oculomotor, trochlear & abducens nerves tested?

A
  • Test the eye movements of the patient
  • Tracing a H shape & central I shape, get them to follow with their eyes
  • Perform a cover test
40
Q

What is the name of the third cranial nerve?

A

Oculomotor nerve

41
Q

What is the name of the fourth cranial nerve?

A

Trochlear nerve

42
Q

What is the name of the sixth abducens nerve?

A

Abducens nerve

43
Q

How do you perform the trace test for CN 3, 4 & 6?

A
  • Hold your finger 30cm in front of the patient’s eyes and ask them to hold their head still
  • Slowly trace a large H shape and a central I shape with your finger, taking the patient’s eyes to the limits of their gaze as you do so
44
Q

What are the potential findings of the trace test for CN 3, 4 & 6?

A
  • Diplopia
  • Disconjugate eye movements
  • Nystagmus
  • Ptosis
  • Restriction of eye movements
45
Q

What is diplopia?

A

Double vision

46
Q

What is nystagmus?

A

Involuntary eye movement

47
Q

What may ptosis indicate?

A

An oculomotor lesion

48
Q

How do you perform a cover test for CN 3, 4 & 6?

A
  • Get a target to focus on, such as a pen top
  • Cover one of the patient’s eyes and observe the uncovered eye for movement
  • Repeat on the other eye
49
Q

What may be the findings for a cover test for CN 3, 4 & 6?

A
  • Convergent squint

- Divergent squint

50
Q

What is a convergent squint?

A

When the eye moves temporally

51
Q

What is a divergent squint?

A

When the eyes moves nasally

52
Q

How would you test the trigeminal nerve?

A
  • Demonstrate the tension of cotton wool with eyes open
  • Get patient to close their eyes
  • Place on forehead, cheek & jaw
53
Q

What is the name of CN 5?

A

Trigeminal Nerve

54
Q

Cotton wool isn’t felt on the forehead when testing for CN5. What branch is affected?

A

Ophthalmic branch

55
Q

Cotton wool isn’t felt on the cheek when testing for CN5. What branch is affected?

A

Maxillary branch

56
Q

Cotton wool isn’t felt on the jaw when testing for CN5. What branch is affected?

A

Mandibular branch

57
Q

What should be noted when assessing CN5?

A

Whether there feels a difference between the sides of the body

58
Q

How do you test the motor component of the trigeminal nerve?

A

Assess the temporals and masseter muscle

59
Q

How do you assess the temporalis/masseter muscles?

A
  • Get the patient to clench their teeth & palpate the temporalis simultaneously
  • Get the patient to open their jaw and try and get them to resist you closing it
  • Also perform a jaw jerk
60
Q

How do you perform a jaw jerk?

A
  • Relax jaw down slightly
  • Place finger below lip
  • Hit finger with hammer
  • Sudden brisk closure = UMN lesion
61
Q

How do you assess the facial nerve?

A
  • Inspect the patient’s face for asymmetry, paying attention to the forehead wrinkles, nasolabial folds and the angles of the mouth
  • Test the motor supply of the face
  • Ask about changes to taste/hearing
62
Q

What is the name of CN7?

A

Facial nerve

63
Q

How is the motor supply of the facial nerve tested?

A

Ask the patients to copying you doing these actions:

  • Raised eyebrows
  • Close eyes
  • Blow out cheeks
  • Smile
  • Purse lips
  • Close lips
64
Q

What symptoms may a patient have with changes to the facial nerve?

A

Changes to hearing or taste

65
Q

How is the vestibulocochlear nerve tested?

A
  • Ask about changes to the hearing
  • Perform a gross hearing test
  • Perform Rinne’s Test
  • Perform Weber’s Test
  • May perform Turning Test
66
Q

What is the name of CN8?

A

Vestibulocochlear nerve

67
Q

How is a gross hearing test performed?

A
  • Assess the hearing by covering one ear, and whisper a number into another
  • Repeat at arms length away
  • Repeat on other side
68
Q

How is Rinne’s test performed?

A
  • Tap a tuning fork and place it on the base of the mastoid process
  • If they can hear = get them to tell you when it has stopped
  • Once the patient can no longer hear, move the tuning fork to approx 1 inch from the external auditory meatus
  • Air conduction should be better than bone conduction
69
Q

What is a Rinne’s positive finding?

A

The ability to hear the tuning fork via air conduction

70
Q

What is neural deafness?

A

Both air and bone conduction are reduced equally

71
Q

What is a Rinne’s negative finding?

A

Bone conduction is better than air conduction (conductive deafness)

72
Q

How is a Weber’s Test performed?

A
  • Place a tuning fork onto the forehead of the patient

- Tap the tuning fork and place it in the midline of the forehead

73
Q

What are the two findings of Weber’s test?

A
  • Conductive deafness = sound is heard louder on the side of the affected ear
  • Neural deafness = sound is heard louder on the side of the intact ear
74
Q

How is the Turning test performed?

A
  • Stand patient up
  • March on spot
  • Pathology = patient turns towards lesion side
75
Q

How are the glossopharyngeal & vagus nerves tested?

A
  • Assess the soft palate and uvula

- Assess whether the uvula is in the midline at rest & note any deviation when saying ‘ah’

76
Q

What is the name of CNIX?

A

Glossopharyngeal nerve

77
Q

What is the name of CNX?

A

Vagus nerve

78
Q

What findings may be found on assessment of glossopharyngeal/vagus nerves?

A
  • Deviation of uvula = occurs away from the side of a glossopharyngeal nerve palsy
  • Assess for a Bovine cough for vagus nerve palsy
79
Q

What is a Bovine cough?

A

A non-explosive cough

80
Q

What may a Bovine cough indicate?

A

A palsy in CNX

81
Q

How is the accessory nerve tested?

A
  • Test the trapezius muscle by asking the patient to shrug their shoulders against resistance
  • Test the power in the sternocleidomastoids by asking the patient to turn their head against resistance
82
Q

What is the name for CNXI?

A

Accessory Nerve

83
Q

How is the hypoglossal nerve assessed?

A
  • Inspect the tongue for wasting and fasciculations at rest
  • Ask the patient to stick their tongue out to see if there is any deviation (towards lesion side)
  • Place your hand on the cheek of the patient and get them to push their tongue against your hand - to see if there is weakness of the tongue
84
Q

What are fasciculations?

A

A spontaneous, involuntary muscle twitch

85
Q

What is the name of CNXII?

A

Hypoglossal nerve

86
Q

What would be done to complete a cranial nerve examination?

A
  • Full neurological examination of the upper and lower limbs
  • CT/MRI head

Phase 2b Medicine (17 decks)

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