Cranial Nerves Exam

Question 1

What is the first step?

Answer 1

Introduce self
Confirm name and DOB
Ask for consent
Ask if they are in any pain

Question 2

What do you do after the introduction?

Answer 2

General inspection

Question 3

What kind of things are you looking for in a general inspection?

Answer 3

Walking aids
Hearing aids
Medication

Question 4

What is the CN I ( Olfactory Nerve) Test

Answer 4

Ask if they have had any changes to their sense of smell recently

Question 5

What is the order of the CN II ( Optic Nerve) Test?

Answer 5

Inspect pupils
Visual Acuity
Visual Fields
Accommodation reflex
Pupil reflexes ( direct and consensual)
Say you would perform fundoscopy and access blind spot

Question 6

What are you accessing the pupils for?

Answer 6

Size
Shape
Symmetry

Question 7

How do you assess visual acuity?

Answer 7

Ask if they normally use glasses
Using a Snellen chart
Get them to stand 6m away
One eye at a time
Ask them to read to the last line

Question 8

What comes after the visual acuity test?

Answer 8

Pupillary Reflexes

Shine light into each eye , direct and consensual

Question 9

What do you perform after the visual acuity test?

Answer 9

The accommodation reflex test

Question 10

How do you do the accommodation reflex test?

Answer 10

Place an item about 30cm away their face and ask them to focus on it . Then slowly move it towards their face to assess their pupil response

Question 11

What should you see of the pupils in the accommodation reflex?

Answer 11

Constriction
Convergence

Question 12

What do you do after the accommodation reflex?

Answer 12

Visual Neglect

Question 13

How do you test for visual neglect?

Answer 13

Ask patient to focus on your nose and place arms out . Wiggle one side and ask them to point at which side it was

Question 14

What do you assess after visual neglect?

Answer 14

Visual fields

Question 15

How do you assess visual fields?

Answer 15

Ask the patient to cover one eye with their hand, you cover the mirrored eye with your hand.
Ask them to focus into your eyes
Ask them to tell you when they see your finger wiggling, compare to your own visual field
Do each corner ( box shape )

Question 16

What do you assess after visual fields?

Answer 16

Fundoscopy

Question 17

What are you looking for with a a fundoscope?

Answer 17

Any optic disc pathologies
E.g. Papilloedema

Question 18

How do you asses CN III, IV and VI?
(First step)

Answer 18

Inspect eyelids for ptosis

Question 19

What can ptosis be caused by?

Answer 19

Oculto motor nerve palsy
Horner’s Syndrome
Myasthenia Gravis

Question 20

What do you do after inspecting their eyelids?

Answer 20

Inspect their eye movements

Question 21

How do you inspect eye movements?

Answer 21

Be at eye level
Ask patient to keep their head still
Ask them to follow your finger with thier eyes
Make a H shape with your finger
Ask if they had any pain or double vision

Question 22

What are you looking for in an eye movement test?

Answer 22

Strabismus ( eyes not aligning )

Question 23

What do you access after CN III, IV and VI

Answer 23

CN V ( Trigeminal )

Question 24

How do you access CN V sensory component?

Answer 24

Light touch (cotton bud ) and pinprick sensation of the forehead (V1), cheek (V2) and lower jaw (V3)

Question 25

How do you assess CN V Motor Function?

Answer 25

Test the muscles of mastication Inspect the temporalis and masseter for wasting Palpate the master and ask patient to clench jaw Ask patient to open their mouth whilst you apply resistance to the jaw Ask them to swing their jaw side to side ( pterygoids )

Question 26

How do you assess CN VIII ( Facial Nerve ) special sensory function ?

Answer 26

Ask if they’ve had an changes to their sense of taste

Question 27

How do you assess the CN VII (Facial Nerve) motor function?

Answer 27

Ask patient to : Raise thier eyebrows Close eyes and don’t let me open them Blow out cheeks Smile and show teeth Purse lips

Question 28

How do you assess CN VIII (vestibulocochlear nerve) motor function?

Answer 28

Ask if they have had any changes to their hearing recently

Question 29

What do you do after asking about changes to their smell?

Answer 29

Whisper test Tell patient you are gonna whisper 3 words in their ear and ask them to repeat it back to you. Cover one of their ears , e.g. say “55, 75, 33 “

Question 30

What do you do after the whisper test?

Answer 30

Rinne’s Test Apply vibrating fork to the patients mastoid process and ask them to say when they can no longer hear it. Then move it off and ask if they can now hear it, they should be able to . Air conduction > Bone conduction

Question 31

What do you do after Rinne’s Test?

Answer 31

Weber’s Test Vibrate fork and place it on their forehead. Ask them if it is louder on one side

Question 32

How do you assess CN IX and X ( Glossopharyngeal + Vagus )?

Answer 32

Ask patient to open their mouth Inspect thier soft palate and uvula Ask them to say ‘ah’ should be no deviation Ask them to cough Say you would do gag reflex also

Question 33

How do you assess CN XI?

Answer 33

Assess SCM and trapezius for wasting Ask them to raise shoulders (apply resistance) Ask them to turn the head left (apply resistance) Ask them to turn their head right ( apply resistance)

Question 34

How do you assess CN XII ( Hypoglossal Nerve) ?

Answer 34

Ask patient to open mouth Assess tongue for wasting/fasciculations Ask them to protrude tongue Place your finger on each check and ask them to press against it