Cranial nerves exam Flashcards
(12 cards)
Introduction
- Wash hands
- Introduce
- Patient details
- Permission: Today I have been asked to perform an examination of some of the nerves in your head and neck - this will involve me having a look and a feel of your face and neck. We have our examiner here as chaperone. Does that sound okay?
- Exposure - N/A
- Reposition - sat opposite
- Any questions? Any pain?
General inspection
Squint, ptosis, facial droop, asymmetric or abnormal eye position and pupils
CN I
Olfactory
Noticed any changes in smell?
Offer smelling salts in each nostril separately
CN II
Optic - SPAIFFIB
ASK ABOUT CORRECTIVE LENSES
Snellen - acuity
Pupil - describe, torch individual, swinging torch
Accommodation - look at finger then wall
Inattention - wiggle left or right finger, tell me which
Fields - both cover same eye, tell me when you can see finger
Fundoscope
Ishihara
Blind spot
CN III, IV + VI
Oculomotor, Trochlear, Abducens
H test - any pain, double vision, blurring
Nystagmus
CN V
Trigeminal
Test light and sharp touch in V1, V2 and V3
Clench jaw, feel temporalis and masseter
Offer jaw jerk and corneal reflex
CN VII
Facial
Pull faces - raise eyebrows, close eyes against pressure, puff cheeks against pressure, smile, purse lips
Noticed any change in taste? Offer to check anterior 2/3
CN VIII
Vestibulocochlear
Rub fingers in one ear, whisper number in the other
Rinne’s and Weber (512Hz)
Offer to test balance
CN IX + X
Glossopharyngeal + Vagus
Check for uvula deviation
Offer to test cough, swallowing and gag reflex
CN XI
Accessory
Lift shoulders against pressure, turn head against pressure
CN XII
Hypoglossal
Stick tongue out - check for deviation
Push tongue against cheek against pressure
Say “British Constitution” and “Baby Hippopotamus”
To conclude:
THANK, WASH HANDS
To conclude - Full neuro (UL + LL) examination + MMSE, gait and balance
