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ECR 2012 > ECR Cranial Nerve and Eye Exam > Flashcards

ECR Cranial Nerve and Eye Exam Flashcards

1
Q

What does HPI include

A

General physical exam

Visual loss/changes

Diplopia (double vision)

Discharge

Erythema/redness

Eye pain

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2
Q

Related Hx of

A 
Trauma
Employment exposure
Allergies
Corrective lenses
Medications
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3
Q

Common presentation of eye problems

A

vions loss (retina disease/stroke)

Visual distortion (macular degeneration, medication side effect

Itching/foreignbody sensation (foreign body, allergies)

Headache/dizziness (migrain/cerebllar disease)

Eye pain (glaucoa/ sinusitis)

Light sensitivity (coreanl abrasion/ meningities)

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4
Q

What eye chart is used for far vision

A

Snellen Chart

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5
Q

What eye chart is used for near vision

A

Rosenbaum card

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6
Q

What is the apporach to exam (3 parts)

A
  1. Vision assessment (always document vision PRIOR to and AFTEr exam)
  2. Inspectin ,palpation, and cranial nerve testing (external eye and ass. structures moving to more internal structures)
  3. Opthalmoscopic examination (internal eye)
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7
Q

What do you do for vision assessment?

A

Central Vision

  • distance visual acuity
  • near visual acuity

Visual fields

Color vision if warranted

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8
Q

What can DM, HTN, AIDs cause in ye?

A

Retinal changes

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9
Q

What can cause dry eye

A

Rheuatologic conditions

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10
Q

What can severe medication reaction/ Herpes Zoster cause

A

Red/eye conjunctivitis

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11
Q

Thyroid disease can cause

A

Proptosis/exopthalamos

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12
Q

Multiple sclerosis/ inc. intracranial pressure

A

Optic nerve changes/ body of eye; mc”

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13
Q

liver/biliary/pancreatic disease

A

scleral icterus

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14
Q

What is an Amsler Grid?

A

Used for central vision deficits like MACULAR DEGENERATION

stare at center dot to see if lines are croooked or bent

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15
Q

What does it mean if you see crooked lines or liens missing?

A

Macula degeneration!

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16
Q

What does the macula do?

A

macula of retina

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17
Q

How do you give external eye exam?

A

INspect surrounding areas
Eyebows for size, extension, hair texture
Orbial area for edema, exopthalamos (protudig troauma0
eyelids
lacrimal apparatus

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18
Q

How do you assess external pupil reaction ?

A

Direct
Consensual
Accomodation

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19
Q

What does it mean to do direct pupil exam

A

shine light to left eye–> left pupil constricts

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20
Q

Consensual pupil exam

A

Shind light to left eye, right pupil will contract

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21
Q

Accomodation

A

constriction of pupil and CHANGE OF SHAPE of lens to assist focusing on a lose object

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22
Q

Accomodation

A

constriction of pupil and CHANGE OF SHAPE of lens to assist focusing on a lose object

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23
Q

How do you test Extraocular muscles

A

muscle alignment/balance with penlight

movement using 6 cardinal fileds f gaze (H)

Conjugate (workign togehter) or dysconjugate

Assess convergence (follow fingers as you move it towards bridght of nose)

Observe for nystagmus

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24
Q

What is nystagmus

A

fine rhythmic oscillation of eyes

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25
What is strabismus
misalignment of eyes
26
Which EOM for right and up
Right superior rectus muscle | Left inferior oblique
27
Which EOM for Left and up
Right inferior oblique | Left superior recturs
28
Which EOM for Right
Right lateral rectus | Left medial rectus
29
Which EOM for Left
Left lateral rectus | Right medial rectus
30
Which EOM right and down
Right inferior rectus | Left superior oblique
31
Which EOM for left and down
Right superior oblique | Left lateral rectus
32
What are components of the fundus?
Optic nerve/optic disc Retina Arteries Veins Macula and Fovea
33
What are common presentations of vision
change or loss of vision Double vision (diplopia) Facial weakness difficulty speaking Difficulty swallowing Change or loss of hearing Imbalance/vertigo
34
How do you test CN I
Olfactory occlude and let patient semll something with one nostril at atime NO noxious stimuli such as smelling salts or ammonia
35
How do you test CN II
Optic Visual Acuity- eye chart Visual Fields- Confrontation (2 wiggling fingers) Visualization of the nerves (opthalamoscopic exam) Pupillary response (afferent II, efferent III)
36
How do you test CN III
Oculumotor MOtor: 4/6 muscles (inferior rectus, inferior olique, medial rectus, supieror rectus) Convergence (ask pt to follow finger as u bring it to bridge of nose) Elevate eyelid (levator palpebrae superioris m) Pupillary light (direct and consensual)
37
Signs to look for if CN III is affected
Right CN III Palsy Ptosis (eyelid drooping) Eye is "down and out" at rest Pupil more dilated than opposite eye
38
How to test CN IV and VI
IV- Trochlear VI- Abducens (LR6,SO4)3 CN IV- superior oblique; moves eye down adn in CN VI- Lateral rectus; moves eye into abduction
39
Sings to look for if CN VI affected
right CN VI palsy Excessive adduction at rest Cannot adduct when gazing left
40
HOw to test for CN V Motor
Trigeminal Motor: muscles of mastication- masseters, pterygoids, temporalis Palpate Assess Strength
41
How to test for CN V Sensory
Trigeminal ``` Sensory -sensation to face (sharp or cold?_ -3 divisions V1- Opthalamic V2- Maxiallary V3- Mandibular ``` Touch to face Corneal Reflex
42
How do you test corneal reflex
CN V and VII Use cotton and put to side of eye Sensory input from surface of eye CN V Motor response from CN VII (facial N) In by V Out by VII
42
How to test sensory for CN VII
Facial Sensory: Taste to anterior 2/3 Sesnation to small area behind ear and ear canal
43
How to test motor for CN VII
Facial ``` Muscles of facial expression Close eyes tightly Raise eyebrows Puff out cheeks Show me your teeth ``` Note asymetry, weakenss
43
How to test CN VIII (acoustic)
Acoustic (vestibulocochlear) Semicicrular cnals/vestibular apparatus balance warm/cold caloric testing special diagnostic maneuvers *not clinically useufl for us yet_
44
How to test for CN VIII (cochlear)
``` Cochlea Hearing Acutiy (whisper test) Rinne Test Weber Test ```
44
If no hearing loss, is it louder in air or bone for Rinne test
Air > Bone
45
If no hearing loss, what is result of Weber test
hear it midline
45
If there is Sensorineural damage waht are results for Rinne and Weber
Rinee- Air > Bone Weber : Louder in NORMAL EAR
46
If there is Conducton damage what are results for Rinne and Weber tests
Rinne test- Bone >A ir Weber: Louder in IMPAIRED ear
46
CN IX
IX- Glossopharygeal Sensory ; soft palate, pharynx, posterior tongue Motor stylopharygenas
47
CN X
Motor: movement of the uvula and soft palate with phonation and gag
48
How to test CN IX and X
test together let patient say "Ahhh" Gag rellex Swallow water look for symmetric elevation of palate, midline uvula Difficulty swallong ,poor phonation with speaking
49
How to test CN XI
Accessory AKA: Spinal accessory nerve Motor Trapezius (shrug shoulders)/ sternocleidomastoids (resist face) assess strenght/test against resistance
50
How to est for CN XII
Hypoglossal Motor- movement and protrusion of tongue Assess position, movment and strength Stick tongue straight out and move it side ot side Look for fasciculations (involuntary muscle movement), atrophy, deviation from midline
51
CN IX
IX- Glossopharygeal Sensory ; soft palate, pharynx, posterior tongue Motor stylopharygenas
52
CN X
Motor: movement of the uvula and soft palate with phonation and gag
53
How to test CN IX and X
test together let patient say "Ahhh" Gag rellex Swallow water look for symmetric elevation of palate, midline uvula Difficulty swallong ,poor phonation with speaking
54
How to test CN XI
Accessory AKA: Spinal accessory nerve Motor Trapezius (shrug shoulders)/ sternocleidomastoids (resist face) assess strenght/test against resistance
55
How to est for CN XII
Hypoglossal Motor- movement and protrusion of tongue Assess position, movment and strength Stick tongue straight out and move it side ot side Look for fasciculations (involuntary muscle movement), atrophy, deviation from midline

ECR 2012 (16 decks)

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