Flashcards in ECR Cranial Nerve and Eye Exam Deck (60):
1
What does HPI include
General physical exam
Visual loss/changes
Diplopia (double vision)
Discharge
Erythema/redness
Eye pain
2
Related Hx of
Trauma
Employment exposure
Allergies
Corrective lenses
Medications
3
Common presentation of eye problems
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)
4
What eye chart is used for far vision
Snellen Chart
5
What eye chart is used for near vision
Rosenbaum card
6
What is the apporach to exam (3 parts)
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)
7
What do you do for vision assessment?
Central Vision
-distance visual acuity
-near visual acuity
Visual fields
Color vision if warranted
8
What can DM, HTN, AIDs cause in ye?
Retinal changes
9
What can cause dry eye
Rheuatologic conditions
10
What can severe medication reaction/ Herpes Zoster cause
Red/eye conjunctivitis
11
Thyroid disease can cause
Proptosis/exopthalamos
12
Multiple sclerosis/ inc. intracranial pressure
Optic nerve changes/ body of eye; mc"
13
liver/biliary/pancreatic disease
scleral icterus
14
What is an Amsler Grid?
Used for central vision deficits like MACULAR DEGENERATION
stare at center dot to see if lines are croooked or bent
15
What does it mean if you see crooked lines or liens missing?
Macula degeneration!
16
What does the macula do?
macula of retina
17
How do you give external eye exam?
INspect surrounding areas
Eyebows for size, extension, hair texture
Orbial area for edema, exopthalamos (protudig troauma0
eyelids
lacrimal apparatus
18
How do you assess external pupil reaction ?
Direct
Consensual
Accomodation
19
What does it mean to do direct pupil exam
shine light to left eye--> left pupil constricts
20
Consensual pupil exam
Shind light to left eye, right pupil will contract
21
Accomodation
constriction of pupil and CHANGE OF SHAPE of lens to assist focusing on a lose object
22
Accomodation
constriction of pupil and CHANGE OF SHAPE of lens to assist focusing on a lose object
23
How do you test Extraocular muscles
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
24
What is nystagmus
fine rhythmic oscillation of eyes
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