ECR Cranial Nerve and Eye Exam Flashcards Preview

ECR 2012 > ECR Cranial Nerve and Eye Exam > Flashcards

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

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