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9 Cards in this Set
- Front
- Back
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CN I: Olfactory
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- Usually not tested.
- Rash, deformity of nose. - Test each nostril with essence bottles of coffee, vanilla, peppermint |
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CN I: Olfactory
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- With patient wearing glasses, test each eye separately on eye chart/ card using an eye cover.
- Examine visual fields by confrontation by wiggling fingers 1 ft from pt's ears, asking which they see move. •Keep examiner's head level with patient's head. - If poor visual acuity, map fields using fingers and a quadrant-covering card. - Look into fundi.For more detail, See Eye Exam. |
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CN III, IV, VI: Oculomotor, Trochlear, Abducens
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• Look at pupils: shape, relative size, ptosis.Shine light in from the side to gauge pupil's light reaction.
• Assess both direct and consensual responses. • Assess afferent pupillary defect by moving light in arc from pupil to pupil. unne). - "Follow finger with eyes without moving head": test the 6 cardinal points in an H pattern. • Look for failure of movement, nystagmus [pause to check it during upward/ lateral gaze]. _ Convergence by moving finger towards bridge of pt's nose. - Test accommodation by pt looking into distance, then a hat pin 30cm from nose. If MG suspected: pt. gazes upward at Dr's finger to show worsening ptosis. |
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CN V: Trigeminal
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- Corneal reflex: patient looks up and away.
• Touch cotton wool to other side. • Look for blink in both eyes, ask if can sense it. • Repeat other side [tests V sensory, VII motor]. - Facial sensation: sterile sharp item on forehead, cheek, jaw. • Repeat with dull object. Ask to report sharp or dull. • If abnormal, then temperature [heated/ water-cooled tuning fork], light touch [cotton]. - Motor: pt opens mouth, clenches teeth (pterygoids). • Palpate temporal, masseter muscles as they clench. |
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CN VII: Facial |
- Inspect facial droop or asymmetry.Facial expression muscles: pt looks up and wrinkles forehead.
• Examine wrinkling loss. • Feel muscle strength by pushing down on each side. - Pt shuts eyes tightly: compare each side. - Pt grins: compare nasolabial grooves.Also: frown, show teeth, puff out cheeks. - Corneal reflex already done. See CN V |
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CN VIII: Vestibulocochlear
(Hearing, Vestibular rarely) |
Dr's hands arms length by each ear of pt.
• Rub one hand's fingers with noise on one side, other hand noiselessly. • Ask pt. which ear they hear you rubbing. • Repeat with louder intensity, watching for abnormality. - Weber's test: Lateralization • 512/ 1024 Hz [256 if deaf] vibrating fork on top of patients head/ forehead. • "Where do you hear sound coming from?" • Normal reply is midline. - Rinne's test: Air vs. Bone Conduction • 512/ 1024 Hz [256 if deaf] vibrating fork on mastoid behind ear. Ask when stop hearing it. • When stop hearing it, move to the patients ear so can hear it. • Normal: air conduction [ear] better than bone conduction [mastoid]. - If indicated, look at external auditory canals, eardrums. |
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CN IX, X: Glossopharyngeal, Vagus
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- Voice: hoarse or nasal.
Pt. swallows, coughs (bovine cough: recurrent laryngeal). Examine palate for uvular displacement. (unilateral lesion: uvula drawn to normal side). Pt says "Ah": symmetrical soft palate movement. Gag reflex [sensory IX, motor X]: • Stimulate back of throat each side. • Normal to gag each time. |
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CN XI: Accessory
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- From behind, examine for trapezius atrophy, asymmetry.
- Pt. shrugs shoulders (trapezius). - Pt. turns head against resistance: watch, palpate SCM on opposite side. |
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CN XII: Hypoglossal
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- Listen to articulation.
- Inspect tongue in mouth for wasting, fasciculations. - Protrude tongue: unilateral deviates to affected side. |
