Pd 2

Front 1

I: Olfactory

Back 1

Smell

Front 2

II: Optic

Back 2

Visual aquity, visual fields and ocular fundi

Front 3

III: Oculomotor

Back 3

– Extra ocular muscles

Front 4

IV: Trochlear

Back 4

Extra ocular muscle

Front 5

V: Trigeminal

Back 5

– Corneal reflexes, facial sensation and jaw movements

Front 6

VI: Abducens

Back 6

Extra ocular muscles

Front 7

VII: Facial

Back 7

Facial movements

Front 8

VIII: Acoustic (vestibulocochlear)-

Back 8

Hearing

Front 9

IX: Glossopharyngeal-

Back 9

Gag reflex with X nerve

Front 10

X: Vagus

Back 10

Swallowing and rise of the palate and voice (Gag reflex with IX)

Front 11

XI: Spinal Accessory

Back 11

Shoulder and neck movements

Front 12

XII: Hypoglossal

Back 12

Tongue symmetry and position

Front 13

Cranial nerve I: Olfactory loss of smell

Back 13

nasal disease, head trauma, smoking, aging, and the use of cocaine.
It may be congenital.

Front 14

Cranial nerve II: Optic Nerve Test

Back 14

Visual Aquity: Snellen eye chart
Peripheral vision:
Confrontation testing
A temporal defect in the visual field of one eye suggests a nasal defect in the other eye

Front 15

Pupillary reactions to light.

Back 15

The direct reaction (pupillary constriction in the same eye)
2. The consensual reaction (pupillary constriction in the opposite eye)

Front 16

near reaction

Back 16

Hold your finger or pencil about 10 cm from the patient’s eye. Ask the patient to look alternately at it and into the distance directly behind it.
Watch for pupillary constriction with near effort.
Testing one eye at a time makes it easier to concentrate on pupillary responses, without the distraction of extraocular movement.

Front 17

Testing the near reaction is helpful in diagnosing

Back 17

Argyll Robertson pupil.

Front 18

Nerves III, IV and VI TESTS

Back 18

Extraocular Muscles.
From about 2 feet directly in front of the patient, shine a light onto the patient’s eyes and ask the patient to look at it.
Inspect the reflections in the corneas. They should be visible slightly nasal to the center of the pupils.

Front 19

Nystagmus,

Back 19

a fine rhythmic oscillation of the eyes.

Front 20

ptosis

Back 20

drooping of the upper eyelids
Ptosis in 3rd nerve palsy, Horner’s syndrome (ptosis, meiosis, anhidrosis), myasthenia gravis

Front 21

Cranial nerve V: Trigeminal

Back 21

Cranial nerve V: Trigeminal 
Supplies sensation to the:
1. Face
2. Nasal mucosa
3. Buccal mucosa
Teeth
Subdivisions of the trigeminal nerve:
1. Ophthalmic
2. Maxillar
3. Mandibular

Front 22

Cranial Nerve V—Trigeminal

Back 22

1. Motor function
2. Sensory function
3. Corneal reflex

Front 23

Corneal reflex

Back 23

Corneal reflex
Look for blinking of the eyes, the normal reaction to this stimulus
Absence of blinking suggests a lesion of CN V.

Front 24

Cranial Nerve V—Trigeminal
Motor TEST

Back 24

While palpating the temporal and masseter muscles in turn, ask the patient to clench his or her teeth.
Note the strength of muscle contraction.
Move jaw to sides against resistance: pterygoid
Weak or absent contraction of the temporal and masseter muscles on one side suggests a lesion of CN V.

Front 25

Cranial Nerve VII—Facial

Back 25

Ask the patient to:
1. Raise both eyebrows.
2. Frown.
3. Close both eyes tightly so that you cannot open them. Test muscular strength by trying to open them, as illustrated.
4. Show both upper and lower teeth.
5. Smile. In unilateral facial paralysis, the mouth droops on the paralyzed side when the patient smiles or grimaces.
6. Puff out both cheeks.
Note any weakness or asymmetry.

Front 26

Cranial Nerve VII—Facial.
Peripheral nerve damage

Back 26

bell’s palsy) to CN VII paralyzes the entire right side of the face, including the forehead.

Front 27

Cranial Nerve VII, Facial.
a central lesion affects

Back 27

lower face.

Front 28

Cranial Nerve VIII- Acoustic.
If hearing loss is present

Back 28

test for lateralization, and
compare air and bone conduction

Front 29

Test for lateralization (Weber test).

Back 29

Place the base of the lightly vibrating tuning fork firmly on top of the patient’s head or on the midforehead.

Front 30

In unilateral conductive hearing loss, sound is heard in

Back 30

(lateralized to) the impaired ear.

Front 31

Compare air conduction (AC) and bone conduction (BC) (Rinne test).

Back 31

Normally the sound is heard longer through air than through bone (AC > BC).

Front 32

In conductive hearing loss, sound is heard through bone as long as or longer than it is through air

Back 32

BC = AC or BC > AC)

Front 33

In sensorineural hearing loss, sound is heard longer through air

Back 33

AC > BC

Front 34

Cranial nerve IX: Glossopharyngeal
Supplies sensation to the :

Back 34

Pharynx
Posterior one third of the tongue
Tympanic membrane
Parotid gland (secretory fibers)

Front 35

Cranial nerve X: Vagus

Back 35

Dysphonia or dysarthria may result from paralysis of the vagus nerve.

Front 36

Cranial nerve XI: Spinal Accessory

Back 36

Examination of the spinal nerve:
1. Inspect (from behind) for symmetry, muscle bulk, fasciculation
Motor – ask patient to:

1. Shrug against resistance (trapezius –ipsilateral) .The examiner places both hands on the trapezius muscles, both muscles are palpated between the thumb and index fingers.

2. Turn head to sides against resistance of the examiner’s hand
(SCM – ipsilateral).
“Upon inspection, normal muscle bulk and symmetry noted.
Full force and strength bilaterally.”

Front 37

Cranial nerve XII: Hypoglossal

Back 37

Supplies: motor fibers to the muscles of the tongue.
Testing the motor function:
1. Inspect of the tongue:
-Normally the tongue is protruded and lies in the midline
-Deviation of the tongue to one side is abnormal
-Example of abnormality :
Amyotrophic lateral sclerosis:
Scalloping of the tongue’s surface with fasciculations.
Characteristic of a lower-motor neuron bulbar palsy.

2. Movements of the tounge:
1. Move tongue to sides:
If weakness of one side, the tongue will be push to the side of the lesion.
2. Stick out tongue
3. Put hands over cheek and ask patient to push tongue against cheek.

“No atrophy or fasiculations of the tongue as it lies in he floor of the mouth. With the patient’s tongue protruded, there is normal symmetry, on atrophy, and no deviation from the midline. Full force and strength bilaterally”

Front 38

Test flexion

Back 38

C5, C6—biceps

Front 39

extension

Back 39

C6, C7, C8—triceps

Front 40

Test extension at the wrist

Back 40

C6, C7,C8, radial nerve) by asking the patient to make a fist and resist your pulling it down.

Front 41

Weakness of extension is seen in

Back 41

peripheral nerve disease e.g., radial nerve damage
Central nervous system disease producing hemiplegia e.g. stroke

Front 42

Test the grip

Back 42

C7, C8, T1

Front 43

Test finger abduction

Back 43

C8, T1,ulnar nerveInstructing the patient not to let you move the fingers, try to force them together.
Weak finger abduction in ulnar nerve disorders

Front 44

Test opposition of the thumb

Back 44

C8, T1, median nerve). The patient should try to touch the tip of the little finger with the thumb, against your resistance.
Weak opposition of the
thumb in median nerve disorders such as carpal tunnel syndrome

Front 45

Test adduction at the hips (L2, L3, L4—adductors).

Back 45

Symmetric weakness of the proximal muscles suggests a myopathy or muscle disorder;
Symmetric weakness of distal muscles suggests a polyneuropathy, or disorder of peripheral nerves

Front 46

Deep tendon reflexes

Back 46

These are stretch reflexes which involve only two neurons (also called monosynaptic reflexes).
They represent a particular spinal cord segment.
These are evoked by a sudden stretch of muscle this causes excitation of the neurons which results in direct activation and contraction of the muscle.

Front 47

Test flexion at the hip (L2, L3, L4 — iliopsoas)

Back 47

by placing your hand on the patient’s thigh and asking the patient to raise the leg against your hand.