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10 Cards in this Set
- Front
- Back
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I - Olfactory Nerve (s) |
Smell Test Exclude nasal obstruction. Patient closes eyes. Have patient attempt to identify familiar smell. |
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II - Optic Nerve (s) |
Visual Acuity Test Have patient 3m from snellen chart. Test each eye individually. Visual Field Test (confrontation) Sit across from patient and lock eyes. Move a pen inwards from the periphery to assess visual field defects. Use different levels. Optic nerve lesion = total loss of vision in eye Optic chiasm lesion = bitemporal hemianopia Optic tract lesion (L) = right homogenous hemianopia Lower optic radiation (L) = right upper quadrant hemianopia Upper optic radiation (L) = right lower quadrant hemianopia Temporal lobe lesion (L) = right homogenous hemianopia with sparing of the macula |
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APPEARANCES III - Occulomotor Nerve (m) IV - Trochlear Nerve (m) VI - Abducens Nerve (m) |
III disturbance: eyelid ptosis, cant look up down or to the middle, eye deviated down and out. IV disturbance: cant look down, esp down + in, eye deviated up and out causing vertical diplopia. Difficulty reading and with stairs. VI: cant look laterally, horizontal diplopia on gaze to affected side. |
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TESTS III - Occulomotor Nerve (m) IV - Trochlear Nerve (m) VI - Abducens Nerve (m) |
Ocular movement H-test - patient looking ahead, check for ptosis, alignment, pupillary size/symmetry, Patient follows fingers. Light response Dark room - test pupillary responses, both direct and consensual. Accomodation Focus distant -> focus near Note pupillary constriction / relaxation. |
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V - Trigeminal Nerve (B) |
Function: facial sensory, chewing motor, cornea sensory. Muscles of Mastication Testing -patient bites down, assess maseter and temporalis for wasting. -Patient opens mouth, assess jaw tracking for deviation. (deviates to affected side) -Jaw Jerk: open mouth slightly, place finger on chin, tap finger with hammer and note slight closure. Facial Sensation -patient closes eyes -assess modalities of sensation in different regions (cold/hot, prick, light touch) Corneal Reflex Touch cornea with wisp of cotton wool. |
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VII - Facial Nerve (B) |
Function: motor of facial expression, sensory of anterior tongue. Anterior Tongue: Test sweet / salt with patient closing their eyes. Facial Muscles: -imitate examiner (smile, frown, raise eyebrows) -test eye closure (attempt to open) -test lip closure (pressure on inflated cheeks) Weakness of lower face with forehead sparing = UMN lesion. Weakness of half of face = LMN. |
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VIII - Vestibulocochlear (s) |
Vestibular component not routinely tested. Indications = tinnitus / vertigo Cochlear component - external auditory meatus must be assessed first. Ticking Clock Test Using an audible clock or similar - test that you and patient can perceive sensation. Patient shuts eyes. either move clock into or out of audible range. Weber Test 512hz tuning fork on forehead or top of head. Lateralise hearing. Rinne Test Place 512hz tuning fork to mastoid process. When vibration sensation stops, move to ear and wait for audibility to stop. Normal: AC=2BC, Conductive loss BC>AC, Sensorineural loss, air conductance is less than twice bone conductance.
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IX - Glossopharyngeal (B) X - Vagus Nerve (B) |
Inspection Assess voice for hoarseness and test ability to swallow. Gag Reflex Stroke sides of pharynx with spatula, assess gag reflex. Palatal Reflex Say "ah" - assess symmetrical movement of uvula. Unilateral palsy = deviation away from affected side. |
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XI - Accessory Nerve (m) |
Function: Motor function to sternocleidomastoid and trapezius muscles. Palpate trapezius for strength. Turn head against resistance. Tilt head against resistance. Shrug against resistance. |
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XII Hypoglossal Nerve (m) |
Function: motor innervation of tongue. -inspect relaxed tongue for wasting or fasiculations. -protrude tongue - note deviations (towards affected side) -test strength of tongue against spatula or cheek. |
