Cranial Nerve Examination

Give four things to look out for when undertaking general observations of the patient before commencing a cranial nerve exam:

1) posture

2) gait

3) symmetry

4) abnormal movement

How do you test the olfactory nerve?

ask patient if they have experienced any problems with their sense of smell

Give the five steps used to test the optic nerve:

1) consensual pupil reflex

2) pupillary accommodation

3) visual acuity

4) visual fields

5) fundoscopy

Describe how to test consensual pupil reflex:

shine a light in one eye and look for pupil constriction in the opposite eye

Describe how to test pupillary accommodation:

hold the index finger 1m away from the patient and gradually move it towards the nose - the pupils should constrict

Describe how to test visual acuity:

use a Snellen chart to test each eye separately, 6m away from the patient

Describe how to test visual fields of the eye:

have the patient shut one eye and shut your corresponding eye - move your fingers in all 4 visual fields, asking the patient to say 'yes' when they notice movement

Give 3 aspects observed in fundoscopy:

1) red reflex

2) healthy optic disc

3) healthy optic vessels

How do you test the oculomotor, trochlea and abducens nerves?

move your finger along horizontal and vertical planes, then making a letter H - eyes should move smoothly and synchronously (ask if they experience any double vision)

Give the three tests used to assess the trigeminal nerve:

1) light and sharp touch sensation

2) tension in muscles of mastication

3) jaw jerk reflex

Describe how the sensory aspect of the trigeminal nerve is tested?

light touch (cotton wool) and sharp touch (neuro tip) is tested on the ophthalmic, maxillary and mandibular regions of the face

Describe how the muscles of mastication are assessed when testing the trigeminal nerve:

Feel around masseter, temporalis and pterygoids for tension - to test pterygoids, ask patient to open jaw and keep it open against resistance, then move jaw from side to side

How do you test the facial nerve?

ask patient to raise eyebrows, squeeze eyes, show teeth, purse lips and blow out cheeks against resistance

Give the three tests used to assess the vestibulocochlear nerve:

1) number whisper

2) Rinne's test

3) Weber's test

Describe how to carry out Rinne's test:

place a vibrating tuning fork close to the ear and then on the mastoid process - it should be perceived as louder in air

Describe how to carry out Weber's test:

place a vibrating tuning fork in the centre of the patient's forehead and ask whether they hear it equally on both sides

Give to three methods used to test the glossopharyngeal and vagus nerves:

1) ask patient to cough

2) assess soft palate rise on 'ahh'

3) gag reflex

How do assess accessory innervation of the trapezius?

have patient shrug shoulders and keep them raised whilst you push down

How do assess accessory innervation of the sternocleidomastoid?

have patient turn their head from side to side against your resistance

Give three movements used to asses the hypoglossal nerve:

1) stick out tongue (look for wasting and fasciculation)

2) move tongue from side to side

3) stick tongue into check (with resistance)