Cranial Nerves Examination - Bradford VTS
Cranial Nerves Examination
|I Olfactory | |
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|Any change in sense of smell? | |
|II Optic nerve | |
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|Visual acuity | |
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|Visual fields | |
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|Blind spot (supplementary) | |
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|Fundoscopy | |
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|Pupillary light response | |
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|Accommodation | |
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|Sensory inattention (supplementary) | |
|III,IV & VI Occular motor, Trochlear & Abducens (combined) | |
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|Asks patient to follow index finger as maps out the letter “H” | |
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|Starts in midline | |
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|finishes in midline | |
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|Checks for nystagmus | |
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|Checks for diplopia | |
|V Trigeminal | |
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|Sensory (pin prick and cotton wool checking the three divisions of the trigeminal | |
|nerve) | |
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|Motor (Muscles of mastication) | |
|Open mouth against resistance | |
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|Corneal response (understand how to elicit but do not perform this) | |
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|Jaw jerk | |
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|VII Facial |Rationale |
|(Temporal, Zygomatic, Buccal, Mandillary, Cervical) | |
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|Any change in sense of taste? | |
|Note any abnormal face movements | |
|Raise eyebrows | |
|Screw up eyes | |
|Blow out cheeks | |
|Show teeth | |
|Smile | |
|VIII Vestibulocochlear |Rationale |
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|Air conduction (whisper) | |
|Rinne’s test | |
|Weber’s test | |
|IX Glossopharyngeal (sensory) |Rationale |
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|Palatal sensation (understand but do not try and elicit this response) | |
|IX & X combined (Sensory motor) | |
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|Gag reflex (understand but do not try and elicit this response) | |
|X Vagus (motor) | |
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|Asks patient to say “ah” and checks for Palatal/uvula movement | |
|XI Accessory | |
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|Asks patient to shrug shoulders against resistance (trapezius) | |
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|Asks patient to turn their head to the right/left against resistance | |
|(Sternocleidomastoid) | |
|XII Hypoglossal | |
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|Observes tongue at rest for fasciculation and wasting | |
|Asks patient to protrude tongue (and observe for deviation) | |
|Asks patient to move tongue from left to right and at speed | |
Peripheral Nervous System Examination
|Upper limbs |Rationale |Lower limbs |Rationale |
|General inspection | |General inspection | |
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|Postural abnormalities | |Postural abnormalities | |
|Muscle wasting | |Muscle wasting | |
|Fasciculation | |Fasciculation | |
|Abnormal movements | |Abnormal movements | |
|Tone (hyper/hypotonic) | |Tone | |
|Checks for presence of pain prior to | |(hyper/hypotonic) | |
|commencing | |Checks for presence of pain prior to | |
|Assesses passive movement of the upper | |commencing | |
|limbs | |Assesses passive movement of lower | |
|Checks for cogwheeling | |limbs | |
| | |Checks for clonus | |
|Power | |Power | |
|Checks all muscle groups of the upper | |Checks all muscle groups of the lower | |
|limbs | |limbs | |
|Co-ordination | |Co-ordination | |
|Finger / nose test | |Heel / shin test | |
|Rapid alternating movement of the hands| | | |
|Reflexes | |Reflexes | |
|(both arms) | |(both legs) | |
|Biceps | |Knee | |
|Triceps | |Ankle | |
|Supinator | |Plantar | |
|Sensation | |Sensation | |
|Checks dermatomes of the upper limbs | |Checks dermatomes of the lower limbs | |
|using pin prick and cotton wool touch | |using pin prick and cotton wool touch | |
|Check vibration perception starting | |Check vibration perception starting | |
|with DIP joint of middle finger | |with DIP joint of big toe | |
|Check proprioception using tip of | |Check proprioception using tip of | |
|middle finger | |longest toe. | |
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