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When testing cranial nerve I you shouldn't use noxious triggers like amonia because they might stimulate cranial nerve ____
Disc bulging on fundoscopic exam indicates what eye pathology?
How do you test cranial nerve II?
Optic fundii, Visual acuity near and far, visual fields by confrontation
How do you test cranial nerves II and III?
Inspect pupillary reactions to light, inspect size and shape of pupils, test near response of pupils
What is anisocoria?
Difference in size of >0.4mm in diameter between the right and left pupils
Bitemporal Hemianopsia usually indicates an issue at the ____ ____ and is most frequently caused by a __ tumor.
Homonymous hemianopsia or quadrantanopsias are usually post-____ lesions usually in the ___ lobe
How would you test cranial nerves III, IV and VI
6 cardinal fields of gaze and cover uncover test
What are the two most useful physcial exam tests do to on a patient who complains of diplopia?
6 cardinal fields of gaze and the cover uncover test
Out of the following which is the worst type of nystagmus? Horizontal, verticle, rotary or mixed?
drooping of the eyelids (upper lids)
What type of underlying cause of nystagmus is associated with a decrease in nystagmus when the patient fixes their gaze?
What type of underlying cause of nystagmus is associated with an increase in nystagmus when the patient fixes their gaze?
Cerebellar disease (most frequently associated with gait ataxia and dysarthria
Ptosis can occur in which cranial nerve palsey?
Horner's syndrome contains what three significant symptoms?
Ptosis, meosis and anhydrosis
How would you test Motor functions of cranial nerve 5?
palpate temporal while clenching, palpate massater while clenching as patient to open mouth hold open while pt attempts to close against resistance
How would you test the sensory function of cranial nerve 5?
- sharp dull test bilaterally on each side of the : forhead, cheeks, chin
- Also light touch test with cotton ball a the same points (caution do not sweep across face touch in one point lightly)
If there is an abnormality of sharp sensation of cranial nerve 5 sensory testing then what secondary test can you perform?
Temperature sensation two tubes filled with hot and cold water and touch to each of the 6 points on the face as before
What reflex tests both cranial nerve V and Cranial nerve VII?
- Corneal reflex
- Sensory from CNV and motor from CNVII
what normal process can deminish the corneal reflex response?
How would you test cranial nerve VII?
- Ask patient to:
- raise both eyebrows
- close both eyes tightly so that you cannot open them. Test muscular strenth by trying to open them against resistance
- show both upper and lower teeth
- puff out both cheeks
It is important to check this portion of cranial nerve VII because bells palsey will not spare this area while a lesion or cancer will
How would you assess Cranial nerve VIII?
- wisper test or finger rubbing test
What is the most common cause of sensorineural hearing loss?
Presbyacusis from aging
Vertigo, hearing loss and nystagmus all indicate what issue?
How would you test CN IX and X?
- Ask the patient to say AH or yawn as you watch the movements of the soft palate and pharynx the soft palate normally rises symmetrically the ubula remains in the midline and each side of the posterior pharyns moves medially like a curtain
- Gag reflex for elevation of the tongue and soft palate and constriction of the pharyngeal muscles
What will a patient with Trapezius muscle paralysis look like?
The shoulder droops and the scapula is displaced downward and laterally
Trapezius weakness and atrophy with fasciculations indicates a ____ (peripheral or Central) nerve disorder?
How would you test cranial nerve XI?
- Ask the patient to shrug both shoulders upward against your hands not strenght and contraction of the trapezii
- lock out the shoulder and ask patient to turn head against your hand repeat on the opposite side
How would you test the CN XII?
- Inspect the patients tounge as it lies on the floor of the mouth ask them to stick their tounge out look for deviation atrophy or asymmetry
- ask the patient to push against each cheek with their tounge feel through cheek externally for strength