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I (olfactory)
- Close one nostril and sniff
- Close one nostril and have pt smell familiar smell (coffee, vanilla, peppermint, etc.)
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II (optic nerve)
- Visual acuity (read from card or newspaper)
- Snellen chart (20 ft, left, right, and both eyes)
- Confrontation test (visual fields, peripheral vision)
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III, IV, & VI: (oculomotor, trochlear, & abducens)
- Positions test (focus on obj at 12 in, move horizontally, vertically and diagonally, observe for weakness, paralysis, nystagmus)
- PERRLA
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V (trigeminal)
- Clench teeth, palpate temporal and masseter muscles
- Close eyes, detect wisp of cotton on forehead, cheeks, and chin
- Corneal reflex (only if abnormal)
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VII (facial)
- Facial symmetry on smile, frown, close eyes, lift eyebrows, puff cheeks, show teeth
- Sensory: only tested w/ suspected injury
-
VIII (acoustic)
- Hearing (normal conversation)
- Whisper
- Webber (tuning fork on midline skull, equal or lateralized?)
- Rinne test (air and bone conduction w/ tuning fork)
-
IX & X (glossopharyngeal and vagus)
- Depress tongue, say "aaahh", note midline rise of uvula soft palate
- Touch throat (gag)
- Vocal quality
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XI (spinal)
- Equal size of sternomastoid and trapezius muscles
- Shrug against resistance
- Turn chin against resistance
-
XII (hypoglossal)
- Inspect tongue for wasting or tremors
- Stick out tongue
- Push tongue against cheek
- Say "light, tight, dyanamite"
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