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What are Cranial Nerves (CN)? What are dermatome?
- CN: they govern motor, sensory, and specialized functions like smell, vision, and hearing.
- Dermatome: band of skin innervated by the sensory root of a single spinal nerve.
- Dermatomes relate to the degree and level of motor loss if spinal cord injured.
Obtundation pt? Stupor pt?
- Obtundation: An obtunded pt opens the eyes and looks at you, but responds slowly and is somewhat confused. alertness and interest in the environment are decreased. (shoe the pt. gently)
- Stupor: Arouses from sleep only with pain.
what does CN I and II stand for?
- CN I: olfactory
- CN II: optic.
What do CN III, IV, and VI?
- CN: III oculomotor
- CN IV: Trochlear
- CN VI: abducens.
- They are responsible for the six cardinal fields of gaze.
- Pupil size, shape, response to light, and accommodation.
- Look at opening of upper eyelids (ptosis)
- Convergence of eyes: check for nystagmus.
what do they stand for?
- O: olfactory I
- O: optic II
- O: Oculomotor III
- T: Trochlear IV
- T: trigeminal V
- A: abducens VI
- F: Facial VII
- A: Acoustic VIII
- G: glossopharyngeal IX
- V: vagus X
- S: spinal accessory XI
- H: Hypoglossal XII
What is CN V?
- CN V: trigeminal
- Palpate temporal and masseter muscles and ask pt to clench teeth. Note strength.
- Ask pt to move jaw from side to side.
- Corneal reflex. (blink)
- Check both pain and sensation on the cheeks.
What is the CN VII?
- CN VII: facial. check for 6 things.
- 1) Raise both eyebrows
- 2) frown
- 3) close both eyes tightly and examiner tries to open them.
- 4) Show both upper and lower teeth.
- 5) smile.
- 6) puff out both cheeks.
What is CN VIII?
- CN VIII: acoustic.
- Asses hearing with whispered voice.
- test lateralization with weber test.
- Test air and bone conduction with Rinne.
What is CN IX and X?
- CN IX: glossopharyngeal
- CN X: Vagus.
- Difficult swallowing?
- Ask pt to say "ah" and watch movements of the soft palate and pharynx move symmetrically.
- Test gag reflex.
What is CN XII?
- CN XII: hypoglossal.
- Stick out tongue and inspect for symmetry or any atrophy.
- Move tongue from side to side.
What is the Robemberg test?
- pt. stands with feet together and eyes open, then with eyes closed for 30 to 60 secs w/o support.
- Loss of balance when eyes closed is a POSITIVE TEST.
Pronator drift test?
- pt stands for 20-30 secs with both arms straight forward, palms up, and eyes closed; tap arm briskly downwards.
- Pronation and downward drift of the arm is a positive test. (arms come back to position)
What is Brudzinski test?
- leafing up head towards chin.
- Movement of knees up while leafing head up is a POSITIVE TEST.
- Used for meningeal irritation.
What is Kernig test?
Moving the leg up will move the knee up and will cause irritation.
What are the deep tendon reflexes?
- Biceps (C5-6)
- Triceps (c6-c7)
- Suspinator or branchioradialis (c5-6)
- Kneed/patellar refelx (l2-4)
- Ankle reflex (primarily s1)
What is clonus?
A hyperactive response (+4), continuos rhythm contractions.