Question | Answer |
Olfactory | Cover one nostril (do each nostril separately)
Waft non-noxious odors toward patient (don't allow them to breathe deeply) |
Optic- Visual Acuity | Snellen Chart- visual acuity (numerator- distance pt stands from chart/denominator- # smallest line read on chart)
Test 1 eye at a time
Read smallest line possible |
Optic- Peripheral Vision | Pt's arms outstretch to side, watches stationary object & move hands in, says when he sees hands
Watch PT nose while PT moves arms out to sides; pt tells PT when he can see hands
Normal horizontal peripheral vision = 85 deg from midline |
Oculomotor- Pupillary Reflex | Equality & size of pupils, rxn to light
Put hand b/t eyes, shine light on 1 & observe direct effect where pupil receiving light constricts & other pupil simultaneously does the same |
Oculomotor, Trochlear, Abducens- Strabismus (ocular alignment) | Follow moving target w/o head mvmt
Use an H pattern (horizontal- 3 & 6; vertical- 4)
Check for nystagmus by holding an end range
Convergence of eyes- CN 3
Ptosis of eyelid- CN 3 |
Trigeminal | Ssy- sharp/dull, lt touch
Motor- open/close jaw vs resistance; jaw jerk reflex
Corneal reflex (CN 7)
Open mouth- jaw may deviate to weak side
Move jaw side to side with mouth open |
Facial | Assess asymmetry of face
Ask pt to frown, puff out cheeks (resist one cheek at a time)
Corneal reflex- tests orbicularis oculi |
Vestibulocochlear- Auditory acuity | tuning fork placed on vertex of skull/middle of forehead
Pt indicates on which side tone is louder (should be equal)
Louder on one side- "bad" ear |
Vestibulocochlear | Rub fingers together at a distance & gradually bring toward pt, note distance when first head
Alter conversatoin volume |
Rinne Test for vestibulocochlear n. | Air v. Bone conduction
Hit tuning fork w/ hand
Hold fork against mastoid process
Pt signals when he can't hear vibrations, then you move vibrating fork over ear canal
Pt says when sound stops
AC should be 2x > BC = (+) test
BC>AC = (-) test |
Hearing Loss | Conductive- normal BC, impaired AC, can't hear any sound when tuning fork near ear
Sensorineural- equal reduction of AC & BC; normal pattern prevails |
Glossopharyngeal | Taste on posterior 1/3 of tongue
Gag reflex
Do this test last! |
Vagus | Swallowing
Observe uvula & soft palate for asymmetry
Listen for hoarseness/nasal quality
Have pt say ah & look for asymmetry of structures
Ask pt/caregiver if there have been voice changes |
Cranial Accessory Nerve tested with Vagus. Spinal Accessory... | Strength of SCM/Upper Traps |
Hypoglossal | Tongue protruded- move tongue rapidly side to side
Protrude tongue & don't move (tongue deviates to side of lesion)
Problems with articulation
Strength of tongue- apply resistance through cheek bilaterally |