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Cranial Nerve Examination

Olfactory change in your sense of smell or taste recently?

a cold or a block nose recently?

Formally examine the sense of smell.

Optic

Acuity

usually wear glasses/contact lenses?

wear your glasses/contact

formally assess acuity using a Snellen chart at 6m

lenses while I examine your sight?

Cover your left eye with your left hand and read down the chart from the top

fingers can you see?

see my hand moving?

see this light?

Pupils

Shine a light in your eyes

Look straight ahead for me, please

Accommodation

Look at your eyes closely

look at a point on the far side of the room

look at a point about 15cm from your face over there

Visual Fields

Sit in front of you and formally test your visual field/how well you can see around

Cover your right eye with your right hand please and look straight into my eye

when do you first see the end of the pin/end of my finger

Fundoscopy

examine your fundi/inside of your eye with an ophthalmoscope

to put some eye drops into your eye to help me see inside better.

Shine a light in your eye

Oculomotor, Trochlear, Abducens

suffer from double vision?

put my hand on your chin

follow my finger with your eyes

tell me if you see double at any point.

Trigeminal

Motor

Test the strength of your jaw

Clench your teeth for me

Feel some muscles around your jaw

Push on your chin

open your jaw try to stop me pushing up

Push on the side of your jaw

move your jaw to the left/right side try to stop me pushing back

[jaw jerk reflex]

Sensory

Test your sense of touch on your face

close your eyes and tell me when you can feel me touching your face with this cotton wool

test the corneal reflex which is part of your eye

Dab the cornea gently with cotton wool, dont worry it wont hurt.

Facial

Please raise your eyebrows

Please close your eyes tightly and stop me from opening them

Show me your teeth

Puff out your cheeks

Try to push the air out

Vestibulocochlear

rub your left ear and whisper a number in right ear.

repeat the number, please

Webers

Place a tuning fork on your forehead

Hear the sound equally loud on both sides or is it louder on one side.

Rinnes

Place a tuning fork against the side of your jaw and next to your ear

Hear it louder here or here

Glossophryngeal

Open your mouth

Say aahh

Cough for me

Test your gag reflex

Push down with this at the back of your mouth, it may feel uncomfortable.

Vagus and Accessory

shrug your shoulders up and stop me from pushing them down

turn your head to the right and stop me pushing it back again

Hypoglossal

open your mouth

stick tongue out and move it from side to side

Questions Have you noticed any Do you Can you How many Stating your Intentions I would like to/Im going to Instructing the Patient I want/Id like you to + V1 Could you + V1 Would you mind + verb-ing If you could/can + V1