Cranial nerve examination for CS

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This is from another forum(usmlesource.com) and I thought it might help everybody

A complete CN examination

Cranial Nerves

CN I. You do not need to do it

II. visual acuity (don't do); use ophthalmoscope under (DM, HT, increase intracranial pressure, CVA), check field(fix each other at the nose and close the eyes-same side and move up/down)

III/IV/VI: use right index finger to make half H on the left side with left hand to hold the chin of the patient. Do the same for the reverse eye.

V: Sensation: eyes closed, piece of gauze on forehead, cheek, jaws

Motor: bite down while palpate masseter, temporalis muscles.

VII: Motor: lower: show teetch, puff out the cheek

Upper: make wrinkles on the forehead, close eyes and don't let me open them (do them separately)

VIII: Do not do it, except Weber and Rinne

IX/X/XII: open mouth wide and say ah and see if there is bilateral elevation of soft palate and if uvula is in midline; then ask the patient to stick out the tongue.

XI: Motor: ask the patient to turn the head to the right.




Motor
Upper extremities:

flexion/extension of arm: push down/up/back/forward and then relax

abduction of arm: abduct the arm against resistance

forearm flexion/extension: pull-in and relax and push-out and relax

wrist extension/flexion: make a fist and extend while you pull it up/down

finger adduction: ask the patient to grasp your extended index/midder fingers

finger abduction: resist my attempt to bring fingers together.

Thumb adduction

Upper tone: relax your arms and passively flex/extend upper limbs

Lowe extremities:

Hip adduction/abduction: close/open the legs against resistance

Knee flextion/extension: hold the foot down as you extent the leg; do the reverse for extension

Great toe dorsiflextion/plantarflex.

Lower tone: grasp foot and passively dorsiflex and plantarflex to check ankle clonus.



Reflexes

1. Deep tendon (stretch reflex)

Biceps: place thumb firmly on biceps tendon and use the hammer to struck on thumb

Brachioradialis: strike the styloid process of radius.

Triceps: hang the patien't arm over your arm and strike on triceps tendon

Patellar tendon reflex

Achilles tendon reflex: hold the feet and strike post aspect of calcanus.

2. superficial reflex

Abdominal reflex: use tongue blade to stroke horizontally laterally to medially

3. Abnormal reflex

Babinski: lateral aspect of sole stroke from heel to the ball of foot and curved medially across the heads of metatarsal bones.

Sensation (If the light touch, pain, vibration normal, rest not required)

1. Light touch: close eye and ask the patient to identify the touch. If normal, do 2nd. If abnormal, continue to work proximally until sensation level is identified.

2. pain: close the eyes, tell the patientwhich is sharp and dull and ask the patient to identify

3. vibration: ta

p the tuning fork and place on bony prominence distally and close eyes, ask patient when he no longer feels the vibration on fingers/big toe.

4. proprioception (balance): instruct the patient: this is up, down; then close the eyes and ask me patient what is the direction.

5. tactile localization: close eyes, touch two places (face, right arm) simultaneously and ask the patient to identify both places.

6. 2-point discrimination

7. sterognosis: identify the object placed in the hands

8. graphesthesia: write the number down the palm and ask the patient to say it

9. point localization. Ask 'where is touched'



Cerebellum

1. finger-to-nose: eyes close

2. heel-to-knee

3. Rapid alternating movement

4. Romberg'stest: heels close, arms extend with palms facing upward, close eyes, see if the patient can hold steady.

5. Gait: ask the patient to walk straight ahead and return on tiptoes; walk away in heels and back in tandem gait.

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