Cranial Nerve Examination Notes

Introduction

• Lecturer: Dr. Talha
• Objective: Conduct a cranial nerve examination
• Initial Steps:
  • Wash hands
  • Introduce yourself to the patient
  • Ensure a private and comfortable environment
  • Ask for patient's permission to begin the examination

Glossopharyngeal and Vagus Nerves Examination

• Inspect Uvula:
  • Use a torch
  • Ask the patient to open their mouth and say "ah"
  • Check for uvula deviation (normally centralized)
• Assess Voice:
  • Ask the patient to speak
  • Check for hoarseness
  • Ask the patient to cough to rule out other pathologies
• Vocal Cord Assessment:
  • Ask the patient to make a high-pitched noise
• Swallowing Test:
  • Have the patient swallow water
  • Check for nasal regurgitation

Accessory Nerve Examination

• Test Muscles:
  • Trapezius Muscle:
    • Feel for muscle bulk at shoulders
    • Ask the patient to shrug shoulders
    • Push down against resistance to assess strength
  • Sternocleidomastoid Muscle:
    • Check muscle bulk on both sides
    • Ask the patient to turn head against resistance
      • Right muscle turns head to left
      • Left muscle turns head to right

Hypoglossal Nerve Examination

• Tongue Inspection:
  • Ask the patient to open mouth
  • Look for tongue wasting or fasciculations
• Tongue Protrusion:
  • Ask the patient to protrude the tongue
  • Check for tongue deviation or fasciculations
  • Normal tongue should be centralized

Conclusion

• End of Examination:
  • Cover and thank the patient
  • Ensure patient comfort

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These notes capture the key steps and assessments involved in conducting a cranial nerve examination, including specific tests for glossopharyngeal, vagus, accessory, and hypoglossal nerves.