Cranial Nerves Examination 🧠

Introduction

• Medical student: David
• Patient: Yousef Smith, DOB: January 1, 1993
• Purpose: Perform a cranial nerves examination.
• Patient consent obtained, no pain reported.

Examination Procedure

Cranial Nerve I: Olfactory

• Asked about changes in sense of smell: No changes reported.

Cranial Nerve II: Optic

• Visual Acuity Test: Reading letters off a chart.
  • Covered right eye, read lowest line: TVHXUAHTYOVUAXT
  • Covered left eye, read lowest line: TV
• Pupillary Light Reflex: Shined light into the eye while patient looked ahead.
• Accommodation Reflex: Patient looked at a wall and then at a pen repeatedly.
• Color Vision Test: Reading numbers on color plates.
  • Right eye covered: numbers 12, 8, 29, 5, 3
• Visual Field Test: Wiggling fingers in peripheral vision.
  • Right eye covered, patient indicated seeing: Yes
  • Left eye covered, patient indicated seeing: Yes
• Fundoscopy: Not performed in the transcript but mentioned.

Cranial Nerves III, IV, VI: Oculomotor, Trochlear, Abducens

• Tested eye movements: Patient followed a red pin, reported when it disappeared and reappeared in vision.

Cranial Nerve V: Trigeminal

• Sensory Test: Used cotton and pin to test feeling on the face; patient reported sensation as same on both sides.
• Motor Test: Clench jaw, push against resistance; jaw reflex tested.

Cranial Nerve VII: Facial

• Facial Movements: Raise eyebrows, scrunch eyes, puff cheeks, show teeth, smile, purse lips. All actions performed well.
• No changes noted in taste or hearing.

Cranial Nerve VIII: Vestibulocochlear

• Hearing Test: Whispered numbers in ear: 34, 26
• Used tuning fork:
  • Behind ear: Patient indicated when sound stopped.
  • On forehead: Patient heard sound in the middle.

Cranial Nerve IX, X: Glossopharyngeal, Vagus

• Voice and Swallowing: No changes in voice, no difficulty swallowing.
• Asked to say 'ah,' turn to the side and cough, sip water.

Cranial Nerve XI: Accessory

• Shoulder and Neck Movements: Shrug shoulders, turn cheek towards resistance.

Cranial Nerve XII: Hypoglossal

• Tongue Movements: Stick out tongue, push against cheek with resistance.

Conclusion

• No Stigmata of neurological disease.
• No abnormalities in cranial nerves I through XII.
• Findings consistent with a normal cranial nerves examination.
• Next steps: Perform upper and lower limb neurological examinations.

Additional Resources

• Mention of Geeky Medics for practicing OSCE stations with friends or AI virtual patients.