Cranial Nerves Examination Tutorial

Introduction

• Presenter: David, medical student
• Task: Cranial nerves examination on Yousef Smith (DOB: 1st Jan 1993)
• Objective: Assess the function of the cranial nerves in the patient's face

Preliminary Checks

• Confirm patient’s identity: Yousef Smith, DOB 01/01/1993
• Ask for consent to perform examination
• Check for any pain: None reported

Examination Procedure

Visual Inspection & Initial Questions

• Any changes in sense of smell? No
• Do you normally wear glasses or contact lenses? No

Vision Tests

• Visual Acuity: Read the lowest readable line from a chart using one eye at a time
• Pupil Assessment: Shine light into each eye, check pupil response
• Accommodation Reflex: Look at a distant wall, then at a near pen
• Color Vision: Identify numbers on color plates with one eye at a time
• Peripheral Vision: Point to where fingers wiggle while looking straight ahead
• Field of Vision: Cover an eye, say 'yes' when side wiggling finger is seen
• Fundoscopy: Perform fundoscopy (not detailed here)

Sensory Function

• Sensation Testing: Use cotton wisp and pin for tactile (soft and sharp) sensation
  • Ensure sensation is equal on both sides of the face

Motor Function

• Facial Muscles: Clench jaw, resist mouth-opening
  • Masseter and temporalis muscle check by palpation
• Reflexes: Jaw jerk reflex by tapping chin
• Facial Expressions: Raise eyebrows, scrunch eyes, puff cheeks, show teeth, purse lips

Hearing Test

• Whispering Test: Whisper numbers, ask for repetition
• Tuning Fork Test: Place near ear (Rinne test) and on forehead (Weber test)
  • Identify where sound is heard (middle, left, right)

Balance & Coordination

• Balance Test: Arms outstretched, eyes closed, march on the spot

Additional Checks

• Voice & Swallowing: Check for any changes in voice or swallowing difficulties
• Phonation: Say 'ahh'
• Cough and Sip: Turn aside and cough, then sip water
• Shoulder Strength: Shrug shoulders against resistance
• Head Movement: Turn cheek against hand resistance
• Tongue Movements: Stick tongue out, push against cheek resistance

Conclusion

• Examination Findings: No abnormalities observed in cranial nerves 1-12
• Next Steps: Perform upper and lower limb neurological examinations
• Additional Resource: Geeky Medics, practice OSCE stations