Term
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Definition
| Have patient close both eyes, then occlude one nostril and hold a familiar, pungent substance, such as coffee, tobacco, soap, or peppermint, under the patient’s nose and ask its identity. Repeat this technique with other nostril. |
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Term
| Optic (CN II) & Oculomotor (CN III) |
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Definition
test far vision (Snellen chart) and near vision (pocket card), check peripheral vision (use fingers, have pt. tell you when they see them in all fields..up, down, laterally…)
retinal lesion: blind spot in affected eye
optic nerve lesion: partial or complete blindness
temporal lobe abnormality: blindness in upper quadrant of both visual fields on the side opposite the lesion
parietal lobe lesion: contralateral blindness in lower quadrants of both eyes
occipital lobe lesion: contralateral blindness in corresponding half of each visual field. |
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Term
| Oculomotor (CN III), Trochlear (CN IV), & Abducens (CN VI) |
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Definition
The eyes should move smoothly and in a coordinated manner through all directions of eye movement. Observe each eye for rapid oscillation (nystagmus), movement not in unison with that of the other eye, or inability to move in certain directions. Also note any complaint of double vision (diplopia).
Oculomotor CN 3:pupillary response to light (also tests CN 2)
Trochlear CN 4:lateral and vertical gaze
Abducens CN 6: lateral gaze |
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Term
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Definition
To assess the sensory portion of the trigeminal nerve, gently touch the right side, then the left side of the patient’s forehead with a cotton ball while his eyes are closed. Instruct him to announce the moment the cotton touches the area. Compare the patient’s response on each side. Repeat the technique on the right and left cheek and on the right and left jaw. Repeat for sharp.
To assess the motor portion of the trigeminal nerve, ask the patient to clench his jaws. Palpate the temporal and masseter muscles bilaterally, checking for symmetry. Try to open the patient’s clenched jaws. Next, watch for symmetry as the patient opens and closes his mouth.
Then assess the corneal reflex. |
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Term
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Definition
To test the motor portion of the facial nerve, ask the patient to wrinkle his forehead, raise and lower his eyebrows, smile and show his teeth, and puff out his cheeks. Also, with the patient’s eyes tightly closed, attempt to open the eyelids.
Test the sensory portion of the facial nerve, which supplies taste sensation to the anterior two-thirds of the tongue |
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Term
| Vestibulocochlear(CN VIII) |
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Definition
To assess the acoustic portion of this nerve, test the patient’s hearing acuity. Rub fingertips next to pt’s ear.
To assess the vestibular portion of this nerve, observe for nystagmus and disturbed balance and note reports of dizziness or vertigo. |
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Term
| Glossopharyngeal (CN IX) and Vagus (CN X) |
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Definition
To assess these nerves, which have overlapping functions, first listen to the patient’s voice for indications of a hoarse or nasal quality. Then watch the patient’s soft palate when he says “ah”. Next test the gag reflex but warn the patient first. To evoke this reflex, touch the posterior wall of the pharynx with a cotton swab or tongue depressor.
Taste sensations to the posterior third of the tongue are supplied by the glossopharyngeal nerve (CN IX). |
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Term
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Definition
To assess this nerve, press down on the patient’s shoulders while he attempts to shrug against the resistance.
Then apply resistance to the patient’s turned head while he attempts to return it to a midline position. |
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Term
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Definition
| Observe the patient’s protruded tongue for deviation from midline, atrophy, or fasciculations. Next, ask the patient to move the tongue rapidly from side to side with the mouth open. Then ask him to curl the tongue up toward the nose, then down toward the chin. Then use a tongue depressor folded gauze pad to apply resistance to the patient’s protruded tongue and ask him to try and push the depressor to one side.Listen to the patient’s speech for d, l, n, and t sounds, which require use of the tongue. If general speech suggests a problem, have the patient repeat a phrase or series of words containing these sounds. |
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