Cranial nerve examination - wikipedia Cranial nerve examination This article has multiple issues. Please help improve it or discuss these issues on the talk page. ( Learn how and when to remove these template messages ) This article relies too much on references to primary sources. Please improve this by adding secondary or tertiary sources. ( January 2014 ) This article contains instructions, advice, or how - to content. The purpose of Wikipedia is to present facts, not to train. Please help improve this article either by rewriting the how - to content or by moving it to Wikiversity, Wikibooks or Wikivoyage. ( January 2014 ) The cranial nerve exam is part of the neurological examination. It is used to identify problems with the cranial nerves by physical examination. Can assist in testing the vestibulocochlear cranial nerve. Contents 1 Components 2 In popular culture 3 See also 4 References 5 External links Components Nerve Evaluation Associated conditions I : Olfactory nerve Smell is tested in each nostril separately by placing stimuli under one nostril and occluding the opposing nostril. The stimuli used should be non-irritating and identifiable. Some example stimuli include cinnamon, cloves, and toothpaste. Bilateral loss can occur with rhinitis, smoking, or aging. Unilateral loss indicates a possible nerve lesion or deviated septum. This test is usually skipped on a cranial nerve exam. meningioma II : Optic nerve Visual acuity is tested in each eye separately. Ensure the patient 's vision is corrected with eyeglasses or a pinhole. The patient is asked to read progressively smaller lines on the near card or Snellen chart. Visual fields are assessed by asking the patient to cover one eye while the examiner tests the opposite eye. The examiner wiggles the finger in each of the four quadrants and asks the patient to state when the finger is seen in the periphery. The examiner 's visual fields should be normal, since it is used as the baseline. Fundoscopy Optic neuritis III, IV, VI : Oculomotor nerve, Trochlear nerve, Abducens nerve Pupillary light reflex The patient stares into the distance as the examiner shines the penlight obliquely into each pupil. Pupillary constriction is tested for on the eye examined ( direct response ) and on the opposite eye ( consensual response ). The swinging flashlight test involves moving the light between the two pupils. Normally both direct and consensual responses are ellicited when the light shines on an eye, and some dilation will occur during the swing between. Extraocular movements : First, inspect for ptosis, eye position and nystagmus. The pupil size is measured, its shape and any asymmetry is tested. A commonly used abbreviation to describe normal pupils is PERRLA ( pupils equal, round and reactive to light and accommodation ). The examiner tests ocular movements by standing one meter in front of the patient and asking the patient to follow a target with eyes only, and not the head. The target is moved in an `` H '' shape and the patient is asked to report any diplopia. Then, the target is held at the lateral ends of the patient 's visual field. Nystagmus is tested for. One or two beats is a normal finding. The accommodation reflex is tested by moving the target towards the patient 's nose. As the eyes converge, the pupils should constrict. The optokinetic nystagmus test is optional and involves asking the patient to look at a moving strip of horizontal lines. Nystagmus is normally observed. V : Trigeminal nerve Light touch is tested in each of the three divisions of the trigeminal nerve and on each side of the face using a cotton wisp or tissue paper. The ophthalmic division is tested by touching the forehead, the maxillary division is tested by touching the cheeks, and the mandibular division is tested by touching the chin. Be careful not to test the mandibular division too laterally, as the mandible is innervated by the great auricular nerve ( C2 and C3 ). A common mistake is to use a stroking motion, which will trigger pain and temperature nerves. Instead, a point stimulus should be applied. For pain and temperature repeat the same steps as light touch but use a sharp object and a cold tuning fork respectively. Corneal reflex is conducted along with the facial nerve section of the test. Note the sensory innervation of the cornea is provided by the trigeminal nerve while the motor innervation for blinking the eye is provided by the facial nerve. - Muscles of mastication ( temporalis, masseter ) should be inspected for atrophy. Palpate the temporalis and masseter as the patient clenches the jaw. The pterygoids can be tested by asking the patient to keep the mouth open against resistance, and move from side to side against resistance. A jaw jerk reflex can be tested by placing a finger over the patient 's chin and then tapping the finger with a reflex hammer. Normally the jaw moves minimally. trigeminal neuralgia VII : Facial nerve Inspect for facial asymmetry and involuntary movements. Motor 1 ) Raise both eyebrows 2 ) Frown 3 ) Close both eyes tightly so that you can not open them. Test muscular strength by trying to open them 4 ) Show both upper and lower teeth 5 ) Smile 6 ) Puff out both cheeks Sensory : test for taste Bell 's Palsy, Ramsay Hunt syndrome VIII : Vestibulocochlear Hearing : Whisper numbers in one ear as patient covers the other and ask the patient to repeat the numbers. Alternatively, have patient close their eyes and say `` left '' or `` right '' depending on the side from which they hear the sound. Vigorously rub fingers together in one ear at a time to produce rustling sound. Conduct the Rinne test and Weber test. Vestibular Function acoustic neuroma IX and X : Glossopharyngeal and Vagus Gag response Visualizing uvula deviation away from affected side on articulating `` AHH '' with tongue depressor. Palatal articulation `` KA '' Guttural articulation `` GO '' Lateral medullary syndrome ( IX ) XI : Accessory nerve Shrug shoulders Turn head from side to side XII : Hypoglossal Stick out tongue and move it to one side, then the other Inspect for tongue atrophy, fasciculations or asymmetry in movement or appearance In popular culture Cranial nerve examinations are a common type of role - play in the ASMR community. The performer will pretend to perform the examination on the viewer as a way of triggering an autonomous sensory meridian response, with primary attention given to visual and auditory cues. See also Cranial nerves Cranial nerve nucleus References Jump up ^ Jon Brillman ; Scott Kahan ( 1 March 2005 ). In A Page Neurology. Lippincott Williams & Wilkins. pp. 4 --. ISBN 978 - 1 - 4051 - 0432 - 6. Retrieved 27 June 2011. Jump up ^ `` Examination of the Cranial Nerves ''. Jump up ^ `` Examination of the Cranial Nerves ''. External links NeurologyExam.com Free neurology exam videos by Cleveland Clinic trained neurologist. Medical examination and history taking Medical history Chief complaint History of the present illness Systems review Nursing assessment Allergies Medications Past medical history Surgical history Family history Social history Psychiatric history Progress notes Mnemonics SAMPLE OPQRST SOAP Physical examination General / IPPA Inspection Auscultation Palpation Percussion Vital signs Temperature Heart rate Blood pressure Respiratory rate HEENT Oral mucosa TM Eyes ( Ophthalmoscopy, Swinging - flashlight test ) Hearing ( Weber, Rinne ) Respiratory Respiratory sounds Cyanosis Clubbing Cardiovascular Precordial examination Peripheral vascular examination Heart sounds Other Jugular venous pressure Abdominojugular test Carotid bruit Ankle - brachial pressure index Abdominal Digestive Liver span Rectal Murphy 's sign Bowel sounds Urinary Murphy 's punch sign Extremities / Joint Back ( Straight leg raise ) Knee ( McMurray test ) Hip Wrist ( Tinel sign, Phalen maneuver ) Shoulder ( Adson 's sign ) GALS screen Neurological Mental state Mini -- mental state examination Cranial nerve examination Upper limb neurological examination Neonatal Apgar score Ballard Maturational Assessment Gynecological Well - woman examination Vaginal examination Breast examination Cervical motion tenderness Assessment and plan Medical diagnosis Differential diagnosis Retrieved from `` https://en.wikipedia.org/w/index.php?title=Cranial_nerve_examination&oldid=792967746 '' Categories : Neurology procedures Physical examination Hidden categories : Articles lacking reliable references from January 2014 All articles lacking reliable references Articles needing cleanup from January 2014 All pages needing cleanup Articles containing how - to sections Talk Contents About Wikipedia Edit links This page was last edited on 29 July 2017, at 21 : 56. 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Question: a test for cranial nerve vi would be
Answer: asymmetry