Quick Review: Examination of the Cranial Nerves

by Stephen Holt, MD, MS

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    00:01 So we just covered a lot of material on the Neurologic Exam.

    00:05 Let me just highlight a few key points here.

    00:08 So we went through all of the cranial nerves and we were highlighting the motor function and the sensory function of a variety of these nerves, acknowledging that there are many functions of these nerves, which we can't readily assess on the physical exam.

    00:21 In terms of coordination, we talked about distinguishing between limb ataxia, and gait ataxia.

    00:27 Not to mention distinguishing gait ataxia from sensory ataxia, ataxia that's caused by cerebellar problems versus that caused by sensory problems from the peripheral nervous system.

    00:41 We also talked how to assess for tremor, whether there's resting tremor or action tremor.

    00:46 We reviewed tests of higher cortical functioning, starting with just cortical sensation, and then talking about mental status, for example, dementia and delirium.

    00:57 And lastly, we looked at some of those tests we've used historically in meningitis, acknowledging that they're not particularly useful when making a bedside diagnosis.

    01:07 Which of the following assesses the function of the accessory nerve? A. Sticking out the tongue.

    01:13 B. Asking the patient to bite down while palpating the masseter muscles.

    01:16 C. Assessing for midline uvula.

    01:19 Or D. Asking the patient to shrug his or her shoulders.

    01:26 So sticking out the tongue is a test of the twelfth cranial nerve, the Hypoglossal.

    01:31 Asking a patient to bite down while palpating the masseter muscles would help us to identify a problem with the fifth cranial nerve, the Trigeminal.

    01:40 Assessing for a midline uvula is a feature of the Glossopharyngeal with some contributions from the vagal nerve.

    01:48 So the answer is D. Asking patients to shrug their shoulders is a test of the eleventh or accessory cranial nerve.

    02:01 Which of the following would not be used to assess cerebellar function? A. The Romberg B. Dysdiadochokinesia C. Finger-nose-finger or D. the Heel-shin test.

    02:16 So the Romberg is actually really used to look for a sensory ataxia.

    02:22 When a patient closes their eyes if they were relying upon visual input to help maintain their balance due to a loss of proprioceptive input, you would see that person start to lose their balance.

    02:33 Cerebellar functioning is more about coordination and that's what Dysdiadochokinesia, the Finger-nose-finger and the Heel-shin tests are designed to investigate.

    02:43 So the answer is letter A.

    About the Lecture

    The lecture Quick Review: Examination of the Cranial Nerves by Stephen Holt, MD, MS is from the course Examination of the Cranial Nerves.

    Author of lecture Quick Review: Examination of the Cranial Nerves

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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