Olfactory Nerve

CN 1- Olfactory

Check for patency

Instruct pt to close eyes

test smell in each nostril separately

Optic Nerve

snellen chart for visual acuity

one eye at a time

Visual fields

fundoscopic, fundus for sharp optic disc

A/V 2:3, cup to disc 1:2

CN3

Oculomotor

EOMs

observation of eyelids for ptosis

pupils direct and consensual rxn

Trochlear

EOMs- watch finger w/outmoving head

Finger in H

Note symmetrical and conjuagate w/out nystagmus

cross eye noting convergence

Trigeminal

Demonstrate on back of hand sensation

cotton in 3 branches, scattered & symmetrical

sharp/dull same as above

instruct pt to clench jaw

palpate masseter and temporal muscles

corneal reflex

CN 6

Abducens

EOMS

Facial

Verbalize inspection for tics and symmetry

pt to raise eyebrows, frown, smile, puff cheeks

close eyes tight and don't let me open

taste deficit ant. 2/3 of tongue sweep across horizontally

Vestibulocochlear

Gross hearing, pt occludes one ear

stand opp occluded ear

whisper words or numbers for pt to repeat

CN 9

Glossopharyngeal

Gag reflex using tongue blade

taste deficit pos 1/3

Vagus

Pt says AHH and watch for symmetric rise of soft palate and pharynx

Ask pt to swallow and look for symmetric thyroid mvmt

verabalize observation for hoarsness

Accessory

Verbalize observation for shoulder droop or fasciculations

pt to shrug shoulders against your hands- verbalize trapezius strength

instruct pt to turn head against your hand

verbalize SCM strength

Hypoglossal

verbalize inspection of tongue as it lies on floor of mouth for fasciculations symmetry deviation and atrophy

 instruct pt to stick out tongue, verbalize obs. of straight protrusion with wide open mouth