Professional Documents
Culture Documents
(NEU) 3.4 Examination of The Cranial Nerves - Dr. Nico Paulo M. Dimal MD FPNA
(NEU) 3.4 Examination of The Cranial Nerves - Dr. Nico Paulo M. Dimal MD FPNA
(NEU) 3.4 Examination of The Cranial Nerves - Dr. Nico Paulo M. Dimal MD FPNA
LEGEND
⭐ ❓ 🖊️ 📖 📝 📺
Must Good Lecture Book Prev. Presentation
Know to [lec] [bk] Trans [ppt]
Know [tn]
⭐ Please put the legend before the text
Please do not change legends to maintain uniformity in all batch transes.
📺 Exit Foramina for the Cranial Nerves in the Base of the Skull
Figure 4.
(Source: © Dr. Dimal’s PPT)
OPTIC It sees.
III. CRANIAL NERVE I (OLFACTORY NERVE)
I OCULOMOTOR Its muscles move the eyeball. Functional category:
TROCHLEAR Its muscle moves the eyeball after running through a o special somatic sensory
trochlea. Function:
TRIGEMINAL It has three large sensory branches to the face. o olfaction (smell)
📝 Arise from the olfactory receptor nerve cells in the
ABDUCENS It abducts the eye. olfactory mucous membrane.
I FACIAL It moves the muscles of all facial orifices. 📝 Olfactory hairs: short cilia from peripheral process,
project to mucus covering the surface of the mucous
I VESTIBULOCOCHLEAR It equilibrates, hears. membrane. It reacts to odors in the air and stimulate the
olfactory cells.
GLOSSOPHARYNGEAL It supplies taste fibers to the tongue and activates the 📝 Olfactory bulb: possesses several types of nerve cells.
pharynx during swallowing. Mitral cell is the largest. Incoming olfactory nerve fibers
VAGUS It is a vagrant, wandering from the pharynx to the splenic synapse with the dendrites of the mitral cells and form
flexure of the colon. rounded areas- synaptic glomeruli.
SPINAL ACCESSORY It arises from neuronal cell bodies in the cervical spinal cord,
Needs:
runs into the skull, out again, and conveys accessory fibers to o aromatic substance like coffee in an opaque vial
the vagus. o Penlight
I HYPOGLOSSAL It runs under the tongue.
Technique:
o Check nostrils
Function of the Cranial Nerves o Test one nostril at a time by compressing the other
o Ask Pt to close eyes and sniff
Number Function
o Pt identifies the substance or not
I Smells 📝 You can use 2 different stimuli so
that you’re sure that the patient isn’t just
II Sees saying the same response as in the
other side.
III, IV, and VI Move eyes; III constricts pupil
📝 Sometimes, some people would do
V Chews and feels the front of the head fake testing and put an empty bottle
close to the open nostril and ask if
VII Moves the face, tears, snots, tastes, salivates he/she smells anything, just to make
sure that the patient is attentive and
VIII Hears, equilibrate actually responding honestly.
IX Tastes, salivates, swallows, monitors carotid body and sinus
Sample abnormal findings
o Pt is unable to identify the substance on one/both
X Tastes, swallows, lifts palate, phonates, afferent and parasympathetic side/s (anosmia)
efferent to thoracicoabdominal viscera
XI Turns head, shrugs shoulders
Figure 8. CN I EXAMINATION
(Source: © Dr. Dimal’s PPT)
Figure 9. CN II EXAMINATION
(Source: © Dr. Dimal’s PPT)
IV. CRANIAL NERVE II (OPTIC NERVE)
Functional category: o Visual fields: confrontation testing
o special somatic sensory Position yourself 50 cm away from the
Function: patient
o vision Test one ye at a time, one hemifield at a
📝 conveys the afferent axons for both vision and time, one quadrant at a time
pupilloconstriction. Patient should look into Examiner’s eye
📝 (Patient’s right eye to Examiner’s left
Needs: eye)
o Snellen chart or Pocket vision chart (aka Patient should identify Examiner’s
Rosenbaum chart) finger/s per quadrant
o Ophthalmoscope Map out field defect, if any
o Penlight Test for visual attention
⭐ Components:
o Visual acuity
o Visual fields
o Ophthalmoscopy
o “Always start with visual acuity, you don’t go
straight to visual field nor ophthalmoscopy
because want to ensure that the patient can see
before asking about visual field and etc.”
Technique:
o Visual acuity
Pocket near vision chart should be 14
inches away from the pt’s eyes
Have the pt read each
number from the chart,
beginning from the biggest
row to the smallest
Figure 10. CN II EXAMINATION
Pt must be able to read
(Source: © Dr. Dimal’s PPT)
majority of the numbers
Test each eye separately w/ correction
Remind the pt to squint lightly
because if the pt squint’s too
much the pt will have a
difficulty with the following
examinations
If the patient have glasses, let
them wear it
If unable to read the tool, test counting
fingers à light projection à light
reception
Counting fingers: usually
done 5 feet away from the pt
and tell the pt to respond how
many fingers are shown by
the ex
o Direct Opthalmoscopy
Instruct patient to fixate ahead
Examine patient’s right eye w/
examiner’s right eye, patient’s right eye
w/ examiner’s left eye
Maintain a proprioceptive link
Check ROR, clarity of media, disc
margins, artery to vein ration (2:3), cup
to disc ratio (<0.5), exudates
FIGURES
Do not use pixelated photos
As much as possible, avoid taking photos at an angle
For figure-heavy subjects like anatomy, label them as much as
possible
FORMAT
Details: Arial, 8, Bold, Centered
3 Sensory Divisions of the trigeminal nerve: ⭐In the picture format: go to picture styles > border. Use ¼
V1- Opthalmic weight, black outline to distinguish it from the next
V2- Maxillary
Use “top and bottom” wrapping
V3- Mandibular
CITATION
Details: Arial, 7, in between parentheses
If it came from the professor or a classmate, put alt + 0169 to
insert ©
o Example: (Source: © LN, FN)
and check for choking response and o Have Pt turn head to either side, apply hand on side of Pt’s
symmetry of palatal elevation head while the other hand is on Pt’s shoulder; palpate SCM
o Not routinely done only when you tone during contraction
expect a LMN problem o Have Pt push forehead against Ex’s hand while the other
hand is on Pt’s nape
o Sample findings: Uvula is midline, palatal o Have Pt raise both shoulders; Ex then pushes
elevation is symmetric, good gutturals, no shoulders downwards
dysphonia o Key here is where to place your hand
If intubated: (+) gag on endotracheal o The SCM turns the head to the other side, same side if tilting
tube tugging or suctioning (right tilts to the right side)
📝 The Glossopharyngeal nerve (CN IX) supplies the stylopharyngeus muscle o Trapezius elevates the shoulder on that side
and sends secretomotor fibers to the parotid gland. Sensory fibers o Also palpate the bone – press neck then feel the SCM bone
innvervate the posteror 1/3 of the tongue for general sensation o Forward movement – SCM bilaterally – tulak po ang aking
and taste. kamay paganito (palpate bone)
📝 Isolated lesions of CN IX are rare and usually involve the vagus o Lingon kayo sa kaliwa, tutulak ko labanan nyo (hawak sa
nerve (CN X)
balikat and check tone)
📝 To test for gag reflex use cotton swab and stimulate the back
o Akyat balikat patenga
of the throat (do it on both sides, not in the midline) that will
o Angat muna before tulak
cause the patient to gag ☤ (pharyngeal muscles will contract)
o Sample Findings: GOOD SCM tone bilaterally, good head
o 📝 Gag reflex is often impaired in patients with stroke –
turn and shoulder elevation bilaterally
supratentorial or infratentorial, especially when multiple
o Always compare left vs right
strokes are present
📝 Unilateral lesions of the vagus nerve will show little or no gag
reflex on that side. 🕮
Observe palatal elevation patient says “aaah” ☤
o Normally the soft palate rises and the uvula moves backward
in the midline 🕮
Reminder: check for palatal elevation, NOT uvula deviation
o Should be symmetric (both should elevate)
Also test for swallowing reflex☤
To check for laryngeal and pharyngeal dysarthria ☤
o Ask the patient to say “mi-mi-mi" (for laryngeal)
o Ask the patient to say “ka-ka-ka" (for pharyngeal)
o Slurring is a sign of lesion in these nerves
All muscles of the larynx are supplied by the recurrent laryngeal
branch of vagus, except the cricothyroid muscle which is supplied
by the external laryngeal branch of the vagus.
Hoarseness or absence of voice may occur as a symptom of vagal
nerve palsy.
Lesions involving the vagus nerve in the posterior cranial fossa
commonly involve CN IX, XI and XII.
📺
📺 UPCM Neuro OSCE
Always check for asymmetry ANSWER: Choice A (Arial, 7, main color, justified)
Examination must be driven Insert a 1x1 table. Insert a bullet before the explanation
by hypotheses (based on If there is a figure or table included in the answer, insert it in the
history and findings during appendix and cite it the rationale
the examination) o See Appendix _
Check CN I in those with Follow correct bullet and numbering
history of trauma, cognitive
impairment, and visual issues 3. Question 1
For CN III, IV, and VI: a. Choice A
determine which EOMs are b. Choice B
involved c. Choice C
For CN VII: determine pattern d. Choice D
of facial weakness
Check taste if suspecting RATIONALE (Arial, 7, Bold, main color, justified)
peripheral CN VII lesion ANSWER: Choice A (Arial, 7, main color, justified)
For CN VIII: determine if Insert a 1x1 table. Insert a bullet before the explanation
sensorineural or conductive If there is a figure or table included in the answer, insert it in the
hearing loss appendix and cite it the rationale
Do not test gag reflex o See Appendix _
routinely Follow correct bullet and numbering
Always assess for tongue
atrophy
XI. REFERENCES
1. Question 1 Follow proper APA citations
Arial, 6, justified
a. Choice A You may use a website citation generator
b. Choice B Book
c. Choice C o Author, A. (Year). Title of work (edition). Place of publication:
Publisher
d. Choice D
Journal article
o Author, A. (Publication year). Article title. Periodical title, Volume
(Issue), pp-pp
RATIONALE (Arial, 7, Bold, main color, justified) Online book
ANSWER: Choice A (Arial, 7, main color, justified) o Author, A. (Year). Title of article. Retrieved from URL
Website
Insert a 1x1 table. Insert a bullet before the explanation o With author
If there is a figure or table included in the answer, insert it in the Author, A. (Year). Title of article. Retrieved from URL
appendix and cite it the rationale o Without author
Article title (Year). Title of work (edition). Retrieved
o See Appendix _ from URL
Follow correct bullet and numbering Photo
o Photographer, A. (Photographer). (Year). Title of Photograph
[digital image]. Retrieved from URL
2. Question 1 Previous trans
a. Choice A o Batch year COM-Transcription
b. Choice B Example: 2025COM-Transcription
c. Choice C Lecturer’s PowerPoint
o Lecturer, A. (Year). PowerPoint title [Lecture PPT]
d. Choice D
APPENDIX
To prevent any changes in the format, please leave the blank space above the appendix.
If there is no appendix, do not delete this portion.
o Instead, you may write No appendices
All appendices in any trans should be in one column
Figures and tables that’s large in size should be placed here
Includes figures and tables used to rationalize the answers in the review questions
Table for the abbreviations used must be included in the appendix
Note:
You may insert meme and any motivation quotes in the trans. Please place them accordingly, suggested area is at the end of the trans.
Let us work together as a batch. Please treat the transes as your own reviewers
and keep its content informative and helpful.
One for All, All for One.
Let’s go Batch 2026! Walang iwanan!