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Cranial nerve examination

Pre-Examination Preparation

Review the patient's medical history

Gather necessary equipment (penlight, cotton swab, tuning fork, etc.)

Explain the procedure to the patient

Cranial Nerve I: Olfactory Nerve

Test the patient's sense of smell by presenting familiar scents

Ask the patient to identify each scent with their eyes closed

Cranial Nerve II: Optic Nerve

Test visual acuity using a Snellen chart

Have the patient stand or sit 20 feet away from the chart
Ask the patient to cover one eye and read the smallest line they can see clearly
Repeat for the other eye

Test visual fields by confrontation

Have the patient cover one eye while you cover the opposite eye
Hold a target in each quadrant and ask the patient when they first see it
Repeat for the other eye

Perform fundoscopic examination

Darken the room and dilate the patient's pupils with eye drops
Use an ophthalmoscope to examine the optic disc, macula, and blood vessels
Document any abnormalities

Cranial Nerves III, IV, and VI: Oculomotor, Trochlear, and Abducens Nerves

Assess extraocular movements by asking the patient to follow your finger in various directions

Check for nystagmus

Evaluate pupillary response to light

Cranial Nerve V: Trigeminal Nerve

Test facial sensation by lightly touching the patient's face with a cotton swab

Assess motor function by asking the patient to clench their jaw

Cranial Nerve VII: Facial Nerve

Ask the patient to smile, frown, raise their eyebrows, and puff out their cheeks

Assess taste perception on the anterior two-thirds of the tongue

Cranial Nerve VIII: Vestibulocochlear Nerve

Test hearing using a tuning fork or audiometer

Assess balance and coordination

Cranial Nerves IX and X: Glossopharyngeal and Vagus Nerves

Evaluate the patient's ability to swallow

Assess gag reflex

Cranial Nerve XI: Spinal Accessory Nerve

Test shoulder shrug strength by asking the patient to shrug their shoulders against resistance

Assess head rotation

Cranial Nerve XII: Hypoglossal Nerve

Ask the patient to stick out their tongue and move it from side to side

Assess tongue strength and coordination

Post-Examination

Document findings accurately

Discuss results with the patient and any necessary follow-up steps

Ensure patient comfort and address any concerns

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