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Cranial Nerve Examination
- CN II (optic): visual fields; pupillary reaction and accommodation
- CN III, IV, VI (Oculomotor, Trochlear, Abducens): extraocular movements; convergence
- CN V (trigeminal): sensory (sharp) and motor (clenches teeth while examiner palpates masseter and temporalis)
- CN VII (facial): smile, frown, puff cheeks, raise eyebrows, shut eyes while examiner attempts to pry them open
- CN VIII (auditory): finger rubs
- CN IX and X (glossopharyngeal, vagus): articulation; "ah" and note palate movement
- CN XI (accessory): shoulder shrug and neck strength against resistance
- CN XII (hypoglossal): stick out the tongue and move side to side
Special Considerations: CNVIII
- Use tuning fork is decreased hearing (Weber test)
Motor Exam: compare side to side
- Observe for bulk and abnormal movements
- Testing tone: passively flex and extend elbows
- Strength Testing against resistance
- Abduct shoulder
- Flex and extend elbow
- Spread fingers
- Thumb opposition to pinkie
- Flex hips
- Flex and extend knee
- Dorsiflex and plantarflex ankle
Coordination and Gait: Cerebellar Function
- Finger to nose testing
- Heel to shin testing
- Rapid alternating movements
- Romberg Testing
- Gait: walking and turning
- Tandem gait
- Walking on heels and toes
Reflex Examination: Tendon reflexes
- Biceps
- Triceps
- Brachioradialis
- Knee
- Ankle
- Babinski
Special Considerations: Reflexes
- Test for clonus by quickly dorsiflexing the foot on both sides
Sensory Examination
- Vibratory sensation bilaterally on index finger and great toe
- Subjective light touch tested symmetrically on upper and lower extremities
Special Considerations: Sensory Examination
- Position sense or proprioception bilaterally on index finger and great toe
- Two point discrimination
- Graphesthesia
- Stereognosis
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