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Imperial College London Surgical Society Junior Anatomy Series CPA SUMMARY GUIDE Cranial Nerves Examination Kavyesh Vivek Defne Artun (CPA Lead) Anya Nanchahal (Phase 1a Lead) Andrea Perez Navarro (Phase 1b Lead) Imperial College London Surgical Society Junior Anatomy Series Contents Examination Anatomy Imaging Pathology presentation Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series Inspection • Medical paraphernalia • Walking frame • Hearing aids • Glasses • Medication • Furosemide • Aminoglycosides • Aspirin • Pathological signs • Muscle wasting • Facial asymmetry • Fasciculations Kavyesh Vivek Defne Artun (CPA Lead) Imperial College London Surgical Society Junior Anatomy Series Nose & Mouth • Smell (CN I) • Changes in smell • Check with fragrance oils using cotton wool • Gag reflex & swallowing (CN IX) • Check for equal reflex on left & right • Ask them to swallow some water to check all muscles functional on both sides & no asymmetry • Uvula (CN X) • Ask patient to say “aah”, check symmetrical uvula rise on left & right • Deviation away from side of lesion • Tongue (CN XII) • Ask patient to stick tongue out • Deviation to side of lesion Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series Eyes • Vision (CN II) • Acuity • Snellen Chart • Letter/magazine • Ishihara plates • Fields • Visual inattention (open and close hands, ask patient to point to which one) • Visual fields (close one eye with palm of hand, move hand inwards, ask to point out hand when the see it) • Blind spots (red neuro-tips) • Reflexes • Accomodation (ask focus on distant object then your nose) • Direct & consensual pupillary reflex • Swinging light reflex • Optic disc • Ophthalmoscope (visualize optic disc) • Movement (CN III, IV & VI) • Inspection (partial ptosis (Horner’s), complete ptosis (CN3 lesion)) • H-test (LO4, SR6) • Saccades test Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series Face • Sensation (CN V) • Check using a piece of cotton wool, use collar bone of patient as reference point for the sensation • Ophthalmic (V1) • Maxillary (V2) • Mandibular (V3) • Muscles (CN V) • Clench jaw • Feel for temporalis & masseter • Facial expression (CN VII) • Raise eyebrows • Scrunch eyes (try gently opening them with thumbs) • Show teeth • Purse lips • Puff cheeks out (try pushing air out) Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series Ears & Gait • Hearing (CN VIII) • Crude test whispering either side using tragal pull to close the other ear • Weber’s (forehead) & Rinne’s (mastoid process) test • 512Hz Tunning fork • Balance (CN VIII) • Any changes to balance • Walk on the spot • Walk in straight line • Dix-Hallpike test Shoulders and Neck • Sternocleidomastoid (CN XI) • Ask patient to turn head to either side whilst providing resistant using your forearm • TrapeziusCN XI) • Ask patient to shrug shoulders whilst providing resistance Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series Eye • Superior rectus: elevation, adduction, internal rotation • Inferior rectus:depression, adduction, external rotation • Medial rectus: adduction • Lateral rectus: abduction • Superior oblique: depression, abduction, internal rotation • Inferior oblique: elevation, abduction, external rotation • Levator palpebrae superioris: elevation of upper eyelid Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series Cranial Foramina • I (Olfactory):Cribriform plate • II (Optic):Optic canal • III (Oculomotor): Superior orbital fissure • IV (Trochlear): Superior orbital fissure • V1 (Trigeminal (ophthalmic)): Superior orbital fissure • V2 (Trigeminal (maxillary)): Foramen rotundum • V3 (Trigeminal (mandibular): Foramen ovale • VI (Abducens): Superior orbital fissure • VII (Facial):Internal acoustic meatus to stylomastoid foramen • VIII (Vestibulocochlear): Internal acoustic meatus • IX (Glossopharyngeal): Jugular foramen • X (Vagus): Jugular foramen • XI (Accessory): Jugular foramen • XII (Hypoglossal): Hypoglossal canal Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series Cranial Foramina Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series Fundoscopy Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series Facial Nerve Palsy Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series Facial nerve palsy • Bell’s Palsy th • UMN lesion of the 7 cranial nerve (facial nerve) Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series Overall Cranial Nerves Exam This table may include steps that you do not need to know for the CPA exam Defne Artun (CPA Lead) Kavyesh Vivek Imperial College London Surgical Society Junior Anatomy Series WE HOPE YOU ARE ENJOYING OUR SERIES! Feedback Please fill out the following feedback form. Let us know if there is anything we can improve on: ü Are we missing anything? ü Want to see more of something? ü What are we doing well? ü Finding anything confusing? Kavyesh Vivek (Lecturer) kv219@ic.ac.uk Defne Artun (CPA Lead) da1019@ic.ac.uk Anya Nanchahal (Phase 1a Lead) sn1119@ic.ac.uk Andrea Perez Navarro (Phase 1b Lead) ap6418@ic.ac.uk