First I'm gonna look at her conjunctiva. I notice that they're pink and clear, no drainage or lesions. I also note that her sclera is white and clear. Now I'm going to test cranial nerve number 2, the optic nerve, and this covers visual acuity and central vision. I use this Snellen eye pocket chart and stand 6 feet away to assess her visual acuity. Can you please cover one eye and read the lowest line possible. Thank you. Please cover now the other eye and read the lowest line possible. Repeat with the other eye. Wonderful. Now leave your eyes uncovered and read the lowest line with both eyes. She has normal vision, 20/20 in her left eye, right eye, and with both eyes. Now, I want to assess peripheral vision related to cranial nerve number 2. Can you please stand up so we will be at the same eye level. And I'm gonna ask her to look straight ahead and not move her head. I stand in front of patient with my hands over patient’s shoulder wiggling my fingers and moving/flexing my arms towards me. Once pt. sees my moving fingers then I stretch my arms so hands are above pt.’s head, wiggle my fingers while flexing my arms. Once patient sees fingers, I do the same again this time coming from below moving my hands up. First of all, do you see my hands now? No. Let me know when you do. Yes. And then I'm going to cover above, do you see them now? No. Let me know when you do. Yes. Now come from below, do you see them now? No. Let me know when you do. Yes. OK, thank you, and you can have a seat. Her peripheral vision is normal. Now I'm going to continue and check cranial nerve number 2 again, the optic nerve, for her pupillary response to light . I'm using the ophthalmoscope light (or pen light). Please just stare at my nose. Now I'm gonna come from the side with my light source, and I notice that the pupil constricts, and then I will check the right eye as well. And her pupils are about two to three millimeters, and they respond to light equally. Now I'm gonna be checking cranial nerves number 3, which is the oculomotor, cranial nerve number 4, which is the trochlear, and cranial nerve number 6, which is the abducens . I will choose an H pattern to assess the extraocular muscles of the eyes. Please follow my finger with your eyes only. Thank you. All conjugate movements of the eyes in each direction are normal and extraocular muscles are intact equally. Now I'm gonna be checking the nose through inspection I do see that the nose is midline and straight. I don't see any obstruction or any noticeable fracture or swelling. Now I will insert my speculum of the otoscope inside her nose. And I'm gonna tip her nose up with the thumb. I am visualizing the left turbinates ; I see pink and moist turbinates in her septum midline. (You wanna angle anteriorly,) and I do see that her septum is straight, there's no deviation. Now I do the same on the right side, looking at the septum anteriorly, or medially, and I do see that she does have a straight septum, and her turbinates on the lateral aspect are nice and pink, and healthy, there's no swelling or bogginess.
3 And now, I'll palpate the sinuses beginning with the frontal sinuses. Let me know if you feel any
- Fall '15
- trigeminal nerve