NR509_IMMERSION_EXAM

CN 5 (Trigeminal) Motor – palpate over the masseter muscle as patient clenches jaw I will test the trigeminal nerve, which is cranial nerve number five. It has a motor component, and I will palpate over the masseter muscle as you clench your jaw. And I don't feel any distortions, and you have great strength CN 5 (Trigeminal) Sensory – light touch sensation to forehead, cheeks, chin, nose (patient closes eyes) Now I am testing the sensory portion of the Trigeminal nerve, which is cranial nerve 5. Please close your eyes and let me know where you feel me touch. Forehead, right cheek, left cheek, chin, nose. You have correctly identified where you are being touched. CN 7 (Facial) Inspect for facial symmetry with smile, frown, raise eyebrows, puff cheeks, pucker lips Next, I will test your facial nerve, which is cranial nerve number seven. And I will ask you to do some facial expressions. Please begin with a smile, and I see that it is symmetrical. Next, frown for me. OK. Now raise your eyebrows and go ahead and puff up your cheeks, and I notice they’re equal bilaterally. And now I want you to pucker your lips, very tight pucker. All of your expressions are bilaterally symmetrical. EAR Inspect outer ear for skin lesions and symmetry I’m will inspect your ears for any nodules or any skin lesions. I look at both ears and note that they are symmetrical without any nodules or lesions. Now I am going to look inside your ear canal with the otoscope. Inspect auditory canal and TM (using otoscope). Palpate pinnae and tragus for nodules & tenderness. I'm will pull your auricle up and back. Your external auditory canal is clear, there's no swelling, redness, drainage or cerumen. The tympanic membrane is pearly gray, and there is no effusion in the middle ear. I will do the same for your other ear, pull the auricle up and back, looking into the external auditory canal. I see it is clear without cerumen, swelling, redness, or drainage. Your tympanic membrane is pearly grey, and there's no fluid in the external auditory canal. You have normal eardrums and ears. I'm going to palpate your pinna and tragus for any nodules or tenderness. No nodules or tenderness are noted. CN 8 (Acoustic) Whisper Test (whisper words out of sight, and patient repeats words back) Test one ear at a time! I will be testing your acoustic nerve, which is cranial nerve number eight, and that is your hearing. I will be performing a whisper test, so I'm going to ask you to cover one of your ears. Now, I will stand behind you, cover my mouth, and whisper three words. One, two, three. (One, two, three.) And let's do the other side. Four, five, six. (Four, five, six.) Your hearing is intact bilaterally. EYE Inspects sclera and conjunctiva I will examine your eyes and begin with looking at your conjunctiva. I notice that they're pink and clear, no drainage or lesions. And I also note that your sclera is white and clear. CN 2 (Optic) Assess gross visual acuity and peripheral/central vision Now I'm going to test cranial nerve number two, the optic nerve, and this covers central vision. And I will use this Snellen eye pocket chart. I'll stand six feet away and ask you to cover one eye. Now read the lowest line possible. (LTFPH). Repeat with the other eye. (LTFPH). And with both eyes? (LTFPH). And you have normal vision, 20/20 in the left eye, right eye, and with both eyes. And now I will check cranial nerve number two, the optic nerve again, covers peripheral vision. I would like you to stand up, so we are at the same eye level. Please look straight ahead and keep your head still. First, do you see my hands now? (No.) Let me know when you do. (Yes). Now I'm going to come from 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. Your peripheral vision is normal. ......................................................................................................CONTINUE