NUR 6001 Exam 3 Study Guide 2026 | Cranial Nerves
& Special Tests Overview | Complete Solutions PDF-
William Paterson University
Study Guide
Cranial Nerves
Know the cranial nerves, their function (sensory, motor, or both), and tests:
Occasionally, our old trusty truck acts funny, very good vehicle anyhow
1. Olfactory (I) – Sensory; smell test (identify odors)
2. Optic (II) – Sensory; visual acuity, visual fields
3. Oculomotor (III) – Motor; extraocular movements (EOM), PERRLA
4. Trochlear (IV) – Motor; downward/inward eye movement (EOM)
5. Trigeminal (V) – Both; facial sensation, jaw clenching
6. Abducens (VI) – Motor; lateral eye movement (EOM)
7. Facial (VII) – Both; facial expressions, taste (anterior 2/3 of tongue)
8. Vestibulocochlear (VIII) – Sensory; hearing and balance (whisper test)
9. Glossopharyngeal (IX) – Both; swallowing, taste (posterior 1/3 of tongue)
10. Vagus (X) – Both; palatal movement, voice, gag reflex
11. Accessory (XI) – Motor; trapezius/sternocleidomastoid strength
12. Hypoglossal (XII) – Motor; tongue movement
Special Tests & Their Indications
1. McMurray's Test - Meniscal Tear
- Indication: Meniscal tear, usually of the medial or lateral meniscus.
- How to Perform:
- Have the patient lie supine with the knee fully extended.
- Support the heel of the patient's foot and flex the knee.
- Externally rotate the tibia and extend the knee for the medial meniscus, or internally
rotate the tibia and extend the knee for the lateral meniscus.
- Palpate the joint line during the maneuver.
- A click or pop along with pain may indicate a meniscal tear.
2. Apley's Test - Meniscal Tear vs. Ligamentous Injury
- Indication: To differentiate between meniscal injury and ligamentous injury.
- How to Perform:
- Have the patient lie prone with the knee flexed to 90 degrees.
- Apply downward pressure on the heel and rotate the tibia medially and laterally.
- For meniscal injury: Pain or a clicking sound during rotation is positive.
, - For ligamentous injury: If pain is felt when the downward pressure is applied with
rotation, it may indicate ligamentous damage.
3. Valgus Test - Medial Collateral Ligament (MCL) Injury
- Indication: Medial collateral ligament injury.
- How to Perform:
o Have the patient lie supine with the knee slightly flexed (about 30 degrees).
o Place one hand on the outside of the knee and the other hand on the ankle.
o Apply outward (valgus) force to the knee while stabilizing the ankle.
o Pain or increased laxity on the medial side of the knee suggests MCL injury.
4. Phalen's Test - Carpal Tunnel Syndrome
- Indication: Carpal tunnel syndrome.
- How to Perform:
o Have the patient place their wrists in full flexion (palms pressed together) for 60
seconds.
o Numbness, tingling, or pain in the thumb, index, or middle fingers indicates a
positive Phalen's test, suggesting carpal tunnel syndrome.
5. Tinel Test - Carpal Tunnel Syndrome
- Indication: Carpal tunnel syndrome.
- How to Perform:
o Tap lightly over the median nerve at the wrist (just proximal to the carpal tunnel).
o A positive Tinel's sign is characterized by tingling or electric shock-like
sensations in the distribution of the median nerve (thumb, index, and middle
fingers), suggesting carpal tunnel syndrome.
6. Neer's Test - Shoulder Impingement
- Indication: Shoulder impingement (specifically involving the rotator cuff or biceps
tendon).
- How to Perform:
o Have the patient sit or stand.
o Stabilize the scapula with one hand.
o With the other hand, passively raise the patient's arm forward and upward
(flexion) above the head.
o Pain or discomfort in the anterior shoulder indicates a positive test for
impingement.
7. Hawkins Test - Shoulder Impingement
- Indication: Shoulder impingement, specifically rotator cuff tendons.
- How to Perform:
o Have the patient sit or stand.
o Flex the shoulder and elbow to 90 degrees.
o Then internally rotate the arm by gently pushing the forearm downward.
o Pain or discomfort in the shoulder during the maneuver suggests rotator cuff
impingement.
8. Thomas Test - Hip Flexion Contracture
, - Indication: Hip flexion contracture (e.g., iliopsoas tightness).
- How to Perform:
o Have the patient lie supine with the legs extended.
o Bring one knee to the chest while keeping the other leg flat on the table.
o A positive test is indicated if the extended leg rises off the table, which suggests a
hip flexion contracture (tight iliopsoas muscle).
9. Apprehension Test - Shoulder Instability/Dislocation
- Indication: Shoulder instability or history of shoulder dislocation.
- How to Perform:
o Have the patient lie supine.
o Abduct the arm to 90 degrees and externally rotate the shoulder.
o Observe for signs of apprehension (i.e., the patient may show signs of anxiety or
attempt to resist the movement) which suggests instability or risk of dislocation.
o A positive test indicates shoulder instability or potential dislocation.
Signs & Their Indications
1. Lachman Sign - Anterior Cruciate Ligament (ACL) Tear
- Indication: ACL injury or tear.
- How to Perform:
o Position: Have the patient lie supine with the knee slightly flexed (20-30 degrees).
o Action:
o Hold the thigh of the patient with one hand to stabilize it.
o With the other hand, grasp the tibia just below the knee.
o Pull the tibia forward (anteriorly) while stabilizing the femur.
o Positive Sign: If there is excessive anterior movement of the tibia compared to the
femur (without a firm endpoint), it suggests an ACL tear. The patient may feel
instability or pain.
2. Bulge Sign - Knee Effusion
- Indication: Knee effusion (fluid in the knee joint).
- How to Perform:
o Position: Have the patient lie supine with the knee extended.
o Action:
o Use the ball of your hand to apply pressure on the medial side of the knee to push
any fluid toward the lateral side.
o With the other hand, tap the lateral side of the knee and observe the medial side
for a "bulge" or wave of fluid moving from the lateral to the medial side.
o Positive Sign: A bulge or wave of fluid on the medial side of the knee suggests
effusion.
3. Kernig's Sign - Meningitis
- Indication: Meningitis (especially when assessing for meningeal irritation).
, - How to Perform:
o Position: Have the patient lie supine.
o Action:
o Flex the patient's hip and knee to 90 degrees.
o Then, attempt to extend the patient's knee while keeping the hip flexed.
o Positive Sign: Pain and resistance to knee extension, often accompanied by back
pain or neck stiffness, suggests meningeal irritation, which is commonly seen in
meningitis.
-
4. Ballottement - Large Knee Effusion
- Indication: Large knee effusion.
- How to Perform:
o Position: Have the patient lie supine with the knee extended.
o Action:
o Apply downward pressure on the suprapatellar pouch (above the knee cap) to
push any fluid downward.
o Then, push the patella downward toward the femur with your fingers.
o Positive Sign: If the patella moves, or there is a feeling of "floating" or bouncing
against the femur, it indicates a large effusion in the knee joint.
-
5. Crepitation - Joint Degeneration
- Indication: Joint degeneration or osteoarthritis.
- How to Perform:
o Position: This test can be performed on any joint with the patient in a relaxed
position.
o Action:
o Move the joint through its range of motion (for example, flexing and extending
the knee or elbow).
o Listen for a grating or crackling sound (crepitus) and feel for any abnormal
sensation.
o Positive Sign: The presence of grating, popping, or crackling sounds during
movement suggests joint degeneration (often due to osteoarthritis).
6. Murphy's Sign - Cholecystitis
- Indication: Cholecystitis (inflammation of the gallbladder).
- How to Perform:
o Position: Have the patient lie supine or sit in a comfortable position.
o Action:
o Place your right hand just below the right rib cage (at the costal margin).
o Ask the patient to take a deep breath.
o As the patient inhales, apply gentle pressure to the area over the gallbladder (right
upper quadrant).
o Positive Sign: If the patient involuntarily stops inhaling or winces due to pain, it is
a positive Murphy's sign, which indicates cholecystitis.
& Special Tests Overview | Complete Solutions PDF-
William Paterson University
Study Guide
Cranial Nerves
Know the cranial nerves, their function (sensory, motor, or both), and tests:
Occasionally, our old trusty truck acts funny, very good vehicle anyhow
1. Olfactory (I) – Sensory; smell test (identify odors)
2. Optic (II) – Sensory; visual acuity, visual fields
3. Oculomotor (III) – Motor; extraocular movements (EOM), PERRLA
4. Trochlear (IV) – Motor; downward/inward eye movement (EOM)
5. Trigeminal (V) – Both; facial sensation, jaw clenching
6. Abducens (VI) – Motor; lateral eye movement (EOM)
7. Facial (VII) – Both; facial expressions, taste (anterior 2/3 of tongue)
8. Vestibulocochlear (VIII) – Sensory; hearing and balance (whisper test)
9. Glossopharyngeal (IX) – Both; swallowing, taste (posterior 1/3 of tongue)
10. Vagus (X) – Both; palatal movement, voice, gag reflex
11. Accessory (XI) – Motor; trapezius/sternocleidomastoid strength
12. Hypoglossal (XII) – Motor; tongue movement
Special Tests & Their Indications
1. McMurray's Test - Meniscal Tear
- Indication: Meniscal tear, usually of the medial or lateral meniscus.
- How to Perform:
- Have the patient lie supine with the knee fully extended.
- Support the heel of the patient's foot and flex the knee.
- Externally rotate the tibia and extend the knee for the medial meniscus, or internally
rotate the tibia and extend the knee for the lateral meniscus.
- Palpate the joint line during the maneuver.
- A click or pop along with pain may indicate a meniscal tear.
2. Apley's Test - Meniscal Tear vs. Ligamentous Injury
- Indication: To differentiate between meniscal injury and ligamentous injury.
- How to Perform:
- Have the patient lie prone with the knee flexed to 90 degrees.
- Apply downward pressure on the heel and rotate the tibia medially and laterally.
- For meniscal injury: Pain or a clicking sound during rotation is positive.
, - For ligamentous injury: If pain is felt when the downward pressure is applied with
rotation, it may indicate ligamentous damage.
3. Valgus Test - Medial Collateral Ligament (MCL) Injury
- Indication: Medial collateral ligament injury.
- How to Perform:
o Have the patient lie supine with the knee slightly flexed (about 30 degrees).
o Place one hand on the outside of the knee and the other hand on the ankle.
o Apply outward (valgus) force to the knee while stabilizing the ankle.
o Pain or increased laxity on the medial side of the knee suggests MCL injury.
4. Phalen's Test - Carpal Tunnel Syndrome
- Indication: Carpal tunnel syndrome.
- How to Perform:
o Have the patient place their wrists in full flexion (palms pressed together) for 60
seconds.
o Numbness, tingling, or pain in the thumb, index, or middle fingers indicates a
positive Phalen's test, suggesting carpal tunnel syndrome.
5. Tinel Test - Carpal Tunnel Syndrome
- Indication: Carpal tunnel syndrome.
- How to Perform:
o Tap lightly over the median nerve at the wrist (just proximal to the carpal tunnel).
o A positive Tinel's sign is characterized by tingling or electric shock-like
sensations in the distribution of the median nerve (thumb, index, and middle
fingers), suggesting carpal tunnel syndrome.
6. Neer's Test - Shoulder Impingement
- Indication: Shoulder impingement (specifically involving the rotator cuff or biceps
tendon).
- How to Perform:
o Have the patient sit or stand.
o Stabilize the scapula with one hand.
o With the other hand, passively raise the patient's arm forward and upward
(flexion) above the head.
o Pain or discomfort in the anterior shoulder indicates a positive test for
impingement.
7. Hawkins Test - Shoulder Impingement
- Indication: Shoulder impingement, specifically rotator cuff tendons.
- How to Perform:
o Have the patient sit or stand.
o Flex the shoulder and elbow to 90 degrees.
o Then internally rotate the arm by gently pushing the forearm downward.
o Pain or discomfort in the shoulder during the maneuver suggests rotator cuff
impingement.
8. Thomas Test - Hip Flexion Contracture
, - Indication: Hip flexion contracture (e.g., iliopsoas tightness).
- How to Perform:
o Have the patient lie supine with the legs extended.
o Bring one knee to the chest while keeping the other leg flat on the table.
o A positive test is indicated if the extended leg rises off the table, which suggests a
hip flexion contracture (tight iliopsoas muscle).
9. Apprehension Test - Shoulder Instability/Dislocation
- Indication: Shoulder instability or history of shoulder dislocation.
- How to Perform:
o Have the patient lie supine.
o Abduct the arm to 90 degrees and externally rotate the shoulder.
o Observe for signs of apprehension (i.e., the patient may show signs of anxiety or
attempt to resist the movement) which suggests instability or risk of dislocation.
o A positive test indicates shoulder instability or potential dislocation.
Signs & Their Indications
1. Lachman Sign - Anterior Cruciate Ligament (ACL) Tear
- Indication: ACL injury or tear.
- How to Perform:
o Position: Have the patient lie supine with the knee slightly flexed (20-30 degrees).
o Action:
o Hold the thigh of the patient with one hand to stabilize it.
o With the other hand, grasp the tibia just below the knee.
o Pull the tibia forward (anteriorly) while stabilizing the femur.
o Positive Sign: If there is excessive anterior movement of the tibia compared to the
femur (without a firm endpoint), it suggests an ACL tear. The patient may feel
instability or pain.
2. Bulge Sign - Knee Effusion
- Indication: Knee effusion (fluid in the knee joint).
- How to Perform:
o Position: Have the patient lie supine with the knee extended.
o Action:
o Use the ball of your hand to apply pressure on the medial side of the knee to push
any fluid toward the lateral side.
o With the other hand, tap the lateral side of the knee and observe the medial side
for a "bulge" or wave of fluid moving from the lateral to the medial side.
o Positive Sign: A bulge or wave of fluid on the medial side of the knee suggests
effusion.
3. Kernig's Sign - Meningitis
- Indication: Meningitis (especially when assessing for meningeal irritation).
, - How to Perform:
o Position: Have the patient lie supine.
o Action:
o Flex the patient's hip and knee to 90 degrees.
o Then, attempt to extend the patient's knee while keeping the hip flexed.
o Positive Sign: Pain and resistance to knee extension, often accompanied by back
pain or neck stiffness, suggests meningeal irritation, which is commonly seen in
meningitis.
-
4. Ballottement - Large Knee Effusion
- Indication: Large knee effusion.
- How to Perform:
o Position: Have the patient lie supine with the knee extended.
o Action:
o Apply downward pressure on the suprapatellar pouch (above the knee cap) to
push any fluid downward.
o Then, push the patella downward toward the femur with your fingers.
o Positive Sign: If the patella moves, or there is a feeling of "floating" or bouncing
against the femur, it indicates a large effusion in the knee joint.
-
5. Crepitation - Joint Degeneration
- Indication: Joint degeneration or osteoarthritis.
- How to Perform:
o Position: This test can be performed on any joint with the patient in a relaxed
position.
o Action:
o Move the joint through its range of motion (for example, flexing and extending
the knee or elbow).
o Listen for a grating or crackling sound (crepitus) and feel for any abnormal
sensation.
o Positive Sign: The presence of grating, popping, or crackling sounds during
movement suggests joint degeneration (often due to osteoarthritis).
6. Murphy's Sign - Cholecystitis
- Indication: Cholecystitis (inflammation of the gallbladder).
- How to Perform:
o Position: Have the patient lie supine or sit in a comfortable position.
o Action:
o Place your right hand just below the right rib cage (at the costal margin).
o Ask the patient to take a deep breath.
o As the patient inhales, apply gentle pressure to the area over the gallbladder (right
upper quadrant).
o Positive Sign: If the patient involuntarily stops inhaling or winces due to pain, it is
a positive Murphy's sign, which indicates cholecystitis.
