Skip to 0 minutes and 12 seconds This second video section covers examination of the head and face and assessment of cranial nerves 2, 3, 4, 5, 6 and 7. Whilst you are watching list any special equipment which may
Skip to 0 minutes and 28 seconds be needed for this examination. Right for this next section I am going to be examining your head and neck. That involves me touching your head, your face, your ears, is that alright? That’s fine. So now I’m going to just have a look at your face and look at various aspects of it. I am assessing the skin characteristics of their
Skip to 0 minutes and 49 seconds face, looking for symmetry of the eyes and ears, observing for any signs of syndromes such as down’s syndrome, any obvious cyanosis which may need intervention before we continue, or jaundice or skin lesions. Lovely thank you, I’ll start by examining your scalp. I’m just going to just feel your scalp. I am feeling for any lumps, bumps or lesions assessing for the quality of the hair and its distribution, if the patient was a child I would be examining the fontanelles. Can I touch your temples? I am going to check your pulses. I am feeling for the temporal pulses, assessing their quality. In the case of temporal arteritis the pulse sight may be tender and palpably inflamed.
Skip to 1 minute and 34 seconds Here we go then and can you open your mouth for me and shut it and clench your teeth. I am testing the motor function of cranial nerve 5. And again open, shut and clench your teeth. Smashing, excellent. And now we are going to test the sensation in your face so I want you to close your eyes and I am going to touch you with my finger in various places. Does that feel the
Skip to 2 minutes and 1 second same as that? Yes. Does that feel the same as that? I am testing the sensory function of cranial nerve 5. Lovely. Now I am going to look at your sinuses, I’m just going to tap lightly on them, tell me if it’s painful. Any discomfort over the frontal or maxillary sinuses would indicate consolidation such as infection or tumour. I’m going to ask you to make some funny faces for me alright? So I want you to frown, could you smile and show me your teeth, could you put out your tongue, could you puff out your cheeks and don’t let me push the air out, lovely. Now squeeze your eyes tight and don’t let me open them.
Skip to 0 minutes and 0 seconds The ability to make these faces in a symmetrical manner shows normal motor function of cranial nerve 7. Now we are going to look at your eyes. So first of all could I ask you just to bring down our lower lids for me please? I am inspecting the eye lashes and eye brows for hair distribution, checking the palperable folds looking for pale conjunctiva which would indicate anaemia, blue sclera which may indicate brittle bone disease, corneal arcus or xanthelasma which indicate high cholesterol palpating the lacrimal gland and nasolacrimal duct for swelling which may indicate obstruction. There, or there? OK, do you use glasses to read? No.
Skip to 0 minutes and 0 seconds OK, cover one eye and then with the other eye I would like you read this top line here. Flu like illness for the last 3 weeks. Excellent, thank you. Now cover the other eye. I am making a coarse assessment of visual acuity. This tests cranial nerve 2. If I am concerned I would use a Snellen chart at 6 metres and test each eye separately again. Now we are going to examine your eyes a little bit more closely and what I am going to do first is shine a light into your eyes so I want you to just look straight ahead OK and then I am going to shine a light into this eye.
Skip to 0 minutes and 0 seconds I am looking at the pupil to assess constriction to light then to the opposite eye to note consensual constriction. This tests the motor function of cranial nerve 3. Excellent. Now I want you to look at this pen torch, the tip, keep your head very still and just follow it with your eyes.I am looking for bilateral eye movements following the pen torch and hold the lateral aspects for a few seconds to note any nystagmus . This tests the motor function of cranial nerves 3, 4 and 6. Thats good and towards your nose I won’t touch your nose,
Skip to 4 minutes and 45 seconds that’s excellent. OK, now I want you to have a look at my nose and then focus on a distant object behind me OK? So focus closely on my nose and then on a distant object. Accommodation is seen when focus changes from far to near with dilation of the pupils on near focus. That’s lovely, thank you. Right, the next one is a test on your vision and the outside of your vision periphery.
Skip to 0 minutes and 0 seconds So for this I want you to cover one eye and I’m going to cover the mirror imagine eye and I want you to keep focusing on my nose, don’t move your eyes, it’s very difficult not to, I’m going to bring the lolly pop stick in and I want you to tell me when you can see it and what colour it is. Now. And tell me is it blue or red? Blue. OK. And again. Now. What colour? Red. And again. Now. Red. OK, you keep you hand there, I have to move mine cause my arms aren’t long enough and again. Now. What colour? Blue. Now. What colour? Red. Now. Red. Excellent and now we will do it with the other eye.
Skip to 0 minutes and 0 seconds So cover that one, blink a couple of times and then. In this test to assess visual fields the sensory aspect of cranial nerve 2 we will use our own visual fields as a rough comparison to ascertain any gross abnormality. If we find any abnormality we would refer for specialist testing. Now. Red. OK, thank you very much.
Head to toe (part 2)
Having covered the initial meeting with the patient, and the observation of gait, balance and spinal assessment, watch this second video (2/6), which covers examination of the head and face, including cranial nerves II, III, IV, V, VI and VII.
List any equipment needed for these assessments.
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