One of the most common cranial nerve examination in MRCP and Medical student exams !
Look at this patient's face and proceed with the necessary.
I remember that when I was practising with eMRCPian before my MRCP PACES exam, he used to tell me that do the necessary and don't examine the cranial nerves from I to XII which would normally be done by most medical students.
It is obvious from inspection that there is loss of nasolabial fold on the left.
Start with cranial nerve VII
- Loss of wrinkling of the forehead, unable to close the L eye tightly, unable to blow the cheeks, mouth deviated to the right on showing the teeth
- Look for Bell's phenomenon - upward movement of eye and incomplete closure of eyelid when the patient attempts to shut the eyelids
- Check the III, IV, VI CN by checking the eye movement, a CP angle tumour can extend to involve these cranial nerves or in cases of NPC where you get multiple CN involvement
- Check the V cranial nerve esp corneal reflex (remember that afferent is V and efferent is VII for corneal reflex)
- Check the VIII cranial nerve - will be involved in CP angle tumour
- You can check other cranial nerves quickly - IX,X,XI,XII
- It won't be necessary to check the CN I or II
- Shine a torch into the ear(the site of the 7th CN palsy) to look for vesicles in Ramsay Hunt syndrome
- Examine the parotid glands for parotid enlargement (remember that the 5 branches of the 7th nerves comes out here - Used to remember "Clincal examination by Talley, O' Connor" which mentioned Two Zebras Bit My Car - Temporal, Zygomatic, Buccal, Mandibular, Cervical)
- Check for lymph nodes enlargement - NPC
- Check also for cerebellar signs of the upper limbs (CP angle tumour)
For medical students, try to remember the pathway of the 7th cranial nerve and the branches of it.