Cranial Nerve Exams for Unintentional ASMR

hello Mr Hamilton hello my name is Dr pit Ford this is your right if I examine you yes thank you before I start have you got any pain anywhere at all no okay I could ask you to walk over to that cupboard turn around and come back please thank you back on the bed okay now I'm going to wiggle your legs around so nice and relaxed okay and I'm going to be testing your strength so I want you to lift this leg straight up off the bed and then I'll resist you so start with this one strong as you can Center on this side push your knees down into the bed now bend your knees up and push me away and on this side okay now lie your legs flat if you could Point your toes up towards your nose as strong as you can and on this side and down to the floor and down to the floor and the same with your big toe so again really nice and relaxed and fluffy I'll take the weight of your leg I'm just going to clench your teeth for me just count your teeth okay all right thank you gonna scratch the bottom of your feet I'm going to test how much you can feel so I'm going to just start by touching your chest and then down your legs so if I could get you to close your eyes and say yes when you feel me touch you let me know if it feels particularly different anywhere yes yes yes yes yes just feel that no okay yes yes does that feeling go away there yeah I can't feel that okay you feel that no okay can't put any of this no okay all right thank you I'm going to do a similar thing with a blunt pin okay so close your eyes it should feel sharp but it shouldn't hurt yeah yes yes yes well it's not quite so sharp okay it's a bit taller there okay you feel that just about here yes it was a bit duller okay yeah just yeah just just can feel that okay okay thank you now you can open your eyes I want you to tell me if you feel this vibrating against you okay okay can you feel any vibrations a little bit you have one minute to complete your examination okay no I can't get that okay and I'm going to move your toes up and down I want you to close your eyes and tell me if you can feel me moving your toe up or down I'll just tell you what I'm doing first that's up and that's down okay so what should I do okay we'll do the same on the other side what's up and that's down okay now could I get you to put the heel of your right foot on your left knee run it down your shin here onto your knee and down your shin and the same on the other side excellent that's great thank you very much hello my name's Vicky and I'm one of the clinical teaching fellows here at Swindon Academy today I'm going to demonstrate examination of the cardiovascular system my patient today is Tim hi Tim pleased to meet you is it all right if I examine your cardiovascular system yes that's fine thank you right Tim if I could start by having a look at your hands you could just put two fingernails together for me like that please and if you could just turn your palms over that's lovely very much I'm just going to take your pulse now stick if I feel the other pulse as well it's lovely have you got any pain in your shoulder no I don't it's going to lift your arm right up into the air that's lovely thank you just going to have a feel for the pulse up here and at this point I would usually take the blood pressure next I need to have a look at your neck can I just turn your face very slightly to the left that's lovely thank you it's lovely now I just need to feel the pulses in your neck next I do need to have a look in your eye can I also look in your mouth thank you if you just open your mouth for me and if you could lift your tongue up to the roof of your mouth let's totally thank you next I need to have a good look at your chest if that's all right I'm going to have a feel for your heartbeat as well okay could you take a breath all the way in and then all the way out and then hold it there double in breathe normally next I'm going to listen to your heart it's okay if I feel your pulse at the same time I also need to listen in your neck if that's all right if you could hold your breath for me and breathe normally and when you're ready hold your breath again that's lovely thank you next I need to ask you to roll to the left and I'm just going to feel for the pulse in your neck at the same time that's lovely thank you and for the next part of the examination I need you to step forward if that's all right okay and if I could just have your wrists I can feel your pulse again and we're going to do that breathing maneuver again so if you could take a breath all the way in and all the way out and just hold it there breathe away and then when you're ready take a breath all the way in and all the way out and hold it there that's lovely thank you while you're sitting up I'm just going to have a listen to your lung bases as well if you could take a deep breath in and out and again in and out that's lovely I'm just going to press on the base of your back that's lovely if you rest yourself back down just going to finish off by having a look at your wrinkles thank you Tim I didn't complete my examination I would like to dip the ear in and do fundoscopy hello there I am my name is Tom Sutton I'm one of the final year medical students and I've just been asked to perform an examination on me today can I just take your name and your age please oh yeah it's Catherine tracker I'm 24. can I call you question is that okay that's fine nice to meet you Catherine just gonna wash my hands quickly so I've just been asked to perform creating on that exam which is the nerves of the face and the head and in order to perform this I'll need to have a look and poison your face and your eyes feel around your face and do some movements with your the muscles of your face as well is that okay with you yeah that's fine it shouldn't cause any pain or discomfort but if it does at any point then you can let me know and we'll stop and I'll be talking out loud to my colleague as we go along if that's okay yeah fine all right okay so it's visible from the end of the bed I'm just inspecting Catherine seeing that she's well at rest that she's not struggling to breathe or there's no other wrap them out to present looking around the bed for any paraphernalia suggesting and creating on their deficit such as glasses or hearing aids and there's none present so that's why so first of all I'm gonna just check for olfactory nerve so Catherine have you noticed any change in smell recently at all no no okay so that's fine I'm gonna move on to the optic nerve um have you do you wear glasses normally no I don't are you doing okay have you noticed any difference in Your Vision recently there okay so first of all to test this formally we use a snowman chart which is displayed here on the side and we have one about six feet away from the patient um so Catherine if you look at the smell in the chart ahead of you and if you just cover one eye with your hand and then read the bottom line for me a e i o u brilliant and then swap hands to the other eye and again read the bottom line a e i o u okay and any difference in the vision there that you noticed you know okay so Acuity seems normal and then move on to test color vision using ishihara plates um but we don't we don't do it for now so we'll move on I've noticed that you've been um have problems with color vision in the past I've been told that you have problems okay so we'll move on for now so now we're going to move on to test the fields of your business um first of all I'm going to check that I'm going to put my arms out to either side about half a meter away from the patient and I'm going to waggle one of my fingers and I'd like to keep looking at me but with your hand just point to the ones that's waggling okay okay good okay so that was fine thank you so I'm just going to check for the fields so if you cover your right eye for me I'm going to cover my left eye at the same time I'm going to put my arm to the right hand side the same distance from me and my patient can you see my finger here and here yeah and here yeah and if you keep your hand on that side I'm going to swap hands can you see my finger here no tell me when you can yeah yeah yeah okay so the fields are normal in the left side and again now if you cover your left eye for me I'm going to cover my row and the same thing can you see my finger head yeah yeah yeah and if you just keep your hand out and swap let me see my finger here tell me when you can yeah yeah yeah okay so the fields are all intact there so now we're going to move on to reflexes so first of all I'm gonna inspect the eyes if you just look at the far corner of the room for me I'm taking a closer look at the eye seeing that the pupils the normal diameter so there's no um that they're symmetrical both sides I'm looking at the orbit and the conjunct divert and make sure that everything's normal there and it seems as soon as everything's normal if you focus on my finger for me I'm going to move it closer to your face and I'd like you to just keep tracking it with your eyes please so accommodation is normal thank you I'm now going to shine the lighting array so again if it's causing too much discomfort just let me know more stop okay so again if you just stare at the far corner of the room I'm looking for Direct consensual constriction of the eye and again on the left side direct and consensual and I'm going to do The Swinging light test swinging from one eye to the other and seeing that they constrict when the light falls on that eye and so there's no evidence of any rapd okay so ideally I would like to move on to fundoscopy using the Optimus ophthalmoscope but for the purpose of this example we'll move on okay so now I'm going to check the movements of the eyes so this time if you focus on my finger I'm about half a meter away from the patient and I need to keep your head still but follow my finger with your eyes please do you notice any blurring at all or in a double vision no does it elicit any pain okay I could see that I was known as stagness in the eyes either okay so again to move on now to check the muscles of mastication which is chewing in the face and it's checking for the trigeminal nerve so I'm going to sit on the side of the bed again if you clench your teeth for me and then unclench and keep clenching and clenching for me I'm just going to put place my hands on your face to check for the muscles okay so I can see I can feel the masseters temporary list muscles and if you open your mouth for me and stop me closing it and the terrible birds are all intact I would do conjunctival reflex but for those of the exam we'll move on and I'm going to test the sensation in the face so I can get my cotton wool I'm just going to touch you at the top of the chest just so you know what it feels like and I'm going to ask you to close your eyes I'm going to touch you on areas of the face and I'd like you to tell me when you feel it touching okay so close your eyes for me yeah yeah okay thank you you can open your eyes did that feel normal both sides yeah and the same okay so that's fine the sensation has been known as the face is intact and I'm going to move on to check the muscles of the face so I'd like you to scrunch your eyes up as tightly as you can for me and stop me opening them and then raise your eyebrows up for me to stop me pushing them down it's fine and puff out your cheeks for me and stop me popping them and then give me a big grin and show me all your teeth that's lovely thank you very much okay I'll then move on to test the vestibular cochlear nerve which is your hearing imbalance have you noticed any difficulty with your hearing at all and have you noticed that you're unstable on your feet or have a trouble with balance okay that's fine I'm going to do a very crude test to check for your hearing um it will just mean me making a rustling one of your ears and then Whispering a number in your other ear and I'd like you to repeat the number out for me okay okay so that was fine so there's no Urban amount of crude hearing if there was then I could move on to Rooney's and Weber's test but for now we'll move on with the examination so now I'm going to test with the glossopharyngeal nerve do you have any difficulty swallowing at all no no okay and can you cough for me okay that's all fine if you open your mouth for me nice and wide I'm going to look at the back of the throat and say ah and I can see that both sides of the pharyngeal Arches move upwards and outwards when she says Ah and there's no way symmetry between them so that's normal I'm now going to test for the accessory nerve so if you shrug your shoulders for me and stop me pushing them down that's fine and if you look to your right for me stop me moving your head and look to your left starting moving ahead that's finally accessory nose intact and now now if you just protrude your tongue for me and move it from side to side and that's why in the hyperglass will never seems to be intact thank you very much for committing me with yourself comfortable I'm just going to present my findings to my colleague thank you so I'm examination Captain Chapel is a 24 year old female there was no abnormalities to find on the cranial nerve examination and to complete my examination I'd like to do a full sensory and motor nervous examination of both the upper remote and lower Limbs and I'd also like to do full fundoscopy and workers and release test

Channel: Alleviate ASMR

Views: 383,095

Keywords: cranialnerveexam, unintentionalasmr, cranialnerveexamasmr

Id: hTG4pAy5h1s

Length: 19min 50sec (1190 seconds)

Published: Tue May 02 2023