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% Document Info
\author{hjsdhaj}
\pdfinfo{
  /Title (cns-examination.pdf)
  /Creator (Cheatography)
  /Author (hjsdhaj)
  /Subject (CNS Examination Cheat Sheet)
}

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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{CNS Examination Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{hjsdhaj} via \textcolor{DarkBackground}{\uline{cheatography.com/201639/cs/42699/}}}
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\noindent
\begin{multicols}{3}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}hjsdhaj \\
  \uline{cheatography.com/hjsdhaj} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 14th March, 2024.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{p{0.72 cm} x{2.88 cm} x{1.224 cm} x{2.376 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{4}{x{8.4cm}}{\bf\textcolor{white}{Preperation:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{W}} & Wash Hands & \seqsplit{Snellen} Chart &  \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{I}} & Introduce Yourself + Patient's Identity & Pen torch &  \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
{\bf{P}} & Permission & \seqsplit{Cotton} Wool &  \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{P}} & Patient Position + Pain & \seqsplit{Opthalmoscope} & Only necessary for fundoscopy \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{E}} & Explaination & \seqsplit{Tuning} Fork & 256Hz or 512Hz \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}----}
\SetRowColor{LightBackground}
\mymulticolumn{4}{x{8.4cm}}{{\bf{Patient should be at the same level as the examiner}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}----}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{General Observations}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Check visually from the end of the bed:}} \newline % Row Count 1 (+ 1)
• Muscle wasting, fasciculaitons, or tremor \newline % Row Count 2 (+ 1)
• Facial asymmetry or loss of expression \newline % Row Count 3 (+ 1)
• Ptosis \newline % Row Count 4 (+ 1)
• Strabismus (misaligned eyes) \newline % Row Count 5 (+ 1)
• Salivation \newline % Row Count 6 (+ 1)
• Obvious discomfort or pain% Row Count 7 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4.08 cm} x{3.92 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{CN 1 Olfactory}}  \tn
% Row 0
\SetRowColor{LightBackground}
Changes in taste or smell recently? & Explored with a smell testing kit \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Tested positive for Covid-19 previously?} \tn 
% Row Count 3 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.48 cm} x{5.52 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{CN 2 Optic}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Visual Acuity}} & Examined using a Snellen chart or text held at arms length \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Visual Fields}} & Examiner and patient close one eye.\{\{nl\}\}Examiner moves an object closer to the centre of the {\bf{midline}}.\{\{nl\}\}Patient remarks when it enters their field of view. \tn 
% Row Count 10 (+ 7)
% Row 2
\SetRowColor{LightBackground}
{\bf{Fundoscopy}} & {\emph{Not required in DEM2}} \tn 
% Row Count 12 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Light Reflexes}} & {\bf{Direct light reflex}} \{\{nl\}\}(Look in the same eye as the light)\{\{nl\}\}\{\{nl\}\}{\bf{Consensual light reflex }}\{\{nl\}\}(Look at the opposite eye to the light) \tn 
% Row Count 18 (+ 6)
% Row 4
\SetRowColor{LightBackground}
{\bf{Accommodation}} & Pupils constrict as object is brought closer \tn 
% Row Count 20 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Patient should wear glasses if normally worn.}} \newline  \newline Offer to check {\bf{near, far, central, and colour vision.}} \newline  \newline {\bf{Light Reflexes:}} \newline  • Sensory -\textgreater{} CN2 \newline  • Motor -\textgreater{} CN3 \newline \{\{nl\}\}\{\{nl\}\}\{\{nl\}\}\{\{nl\}\}\{\{nl\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.52 cm} x{4.48 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{CN 3,4,6 Oculomotor, Trochlear, Abducens}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Ocular Movements}}\{\{width=45\}\} & Patient follows tip of pen in a {\bf{H}} shape \{\{nl\}\}Should be tested to all extremes of eye movement \tn 
% Row Count 5 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{LR\textasciicircum{}6\textasciicircum{}SO\textasciicircum{}4\textasciicircum{}(3)}} \newline Lateral Rectus =\textgreater{} CN6  \newline • Eye will not abduct normally, double vision, horizontally displaced  \newline  \newline Superior oblique =\textgreater{} CN4 \newline • Double vision with oblique displacement of images, left palsy -\textgreater{} occurs when looking to the right, etc. \newline  \newline All other extraocular muscles =\textgreater{} CN3 \newline • In full palsy pupil will be dilated and deviate downwards and outwards \newline • Also innervates levator palpebrae superioris =\textgreater{} Ptosis in palsy}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.76 cm} x{2.66 cm} x{4.18 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{CN 5 Trigeminal}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Sensory:}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Touch Response & Touch opthalmic, maxillary and mandibular regions of the face with cotton whool, compare sensation on both sides.\{\{nl\}\}Show the patient what it feels like first by touching to a central point (chest)\{\{nl\}\}\{\{nl\}\}Offer to repeat with a pointed object \tn 
% Row Count 13 (+ 12)
% Row 2
\SetRowColor{LightBackground}
 & Corneal Reflex & {\bf{Omitted if a lesion is not suspected}} \{\{nl\}\}\{\{nl\}\}Touch lateral region of cornea with a damp piece of cotton wool =\textgreater{} Bilateral blink response \tn 
% Row Count 20 (+ 7)
% Row 3
\SetRowColor{white}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Motor:}}} \tn 
% Row Count 21 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Muscles of Mastication & Patient clenches jaw shut, examiner palpates temporlais, and masseter. \{\{nl\}\}\{\{nl\}\}Patient opens mouth, examiner attempts to close it, patient should be able to resist. \{\{nl\}\}\{\{nl\}\}Patient opens mouth and move jaw from side to side =\textgreater{} Jaw will deviate to the side of the weak pterygoid. \tn 
% Row Count 34 (+ 13)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.92 cm} x{4.08 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{CN 7 Facial}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Patient raises eyebrows}} & Symmetrical wrinkling of forehead due to contraction of the frontalis muscle \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
{\bf{Patient squeezes eyes tightly shut}} & Examiner attempts to open eyes using thumbs \{\{nl\}\}\{\{nl\}\}Tests orbicularis oculi. \tn 
% Row Count 8 (+ 4)
% Row 2
\SetRowColor{LightBackground}
{\bf{Patient smiles}} & Symmetrical smile and equal action of teh orbicularis muscle \tn 
% Row Count 11 (+ 3)
% Row 3
\SetRowColor{white}
{\bf{Patient blows up cheeks}} & Checks buccinator muscle \{\{nl\}\}\{\{nl\}\}If cheeks are pressed lightly by examiner no air should escape \tn 
% Row Count 16 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Do a quick general inspection of the face before starting, check for drooling, facial asymmetry, etc.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.96 cm} x{5.04 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{CN 8 Vestibulocochlear}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Simple Hearing Test}} & Cover one ear and whisper a number in the other, ask the patient to repeat back to you. \{\{nl\}\}{\bf{Repeat for both ears}} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
{\bf{Weber's Test:}} & Place the tuning fork in the centre of the patient's forehead and ask if it is louder on one side or the other. \{\{nl\}\}Normal =\textgreater{} equal loudness on both sides \tn 
% Row Count 12 (+ 7)
% Row 2
\SetRowColor{LightBackground}
{\bf{Rinne's Test:}} & Place tuning fork on the patient's mastoid process with the prongs perpendicular to the ear, patient shoud identify when they can no longer hear it. Then move the tuning fork in front of their ear.\{\{nl\}\}Repeat for both ears \tn 
% Row Count 21 (+ 9)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Rinne's Test:}}  \newline Air conduction \textgreater{} bone conduction = Positive Rinne's \newline Bone conduction \textgreater{} air conduction = Negative Rinne's \newline  \newline {\bf{Weber's Test:}} \newline Heard in the midline = Normal \newline Louder in a ear with a {\bf{negative}} Rinne's test = Conductive hearing loss \newline Louder in a ear with a {\bf{positive}} Rinne's test = Sensorineural hearing loss}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{CN 9, 10, 12 Glossopharyngeal, Vagus, Hypoglossal}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{CN 10 Vagus}} & Ask patient to perform a loud cough. \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Articulation}} & Ask patient to say the days of the week. \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{Depress tongue with tongue depressor}} & When patient says "ahh", the soft palate should elevate symmetrically.\{\{nl\}\}\{\{nl\}\}Will deviate towards the stronger side if palsy. \tn 
% Row Count 11 (+ 7)
% Row 3
\SetRowColor{white}
{\bf{Gag Reflex}} & {\emph{Not normally tested in a conscious patient}}\{\{nl\}\}\{\{nl\}\}Sensory - CN9 Glossopharyngeal\{\{nl\}\}Motor - CN10 Vagus \tn 
% Row Count 17 (+ 6)
% Row 4
\SetRowColor{LightBackground}
{\bf{CN 12 Hypoglossal}} & Ask patient to open mouth, stick out tongue, move tongue from side to side, examiner places hand on patient's cheek and asks patient to press tongue against his hand \tn 
% Row Count 26 (+ 9)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.28 cm} x{4.72 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{CN 11 Accessory}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Patient shrugs shoulders}} & Ask the patient to shrug their shoulders using your hands on their shoulders to resist the movement.\{\{nl\}\}\{\{nl\}\}Symmetrical \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
{\bf{Sternomastoid}} & Ask the patient to turn their head to each side using your hand on their cheek to resist the movement. \tn 
% Row Count 11 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Completing the examination}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Thank Patient}} \newline % Row Count 1 (+ 1)
{\bf{Sanitise hands and equipment}} \newline % Row Count 2 (+ 1)
Other examinations to consider: \newline % Row Count 3 (+ 1)
• Neurological examination of the limbs \newline % Row Count 4 (+ 1)
• Mental state examination% Row Count 5 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}