- 2 days ago
ASMR Roleplay - Relaxing Cranial Nerve Exam (whispered)
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02:08And let's get right to it.
02:15Hello.
02:16My name is Dr. Lavender.
02:18I will be the physician performing your cranial nerve exam today.
02:22Before we get started, can I get your last name and date of birth?
02:28Okay.
02:29Is that with an E?
02:32Perfect.
02:34And it looks like I'm in the right room.
02:38So I see that the nurse already took care of taking your vitals.
02:42You look really good there.
02:44I might check your lungs just to be really thorough.
02:49And before we begin, I have a couple questions to ask you, so go ahead and get comfortable.
02:56So, as you may know, a cranial nerve exam is one where I'm examining all of your senses.
03:02It's usually performed after an injury or if we suspect that the patient has had a traumatic brain injury.
03:10Things of that sort.
03:12So, my first question is, are there any areas of concern?
03:18Do you, have you experienced any changes in your senses?
03:22Like changes in your sight, taste, smell, hearing, sensation?
03:29Okay.
03:30Okay.
03:32So, I know to focus on that.
03:39Okay.
03:40Can you go into a little more detail?
03:44Okay.
03:45So, I will definitely be extremely thorough with that.
03:50Have you had any injuries, any surgeries lately?
03:55Okay.
04:00And that was a couple months ago?
04:04Okay.
04:06And that was inpatient?
04:09Okay.
04:12Do you remember the physician's name who performed that surgery?
04:18Okay.
04:18Okay.
04:19Dr. Richardson.
04:22He is also at our hospital, so I do know him.
04:25Excellent.
04:27Okay.
04:29Do you have any scars?
04:30Any sizable scars?
04:33Okay.
04:34There.
04:36Alright, I'll take a look at that.
04:38Scars can affect sensation.
04:40So, when I'm performing tests to the sense of your skin, the sensation of touch on your
04:48face, you might notice a difference there.
04:52Alright, so let me just make a note of that, because it's not necessarily an indication of
04:57a problem or any issues with your brain or anything like that.
05:01It's more the sensation of a scar can change how you feel, if that makes sense.
05:08It's usually a little number.
05:12Okay.
05:14Well, thank you.
05:15Anything you would like to ask me or tell me before we begin?
05:22Perfect.
05:22Okay.
05:24Well, then let's get started.
05:31All right, let me just sanitize and put some gloves on before we begin.
05:42How's your day going so far?
05:49Okay.
05:50Could be better.
05:51I'm sorry to hear that.
05:53Hopefully, this exam will be pretty relaxing.
05:57No need to be anxious or stressed.
06:01We have no reason to suspect that anything will be wrong.
06:05And if we find something of concern, we'll work together on the next steps, okay?
06:12Okay.
06:17So, let's chose to get these gloves on.
06:20Okay.
06:22Okay.
06:24My day.
06:26It's going well.
06:31You're actually my first patient of the day.
06:35I took the morning off because my kids had a school play that I went and saw.
06:41I don't know if you've seen an elementary school play before, but it's very sweet.
06:47It's very endearing.
06:49The kids are all so nervous, but having fun at the same time.
06:53Trying to remember their little lines.
06:55It was very nice.
06:58It's very nice.
07:00Okay.
07:00So, go ahead and straighten up for me and scoot to the edge of the table.
07:05Good.
07:06Okay.
07:06Just your legs hanging over exactly like that.
07:10Okay.
07:11So, let's go ahead and take a deep breath together.
07:17I like doing that with my patients because a lot of my patients find the doctor's office
07:22a little nerve-wracking, so we want you to just be comfortable.
07:29All right.
07:29So, the first thing we're going to test is field of vision, eye movement, things like
07:33that.
07:34So, go ahead and stare at my nose.
07:37Okay.
07:38Now, on the edge of your vision, I'm going to wiggle my fingers like this, and I want
07:43you to raise your hand and point at which finger I'm moving exactly without breaking eye
07:50contact or staring at my nose, whichever you prefer.
07:53Okay.
07:55All right.
07:55So, just look at me.
07:57Ready?
07:59Good.
08:01Good.
08:03Good.
08:05Exactly.
08:06Okay.
08:07Now, I'm going to come around from behind you and wiggle my fingers, and when you see
08:13my fingers enter your field of view, let me know.
08:16And just keep your head still.
08:19Keep staring at my face, okay?
08:24Good.
08:28Good.
08:31Good.
08:34All right.
08:35Excellent.
08:36So, now I'm going to just rest my hand on your face.
08:39Can you keep your head still and just follow my fingers with your eyes?
08:49Good.
08:50Good.
08:56Now, I'm going to hold a finger here and step back a little.
09:01Now, I want you to rotate between staring at my finger and staring at my face.
09:07Ready?
09:09Ready?
09:09Ready?
09:09Stare at my finger.
09:11Stare at my face.
09:15Stare at my finger.
09:15Stare at my face.
09:17Stare at my finger.
09:18Good.
09:19Okay.
09:20Now, I want you to keep your head still and just follow my fingers with your eyes.
09:25So, again, do not move your head.
09:33Okay.
09:34Good.
09:40Perfect.
09:41Did you experience any pain, any discomfort while you were moving your eyes around?
09:47All right.
09:49If I have permission to touch you, I'm just going to touch around your eye socket.
09:57Make sure that you are not experiencing any pain.
10:00Can you go ahead and close your eyes?
10:02I'm going to very lightly touch right above your eye.
10:06Any pain?
10:08Good.
10:09And then, right below your eyes.
10:12Any pain?
10:14Good.
10:15Okay.
10:15Now, I'm just going to check.
10:19Lift your ducts.
10:20Make sure there's no swelling there.
10:25Any irritation?
10:26Discomfort.
10:29All good?
10:31Perfect.
10:32Can you just go ahead and cover one eye now?
10:37Whichever.
10:38Exactly.
10:39And read the top three lines for me.
10:47Correct.
10:48Now, cover the other eye and read the fourth line for me.
10:54Good.
10:55Okay.
10:56Do you wear glasses or contacts normally?
11:00Okay.
11:01Excellent.
11:05Okay.
11:06Now, I'm going to look in your eyes with a light.
11:09It doesn't look like your pupils are dilated necessarily.
11:14So, I think that won't really be a very, very concern.
11:16Especially because they're the same size.
11:18But, go ahead and stare at my shoulder here.
11:25Bright light.
11:29Okay.
11:35Okay.
11:36Okay.
11:36That looks good.
11:37Let me just...
11:41I'll stare at my shoulder.
11:42I'll stare at the shoulder.
11:50Sorry.
11:50Yes, I am very close to your face.
11:54All right.
11:56Everything looks good.
11:58No redness, irritation, swelling.
12:02Good.
12:03Okay.
12:04Now, I'm going to do the swinging light test.
12:06And that's just to make sure that your pupils react in both eyes exactly the same.
12:12Sometimes, it's a sign of a concussion or injury to the head.
12:16When you shine a light in one eye, one pupil dilates and the other stays the same.
12:23We want them to both react at the same time.
12:27Okay.
12:28So, go ahead and stare at me.
12:38Okay.
12:39They are reacting beautifully.
12:42No sign of issues there.
12:47Good.
12:48Okay.
12:49Let me just test one more time the eye movement.
12:52And can you follow the light with your eyes?
12:59Good.
13:05Excellent.
13:06Okay.
13:10And before I forget, I did want to check your lungs.
13:16So, I'm going to just leave this over here.
13:19Can you go ahead and take a deep breath for me?
13:26Again.
13:26Again.
13:30Good.
13:31And I'm going to lift up your shirt just a little and please sit on your belly.
13:34It is a little bit cold.
13:36All right.
13:37Deep breath.
13:40All right.
13:41Let me just listen for a second.
13:43And then, on your back, deep breath.
13:57Good.
13:58Deep breath over here.
14:04Good.
14:05Okay.
14:06Now, that isn't necessarily part of a cranial nerve exam, but you did mention you've been feeling a little out
14:12of breath lately.
14:13So, I just wanted to check if I hear anything in your lungs or anything like that, but I do
14:19not.
14:20So, it looks good there.
14:22You are a non-smoker, correct?
14:25Any vaping, smoking, anything like that?
14:29Okay.
14:30All right.
14:30Good.
14:31Now, I'm just going to have you open your mouth.
14:35Good.
14:36Just taking a look.
14:38There.
14:41Looks good.
14:43Okay.
14:44Any changes to taste or anything like that?
15:13Well, I'll go ahead and test your smell then.
15:17It looks good to me here, but let's go ahead and just make sure that's operating as it should.
15:28Okay.
15:28So, I have two scents here.
15:31Can you go ahead and close your eyes?
15:34Close, close, close your eyes.
15:37And I'm going to hold up the first scent.
15:41Can you close one nostril?
15:43Well, exactly with your thumb, and I'm going to hold it up.
15:47Go ahead and take a deep smell.
15:54Vanilla.
15:55Good.
15:56And keep your eyes closed.
16:01All right.
16:04Now close the other nostril and take a smell.
16:13Cinnamon cracked.
16:17All right.
16:19So, that seems completely normal.
16:22Now, we're going to move on to checking your ears and your hearing.
16:26Do you clean your ears ever with Q-tips or anything like that?
16:31Okay.
16:32So, I encourage all of my patients who use Q-tips in their ears to never actually enter their ears
16:39with the Q-tip.
16:40Just go around the outside.
16:43Exactly.
16:44Yeah.
16:44We don't want to insert anything into your ear.
16:49You have a risk of hurting your eardrum.
16:52And the ears are actually self-cleaning.
16:54So, if you just want to clean your ears, just go around the hole like this with the Q-tip.
17:01And that's sufficient.
17:03Okay.
17:04So, I'm going to grab a new tip here.
17:12Okay.
17:20And you can't have your eyes open now.
17:23So, I'm just going to pull back on your ear a little bit.
17:27And look in the ear.
17:32It looks good.
17:34You take very good care of your ears.
17:36Good job.
17:39I'm not seeing any inflammation, redness, or impacted wax.
17:45So, we won't be needing to do an ear cleaning on this ear at least.
17:51All right.
17:52Now, I'm going to pull back on your ear on this side and take a look.
17:58Same thing here.
18:00I know it's a teeny bit uncomfortable.
18:03Okay.
18:06Okay.
18:07That looks good.
18:10Okay.
18:10All right.
18:10Now, I'm just going to help aid the ears a little.
18:15Tell me if you feel any discomfort at all.
18:20That's good.
18:21Okay.
18:21Okay. And then, just put it here. No discomfort. When I pull slightly here, it's good. Okay. I'll just check
18:36behind. Check behind here. No pain, right? Good. Okay.
18:46Okay. So, you said no changes to hearing. Perfect. All right. So, I'm going to make a quiet sound. Tell
18:56me which ear you hear it in. You can point or say left or right.
19:05Good. Good. Good.
19:16Good. Okay. Now, I'm going to make a louder sound like this. And I'm going to whisper a word in
19:25the ear. I'm going to have you close your eyes. And I want you to tell me what word you
19:30hear. Okay.
19:35Okay. Blue. Blue. Good.
19:45Violet. Violet. Good. Okay.
19:48Okay. That is all looking excellent now. So, we've covered your nose, ears, eyes, and mouth. So, now we're going
20:01to start to test sensation in your body and your reflexes and your movement.
20:08But first, I just want to check your mind. But first, I just want to check your sinuses. I already
20:12checked your tear ducts. So, I'm just going to check your face here.
20:21You're going to check your sinuses, your lymph nodes. Your lymph nodes. Your lymph nodes being swollen is usually a
20:31sign that your body is fighting something off.
20:34Where in your neck? Can we look up?
20:42Good.
20:44Behind your ears and your neck.
20:48Are you allergic to anything? The nurse should have asked you.
20:53Okay. Good.
20:58Okay. You told her you're allergic to bees.
21:01Alright. When you get... Have you ever been stung by a bee?
21:06Okay.
21:09Alright.
21:10That sounds like a classic reaction.
21:13You have an EpiPen, correct?
21:16I highly encourage you to keep that in your car or your purse or on your person at all times.
21:24Okay. Good job.
21:27I know they're expensive.
21:33Okay.
21:34Everything looks good there.
21:36Like I said, I'm going to just test the sensations on your face now.
21:44So, I have this tool here that has a harder end and a softer end.
21:53I'm going to touch either the soft end or the hard end to your face.
21:59Tell me if you feel soft or hard.
22:02And as an example, that's what soft feels like.
22:07That's what hard feels like.
22:09Ready?
22:10Okay.
22:11Close your eyes.
22:12Close your eyes.
22:15Good.
22:18Good.
22:20Good.
22:24Good.
22:36Perfect.
22:39Now I'm going to touch your face in a mirrored pattern, and I want you to tell me if you
22:46feel the exact same sensation on both sides.
22:51So this should feel the same on both sides.
22:56Okay.
23:04Okay, so there, it feels a little numb.
23:06Um, I think that's due to the scar that you have there.
23:11Let me touch it again.
23:14Okay, slightly less of a sensation there.
23:17All right, I will note that.
23:26Okay, same.
23:35Same.
23:36Okay.
23:40Good, okay.
23:41So let me just check here again.
23:43I'm going to...
23:46Okay, so slightly left here, like I said, because you have a scar there.
23:51That's the most logical explanation for why there's a little less sensation there.
23:58But I will add that to my notes.
24:02You still feel this, though?
24:06What percent do you feel this side versus this side?
24:13Like a hundred to eighty?
24:15Okay.
24:17Good.
24:22All right.
24:24Okay, so I have this metal tool here.
24:29That I'm going to use to press to your face.
24:34It's made of metal.
24:35And it's quite cold.
24:37Not uncomfortably cold.
24:38Just cool.
24:40I want you to tell me if you feel the sensation of cool when I lay it on your face.
24:47And if it feels pretty similar on both sides.
24:51Okay.
24:51Okay.
24:52So, starting here.
25:00Okay.
25:06Then down here on your cheek.
25:10On the other cheek.
25:11On the other cheek.
25:14On the left side of your chin.
25:18The right.
25:19Oh, my right.
25:21Good.
25:23This side of your nose.
25:26And this side of your nose.
25:30Excellent.
25:33Okay, I'm going to change gloves for a fresh pair.
25:51Okay, I do like to change my gloves at least once during exams like this.
25:57Because I do find myself touching a variety of tools.
26:00So, I just want to stay as sanitary as possible.
26:06Alright, so, go ahead and relax your face for me.
26:10Good.
26:10Now, smile.
26:13Good.
26:14Can you frown for me?
26:17Raise your eyebrows.
26:21Okay, good.
26:22Now, close your mouth and puff out your cheeks.
26:26Alright, I'm going to press the hair.
26:28Don't let me press the hair out of your mouth, okay?
26:30Okay, so.
26:35Good.
26:36Okay, now raise your eyebrows again.
26:39And don't let me push down on your eyebrows.
26:43Good.
26:45Close your eyes really tight.
26:47And don't let me open them.
26:52Good.
26:52Okay.
26:54Now, let me just check you out.
27:00Okay, good.
27:01Now, show me your teeth.
27:04Stick out your tongue.
27:07Good.
27:08Everything is looking excellent there.
27:10Now, we're going to move down to your shoulders.
27:14Can you raise your shoulders up and don't let me push them down?
27:19Perfect.
27:20Now, can you look up and hold it?
27:25Now, look down.
27:29And rotate your head to both sides like this.
27:36Good.
27:37Now, look that way.
27:39Okay, I'm just going to push your face slightly to make sure that you can resist that.
27:45So, don't let me move you.
27:48Good.
27:48Now, look that way.
27:52Good.
27:53Everything's looking good there.
27:57Okay, so now I want you to hold my hands and squeeze as hard as you can.
28:03Good.
28:04Okay, now take your hands like this.
28:06Make an okay symbol.
28:08And tap here on your thumb knuckle.
28:13And then at the tip of your thumb.
28:21Good.
28:26Now, I want you to take your fist like this.
28:29And with your other hand, do this rapidly.
28:34Whichever hand first.
28:39Okay, other hand.
28:40Exact same thing.
28:48Okay, now hold your arms out like this.
28:52And don't let me push down.
28:57Good.
28:58Good.
28:58Okay.
28:59Keep them out.
28:59Don't let me push up.
29:02Good.
29:03Alright.
29:05Everything's looking good there.
29:07Okay, so now I want you to hold both hands out.
29:11And then touch your fingers to your nose.
29:16Left or right when I tell you.
29:17But I want you to stare at my face.
29:19Okay.
29:20So you're going to have your hands out like this.
29:23Touch your nose.
29:24While staring at me.
29:26Okay, so hands out.
29:27Good.
29:29Now left hand to nose.
29:32Good.
29:33Okay, keep staring at me.
29:35Right hand to nose.
29:37Left hand to nose.
29:40Right hand to nose.
29:42Good.
29:47Now, I'm going to use this reflex tester and just hit.
29:52Just relax.
29:54Good.
29:55I'm going to tap on your arm.
29:58Good.
30:01Good.
30:02One more time.
30:04Good.
30:06All right.
30:07Now down here at your knee.
30:10Good.
30:11Just relax.
30:13Perfect.
30:18Good.
30:19Okay.
30:23Okay, so now I need you to spread your fingers out in front of you like this.
30:28And don't let me close your fingers.
30:35Good.
30:38Okay.
30:39Now hold your arms up like this.
30:42And don't let me push them towards your face.
30:46Okay.
30:51Good.
30:52Okay, now hold your hands out like this.
30:55I'm just going to push down.
30:56Don't let me move them.
31:00Okay.
31:02And hold your hands out like this again.
31:04And don't let me bend your wrist.
31:14Good.
31:16All right.
31:17So now I want you to look over here at this sign.
31:20I'm going to tap on your forehead.
31:24Don't blink when I tap on your forehead.
31:26So stare over here.
31:32Good.
31:34Continue staring there.
31:40Good.
31:41Okay.
31:41Good job not blinking.
31:43Now I want you to push against me with your arms.
31:47Good.
31:48Okay.
31:50Well, everything looks excellent.
31:52And I did not see anything wrong.
31:55Nothing of note.
31:57Except for the slight feeling of numbness here.
32:01Have you noticed that numbness affecting you?
32:04Affecting your life in any way?
32:06I think it might just be due to the scar there.
32:12Over years it might go away.
32:14But it might not.
32:15That's just kind of a result of having a large scar there.
32:19When you move your eyebrows up and down or make any facial expressions, do you find that
32:25that makes it difficult to do that?
32:28It's too tight or something like that?
32:32No?
32:32Okay.
32:33Excellent.
32:35Let me just tap one more time on this side and this time.
32:40And I want you to reaffirm that this is about 100% and this is 80%.
32:46Okay?
32:54Yes?
32:55Okay.
32:56Well, I will send you a report through the portal online.
33:02Once I analyze everything that I've done today and if I feel like you need to come back in
33:07and we can reassess this area right here, we can do that.
33:15Okay.
33:16Perfect.
33:17Well, thank you so much for coming in today.
33:20You passed with flying colors.
33:22Do you have any questions for me?
33:26Okay.
33:27If you think of any, you can send me a message through the portal.
33:32Exactly.
33:34Okay.
33:35Well, everything was great.
33:36Your sight, your hearing, everything.
33:39So, if anything changes, if you think of a question, I am Dr. Lavender.
33:46I should be available in your portal to send a message to.
33:51Okay.
33:51Well, thank you so much for coming in.
33:53And until next time.
33:58Bye.
34:03Bye.
34:04Bye.
34:04Bye.
34:07Bye.
34:08Bye.
34:09Bye.
34:09Bye.
34:10Bye.
34:10Bye.
34:21Bye.
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