Reset 10 mins Pause Candidate instructionsActor instructionsMark sheet Score Location: You are an final year student in neurology outpatient clinic Patient: 55 year old patient Task: – Please examine this patient’s cranial nerves. Do not examine the visual nerves (II, III, IV, VI). Assume these are normal. – Please provide a running commentary whilst you are examining – After 6 minutes you will be asked a series of questions by the examiner You are a 60 year old patient who has come to a neurology outpatient clinic. Please feel free to stop the examination if the candidate causes pain or discomfort to yourself. When the candidate examines your facial movements, show this photo: Otherwise the examination is normal. Category Question Done Excellent Introduction Candidate appropriately introduced themselves with: Full name Role Clarifies who they are talking to Asks patient for preferred name Étique Examination étique Washes hands Exposes patient appropriately Patient positioned sitting Treats patient with dignity and respect Inspection General inspection Posture Habitus Other signs of neurological conditions Look around the bed (e.g. for mobility aids, NBM signs, glasses, hearing aids) I - Olfactory I - Olfactory Ask patient if they have noticed any change in smell V - Trigeminal V - Trigeminal Inspect for temporalis/masseter muscle wasting Tests sensation over ophthalmic, maxillary and mandibular distributions of the trigeminal nerve Temporalis and masseter muscle power Says they would consider testing corneal reflex and jaw jerk VII - Facial VII - Facial Inspect for facial asymmetry Test facial motor function Says they would consider testing taste (anterior two thirds tongue) VII - Facial - pathology photo_camera When the candidate examines the patient's facial movements, show this photo Identifies left sided facial nerve palsy Identifies LMN lesion due to involvement of whole face VIII - Vestibulocochlear VIII - Vestibulocochlear Crude hearing test Weber’s test Rinne’s test IX, X - Glossopharyngeal, Vagus IX, X - Glossopharyngeal, Vagus Inspects palate and uvula symmetry Assesses speech Assesses cough Assesses swallow Says would consider gag reflex and taste (posterior third of tongue) XI - Accessory XI - Accessory Inspects for sternocleidomastoid/trapezius muscle wasting Tests sternocleidomastoid power Tests trapezius power XII - Hypoglossal XII - Hypoglossal Inspects relaxed tongue Assesses tongue movements/power Closing Closing examination Invites patient to get re-dressed Washes hands Patient Patient score Candidate did not cause any pain to patient Candidate was polite throughout examination Question What is the diagnosis? Left LMN facial nerve palsy Question What are the possible causes? Bell's palsy Ramsay Hunt syndrome SOL Acoustic neuroma Lyme disease Nerve infiltration (e.g. TB, sarcoid, lymphoma) Parotid tumour/surgery Question How is Bell's palsy managed? Short course of glucocorticoids Aciclovir not usually given as unproven efficacy Eye care to prevent corneal injury (e.g. artificial tears, tape eye shut when sleeping Submit your answers to get your score.