Cranial nerves examination – Bell’s palsy

Candidate instructions
Actor instructions
Mark 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.

Lower limb neurological examination – MND

Cranial nerves examination – CN6 palsy

Cranial nerves examination – Bell’s palsy

Submit your answers to get your score.

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