Reset 10 mins Pause Candidate instructionsActor instructionsMark sheet Score Location: You are an final year student in neurology outpatient clinic Patient: 39 year old patient Task: – Please examine this patient’s bulbar cranial nerves – 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 39 year old patient who has come to a neurology outpatient clinic. Your examination is normal. Please feel free to stop the examination if the candidate causes pain or discomfort to yourself. 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) 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 How would you differentiate between bulbar and pseudobulbar palsy Tongue wasting and fasciculations in bulbar palsy (spastic in pseudobulbar palsy) Absent gag reflex in bulbar palsy (increased/normal in pseudobulbar palsy) Speech in bulbar palsy = flaccid = indistinct with nasal twang Speech in pseudobulbar palsy = spastic = monotonous, high- pitched, ‘Donald Duck’ dysarthria Question What is jugular foramen syndrome? Paresis of CN 9, 10, 11 Usual cause is a tumour (most commonly glomus tumour) Submit your answers to get your score.