Cranial nerves examination – bulbar

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10 mins

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Candidate instructions
Actor instructions
Mark 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.

Cranial nerves examination – visual

Cranial nerves examination

Cranial nerves examination – bulbar

Submit your answers to get your score.

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