Core stations Examinations Medicine Neurology

Cranial nerves examination

Candidate instructions
Actor instructions
Mark sheet
Score

Location: You are an final year student in neurology outpatient clinic

Patient: 60 year old patient

Task:
– Please examine this patient’s 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 60 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)
I - Olfactory	I - Olfactory Ask patient if they have noticed any change in smell
II - Optic	II - Optic Acuity - distant vision with Snellen chart Acuity - near vision Acuity - says would test colour vision with ishiharachart Fields - tests visual fields by confrontation Fields - inattention Fields - tests/offers to test blind spots Reflexes - accommodation reflex Reflexes - direct and consensual papillary reflexes Reflexes - swinging light test Ophthalmoscopy - says they would also consider fundoscopy
III, IV, VI - Oculomotor, Trochlear, Abducens	III, IV, VI - oculomotor, trochlear, abducens Inspects for strabismus, ptosis H-test performed correctly
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)
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 are the nerves involved in the gag reflex? Afferent = CN 9 Efferent = CN 10
Question	Describe the difference between afferent and efferent pupillary defects Afferent defect = pupils are symmetrical but when light is shone in the affected eye, neither pupil constricts = CN2 (optic nerve) lesion Efferent defect = affected pupil is persistently dilated, whilst other is reactive to light being shone in either eye = CN3 lesion

Submit your answers to get your score.

Cranial nerves examination – bulbar

Respiratory examination – pneumonectomy

Cranial nerves examination

Submit your answers to get your score.

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