Reset 10 mins Pause Candidate instructionsActor instructionsMark 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.