2021 Phase 1 Physical Examination – Neurology – Head (Cranial Nerves)

Student Name:

Student Number:

Campus:

Assessment items *Quality of performance

U MU MS CS E
1. General inspection (for obvious □ □ □ □ □
abnormalities):
□ Facial asymmetry
□ Eyes
□ Speech and hearing
□ Scars

2. Ask about: □ □ □ □ □ Right side of both eyes processed

□ Change in sense of smell at left side of brain
Images are inverted by time they
□ Change in vision
reach back of eye
□ Change in taste
□ Change in hearing or balance

3. Cranial neve 2: □ □ □ □ □ Snellen chart – cup over eye and

□ Visual acuity test fovea (how well
someone can see something) use
Snellen chart
□ Visual fields +/- colour (fovea), +/-
blind spot: sit close, they fixate on
your pupil and vice versa
Red hat pin is best or static finger
Colour: is it same colour when you
look with each eye, same colour as
you see?
4. Cranial nerves 3, 4 and 6: pupils
□ Equality and size
□ Eyelid symmetry
□ Direct and consensual reaction to light
□ Shine light in eye, pupil constricts
(direct) and other ones constricts too
(consensual). Go from one eye to
other straight away. see if one pupil
constricts more than other. (one eye
receives more than other).
□ Reaction to accommodation
5. Cranial nerves 3, 4 and 6: eye
movements
□ Range of movement horizontal and
vertical until about 30 degrees, take
your time, stop briefly at each
extreme. Target held out (hat pin
ideal). Corners test specific vertical
eye muscles – use H-shape or box.
read down lines until can’t see
properly
Recorded for each eye as 6/x –
‘can see at 6m what a person sees
at x metres’
If patient has refractive error can
use glasses or pinhole
Visual fields:
Test each eye individually (try
make vision fields match, close
your left when you cover their
right) move pin in from upper
corner and see when they can see
the red dot.
□ □ □ □ □ difference in pupils/eyelids?
Oculomotor palsy, horner’s
syndrome
□ □ □ □ □ 3 = oculomotor – keeps eyelid
movements, pns supply to pupil
(constriction)
4= trochlear (pully) – supplies
inferior oblique which depresses,
intorts eye (looks down
6 = abducens – looks laterall
 Convergence at end (bring it into
person)
□ Diplopia double vision. Occurs when
eyes don’t look at same point.
Crossed cover test: cover one eye
then the other, look to see if
uncovered moves in when you move
hand
□ Nystagmus: jerky eye movements,
slow drift from target of fixation. Fast
correction back. Can be in any
direction
6. Cranial nerve 5: □ □ □ □ □ Trigeminal nerve (v): sensation,
jaw musculature
□ Test temperature sensation test
sensation in each division bilaterally 5 divisions:
□ Test light touch - Temporal
□ Compare sides ask for any difference - Zygomatic
- Buccal
□ Resisted mouth opening - Mandibular
- Cervical
Trouble CLOSING not opening
eye
7. Cranial nerve 7: □ □ □ □ □ Facial nerve: facial muscles, taste
anterior 2/3rd of tongue, stapedius
□ Look up and raise brows look at
muscle in ear
ceiling (frontalis) affected in lower
motor neurone facial nerve palsy,
spared in stroke
□ Screw up eyes: close eyes tightly –
relatively spared in UMN weakness
□ Show teeth
Assessment items *Quality of performance
U MU MS CS E
□ Compare sides

8. Cranial nerve 8: □ □ □ □ □
□ Assess hearing (basic) rub fingers next
to ear – can you hear me?
□ Compare sides
9. Cranial nerves 9 and 10: □ □ □ □ □
□ Soft palate movement
□ Speech Ahhh, eeee
□ Cough

10. Cranial nerves 11 and 12: □ □ □ □ □

□ Trapezius shrug shoulders
□ Sternomastoid push against hand
when turning neck
□ Compare sides
□ Tongue protrusion and wiggle
11. Clinical Question □ □ □ □ □

12. Performs examination without causing □ □ □ □ □

pain, distress or embarrassment

13. Performs organised and efficient □ □ □ □ □

examination of the system within the
nominated timeframe

14. Infection control: □ □ □ □ □

□ Hand hygiene at beginning
□ Appropriate dress, nails, jewellery
□ Cleans equipment before and after
use
□ Hand Hygiene at the end

15. Communication: □ □ □ □ □
□ Introduces themselves and
explains what they will do
□ Obtains permission to conduct the
exam
□ Gives appropriate instructions and
explanations to the patient throughout
□ At the end, thanks the patient for
allowing them to conduct the
examination

General comments to student