Y4 logbook Mini-CEX form No.

Formative Mini-Clinical Evaluation Exercise Rating Form

Neurological Examination
(Examination technique may vary but the below steps are merely agreed as minimum requirements)
Student’s name: ......................................................... Date of assessment: _ /__/_____
Patient problem/ Diagnosis: .........................................................................................................................
Patient gender: Male / Female Patient age: .........
Communication - Introduces one's self and confirm patient name
- Explains the purpose of examination and Obtains patient's consent
- Attends to the patient comfort all through the examination
Hand washing - Washes hands in proper technique
General examination Looks for general findings relevant to the case
Cranial Nerves Examination
OLFACORY (I) Mentions the use of scented bottles and testing each nostril separately
OPTIC (II) Tests central vision (acuity) with a Snellen’s Chart
Tests peripheral vision (fields):
- Patient sitting at the same level, looking at the tip of your nose
- Your hand in between yourself and the patient
- Bring the hand in from behind the patient
- Comparison of your fields with the patient
Tests sensory inattention:
- both hands out, patient looks at your nose, which finger is moving
Tests the accommodation reflex: look at corner of room, now look at my
finger, looking for convergence of the eyes and dilation of the pupil
Tests pupillary reflexes: direct and consensual, and swinging light reflex
Offer to test colour vision with Ishihara colour plates
Offer to perform fundoscopy
Oculomotor (III) Tests movement of the eyes in an ‘H’ shape
Trochlear (IV) Asks patient if any blurring or double vision at any time
Abducent (VI) Checking for nystagmus

Trigeminal (V): SENSATION: - Checks light touch sensation in the ophthalmic, maxillary
and mandibular divisions of V with cotton wool, compare both sides.
- States would like to repeat for pain and temperature
MOTOR: - Clench teeth, and feel the masseter and
- temporalis; open jaw against resistance
REFLEX: - Jaw jerk - offers to do the corneal reflex
Facial (VII): MOTOR : Raise eyebrows, Close eyes really tightly, keep shut against
resistance, Puff out cheeks, Show teeth, Smile
SENSORY: Offer to check anterior 2/3 of the tongue for taste sensation
Vestibulocochlear Grossly check hearing by rubbing fingers on each side and then both
(VIII):
If any abnormalities then conduct Rinne’s and Weber’s Tests
Glossopharyngeal Asks patient to open mouth and say ‘aaaaahhhhh’, looking for symmetrical
(IX), Vagus (X) elevation of the uvula in the midline and the soft palate
Offer to test coughing/swallowing and the gag reflex
Accessory (XI): Raise shoulders against resistance
Turn head against your hand, feeling for the contralateral sternomastoid
Hypoglossal (XII) Stick out tongue, looking for wasting, fasciculations and deviation
Observe movements, push tongue into cheek
Say Besma ALLAH Alrahman Alrahim
 Y4 logbook Mini-CEX form No.7

Examination of Upper Limbs

Asks patient to elevate both upper limbs to detect the affected side
Examine Tone Examine muscle tone (normal/ hypotonia/ hypertonia)
Examine muscle Shoulder abduction/adduction
Power: Elbow flexion/extension
wig
zWrist flexion/extension
down
Finger abduction Syndrome
Reflexes: g Thumb opposition
Assess: Biceps reflex, Triceps reflex, supinator jerk
Co-ordination : Finger to nose, ensuring patient can reach, only moves finger position as
patient moves finger to nose
Dysdiadochokinesis
Finger-thumb opposition - one at a time
Sensation: Light touch, all dermatomes, compares side to side
Pain: mentions neurotip/orange stick
Measures vibration sense using correct tuning fork: 128Hz
Measure proprioception – ensure patient’s eyes are closed
Offers to repeat for temperature
Examination of Lower Limbs
Asks patient to elevate both lower limbs to detect the affected side
Tone: Checks tone in the hip (rolling the leg at the knee)
Checks tone in the knee (abrupt flexing of the knee)
Checks for clonus in the ankle and the knee
Power Power in the hip (abduction , adduction, flexion and extension)
Power in the knee (flexion and extension)
Power in the ankle (plantar-flexion and dorsi-flexion)
Power in the toes (curl them up and don’t let me open them)
Compares power on each side
Reflexes Knee jerk (L3/4) – with reinforcement if necessary)
Ankle jerk (S1/2) – with reinforcement if necessary
Plantar reflex (S1,2 L5)
Coordination Heel-shin test

Sensation Tests light touch sensation with cotton wool

o Patient’s eyes are closed
o Compares dermatome on each side and asks the patient if there is any
difference between either side
Tests pain sensation with neurotip and Patient’s eyes are closed
o Compares each side and asks if there is a difference between each side
Offers to repeat for temperature
Tests vibration sense with a 128Hz tuning fork with example of vibration on the
Sternum and Patient’s eyes are closed
o Starts on distal joint and asks patient to tell them when the vibrating stops
o Tests joint position sense on both sides and Patient’s eyes are close
 Y4 logbook Mini-CEX form No.7

This sheet is for full neurological examination, choose one of its parts and ask the student to
perform on the patient.
To complete a full neurological examination, student should mention that he has to complete
a mini mental examination, cranial nerves examination, examination of the motor system,
sensation and coordination of the upper and lower limbs , testing the patient’s gait and
balance
Generic Attributes 1= needs 2= 3= 4= 5=
remediation acceptable good very good exemplary
Focuses examination appropriately
Uses proper Technique
Ability to describe findings Correctly
Interpret findings appropriately
Provide Succinate summary for the case
Over All assessment

Feedback (by Clinical Tutor) Learning agenda derived from case discussion that
will help student to improve his theoretical
What went well ……………………………………………………………. background:
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What can be done in a different way: 2. …………………………………………………
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Assessor’s name, stamp and Signature: