ED Mock OSCE Station 1: Conducting a Cranial Nerve Exam, Lecture notes of Neuroscience

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ED MOCK OSCE Station 1

PROMPT:

Mr(s). Jenson has been brought

to the ED by ambulance after

suffering from a severe acute

headache. Please conduct a

cranial nerve exam.

Grading sheet for the facilitator Prompt: Mr(s). Jenson has been brought to the ED by ambulance after suffering from a severe acute headache. Please conduct a cranial nerve exam. Scored Points Max Points INTRODUCTION Introduce self 1 Signpost/explain exam, ask permission 1 Wash hands 1 Appropriate positioning of patient (sitting at the edge of bed, facing examiner)

General observations 1 Subtotal 5 CRANIAL NERVE 1 Examine OR ask about recent changes in smell/taste of food

CRANIAL NERVE 2

visual acuity  Appropriate positioning of patient  Patient asked to remove glasses  Appropriate use of Snellen Chart (distance, clear instructions given)

visual fields  Appropriate positioning of patient (across from examiner, same eye level)  Patient asked to remove glasses  Appropriate and clear instructions given

Fundoscopy  Mention need to do fundoscopy 1 Light reflex  Patient asked to remove glasses  Direct light reflex tested  Consensual light reflex tested  Appropriate and clear instructions given

Swinging light test (RAPD) 1 Accommodation  Appropriate and clear instructions given

 Clear instructions given 1 Subtotal 15 CRANIAL NERVE 9, 10, 12 Observe  Patient is asked to open the mouth, and examiner observes the palate and the tongue sitting on the floor of the mouth  Patient is asked to say “ahhh”  Patient is asked to stick out their tongue to the middle, then to the left, then to the right  Patient asked to swallow a gulp of water while examiner observes  Patient asked to cough

Tongue power  Patient asked to poke tongue into left and right cheek  Examiner opposes force on the cheek  Clear instructions given by the examiner

Gag reflex  Not required but examiner must mention 1 CRANIAL NERVE 11 Accessory and SCM power  Patient asked to shrug shoulders  Examiner opposes force by pushing down  Patient asked to turn head to either side  Examiner opposes force by placing hand on the opposite cheek  While patient’s head is turned, examiner feels for the contracted SCM

CLOSING

Examiner thanks the patient for their time and indicates conclusion of exam

Subtotal 15

QUESTIONS

What are the signs you expect to see of someone with a CN3 palsy? (max 2 points)  Ipsilateral mydriasis  Unreactive to light or accommodation  Ptosis  Divergent strabismus (down + out)

What are 3 critical investigations you will order urgently in ED? (max 3 points)  FBE (WCC, Hb)  BSL  CT brain  INR

Subtotal 5 TOTAL 60