Cranial Nerves Examination in NHS for OSCE

Cranial Nerves Examination is a vital part of the neurological examination that helps to assess the function of the 12 pairs of cranial nerves. It is a routine procedure that is often performed in the National Health Service (NHS) during Objective Structured Clinical Examinations (OSCEs) to evaluate the neurological status of the patient. In this blog, we will discuss the step-by-step guidelines for performing the Cranial Nerves Examination in NHS for OSCE.

Step 1: Introduction and Consent The first step is to introduce yourself to the patient and explain the procedure. Obtain consent from the patient before proceeding with the examination.

Step 2: Inspection Start by inspecting the patient's face for any asymmetry or abnormality. Look for facial droop, ptosis, or other deformities.

Step 3: Olfactory Nerve (CN I) Test the patient's sense of smell by asking them to close their eyes and identify common scents such as coffee, lemon, or vanilla. Use substances with a strong odor to assess the patient's olfactory function.

Step 4: Optic Nerve (CN II) Assess the patient's visual acuity using a Snellen chart. Test each eye separately and ask the patient to read the smallest line possible.

Step 5: Oculomotor (CN III), Trochlear (CN IV), and Abducens (CN VI) Nerves Evaluate the function of these nerves by examining the patient's eye movements. Ask the patient to follow your finger or a pen as you move it in different directions. Look for any deviation or limitation of movement.

Step 6: Trigeminal Nerve (CN V) Assess the patient's sensation on the face by touching various areas with a cotton swab or pinprick. Ask the patient to clench their teeth to evaluate the strength of the temporalis and masseter muscles.

Step 7: Facial Nerve (CN VII) Test the patient's facial muscles by asking them to perform various facial expressions such as smiling, frowning, and puffing out their cheeks. Look for any asymmetry or weakness of the facial muscles.

Step 8: Vestibulocochlear Nerve (CN VIII) Assess the patient's hearing by asking them to identify sounds of different frequencies and intensities. Use a tuning fork to test the patient's bone and air conduction.

Step 9: Glossopharyngeal (CN IX) and Vagus (CN X) Nerves Evaluate the patient's swallowing ability and gag reflex by asking them to swallow water and touching the posterior pharyngeal wall with a tongue depressor.

Step 10: Accessory Nerve (CN XI) Assess the patient's trapezius and sternocleidomastoid muscles by asking them to shrug their shoulders and turn their head against resistance.

Step 11: Hypoglossal Nerve (CN XII) Ask the patient to stick out their tongue and move it side to side to evaluate the strength and mobility of the tongue.

Step 12: Conclusion and Documentation Once you have completed the examination, thank the patient and document your findings. Record any abnormalities or deficits that you observed during the examination.

In conclusion, performing a Cranial Nerves Examination in NHS for OSCE requires a systematic and thorough approach. By following these step-by-step guidelines, you can effectively assess the function of the 12 pairs of cranial nerves and provide accurate documentation of your findings.

 

Dr.Muhammad Arsalan Khan
Diabetes Specialist
MBBS, MSc (Diabetes & Endocrinology) - DUHS
CCD-BMJ-AKU-RCP (London)