OSCE Neuro Examine Cranial Nerves 3,4 and 6

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

 * Hello my name is [student's name] and I'm a student a first year medical student at [medical school]. Can I please get your full name and age please?
 * Mr. Doe, today my attending physician has asked me to examine your cranial nerves, do I have your permission?

Explain procedure to patient, position and drapes

 * So today we'll just have you sit on the bed and have your eyes follow my finger, are you comfortable with that?
 * I just want to remind you that anything we find today will be confidential.
 * Is there anything you need before we begin?
 * The patient is properly draped.

Inspect for strabismus and comment on findings. Describe the strabismus associated with each of CN 3, 4, 6

 * Please hold your head still with both of your hands.
 * Follow my finger with your eyes.
 * The patient was able to follow my finger with their eyes in all directs which suggest their have normal extraocular muscles.
 * I did not notice any Strabismus which is a misalignment of the eyes that occurs when Cranial Nerve III, IV, or VI is paralyzed.
 * When Cranial Nerve III is paralyzed the eye cannot look up, down or inward.
 * When Cranial IV is paralyzed, the eye cannot look down and inward.
 * When Cranial Nerve VI is paralyzed, the eye cannot a-b-duct.

Examine CN 3, 4 and 6 and comment on findings including direction of diplopia expected in each and concordant movement of eyes.

 * If one eye was unable to follow my finger, this can suggest diplopia (double vision).
 * Diplopia is a neuropathic sign (Neuropathy) associated with CN III, IV, or 6 and can be caused conditions such as:
 * Myasthenia Gravis
 * Trauma
 * Thyroid Ophthalmopathy
 * Internuclear Ophthalmoplegia
 * Diplopia with one eyed covered can suggest:
 * Problems with glasses or contacts
 * Cataracts
 * Astigmatism
 * Ptosis
 * That's all for your exam today, thank you for coming in.