OSCE Neuro Examine Cranial Nerves 5 and 7

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

 * Hello my name is [Medical Student] and I'm 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 do examination of your Cranial Nerves, do I have your permission?

Explains procedure to patient, positions and drapes

 * Today examination involves me touching various parts of your face, are you comfortable with that?
 * I just want to remind you that anything we find will be confidential.
 * Is there anything you need before we begin?

Test light touch in the three branches of the trigeminal nerve and comments on findings. Describe how to test for the corneal reflex

 * I'm going to be touching you in difference places with this cotton, please close your eyes and say "yes" whenever you feel the touch.
 * Ophthalmic Nerve Test:
 * *Touch the cotton to the patient's forehead; repeat on the opposite side.*
 * Maxillary Nerve Test:
 * *Touch the cotton to the patient's upper cheek; repeat on the other side.*
 * Mandibular Nerve Test:
 * *Touch the cotton to the patient's chin; repeat on the other side.*
 * The patient was able to feel the cotton in all areas.
 * If the patient had isolated facial sensory loss, this could suggest trigeminal neuralgia.
 * If the patient had ipsilateral face and contralateral body sensory loss, this could suggest a stroke at the brainstem.
 * I would like to take this time to talk about the corneal reflex.
 * This test is performed by approaching the patient from the side and touching the cornea (pupil+iris) of their eye with cotton.
 * Blinking or tearing is the normal corneal reflex and suggest that Cranial Nerve 5 and 7 is intact.
 * No blinking suggest damage to Cranial Nerve 5 or 7.

Test strength of the muscles of mastication and comment on findings

 * Mr. Doe, I'm now going to test your chewing muscles.
 * *Palpate both mastication muscle*
 * Please clench your teeth for me.
 * *Palpate masseter muscles*
 * Please clench your teeth again.
 * Both the temporal and masseter muscles strength felt normal.
 * If I were to feel unilateral weakness this, could suggest a pontine lesion.
 * If I were to feel bilateral weakness, this could suggest cerebral hemisphere disease.

Test jaw jerk and comment on findings

 * Mr. Doe, can you please move your jaw from side to side please?
 * The patient was able to move their jaw from side to side.
 * Difficulty moving from side to side could suggest pterygoid muscle weakness.

Inspects the face for evidence of CN 7 paralysis and explains the different findings for a central versus a peripheral lesion

 * I do not see any lip drooling which can suggest a central lesion which is associated with paralysis of only the lower face.
 * Lip drooling along with trouble closing the eye, flat nasolabial fold, and no forehead wrinkling can suggest a peripheral lesion.

Test strength of muscles innervated by the facial nerve including eye closure, cheek puffing, smile, and wrinkling of forehead and comment on findings

 * Mr Doe, I'm now going to test the muscles of your face.
 * Please raise both eyebrows.
 * Please frown.
 * Please close both eyes as tight as you can while I try to open them.
 * Please show me your teeth.
 * Please smile.
 * Please puff out both cheeks.
 * The patient was able to perform all the task.
 * This suggest the patient does not have upper or lower face paralysis associated with trauma, Bell's Palsy or stroke.
 * That's the end of the exam, thank you come coming in today.