Neurological Examination & Cranial Nerves with write up
Superior
Full points awarded
1/1, 2/2, 3/3, 4/4, etc Competent
(¾ points awarded)
0.75/1, 1.5/2, 2.25/3, ¾, etc Below standard
Half points awarded
0.5/1, ½, 1.5/3 2/4, etc. Far below standard/Item not done
0 points awarded
Student performs the item smoothly, correctly, without notes and while verbalizing the component.
For example, while the student is auscultating, he/she verbalized the appropriate locations for auscultation, performs it, and verbalizes what she/he is listening for (“I am listening for any crackles, wheezing, rales, rhonchi, or friction rub, and I note only bronchovesicular or clear lung sounds” Student either verbalizes the item only (but correctly) or student performs the item correctly but does not verbalize the step, or may use notes to aid them in performance of item. Student performs some elements of the item correctly, or does not verbalize the item correctly, or relies or reads from notes while doing the exam. Student does not perform or verbalize the item, or performs it completely incorrectly or in an unsafe/unclean manner.
PHYSICAL EXAM
Cognition
_____ 1 Level of Consciousness (describe)
_____ 1 Orientation (assess orientation to person, place, time, event)
_____ 1 Speech (must verbally state assessment of speech)
_____ 1 Memory (performs both a recent and a remote memory test)
_____ 1 Reasoning (performs one reasoning/judgement test)
Cranial Nerves (student needs to state the number and name of each cranial nerve)
_____ 1 I Olfactory – Identifies odors with eyes closed, each nare at a time
II Optic:
_____ 1 Snellen Chart or gross screening each eye separately and then both eyes together at 6 feet with handheld chart or 20 feet with wall chart
_____ 1 Peripheral vision – visual fields by confrontation, each eye
_____ 2 Funduscopic (look at retina, optic disc/cup, vessels)
_____ 1 procedure (R eye of patient to R eye of examiner)
III Oculomotor
_____ 1 EOMs specifically for III (all but lateral and medial/downard)
_____ 1 pupillary reflex directly
_____ 1 pupillary reflex consensually
_____ 1 nystagmus (verbalize if present, and how many beats)
IV Trochlear
_____ 1 EOMs downward and medially
V Trigeminal
_____ 1 bilateral sensation testing of forehead, cheek, AND jaw using sharp and dull
_____ 1 opening jaw against resistance
VI Abducens
_____ 1 EOMs laterally
VII Facial
_____ 1 upper 7th – wrinkle forehead
_____ 1 lower 7th – puff cheek or smile
VIII Acoustic
_____ 1 Whisper, watch tick (each ear)
_____ 1 Weber and Rinne – each ear
IX, X Glossopharyngeal & Vagus
_____ 1 uvula movement with “aaah”
_____ 1 swallowing and gag (may verbalize do not need to demo gag)
XI Spinal Accessory
_____ 1 sternocleidomastoid strength against resistance
_____ 1 trapezius strength
XII Hypoglossal
_____ 1 moves tongue in midline
_____ 1 test strength with tongue blade or push tongue against cheek
Cerebellum
_____ 1 general gait
_____ 1 tandem walk
_____ 1 walk on heels
_____ 1 walk on toes
_____ 1 Romberg, and pronator drift
_____ 1 rapid alternating movements (hands/lap or finger to nose to finger)
_____ 1 patient instruction
Sensory System
_____ 1 Joint position sense, eyes closed
_____ 1 2 point discrimination
_____ 1 stereognosis OR graphesthesia
Upper extremities
_____ 1 superficial tactile sensation – (cotton ball)
_____ 1 superficial pain sensation – (pin prick)
Lower extremities
_____ 1 superficial tactile sensations- (cotton ball)
_____ 1 superficial pain sensations – (pin prick)
_____ 1 vibration sense
_____ 1 patient instruction
Motor System
Upper extremities: deltoids, triceps, biceps
_____ 1 strength
_____ 1 comparison side to side
_____ 1 hand grip
_____ 1 finger strength
Lower extremities: quads, hamstrings, hip abductors, and adductors
_____ 1 strength
_____ 1 comparison side to side
Reflexes
Deep tendon reflexes (bilateral)
_____ 2 biceps
_____ 2 triceps
_____ 2 patellar
_____ 2 Achilles
Superficial reflexes
_____ 2 plantar (babinski)
Professionalism
_____ 2 Appearance: Student was neatly dressed (business casual) or wore lab coat over street clothes with neat appearance. Full points = professional attire and lab coat. ¾ points for some aspect of professional attire missing, ½ credit or lower = not professional/street clothes with no lab coat
_____ 2 Autonomy: Ability to perform exam independently (1=constantly referred to notes, 2 = referred to notes about ½ the time, 3 = rarely/occasionally looked at notes, 4 = did not utilize notes)
______ 1 Consent: Student verbally consented patient at the beginning of the video. Done = full points Not done = 0 points.
______ 2 Communication: 1 = student did not verbalize steps of exam to patient or to camera, 2 = student sometimes verbalize steps of the exam to patient and professor 3 = student verbalized most steps of the exam to patient and professor, 4 = studently constantly verbalized steps of exam to patient/professor
______ 2 Flow/Positioning: Full points: Exam was smooth with few interruptions and minimized patient movements, patient was placed in the proper position for exam techniques. ¾ points: Mostly smooth, few interruptions, ½ points = several interruptions, exam not very smooth ¼ points – very jarring exam, multiple movements by the patient, poor flow and sequencing
TOTAL EXAM = 70 points
DOCUMENTATION
Category Superior Competent Below standard Far Below standard
Format The chosen format was neat and easy to read. Headings were clear.
5 The format was mostly easy to read and understand
4 The format was inconsistent, headings and different areas were not delineated.
3 Very poor format, note was confusing to read.
1
Spelling/grammar/Correct medical terminology Clean note with zero or one mistake. Student used proper medical terms or acceptable abbreviations throughout the note
10 Mostly clean note, but some terms were not correct or some abbreviations were not appropriate.
8 Several errors or misuse of terminology and abbreviations.
6 Many errors and terms that distracted from the note, making it difficult to read.
4
Content Complete summary of objective findings. All findings in the exam written in the note properly
15 Partial, but accurate summary of objective information.
13 Limited summary of objective findings, missing many pieces performed in the exam.
10 Minimal written objective findings. Missing more than 50% of findings during exam.
7
Documentation Total 30
Phys Exam Total 70
TOTAL POINTS 100
