Cranial Nerve Examination – OSCE Guide

1 ✅ CN I – Olfactory Nerve ( Type : Sensory Nerve , Function : Olfaction )

Wash hands, Introduce yourself, Explain the procedure Clearly . Obtain 0.5
Informed consent ,Position the patient comfortably sitting.
Self-test the odorant. 0.5
Check each nostril for infection, inflammation, or foreign body. 1
Instruct the subject to close both eyes and one nostril. 1
Bring the odorant close and ask the subject to sniff and identify it. 1
Repeat with the other nostril. 1
Result: ☐Above expectation , ☐ Meets expectation , ☐ Below expectation
Certificatio ☐Certified ☐ Repeat
n:
3 ✅ CN II – Optic Nerve (Type : Sensory Nerve , Function : Vision )
Wash hands, Introduce yourself, Explain the procedure Clearly . Obtain
Informed consent ,Position the patient comfortably sitting.
3a. Visual Acuity Testing
Far Vision: Ask: “Do you wear spectacles or contact lenses for
distance?” If yes,
test with and without correction. Position the patient: Standing or
sitting 6 meters (20 feet) away from the Snellen chart. Ask the
patient to cover the left eye with an occluder or clean hand (no
pressure on the eye). Ask them to read aloud the smallest line they
can see clearly from top to bottom. Note the last line read correctly.
Records findings accurately. Repeat the same procedure.
Near Vision : Ask the subject to sit comfortably in good light.Asks
the subject ot
hold the Jaeger's chart roughly at 25 mc distance from the eye.Asks
the subject ot close one eye and read from the Jaeger's chart from
top to bottom .Record findings accurately . Tests the visual acuity
of other eye
3b. Visual Field Testing
Visual Field Testing by Confrontation Method
Positions the subject: seated comfortably 1 meter away, face-to-face
with eyes
at the same horizontal level.
Instructs the subject to cover the right eye with palm and fix gaze on
examinee’s
left eye.
Examinee covers own left eye and focuses on the subject’s right eye.
Moves wiggling finger from periphery to center in all four quadrants
(temporal,
superior, inferior, nasal).
Asks subject to raise hand when finger is seen.
Repeats the same steps on the other eye.
Visual Field Testing by Perimetry Method
 3c Colour vision Testing
Asks the subject to close one eye with his palm . Asks the subject to
identify the
hidden numbers to trace the tracts in Ishihara's chart within 3-5
seconds/page and check the same with the answer key. Repeat
the procedure on the other eye .
3d. Pupillary Reflex

Light reflex : Direct : Instructs the subject to close one eye and
fix gaze on a distant object. Brings the torch from the side, not from
the front, and shines it on the cornea of the open eye. Observes for
prompt constriction of the same (stimulated) pupil. Repeats the
test on the other eye in the same manner.
Indirect : Asks the subject to place the ulnar border of one hand
vertically between the eyes, over the nose (to prevent light spill).OR
the examiner place the ulnar border of one hand between the
sunject's eyes . Shines light from the side on one eye, and observes
the contralateral pupil for constriction. Repeats
the test for the other eye.

Accomodation Reflex : Positions the subject seated comfortably

in a well-lit room, facing the examiner. Asks the subject to focus
on a distant object . Then brings a finger or pen slowly from a
distance towards the subject’s nose (midline). Instructs the subject
to shift focus to the near object as it approaches.
Observes the changes in the eyes .
Result: ☐Above expectation , ☐ Meets expectation , ☐ Below expectation
Certificatio ☐Certified ☐ Repeat
n:
4 ✅ CN III , IV , & VI– Occulomotor , Abducent , & Trochlear ( Type : Motor Nerve )

Wash hands, Introduce yourself, Explain the procedure Clearly . Obtain

Informed consent ,Position the patient comfortably sitting.
To Test conjugate movements of the eyeball

To Testparasympathetic division of III nerve by direct light reflex

To Testparasympathetic division of III nerve by Indirect light

 reflex

To Testparasympathetic division of III nerve by accomodation

eflex

Result: ☐Above expectation , ☐ Meets expectation , ☐ Below expectation

Certificatio ☐Certified ☐ Repeat
n:
5 ✅ CN V– Trigeminal (Type : Mixed Nerve )
Wash hands, Introduce yourself, Explain the procedure Clearly . Obtain
Informed consent ,Position the patient comfortably sitting.
To test the motor component
Test the temporalis and masseter muscle by asking the subject to 1
clench
his/her teeth and then palpates the muscles with your palm and
compare the power on both sides.
Test the lateral pterygoid muscle by asking the subject to open his 1
mouth and
looks or derivation of jaw.
Elicit jaw jerk by asking the the subject to slightly open the mouth , 1
places the
forefinger of your non-dominant hand below the subject's lower lip on
the chin and strike on it in downward direction with the pointed wnd
of the knee hammer and looks for the upward jerk of the jaw.
To test the Sensory component

To access the funstions of secretary fibers of the Sensory

component

Result: ☐Above expectation , ☐ Meets expectation , ☐ Below expectation

Certificatio ☐Certified ☐ Repeat
n:
6 ✅ CN VII– Facial ( Type : Mixed Nerve )
Wash hands, Introduce yourself, Explain the procedure Clearly . Obtain
Informed consent ,Position the patient comfortably sitting.
To test the motor component
 To test the Sensory component

Result: ☐Above expectation , ☐ Meets expectation , ☐ Below expectation

Certificatio ☐Certified ☐ Repeat

n:
7 ✅ CN VIII– Vestibulo-cochlear Nerve ( Type : sensory Nerve : Function : Hearing )

Wash hands, Introduce yourself, Explain the procedure Clearly . Obtain 0.5
Informed consent ,Position the patient comfortably sitting.
Rinne's test 2

Weber's test 1.5

Schwaback's test 1

Result: ☐Above expectation , ☐ Meets expectation , ☐ Below expectation

Certificatio ☐Certified ☐ Repeat
n:
8 ✅ CN IX –
Wash hands, Introduce yourself, Explain the procedure Clearly . Obtain
1
Informed consent ,Position the patient comfortably sitting.

Result: ☐Above expectation , ☐ Meets expectation , ☐ Below expectation

Certificatio ☐Certified ☐ Repeat
n:
 9 ✅ CN X –
Wash hands, Introduce yourself, Explain the procedure Clearly . Obtain
Informed consent ,Position the patient comfortably sitting.

Result: ☐Above expectation , ☐ Meets expectation , ☐ Below expectation

Certificatio ☐Certified ☐ Repeat
n:
 10 ✅ CN XI –
Wash hands, Introduce yourself, Explain the procedure Clearly . Obtain
Informed consent ,Position the patient comfortably sitting.

Sternocleidomastoid Muscle : Asks the subject to turn his/ her

2
neck while applying gentle resistance over the chin or depress the
chin against resistanc . Assesses strength and bulk of the opposite
sternocleidomastoid muscle.

Trapezius Muscle: Stands behind the subject and asks them to shrug 2
shoulders
.Applies gentle downward pressure and assesses strength/symmetry
Result: ☐Above expectation , ☐ Meets expectation , ☐ Below expectation
Certificatio ☐Certified ☐ Repeat
n:
11 ✅ CN XII –
Wash hands, Introduce yourself, Explain the procedure Clearly . Obtain
Informed consent ,Position the patient comfortably sitting.

Result: ☐Above expectation , ☐ Meets expectation , ☐ Below expectation

Certificatio ☐Certified ☐ Repeat
n: