Patient Centered Medicine II Semester III
F:\2006-07\FORMS\NeuroExamEvalChecklist for graders-9-06.doc - 1 - Revised: 07/11/06
Neurologic Exam Evaluation Checklist (NEURO OSCE)
Student’s Name: ______________________________
Date: _____Monday September 11 ______Friday September 15
Evaluator’s Name: _______________________________________________
Mark A if the step was done correctly
Mark B if the step was done but if the technique was unsatisfactory
Mark C if the step was omitted
PLEASE NOTE: FOR ITEMS MARKED “B,” THE EVALUATOR NEEDS TO BE SPECIFIC
AS TO WHY THE STEP WAS UNSATISFACTORY. PLEASE WRITE DIRECTLY ON THIS
SHEET.
_____ 1. WASH HANDS
CRANIAL NERVES:
_____ 2. ASSESS VISUAL FIELDS
The student can check one eye at a time, or have pt with both eyes open.
_____ 3. DO THE FUNDUS EXAM (CN2 Student inspects both eyes with the ophthalmoscope.)
_____left eye
_____right eye
_____ 4. ASSESS PUPIL RESPONSE TO LIGHT (CN2, 3)
___Right eye
___Left eye
(The examiner should check for the direct and consensual response to light in each pupil)
_____ 5. CHECK FOR ALL 6 CARDINAL POSITIONS OF GAZE (CN 3, 4, 6)
-Examiner makes a large “H” while pt moves their eyes
_____ 6. ASSESS THE 3 SENSORY DIVISIONS OF CN 5 (light touch on pt’s face)
-SIX AREAS MUST BE ASSESSED –
_____both sides of the forehead (ophthalmic division of CN5)
_____both sides superficial to maxillary sinuses = cheeks (maxillary division)
_____both sides superficial to the mandibles = jaw (mandibular division of CN5)
_____ 7. ASSESS CN 7
Examiner asked pt to raise both eyebrows or frown or wrinkle my forehead. (CN7)
_____ 8. ASSESS CN 7
Examiner asked pt to “show my teeth” or “smile and show your teeth” (CN7)
