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PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
11/28/14, 10:23 PM
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Sigma
I Olfactory
Smell
-------------------------------------------------------------------------------Many examiners skip this cranial nerve during a comprehensive exam, but if the patient complains
of loss of smell (anosmia), it should be included in the physical exam.
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Topic ID #
Started 10 y
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FAQ: How to examine the cranial nerves? PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
11/28/14, 10:23 PM
Thread inde
name=Forum
Feed
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II Optic
Vision
name=Foru
Top contrib
Important: In cases of eye pain, injury, or visual loss, always check visual acuity before proceeding
with the rest of the exam or putting medications in your patient's eyes.
Allow the patient to use their glasses or contact lenses. You are interested in the patient's best
corrected vision.
Position the patient 20 feet in front of the Snellen eye chart (or hold a Rosenbaum pocket card at a
14-inch "reading" distance).
Have the patient cover one eye at a time with an opaque card.
Ask the patient to read progressively smaller letters until they can go no further.
Record the smallest line the patient read successfully (20/20, 20/30, etc.)
Repeat with the other eye and then both eyes combined.
Visual acuity is reported as a pair of numbers (e.g., 20/20) where the first number is how far the
patient is from the chart and the second number is the distance from which the "normal" eye can
read a line of letters. For example, 20/40 means that at 20 feet the patient can only read letters a
"normal" person can read from twice that distance.
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DURING THE EXAM YOU CAN SHOW SOME NEWSPAPER TO THE PATIENT FOR READING. HOWEVER,
YOU SHOULD BE ABLE TO EXPLAIN ALL THE ABOVE IF THE EXAMINER ASK FOR IT.
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PLAB 2 Expe
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Check convergence by moving your finger toward the bridge of the patient's nose.
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PLAB 2 For
# This forums
--------------------------------------------------------------------------------
Part 2.
# As you all kn
tougher every
to 50-60% fro
V Trigeminal (Motor)
# This forum w
in OSCE for th
#
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FAQ: How to examine the cranial nerves? PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
11/28/14, 10:23 PM
Ask the patient to open their mouth and clench their teeth.
Palpate the temporalis and masseter muscles as they do this.
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V: Trigeminal (Sensory)
Sensory to the Face
-------------------------------------------------------------------------------Test the Three Divisions for Pain Sensation
Explain what you intend to do then ask the patient to close th
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Right CN3 Palsy: Patient's right eye is deviated laterally, there is ptosis of the lid, and the right
pupil (middle picture) is more dilated than the left. Note:
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FAQ: How to examine the cranial nerves? PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
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Sixth Left Cranial Nerve Palsy: Left eye cannot move laterally beyond midline. In this case, caused
by metastatic squamous cell cancer of the head and neck.
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FAQ: How to examine the cranial nerves? PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
11/28/14, 10:23 PM
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Peripheral Left Cranial Nerve 7 Palsy: Picture on left demonstrates loss of wrinkles on left side
of forehead, inability to raise left eyebrow, and loss of left nasolabial fold. Picture on right
demonstrates
inability to close left eye or raise corner of mouth. In this case, the cranial nerve deficit was a
result of
metastatic malignancy though Bell's Palsy would have a similar appearance.
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Cranial Nerve 9 Dysfunction: Patient has suffered stroke, causing loss of function of left CN 9. As a
result, uvula
is pulled towards the normally functioning (ie right) side.
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FAQ: How to examine the cranial nerves? PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
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Cranial Nerve 12 Dysfunction: Stroke has resulted in loss of function of left CN 12. When patient
sticks tongue out, it therefore deviates to the left.
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Cools - I've done an OSCE Buster for this - the lower cranial nerves tend to be examined seperately
from those doing the eyes.
See
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FAQ: How to examine the cranial nerves? PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
11/28/14, 10:23 PM
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In Diabetic mononeuropathy, Cr. III, IV are involved and needed to be tested and pupillary function should be tested separately.
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FAQ: How to examine the cranial nerves? PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
11/28/14, 10:23 PM
the pupil is completely spared but all other muscles innervated by the 3rd nerve are affected (eg,
diabetic 3rd nerve paresis), the cause is likely to be an ischemic process of the oculomotor nerve
or the midbrain; a demyelinating process is less likely. However, about 5% of posterior
communicating artery aneurysms causing oculomotor paralysis spare the pupil.
Third cranial nerve palsies are most indicative of serious disease when associated with severe
headache or altered consciousness.
A thorough neurologic examination with CT or MRI is performed. Lumbar puncture is reserved for
suspected subarachnoid hemorrhage when CT does not show blood. Cerebral angiography must be
performed if aneurysm causing subarachnoid hemorrhage is strongly suspected or when the pupil is
clearly affected and no head trauma serious enough to fracture the skull has occurred.
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Bit long winded for a 5 minute OSCE station, but very thorough nonetheless.
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Diabetic MONOneuropathy affects one nerve, hence the MONO. Polyneuropathy affects more than
one nerve.
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FAQ: How to examine the cranial nerves? PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
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Thanks very much for the details. I'd like to add one more thing for 2nd Cranial Nerve which is very
important i.e. Visual Fields.
Regards
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It should be done ideally after the visual aquity test. Then to rule out any Scotoma, the test should
be done with Red Hat Pin, bringing to the central field with one eye closed and ask the patient "
what colour the pin is". If the answer is pink it means there is scotoma. Later, the Pin should be
moved to horizontally towards temporal region, where it disappears. Again asking for colour to role
out Optic nerve damage.
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Allow the patient to use their glasses or contact lenses. You are interested in the patient's best
corrected vision.
Position the patient 20 feet in front of the Snellen eye chart .
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FAQ: How to examine the cranial nerves? PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
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hi guys.... this is an excellent step on how to examine CNs which is thought to be very hard..A
good approach is to know the nerves by heart so that it will be easy to perform the examination.
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2) Optic nerve:
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FAQ: How to examine the cranial nerves? PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
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I suppose, the Visual fields are part of Second which should be carried out. This OSCE was many
times in exams where they wanted us to check the visual fiels and give them diagnosis such as
Homonymous Hemianopia or Bitemporal.
Regards
Location: U.K.
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FAQ: How to examine the cranial nerves? PLAB 2 - Part 2 of Professil and Linguistic Assessments Board Exam Conducted by GMC, UK Forums
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