![]() Visual acuity Assessment of visual acuity (distance)īegin by assessing the patient’s visual acuity using a Snellen chart. Examples of asymmetry include a large pupil in oculomotor nerve palsy and a small and reactive pupil in Horner’s syndrome.If the pupil is more pronounced in bright light this would suggest that the larger pupil is the abnormal pupil, if more pronounced in dark this would suggest the smaller pupil is abnormal. This may be longstanding and non-pathological or relate to actual pathology. Note any asymmetry in pupil size between the pupils (anisocoria).Peaked pupils in the context of trauma are suggestive of globe injury.posterior synechiae associated with uveitis). Pupils should be round, abnormal shapes can be congenital or due to pathology (e.g.Pupils are usually smaller in infancy and larger in adolescence.smaller in bright light, larger in the dark). Normal pupil size varies between individuals and depends on lighting conditions (i.e.The pupil is the hole in the centre of the iris that allows light to enter the eye and reach the retina. There is no motor component to the optic nerve. The optic nerve (CN II) transmits sensory visual information from the retina to the brain. COVID-19: transient anosmia is a common feature of COVID-19.Parkinson’s disease: anosmia is an early feature of Parkinson’s disease.Genetics: some individuals have congenital anosmia.Head trauma: can result in shearing of the olfactory nerve fibres leading to anosmia.Mucous blockage of the nose: preventing odours from reaching the olfactory nerve receptors.There are many potential causes of anosmia including: However, this is unlikely to be required in an OSCE. lemon, peppermint), or most formally using the University of Pennsylvania smell identification test. Olfaction can be tested more formally using different odours (e.g. There is no motor component to the olfactory nerve.Īsk the patient if they have noticed any recent changes to their sense of smell. The olfactory nerve (CN I) transmits sensory information about odours to the central nervous system where they are perceived as smell (olfaction). Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications.Visual aids: the use of visual prisms or occluders may indicate underlying strabismus.Hearing aids: often worn by patients with vestibulocochlear nerve issues (e.g.Walking aids: gait issues are associated with a wide range of neurological pathology including Parkinson’s disease, stroke, cerebellar disease and myasthenia gravis.Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status: spasticity, weakness, wasting, tremor, fasciculation) which may suggest the presence of a neurological syndrome). Limbs: pay attention to the patient’s arms and legs as they enter the room and take a seat noting any abnormalities (e.g.Strabismus: may indicate oculomotor, trochlear or abducens nerve palsy.Pupillary abnormalities: mydriasis occurs in oculomotor nerve palsy.Eyelid abnormalities: ptosis may indicate oculomotor nerve pathology.Facial asymmetry: suggestive of facial nerve palsy.Speech abnormalities: may indicate glossopharyngeal or vagus nerve pathology.Perform a brief general inspection of the patient, looking for clinical signs suggestive of underlying pathology: ![]() Gain consent to proceed with the examination.Īsk the patient to sit on a chair, approximately one arm’s length away.Īsk the patient if they have any pain before proceeding with the clinical examination. Introduce yourself to the patient including your name and role.Ĭonfirm the patient’s name and date of birth.īriefly explain what the examination will involve using patient-friendly language. Wash your hands and don PPE if appropriate. You might also be interested in our premium collection of 1,000+ ready-made OSCE Stations, including a range of clinical examination stations ✨ Introduction
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