Neurology Department

Faculty of Medicine
Zagazig University
OSCE Checklist Neurology

Assess deep reflexes

Item Score
Wash your hands
Introduce yourself to the patient
Briefly explain what the examination will involve using patient-
friendly language and take oral consent
Position the patient appropriately on the examination couch
and stand on the right side of the patient
Assess deep reflexes in the right upper limb
- Assess biceps reflex.
- Assess brachioradialis reflex.
- Assess triceps reflex.
Assess deep reflexes in the Left upper limb
- As in the right upper limb.
Assess deep reflexes in the right lower limb
- Assess knee reflex.
- Assess ankle reflex.
Assess deep reflexes in the left lower limb
- As in the right lower limb.

Conclude your findings

Thank Patient

Total Score:

Examiner Signature
Neurology Department
Faculty of Medicine
Zagazig University
Neurology Department
Faculty of Medicine
Zagazig University
OSCE Checklist Neurology

Assess cortical sensation

Item Score
Wash your hands
Introduce yourself to the patient
Briefly explain what the examination will involve using patient-
friendly language and take oral consent
Position the patient appropriately on the examination couch
and stand on the right side of the patient
- Assess tactile localization.
- Assess tactile discrimination.
- Assess perceptual rivalry.
- Assess stereognosis.
- Assess graphothesia.
NB:- you should perform these tests in the 4 limbs.
Conclude your findings
Thank Patient

Total Score:

Examiner Signature
Neurology Department
Faculty of Medicine
Zagazig University

OSCE Checklist Neurology

Assess 3rd, 4th and 6th cranial nerves

Item Score
Wash your hands
Introduce yourself to the patient
Briefly explain what the examination will involve using patient-
friendly language and take oral consent
Position the patient appropriately on the examination couch
and stand on the right side of the patient
- Assess ptosis.
- Assess pupils: they should be equal, round & reactive to

light, & accommodation.

- Examine the pupil in a semi dark room & do not stand in

front of patient; have patient fixate the eyes on a distant

object while you shine the light obliquely at the pupils.
- The light reflex: If you expose one eye to light, while shading

the other, normally there is constriction of the pupil of the

exposed eye (direct reaction) as well as of the other eye
(consensual reaction).
- The accommodation (near) reflex: When the patient is
asked to follow your finger with both his eyes from a far to
a near point.
- Cilio-spinal reflex: Pinching the skin on one side of the neck
results in dilatation of the ipsilateral pupil.
- Assess extra ocular movements:

- Test abducent N 6th by asking patient to look laterally.

Neurology Department
Faculty of Medicine
Zagazig University
- Test trochlear N. 4th by asking patient to look inwards &
downwards.
- Test oculomotor N. 3rd by asking patient to look in all other
directions.
- These tests are done for each eye alone: If their results are
normal this indicates that the ocular nerves are intact.
- Then repeat the same tests on both eyes simultaneously for
conjugate movement.
Nystagmus:
- Ask the patient to look at your finger. Move your finger
slowly, & briefly hold your finger in four directions (i.e.
upwards, downwards, right then left). Be sure the patient is
able to see your finger with both eyes. Hold your finger at
about a 30o angle & about 30 cm from his eyes

Conclude your findings

Thank Patient

Total Score:

Examiner Signature
Neurology Department
Faculty of Medicine
Zagazig University

OSCE Checklist Neurology

Assess 7th cranial nerve

Item Score
Wash your hands
Introduce yourself to the patient
Briefly explain what the examination will involve using patient-
friendly language and take oral consent
Position the patient appropriately on the examination couch
and stand on the right side of the patient
a) Motor Part: Examine for the muscles of expression of the
face:
❖ Look at the patient’s face & note if there is any asymmetry
between the nasolabial folds, forehead wrinkles, blinking,
or smiling.
1) Upper face (Frontalis & orbicularis oculi)
a) Test for raising of the eyebrows.
b) Test for firm closure of the eye lids (Bell's phenomena
may be seen)
2) Lower face (orbicularis oris, buccinator & retractor
anguli):
a) Look for absent nasolabial fold & dropping of the
angle of the mouth, present in facial paralysis.
b) Test for whistling, blowing the cheeks & showing the
teeth.
b) Sensory Part:
1) Examine for the taste sensation (Chorda tympani N.) over
the anterior two-thirds of the tongue by drying the
Neurology Department
Faculty of Medicine
Zagazig University
patient's tongue & then applying a drop of sweet, bitter
or salty solution on its tip. See if the patient can properly
recognize the taste.
2) Look at the external auditory meatus the cutaneous
distribution of CN 7th. Note any vesicles suggestive of
herpes zoster.
c) Glabellar Reflex:
▪ In the normal adult, tapping the glabella (root of the
nose) results in blinking (contraction of orbicularis oculi
muscles); this blinking stops after 2-3 taps (due to
habituation). In Parkinsonism the blinking continues with
the taps as long as the stimulus is applied (loss of
habituation).

Conclude your findings

Thank Patient

Total Score:

Examiner Signature
Neurology Department
Faculty of Medicine
Zagazig University
OSCE Checklist Neurology

Assess 5th cranial nerve

Item Score
Wash your hands
Introduce yourself to the patient
Briefly explain what the examination will involve using patient-
friendly language and take oral consent
Position the patient appropriately on the examination couch
and stand on the right side of the patient
a) Motor part:
1) Test for the power of muscles of mastication:
- Temporalis: Ask the patient to clench his jaws while you
put your hands over the temples to palpate the muscles.
- Masseters: The patient clenches his jaws while you palpate
the contracted muscle between four fingers over its
posterior border & the thumb over its anterior border.
- Pterygoids: Ask the patient to open his mouth while you fix
his head.
2) Jaw reflex:
- While the mouth is slightly open, place your index finger
on the lower jaw, & then tap it from above downwards.
b) Sensory part:
▪ Test for sensations including pain (using a pin) & touch

(using a piece of cotton) over the face & compare

between:
a) Both sides of the face.
b) The ophthalmic, maxillary & mandibular division on each
side.
c) The inner & outer parts of the face.
Neurology Department
Faculty of Medicine
Zagazig University
C) Corneal & Conjunctival reflexes
- Ask the patient to look upwards & inwards. Touch the
corneo-conjunctival junction from the lateral side (to avoid
direct photic stimulation) using a thin piece of cotton.

Conclude your findings

Thank Patient

Total Score:

Examiner Signature
Neurology Department
Faculty of Medicine
Zagazig University
OSCE Checklist Neurology

Assess 12th cranial nerve

Item Score
Wash your hands
Introduce yourself to the patient
Briefly explain what the examination will involve using patient-
friendly language and take oral consent
Position the patient appropriately on the examination couch
and stand on the right side of the patient
A. Inspect the tongue for:
● Deviation:
● Wasting
● Fasciculations
● Abnormal movements
● Dimpling of the tongue on tapping it
B. Test for the power of the muscles of the tongue by
asking the patient to push the inner side of his cheek with the tip
of his tongue.

Conclude your findings

Thank Patient

Total Score:

Examiner Signature
Neurology Department
Faculty of Medicine
Zagazig University
OSCE Checklist Neurology

Assess coordination
Item Score
Wash your hands
Introduce yourself to the patient
Briefly explain what the examination will involve using patient-
friendly language and take oral consent
Position the patient appropriately on the examination couch
and stand on the right side of the patient
A. IN THE UPPER LIMB:
1) Finger-to-nose test: Patient brings the tip of his forefinger
from a distance onto the tip of his nose. The test is
conducted with the eyes open then closed.
2) Finger-to-finger test: Patient brings the tips of his
forefingers from the distance of his outstretched arms to
meet each other in the midline.
3) Finger-to-doctor's finger test: Patient brings the tip of his
forefinger from a distance to doctor's forefinger.
4) Adiadokokinesis or Dysdiadokokine: Patient is asked to do
rapidly alternating movements e.g. pronation & supination
of the forearm.
5) Rebound phenomenon: Patient, with his elbow fixed, flexes
it against resistance. When the resistance is suddenly
released the patient's forearm flies upwards & may hit his
face or shoulder. You must to protect his face by your hand.
6) Buttoning & unbuttoning test.
B. IN THE LOWR LIMB:
Neurology Department
Faculty of Medicine
Zagazig University
1) Heel-to-knee test: Patient raises his leg, brings down its
heel onto the knee of his other leg & slides it down along
the shaft of the tibia. You must to protect his patella by
your hand.
2) Walking along a straight line: foot close to foot (tandem
gait).
3) Romberg's test: ask the patient to stand with the heels
together, 1st with his eyes open, then with his eyes closed.

Conclude your findings

Thank Patient

Total Score:

Examiner Signature
Neurology Department
Faculty of Medicine
Zagazig University
OSCE Checklist Neurology

Assess muscle tone in the upper limb

Item Score
Wash your hands
Introduce yourself to the patient
Briefly explain what the examination will involve using patient-
friendly language and take oral consent
Position the patient appropriately on the examination couch
and stand on the right side of the patient
Assess muscle tone in the right upper limb
1) Passive flexion & extension of all the joints.
2) Shaking method for the wrist & ankle only.
3) Tone at the hip: patient is lying with straight legs. Roll the
knee from side to side.
4) Gower's method for the shoulder (as in myopathy): Place
your hands in the patient's axillae & try to lift his shoulders.
Assess muscle tone in the left upper limb
- As in the right lower limb.

Conclude your findings

Thank Patient

Total Score:

Examiner Signature