OSCE

Neurological Test
Upper Limb
 SWIFT
o Scars
o Wasting of muscle
o Involuntary movements
o Fasciculation’s
o Tremors
 Stick arms in front pronated and supinated
o See if there is any drift
 Muscle power test
o Arms at shoulder
o Shoulder Abduction (C5)
 Push down on muscle
o Shoulder adduction (C6, C7)
 Push up on arm
o Elbow Flexion (C5, C6)
 Pull muscle away
o Elbow Extension (C7)
 Push muscle towards body
o Wrist extension (C6)
 Wrist tilt up

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o Wrist flexion (C6, C7)
 Wrist tilt down
o Finger extension (C7)
 Hand straight out in front
 Prevent hand by pushing finger down
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o Finger Abduction (T1)
 First dorsal interosseous

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 Abductor digit minimi

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o Thumb abductor (C8, T1)
 Turn hand around, thumb up
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 Reflexes
o Bicep reflex (C5, C6)
o Triceps reflex (C6, C7)
o Supinator reflex (C5, C6)

Assess each dermatome

Nose to finger test

 Fast
Back and forth hand

Cranial Nerve
 CN I (Olfactory)
 o Change in smell
 CN II (Optic)
o Inspect pupil size and alignment
o Hand in between head and shine light
o Light swing test
o Visual Inattention
 Patient stares at you and point to the finger that is moving (high and low)
o Visual Fields
 CN III, CN IV, CN VI
o Tell patient to cover one eye
 Hand move in a H motion
 CN V
o Feel patient
 V1 (ophthalmic branch)
 Above eyebrows
 V2 (maxillary branch)
 Cheeks
 V3 (mandibular branch)
 Chin
 Access muscle wasting (“im going to feel some muscles around your face”)
o Clench jaw and feel eye level, cheeks
o Open month and don’t let me close it
 CN VII (Facial)
o Raise eyebrow
o Close eyes as hard and don’t let me open them
o Puff cheeks and don’t let me push them it
o Purse lips
o Show teeth
o Change in taste?
o Change in hearing? Louder or softer than usual
 CN VIII (Vestibulocochlear)
o Snap from close to far
o Tuning fork
o Close you eyes and march
 CN IX (Glossopharyngeal) CN X (Vagus)
o Say ahhh
o Move tongue side to side
 CN XI (Accessory)
o Shrug shoulders with arms on his shoulders
o Turn head against my hand
 CN XII (Hypoglossal)
o Push tongue against fingers on side of mouth
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