DME - OSCE revision

Question 1

DRS ABC.
What is the D stage?

Answer 1

Danger:
Check danger to self, casualty and others e.g. sharps, equipment leads, blood etc.

Question 2

DRS ABC.
What is the R & S stage?

Answer 2

Approach pt and check for Response:
Shake gently by both shoulders, speak loudly into each ear. If they respond, place in recovery position and request urgent medical review.

No response: CALL FOR HELP. Ask helper to stay in the vicinity whilst you assess for signs of life.

Question 3

DRS ABC.
What is the A stage?

Answer 3

Airway:
Open airway using chin lift / head tilt.
Jaw thrust if risk of c-spine injury.
- remove obvious obstruction from airway using forceps and suction where possible.

Dentures left in situ if well fitted - helps maintain structure of face during resuscitation.

Question 4

During the Breathing stage in DRS ABC, which signs of life would you check for?

Answer 4

• Look for chest rise and fall
• Listen for breathing sounds
• Feel for their breathing on side of your face
• Look for signs of perfusion, coughing, limb movement.
• Feeling for body warmth.
• Can palpate carotid pulse simultaneously if you feel confident.
• these checks shouldn’t take longer than 10 secs.

Question 5

What do you do when checking for signs of life where:
- patient is breathing normally and has a pulse?
- No signs of life - no breathing/coughing/movement/pulse

Answer 5

Patient is breathing normally and has a pulse: may need urgent medical attention. Whilst waiting, give oxygen.

No signs of life: send helper for crash trolley. Call 999 - type of arrest: adult/paeds and location. Begin CPR 30:2.

Question 6

At the Circulation stage, where a patient has no signs of life, how is CPR carried out?

Answer 6

Cardiopulmonary resuscitation is carried out with:
1. 30 chest compressions at a rate of 100-120/min.
Depth of 5-6cm (1/3 of the depth of pt’s chest). Carried out on centre of chest, fingers locked together and arms locked out. Press evenly + regularly, keeping body weight over the centre of pts chest.

2 breaths - delivered slowly over approx 1 second.

*Continue until help arrives or feel too exhausted to continue. Continue CPR until AED pads are applied and machine analyses rhythm of heart.

Question 7

What is an automated external defibrillator?

Answer 7

Device that delivers shock to a patient who has had a cardiac arrest.

Question 8

Who is the recovery position for?

Answer 8

For an unconscious but breathing pt.
Placed in recovery position to help maintain their airway & prevents them from choking.

Question 9

How is the recovery position carried out?

Answer 9

• Remove pts glasses, empty keys, mobile phones etc from pts pockets.
• Kneel beside pt, straighten their limbs as long as no obvious injury
• Place arm nearest to you at right angles to their body, below bent, palm uppermost.
• Bring other arm across their chest and hold the back of their hand against their cheek nearest to you.
• Reach across the pt, and with other hand, pull their furthest away knee up into flexed position with foot on the ground. Then pull pt towards you.
• Tilt head back to maintain open airway.
• Check their breathing at regular intervals until assistance arrives & takes over.

Question 10

Define vital signs & give examples.

Answer 10

Measurement of a number of physiological parameters which include temperature, pulse, respiratory rate, blood pressure and oxygen saturation.

Question 11

What is ACVPU?

Answer 11

A- alert – oriented to time and place. Follows commands.

C- confusion that is new / delirium

V- verbal – opens eyes to verbal stimuli (loud voice, shouting)

P- pain – fails to open eyes to verbal stimulus but opens eyes to painful stimuli (pinching earlobe, shaking pt)

Unresponsive – when non-responsive to verbal or pain stimuli. May require call to 999 and active airway management.

Question 12

What are the general considerations before administering a drug?

Answer 12

1. Confirm pt details - name, d.o.b
2. Prescriptions & allergies
3. Explain procedure & gain consent
4. Infection control

Question 13

What is SBARR?

Answer 13

Situation - who’s the pt? / Where are they?

Background - why? What is the main issue?

Assessment - explain current problem. A-E findings.

Recommendations - what have you done so far. Anything else required?

Read-back - Do they have all the info?

Question 14

How is a patient with anaphylaxis symptoms treated?
- red rash, swollen tongue/lips, difficulty breathing.

Answer 14

Administer epipen (adrenaline) to outer thigh. (intramuscular injection).

Question 15

What are the disadv of administering drugs?

Answer 15

Can be harder to take out of pts system

Risk of infection

Question 16

How do you take a patients temperature?

Answer 16

1. Explain procedure to pt
2. Wash hands
3. Need an ear thermometer - apply disposable tip using no touch technique.
4. Turn thermometer on, insert into their ear, whilst pulling ear backwards. Press and release scan button.
5. Remove from ear after bleep, and remove probe cover by pressing release button. Dispose in clinical waste.
   Record temp taken and which ear.

Question 17

How do you record a patients pulse?

Answer 17

1. Explain procedure to pt - need to take their pulse
2. Clean hands with hand gel
3. Palpate pulse for 30 s and x2. If pulse irregular, take for 1 min. (also 1 min if it’s the first time the pt’s pulse has been taken). Assess for rate and rhythm.

Question 18

What is a pulse oximeter?

Answer 18

Device that works out the oxygen saturation in arterial blood by comparing how much red and infra-red is absorbed by the blood and then translates it into a %.

The probe monitors % haemoglobin in arterial blood that is oxygenated. Checks how well oxygenated your blood is.

Question 19

What is the normal arterial oxygen saturation?

Answer 19

96-100%
88-92% in pts with chronic respiratory disease saturations. e.g. COPD

Question 20

What factors can affect accurate oxygen saturation readings?

Answer 20

• Cold extremities may give falsely low readings
• Nail polish should be removed to prevent falsely low readings
• The finger with the probe in situ should be keep still to prevent motion artefact
• High levels of ambient light may interfere the absorption of red in oxygenated blood giving a false result

Question 21

How is the pts respiratory rate taken?

Answer 21

• Try to take when pt unaware e.g. after taking pts pulse, count respiration for 30s whilst continuing to hold the wrist.
• Observe for pattern, abnormalities & depth.

Question 22

How is a patients blood pressure taken?

Answer 22

Need BP cuff, stethoscope and alcohol wipes.

1. Check pts details. Pt should rest for 3-5 mins before BP measured.
2. Explain what you will do and why you need to measure their BP.
3. Wash hands and clean stethoscope. PPE.
4. Sit pt comfortably with their arm supported at heart level, palm facing upwards. Can use a pillow.
5. Apply cuff to upper arm, and ensure bladder of cuff centred over brachial artery. Ensure it is high enough to place diaphragm of stethoscope over brachial artery without it rubbing on the cuff.
6. Palpate radial / brachial pulse.
7. Close valve sphygmomanometer.
8. Inflate cuff until you no longer feel pulse = gives estimated systolic pressure.
9. Deflate cuff entirely.
10. Then place diaphragm of stethoscope over brachial pulse, close valve and re-inflate the cuff to 20-30mmHg above estimated systolic pulse.
11. Slowly deflate cuff at a rate of about 2mmHg/sec. Note systolic pressure on gauge when two consecutive heart beats can be heard. Read to nearest 2mmHg.
12. Deflate cuff, listening for when sounds disappear - this is the diastolic pressure.

Remove cuff, thank pt, remove PPE. Wash hands.

Question 23

How to record pts oxygen saturations?

Answer 23

1. Explain procedure to pt
2. Clean hands with hand gel
3. Pulse oximeter: place probe on index finger

Question 24

How is peak expiratory flow measured?

Answer 24

1. Explain to the patient that you wish to record their peak flow and why. [involves breathing out into a peak flow meter]
2. Ask the patient to stand (ideally) or sit upright.
3. Check that the peak flow monitor has a new, disposable mouthpiece.
4. Check that the gauge on the peak flow monitor is moved to zero.
5. Ask pt to hold monitor horizontally, take a deep breath before blowing as hard & fast as possible into mouthpiece. Lips should completely seal mouthpiece to achieve an accurate reading.
   * Demo to pt, change mouthpiece and ask them to perform same procedure.
6. Ask pt to repeat x3. Record the best of these results.

Question 25

What is choking?

Answer 25

Condition which is often caused by inhalation of a foreign body such as food, that partially or completely obstructs the airway.

Partial obstruction- foreign body can be expelled by coughing.

Question 26

How is a choking pt managed?

Answer 26

• Observe for signs of choking (pt clutching throat, coughing)
  Ask pt are you choking? - if able to vocalise a response: partial obstruction so encourage pt to cough whilst leaning forwards.

If pt unable to vocalise response - obstruction may be complete.
Remove obvious debris from mouth including loose dentures.
Stand to side and slightly behind pt. Support them by placing one arm across their chest and lean them forward.
5 back slaps between their scapulae with heel of your hand. Check their mouth after each back slap for dislodged obstruction.

5 abdominal thrusts - stand behind pt and put arms around upper part of their abdomen. Lean pt forward and with clenched fist, place beneath their sternum. Grab fist with your other hand and pull sharply upwards and inwards to expel air from lungs to dislodge obstruction.

Call 999 if 1 cycle of abdo thrusts fail. Repeat 5 back slaps, 5 abdo thrusts until medical assistance arrives or pt begins to lose consciousness.

CPR if pt becomes unconscious: 30 chest compressions. 2x air.

Question 27

How is blood glucose measured?

Answer 27

1. Introduce yourself to pt. Wash hands. Wear gloves.
2. Check ID - D.O.B
3. Explain procedure to pt.
4. Prime the pen and attach a clean lancet
5. Choose site on the patient’s finger on lateral side (furthest from their thumb)
6. Warn the patient what to expect and prick the side of patient’s finger with the lancet
   * Ask the patient to hang their hand downwards and rub their hand to increase blood flow if necessary
7. “Milk” the patient’s finger to extract a large drop of blood, sufficient to cover the test pad in one go. Hold the test strip in the glucometer against the drop of blood. The strip will draw up the appropriate quantity of blood
8. Whilst the glucometer calculates a reading, apply pressure to puncture site and elevate the patient’s finger. Ensure bleeding has stopped.

Dispose of needle and strip into sharps bin.
Remove gloves and wash hands.

Question 28

What type of injections are there?

Answer 28

1. Intramuscular (deep into muscles)
2. Subcutaneous (under the subcutaneous fat under skin)
3. Intradermal (shallow / superficial into dermis)

Question 29

What type of needles are there?

Answer 29

Orange (25G)- thinnest
Blue (23G)
Green (21G) - thickest.

Question 30

How is an intramuscular injection carried out?

Answer 30

• Introduce yourself to the patient
• Check patient ID: name and DOB
• Explain the procedure and gain consent
• Ask/assist patient to adjust clothing
• Wash hands

Drug:
Check name of drug, the dose, route, time, expiry date, integrity of packaging, diluent if required. Check drug for debris, cloudiness/discolouration in liquid drug.

Equipment: Kidney dish, blunt drawing up filter needle, injection needle, 2ml syringe, gauze swab

-Gloves -> Attach drawing up needle. (Filter needle for glass vial and red topped needle for plastic vial) Holding needle and drug vial vertical at eye level draw up required quantity of medication. Don’t re-sheath needle
-Remove needle by hand and dispose in sharps bin.
- Replace with blue (23G) or green (21G) needle for the patient with more considerable subcutaneous tissue.
- Hold syringe vertically and expel air from syringe and prime needle ensuring correct amount of drug in syringe.
-Choose and expose site. Check for skin integrity and cleanliness. Socially clean skill does not require additional cleaning. Observe for haematoma, hardened skin recent injection site etc. Consider underlying structures and anatomy.
- Warn patient that they will feel a sharp scratch.
- Use thumb and forefinger to slightly stretch subcutaneous tissue.
Insert needle at 90°, swiftly but gently, to approximately 2/3 the needle length, ensuring needle tip is delivering drug to muscle layer.
- Aspirate. If blood is evident remove needle and apply pressure before continuing procedure with clean equipment.
*If no blood is visible, slowly inject drug. More viscous solutions will take longer to administer.
- Remove needle and apply safety needle device cover and dispose into the sharps bin immediately. Press on puncture site with gauze swab. Observe for localised and systemic reaction.
-Dispose of equipment in relevant clinical waste bin.
- Ensure patient is comfortable
-Wash hands and record procedure appropriately

Question 31

How is a subcutaneous injection carried out?

Answer 31

• Introduce yourself to the patient
• Check patient ID: name and DOB
• Explain the procedure and gain consent
• Ask/assist patient to adjust clothing
• Wash hands

Drug:
Check name of drug, the dose, route, time, expiry date, integrity of packaging, diluent if required. Check drug for debris, cloudiness/discolouration in liquid drug.

Equipment: Kidney dish, blunt drawing up filter needle, injection needle, 2ml syringe, gauze swab

-Gloves -> Attach drawing up needle. (Filter needle for glass vial and red topped needle for plastic vial) Holding needle and drug vial vertical at eye level draw up required quantity of medication. Don’t re-sheath needle
-Remove needle by hand and dispose in sharps bin.
- Replace with orange (25G) needle
- Hold syringe vertically and expel air from syringe and prime needle ensuring correct amount of drug in syringe.
-Choose and expose site. Check for skin integrity and cleanliness. Socially clean skill does not require additional cleaning. Observe for haematoma, hardened skin recent injection site etc. Consider underlying structures and anatomy.
- Use thumb and forefinger to pinch up the subcutaneous tissue
- Warn patient that they will feel a sharp scratch.
- Insert needle at 45° degree angle, bevel up, swiftly but gently to approximately 2/3 of needle length, to ensure drug will be delivered into the subcutaneous fat and then slowly inject the drug.

• Aspirate. If blood is evident remove needle and apply pressure before continuing procedure with clean equipment.
  *If no blood is visible, slowly inject drug. More viscous solutions will take longer to administer.
• Remove needle and apply safety needle device cover and dispose into the sharps bin immediately. Don’t apply pressure or rub. Observe for localised and systemic reaction.
  -Dispose of equipment in relevant clinical waste bin.
• Ensure patient is comfortable
  -Wash hands and record procedure appropriately

Question 32

Some subcutaneous injections are available in pre filled syringes, including heparin and insulin and should be injected at ____________.

Answer 32

90° to accommodate the short needle.

Question 33

What type of injection is LA?

Answer 33

an intradermal injection

Question 34

How would you carry out an intradermal injection?

Answer 34

Do checks as above - introduce yourself to pt, wash hands, explain procedure to pt, pt ID, drug contents, expiry etc, gather equipment.

Set up orange 25G needle, expel any air from syringe. Clean skin.

Insert needle at 15 degree angle with bevel up - don’t pinch or stretch skin. Slow injection. Fluid may bleb to form beneath skin - normal process leave it as is. Don’t rub or apply pressure.

Dispose needle into sharps. Ensure pt comfortable. Wash hands. Record notes.

Question 35

What type of injection is used for glucagon administration?
Glucagon - hypoglycaemia

Answer 35

Intramuscular injection using blue (for older pts, or those who are thinner) or green (larger) needle.
90 degrees and flatten skin.
- On gluteus muscle or outer thigh.

Question 36

What type of injection is used for adrenaline administration?

Answer 36

Subcutaneous injection using orange needle.
45 degrees and pinch skin.
- On stomach or arm

Question 37

Before administering a drug, what should be checked?

Answer 37

• Expiry date
• Batch no.
• Dose
• Correct drug
• Right time / pt / route ?

Question 38

When carrying out a cranial exam, what is the introduction process?

Answer 38

Greet patient. Introduce yourself and your role.
Explain what you are going to do and why, and gain consent to proceed with the examination.
Clean your hands.
Ongoing communication- clear instructions and attention to patient’s comfort. Ongoing professional manner.
Examination method is structured and performed fluently and in a logical order.

Question 39

What general observation is carried out prior to cranial exam?

Answer 39

Consider posture, gait and symmetry, and whether there are any abnormal movements. Also note whether the patient is wearing glasses or hearing aids.

Question 40

What are the cranial nerves 1-6?

Answer 40

1. Olfactory (sensory. Involved in smell)
2. Optic (sensory. Involved with vision)
3. Oculomotor (Motor. Helps move eyes and focus. Controls size of pupil in response to light)
4. Trochlear (Motor. Helps move eyes up, down & inwards movements)
5. Abducens (Motor. Helps with outward eye movements e.g. looking to side)
6. Trigeminal (sensory and motor. 3 divisions: opthalmic, maxillary and mandibular. Sensory info of upper middle and lower parts of face. V3- movement of muscles within the jaw and ear).

Question 41

What are the cranial nerves 7-12?

Answer 41

7. Facial nerve (sensory and motor - moves muscles of facial expression, muscles in jaw, provides taste for anterior 2/3 of the tongue, supplies glands in H&N region saliva and tears, sends sensations from outer parts of ear)
8. Vestibulocochlear nerve (sensory - involves hearing and balance)
9. Glossopharyngeal nerve (Enables swallowing, salivation, taste sensation to posterior 1/3 of tongue and sensation to oral cavity.
   Motor- pharyngeal & parotid gland. Sensory - touch & taste, external ear and middle ear cavity, increase secretion from the parotid salivary gland, soft palate).
10. Vagus nerve - motor: supplies heart (slows HR), lungs and upper digestive tract and other chest & abdomen. Sensory: taste sensation to epiglottis & root of tongue, thoracic and abdominal viscera, external acoustic meatus. Controls digestion, HR, RR, reflexes such as coughing, sneezing, swallowing and vomitting.
11. Accessory - movement of head, neck and shoulders. Motor: laryngeal muscles, sternocleidomastoid, trapezius.
12. Hypoglossal nerve (supplies the tongue - Motor: tongue movements - intrinsic & extrinsic tongue muscles.

Question 42

Describe the function of V1,V2 and V3 divisions of Trigeminal nerve.

Answer 42

Ophthalmic- sends sensory information from the upper part of face, including your forehead, scalp, and upper eyelids.

Maxillary- communicates sensory information from the middle part of face, including your cheeks, upper lip, and nasal cavity.

Mandibular- sensory and a motor function. It sends sensory information from ears, lower lip, and chin. It also controls the movement of muscles within jaw and ear.

Question 43

What is the general intro before cranial exam?

Answer 43

1. Wash hands. PPE.
2. Introduce yourself to pt - name and role.
3. Confirm name and D.O.B
4. Explain exam to pt. No jargon.
5. Gain consent.
6. Ask pt to sit on chair - arms length away.
7. Ask pt if they have any pain.

Question 44

After the intro, what general inspections can be made suggesting underlying pathology?

Answer 44

• Speech abnormalities: may indicate glossopharyngeal or vagus nerve pathology.
• Facial asymmetry: suggestive of facial nerve palsy.
• Eyelid abnormalities: ptosis (drooping upper eye lid) may indicate oculomotor nerve pathology.
• Pupillary abnormalities: mydriasis (dilation of pupil) occurs in oculomotor nerve palsy.

Strabismus (lazy eye): may indicate oculomotor, trochlear or abducens nerve palsy.

• Limbs: pay attention to the patient’s arms and legs as they enter the room and take a seat noting any abnormalities (e.g. spasticity, weakness, wasting, tremor, fasciculation (flickering contractions))- which may suggest the presence of a neurological syndrome.

Question 45

What other objects/equipment may provide useful insights into pts MH?

Answer 45

Walking aids: associated with a wide range of neurological pathology including Parkinson’s disease, stroke, cerebellar disease and myasthenia gravis (muscle weakness).

Hearing aids: often worn by patients with vestibulocochlear nerve issues (e.g. Ménière’s disease - vertigo, ringing noises).

Visual aids: the use of visual prisms on glasses or occluders (covering eye/glasses) may indicate underlying strabismus.

Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications.

Question 46

1. How is the olfactory nerve tested?

Answer 46

Screening question - ask pt if they have any problems with sense of smell or noticed any recent changes.

Can test using strong smelling foods like coffee, citrus fruit.

Question 47

What are the 4 aspects of assessment in the optic nerve?
CNII

Answer 47

1. Pupillary reflexes to light and accommodation
2. Visual acuity
3. Visual fields
4. Fundoscopy - visualisation of retina using fundoscopy.

Question 48

How is pupillary reflexes to light and accommodation observed?
CNII

Answer 48

• Size - Pupils get smaller in bright light, and larger in dark light. Usually smaller in infancy and larger in adolescence.

*Shape & symmetry- should be round & symmetrical.
If there was a problem, one would get smaller to light, and other would remain large (the abnormal pupil)

Examples of asymmetry include a large pupil in oculomotor nerve palsy and a small and reactive pupil in Horner’s syndrome (drooping eyelid, constricted pupil, bloodshot eye).

Assessment: direct and consensual pupillary reflexes.
1. Shine light into left pupil (should constrict)
2. Shine light into right pupil whilst looking for constriction on left side. This is consensual light reflex. Check for the opposite side.

Assessment: pupillary accomodation.
1. Hold your index finger approximately 1 metre away from the patient and gradually move it towards their nose. (both pupils should constrict as the eyes converge and accommodate to continue focusing on your finger).

Question 49

How is visual acuity tested?
CNII

Answer 49

Use a Snellen chart. If pt wears glasses, use for exam.

1. Stand the patient at 6 metres from the Snellen chart.
2. Ask the patient to cover one eye and read the lowest line they are able to.
3. Record the lowest line the patient was able to read (e.g. 6/6 (metric) which is equivalent to 20/20 (imperial)).
4. You can have the patient read through a pinhole to see if this improves vision (if vision is improved with a pinhole, it suggests there is a refractive component to the patient’s poor vision).
5. Repeat the above steps with the other eye.

Question 50

How is the visual field assessed in CNII exam?

Answer 50

Tested by checking the patient can detect finger movement in each of the four quadrants of the visual field.

Ask pt to cover one eye. Sit at arms length in front of them. Cover your eye that is directly opposite to their covered eye.

Ask pt to say yes when they see fingers move. Move fingers from periphery of visual field towards the centre.

Question 51

How is CN 3,4 and 6 work synergistically in normal eye movement. How are they assessed?

Answer 51

Start the examination by looking for any asymmetry of eye position at rest, and checking for ptosis (drooping eyelid).

1. Ask pt to follow finger without moving head. Let me know if you start to see double vision.
2. Move your finger along horizontal and vertical planes, then by making a letter H.

In a normal examination eyes will move smoothly and synchronously. Where a cranial nerve abnormality exists the eyes will not move synchronously and this will cause the patient to experience double vision.

Question 52

How is the sensory & motor division of the CNV assessed?

Answer 52

Sensory:
Test light touch sensation using cotton wool in each of the 3 divisions – ophthalmic, maxillary and mandibular divisions, comparing each side to the other. Forehead -> cheek -> chin.

Then test sharp touch sensation using a neurotip.

Motor:
1. Ask pt to clench and feel massater on both sides
2. Pterygoid: Open mouth and don’t let me close it

Question 53

The facial nerve test involves testing of the muscles of facial expression: frontalis, orbicularis oculi, orbicularis oris and buccinators. How is it assessed?

Answer 53

Assess for facial asymmetry *should be symmetrical throughout the exam on both sides.

1. Wash hands. PPE. Check pt details. Explain procedure. Consent.
2. Ask pt to raise eyebrows as high as possible and keep them there, don’t let me push them down.
3. Squeeze your eyes tight and don’t let me open them.
4. Can you show me your teeth? Can you now purse your lips?
5. Can you blow out your cheeks and keep them there.

Question 54

How is the vestibulocochlear nerve assesed?

Answer 54

Ask pt if they have any hearing difficulty.

Then explain that you will whisper a number into each ear in turn and ask them to repeat it. Mask the ear not being tested.

If any hearing difficulty is detected, further testing to distinguish between conductive and sensorineural deafness can be done using Rinne’s test and Weber’s test

Question 55

What is the Rinnes test?

Answer 55

This test uses a tuning fork to ascertain whether bone conduction is louder than air conduction, and therefore is used to measure conductive hearing impairment.

Ring tuning fork, and hold it at the entrance to the external auditory canal (in front of ear) - this is sound A for Air conduction.

Then place the vibrating tuning fork on the bony prominence of the mastoid process (behind ear)– this is sound B for Bone conduction

Then ask which sound your patient perceives as being the loudest.

In normal hearing Rinne’s test is positive, and this is when sound A (air conduction) is louder than sound B (bone conduction)

Rinne’s test is negative in a conductive hearing impairment, making bone conduction louder than air conduction.

Question 56

What is Weber’s Test?

Answer 56

Investigates unilateral hearing impairment.

Place the vibrating tuning fork in the centre of the patient’s forehead and ask whether they hear this equally on both sides, or whether they perceive the sound to be louder in one ear.

In normal hearing sound will be detected equally on both sides.

If the sound localises to one ear it could mean that there is either an ipsilateral conductive hearing loss (which can be confirmed by the findings from a negative Rinne’s Test) or a contralateral sensorineural hearing loss.

Question 57

The Glossopharyngeal & vagus nerves supply sensation & motor control for the muscles controlling movement of the mouth and throat. How are they tested?

Answer 57

Ask your patient to give a cough, and then ask your patient to open their mouth whilst you look at the soft palate. Ask the patient to say ‘aaaah’.

In a normal examination the palate should rise equally on both sides.

Gag reflex: the afferent (sensory) pathway of this reflex is the Glossopharyngeal Nerve. The efferent (motor) pathway of this nerve is the Vagus.
-It is tested when clinically indicated.
Touch the posterior pharynx first to one side, and then the other with a wooden stick – this will cause the palate to rise and the patient to ‘gag’.

Question 58

The accessory nerve supplies the trapezius & sternocleidomastoid muscles. How is it tested?

Answer 58

Test by asking patient to shrug their shoulders and keep them raised whilst you push down to test the strength of the trapezius.

The ask patient to turn their head first to one side and then the other, again asking them to keep this position against resistance to test the strength of the sternocleidomastoid muscles.

In a normal examination movement and power of the muscles should be equal on both sides.

Question 59

The hypoglossal nerve supplies the tongue. How is it tested?

Answer 59

1. Ask pt to stick out their tongue. Observe for wasting or fasciculation (muscle contractions).
2. Ask pt to move tongue side to side. Then ask them to move their tongue into one cheek and keep it there against resistance, then check the other side.

In a normal examination movement and power of the tongue should be equal on both sides.

In an abnormal examination the tongue will deviate towards the side of the lesion, because the inactive fibres will be overpowered by the functioning muscle fibres on the opposite side.