Clinical Skills Formative/Summative: CNS

Physical Exam

1. Test for orientation by asking patient the following questions:

a. Who are you?
b. Where are you now?
c. What is todays date?

2. Test for short-term memory by asking patient to remember (3) words and
repeat later in the examination.
a. House
b. Rock
c. Horse

3. Cranial Nerves
a. CNI:
i. Ask for changes in smell (eg, anosmia)
ii. Have pt. to close eyes and place an opened alcohol swab near
the pts. nose. Ask the pt. to recognize the smell.
b. CN II:
i. Snellen Chart
ii. Have pt. to cover one eye and ask for quantity of finger before
patient (repeat with other eye)
iii. Pupillary Light Reflex
iv. Fondo de Ojo
c. CN III, IV, VI: Have patient rotate eyes (following your hand
movements) by forming an H
d. CN V: Have patient close eyes and evaluate sensation of 6 points on
face.
Ask: Lo siente?, Donde? Similar la
i. Forehead
sensacin bilateral?
ii. Cheeks
iii. Chin
e. CN VII: Have patient do the following (very helpful to simulate the
movements for patients):
i. Clench mandible and feel jaw
ii. Smile
iii. Frown
iv. Lift Eye Brows
v. Puff Cheeks
f. CN VIII:
i. Rub fingers next to patients ears with patients eyes closed and
ask if he can hear that (bilaterally)
ii. Tuning Fork Exam (Ask patient to indicate when they do not
hear vibration)
1. Weber:
 a. Top of head or forehead
b. Both ears? If felt = good hearing
2. Rhianne: Have tuning fork vibrate in air and place in
mastoid process to test for conduction.
a. Bilaterally
b. Ask patient if felt or heard?
g. CN IX, X, XII: Have patient do the following:
i. Pull tongue out
ii. Move tongue side to side or say La-la-la
iii. Evaluate Uvula (with penlight)
h. CN XI: Have patient do the following movements:
i. Shrug shoulders bilaterally
ii. Shrug shoulders with resistance
iii. Turn head Rt and Lt
iv. Turn head Rt and Lt w/ resistance

4. Reflexes (We must complete 1 upper extremity and 1 lower extremity)

a. Upper extremities: Biceps or triceps bilaterally
b. Lower extremities: Patellar

5. Sensation (We do not have to do both dull and sharp as long as patient
indicates sensation)
a. Upper extremities: Ask patient if it felt the same and exact location
where it was felt.
b. Lower extremities: Ask patient if it felt the same and exact location
where it was felt.
Both dull and sharp exams must be done on patients with Diabetes or Guillen-
Barre including tuning fork exam on fingers and toes.

6. Cardiovascular Exam (Complete this with both bell and diaphragm and
ALWAYS begin at aortic valve)
a. Aortic Valve
b. Pulmonary Valve
c. Tricuspid Valve
d. Mitral Valve

7. Carotids
a. Palpate
b. Auscultate (using bell)

8. Pulmonary Exam (If time complete this auscultation as well)

9. Pulse (Bilaterally and 5 seconds)

a. Upper extremities: Radial
b. Lower extremities: Pedal or Popliteal
10. Coordination (Used to confirm Parkinsons Diagnosis)
a. Ask patient to extend arms and pronate/supinate
b. Ask patient to place hands on legs and pronate/supinate

11. Strength and Resistance: (Choose only one on legs)

a. Arms
b. Finger Abduction
c. Fingers to thumbs (adduction)
d. Thumbs (*** Very important)
e. Thighs
f. Legs** (Preferred on camera)
g. Feet

12. Balance (Have patient stand and complete the following exams)
a. Stand up straight
b. Walk on toes
c. Walk on heels
d. Romberg Sign: stand behind patient, if they have good balance they
should be able to support while extending their arms and closing eyes.
e. Have patient join feet and try to balance with closed eyes

13. Babinski sign (Tell patient what you will be doing to them)
a. Sharp object to foot
b. Heel to toes and around
c. Bilaterally

14. Cerebellar Function:

a. Finger to nose with eyes open (Finger can be moving)
b. Finger to nose with eyes closed

15. Ask patient to recall (3) words.

Diagnostic Exams to perform:

CT
MRI
EEG
EKG

DONT FORGET TO ADVICE PATIENT ON ANY HARMFUL

HABITS THEY MAY HAVE!