This is a hot case where the candidate is led to a random patient, and asked to "examine their neurological system".
The key to success is to look like you've done it before. Therefore, the candidate is expected to produce a series of smooth dance steps.
A suggestion made by an ex-examiner is as follows:
- Start by asking whether there is a language barrier.
- Observe the respiratory pattern.
- Start with the GCS. In the completely unconscious patient, you should ask before inflicting pain.
- Next, ask whether anything precludes you from moving the neck. Check for neck stiffness.
- Then, start with the cranial nerves.
- CN II and III: pupillary reflex
- CN III and V: corneal reflex
- CN III, IV, VI: note any gaze deviation
- CN VII: painful stimulus over the orbit
- CN VII: oculocephalic or caloric reflex
- CN IX and X: gag reflex, cough reflex
- CN XII, tongue fasciculation
- Then, go on to examining the rest of the neurological system:
- Observe the exposed patient
- Power (may have to inflict pain again)