MCU College of Medicine

Clinical Neuroanatomy
Department of Human Anatomy
Section of Neuroanatomy Clinical Skills Demo and Return-Demo
AY 2018-2019

STUDENTS’ GUIDE on
Clinical Skills – Cranial Nerve Testing (CN I to VI)
Objectives of the activity:
1. To introduce the clinical application of one’s knowledge on the anatomy and functions of the first six cranial nerves
2. To guide the students during the practice on doing the neurological examination of the cranial nerves
3. To provide a venue for the faculty to give feedbacks on the actual students’ performance on a specific task to be performed
Instructions to the Students:
1. Please read the content of this guide prior to the actual activity. One may refer to the standard references for further skills
refinement.
2. During the Demo:
- The faculty staff will demonstrate the technique of cranial nerve (first 6 CN) testing to the entire class (or by group) with a
normal subject/volunteer student
- Emphasis will be made on the uniformity of the performance of the clinical task/ technique for standardization
- Queries may be asked and will be entertained by the faculty
3. During the Return-demo:
- You will be grouped and the tasks will be performed among yourselves
- Please observe a specific time frame for the performance of each segment of the clinical skills
- Make use of the “guide” below for the standard procedures; variations of the techniques may be noted
- The faculty will constantly check on the return-demo and your group will given feedbacks
4. A separate date for the evaluation of the clinical skills is in place (check on the schedule of activities). During the separate
evaluation activity, students will be evaluated by the assigned faculty staff based on the parameters of the EVALUATION
FORM for Clinical Skills (attached). Absent student (unexcused) will be given a score of zero.

Groupings for the Demo-Return Demo Activity

Section 1
GROUP I – Dr. Taplac GROUP III – Dr. C. Gironella
1. ACHONDO, CARLOS JR. D. 1. DHAKAL, PRATIK
2. ACTTANASIRI, KETSARA NA 2. DICIEMBRE, DANICA JILL E.
3. ADIL, FATHIMATH LOONA 3. DKHAR, UNIKIE ELIZABETH
4. AGRAAN, SHANE MOLYN V. 4. DSA, CAROLYN DORIS
5. ALANO, KATHLEEN MARTIE A. 5. DURANA, CHIARI EMILIE I.
6. ALBA, REMAR DE LA CRUZ 6. EMPAYNADO, AIRA LOUISE E.
7. ANZURES, YELENA C. 7. FADRIQUELAN, SHAIRYLL QUEENIE
8. APALISOK, MEGGYROSE DIOKNO 8. FALCULAN, CARY V.
9. ARAYA, EDERLYN P. 9. FEUDO, ANNE CLAIRE F.
10. ARCIAGA, FRANCES GELINE R. 10. FREAL, CHRISLEN M
11. ARENQUE, MARY ROLHALANE 11. FULE, JENNILYN G.
12. AROCENA, MELSERGIO T. 12. GUPTA, ANKIT KUMAR
13. ASUNCION, EDUARDO M. 13. JADAV, USHA ASHOKBHAI
14. AVAIYA, PRIJESH ASHOKBHAI 14. JAYANCHANDRAN, GUNASEKARAN
15. AVENA, KATRINA LAWENKO 15. JOSE, MATHEW
16. BADIOLA, MICHAEL IAN D. 16. KAMERKAR, MANALI
17. BANTA, ROLAND 17. KANANI, PANKTI JAYESH
18. KAUR, PARDEEP
19. KAUSHAL, OJASVI
GROUP II – Dr. Gonzales GROUP IV – Dr. Difuntorum
1.
2.
BERNABE, RONALIE L.
BLACK, DWIGHT JOSLIN R. 1. KHAN, SAMAR
3.
4.
BORJE, MA. KLARIZE ALEXANDRIA
CAOILE, CHRISTIAN MAREVICK D.
2. LALANI, AZIM AMIRALI
5.
6.
CARAG, NELIE ANN B.
CASTILLO, CHARISSA CLAUDINE F
3. LAMUG, BEVERLY GRACE A.
4. LASTIMOSA, JANINA N.
7. CASTRENCE, MARGARET JANE T.
8. CASTRO, LEN MARIZ D. 2. LEPON, LUCERNIE M.
9. CHARLES, PRIYAKUMARAN
10. CHAUDARI, SARANG MAGHABHAI 3. MADDATU, LYANE R.
11.
12.
CHONGTHAM, SIDHARTH
CHUA, ARIEL ANASTASIA G. 4. MADRIDANO, JAKE STEVEN J.
13.
14.
CRUZ, JAZMINE ALAINE T.
CRUZ, LAREZA JEAN D.
5. MAGDAEL, NATHANIEL VON R.
15.
16.
DE JESUS, JEJOMAR J.
DELA CRUZ, GAUDINE AIRIEL S.
6. MAHITHIPHARK, CHARLENE

17. DELA CRUZ, ROMELIZA ANN L. 7. MAITI, SUBHENDU

18. DESAI, RUTVIJ ATUL
19. DEY, SOUMAMITRA 8. MALILAY, AIRAM

9. MANUBAY, ANTONIO

10. MANALILI, MARIA

11. MANALO, XIEN

12. MANGLA, ANNIE

13. PATEL, ARPIT

14. PATEL, MAULIK

15. PATIL, HIMANI

16. SALVADOR, KRISTINE

Section 2
GROUP I – Dr. Taplac GROUP III – Dr. C. Gironella
1. BHATTAMISHRA, KAUSTUV 1. SAMEEH, ABDUL
2. CHAUDARY, RAJAN HARISHKUMAR 2. SANTOS, ERROLYN NERISSE R.
3. DUTT, SOHAN 3. SANTOS, SHEILA MARIE S.
4. HADIYA, PRATIK GIRISHBHAI 4. SEHGAL, MUSKAN
5. KAUSHIK, HARSHIT 5. SEÑADO, JUAN MIGUEL D.
6. MASOOD, ILYA 6. SEPULVEDA, PATRICIA, MAE S.
7. MATAGA, CONRADO VIZCARRA 7. SHAH, ARIHA NARESHKUMAR
8. MENDOZA, CLARISSE MELODY C. 8. SINGH, PRASHANT MANOJ
9. MERCADO, ENRIQUE, MIGUEL T. 9. SINGH, ROHIT KUMAR
10. MERIÑO, WILBERT PAOLO R. 10. SIO, ANNE PATRICIA S.
11. MOJICA, KIZER LYAN U. 11. SUAREZ, SHARLENE CELESTINE M.
12. MORALES, MARIELLE H. 12. SUTNGA, DAUNIJIEDMI
13. NAPIZA, PATRICK R. 13. TABARANGAO, AVEGAIL P.
14. NARAG, FRAN CHESTER D. 14. TAMSE, ROWEN MIKHAIL V.
15. OBNIAL, CHRISTIAN FLOYD T. 15. TAN, JOSEPH GINO F.
16. OLFINDO, HANNAH IZABELLA L. 16. TAN, KRISTEN AUDREY G.
GROUP II – Dr. Gonzales GROUP IV – Dr. Difuntorum
1. OPUR, YUNNI GRACELLA 1. TANCHUICO, MA. ANNE PAULINE C.
2. OSTAN, FROILAND SIAOTONG 2. TRINIDAD, REGIE A.
3. PACHECO, ISOLINA CLEIDE SIRIA 3. UMALI, CATHERINE JOY N.
4. PAME, SUIYILE 4. VALENTON, TONI KLIA A.
 5. PANDA, RAHIL 5. VENTURA, RAYMART J.
6. PAREDES, ART CYRIL G. 6. VILLANUEVA, JOAN M.
7. PESUEÑA, ANGELICA BEATRICE C. 7. VILLANUEVA, MARIA DIANA CECILIA
8. PINEDA, ADRIAN RENZ R. 8. VILLANUEVA, MARIUS PAUL L.
9. RAFANAN, LADY MARGARET C. 9. VILLAROSA, ALYSSA NICOLE M.
10. RENTILLO, SHEILDZ D. 10. VILLORIA, JOHN NICHOLAS NOEL L.
11. RIFGA, FATHMATH 11. VINLUAN, DANICA MARIE C.
12. ROSIMO, EZEKIEL T. 12. VIRANI, MEET PRAKASHBHAI
13. RUFINO, ARIANNE C. 13. VIROLA, CARL ARVI T.
14. SADANG, RENZO LOU D. 14. VISTAN, PAOLO MIGUEL M
15. SAKSHI, SIMONA 15. YADAV, YOGESH
16. SALONGA, GABRIEL LOUIS C.

The Cranial Nerve Testing (CN I to VI)

Task: Neurological evaluation of cranial nerves I to VI
Materials needed: Test agents (eg. coffee, tobacco) in opaque bottles/small containers; Wisp of cotton or tissue paper (for trigeminal
fine touch testing); Disposable pin or tongue depressor (for trigeminal pain testing)

Cranial Nerve I—Olfactory Nerve

Procedure:
1. After explaining to the subject what you intend to perform, check first for any nasal obstruction; be sure that each nasal passage is
patent/functional by compressing one side of the nose and asking the patient/subject to sniff through the other
2. Instruct the subject/patient to close both eyes and compress one nostril
3. Using an opaque vial of aromatic non-irritating material (e.g. coffee or tobacco), hold aromatic substance in front of subject’s open nostril and ask
the him/her to sniff and wait for the him/her to “perceive” and “identify” the material
4. Instruct the subject to compress the opposite nostril and present “no stimulus” (or a different scent) to the subject’s open nostril; this is to check for
the authenticity of the patient’s response
5. Present the aromatic material to the previously untested nostril and asked the subject to sniff; wait for him/her to perceive and identify the material

Cranial Nerve II – Optic Nerve (emphasis will only be on the Gross Confrontational
Test)
Procedure:
1. Explain to the subject the procedure to be done; confront the patient by standing
approximately 50 cm (~20 inches) away in front of the subject, instruct the him/her to look
directly into the your (examiner’s) eye (eye to eye). For screening purposes, you may test
the visual fields without covering any of the subject’s eye
2. Option may include examination of the visual fields of the eyes separately, as follows: start
with your left eye directly in line with the patient’s right eye; the subject covers his/her left
eye with the left hand
3. Hold up your fingers just outside your own peripheral field, hold your fingers equidistant
between your eye and the patient’s
4. Ideally the finger should extend beyond the perimeter of the field. Wiggle the finger slowly
and move it very slowly toward the central field
5. Request the patient to say “ NOW” (or point at the wiggling finger) as soon as he/she sees your wiggling finger. Try to match the perimeter of the
patient’s visual field against your own
6. Test all visual field quadrants of each eye separately, each time starting at the limit of the field

Cranial Nerves III, IV, and VI – Oculomotor, Trochlear and Abducens nerves (Testing for Extraocular muscle movements)
Procedure:
1. Explain to the subject the procedure to be done; observe and note if ptosis/eyelid drooping is present
2. Prior to examination of range of movement of the extraocular muscles, explain to the subject that he/she has to follow your finger (or much better,
a pen) using only his/her eyes without moving the head
3. Establish propioceptive link (hold subject’s head to avoid movement)
4. Ask the subject to follow you finger/pencil as you sweep through the six cardinal directions of gaze. Please refer to the image at side for your
guidance on the cardinal movements.
5. Making a wide H in the air, lead the patient’s gaze (1) to the patient’s extreme right, (2) to the right and upward, and (3) down on the right; then (4)
without pausing in the middle, to the extreme left, (5) to the left and upward, and (6) down on the left.

Cranial Nerve V – Trigeminal Nerve

A. Sensory - Testing for Fine Touch (using a wisp of cotton or tip of a tissue paper)
1. After explaining to the subject what you intend to perform, ask him/her to close his/her eyes during the
sensory testing
2. Using a wisp of cotton or tip of a tissue paper, lightly touch the subject’s/patient’s face per division
(ophthalmic, maxillary, and mandibular) of the trigeminal nerve; compare the right with the left fine touch
perception- check for symmetry (assess equal perception per corresponding division of the trigeminal
nerve)

B. Sensory - Testing for Pain (using a freshly fractured/broken tongue depressor; disposable
sharp-edged object)
1. Instruct the subject that you will apply something uncomfortable on his/her face and ask him/her whether it is sharp or dull
2. Follow the testing of the distributions of the trigeminal (as in the testing for fine touch); always check for symmetry

C. Motor Function Testing

1. After explaining to the subject what you intend to perform, inspect first the subject’s temporalis and masseter muscles; look for asymmetry or
atrophy of the muscles
2. Ask the subject to open and close his/her mouth and move the jaw from side to side to check for asymmetry/deviation
3. Palpate both of the subject’s masseters “simultaneously” while asking the him/her to clench the teeth strongly and unclench them
4. Ask the subject to forcefully open jaw on resistance; ask the subject to move the jaw from side to side on resistance
 Manila Central University
College of Medicine
Department of Human Anatomy
Section of Neuroanatomy
AY 2018-2019

EVALUATION TOOL
RATING SCALE FOR CLINICAL SKILLS
Topic: Cranial Nerve Testing (Cranial Nerves I to VI)
Instructions to the Evaluator:
1. Read the components of the evaluation tool below and assess the performance of individual students on the assigned
task (GLOBAL ASSESSMENT)
2. Flexibility on the scoring of the performance per parameter may be allowed based on the prudent judgement of the
evaluator; allow 1-2 minutes to accomplish the entire task per student
3. Absent student (unexcused) must be given a score of zero (0)

Needs Fair Good Very Good Outstanding EXCELLENT

improvement

Score: 75 and Score: 76-80 Score: 81-85 Score: 86-90 Score: 91-95 Score: 96-100
below

 Positioning  Positioning of  Positioning of  Positioned the  Positioned the  Positioning of

of the the subject is the subject is subject subject the subject is
subject is awkward enough but properly and correctly and perfect
improper uncomfortable comfortably comfortably
 Performed the  Performed the  Performed the
Performanc  Performance task/techniqu task/techniqu  Performed the  Performed the task/technique
e of the task or e haphazardly e with minimal task/techniqu task/techniqu precisely
parameters technique is and with error/s or e correctly e accurately without
not error/s or omission/s withoutl without error/s error/s;
acceptable omission/s error/s or Perfect
 Accomplished omission/s performance
 Accomplished the  Accomplished
 Did not the task/procedur  Accomplished the  Accomplished
accomplish task/procedur e within the the task/procedur the
the e just within time limit task/procedur e within the task/procedur
task/procedu the time limit e within the time limit e within the
re within the time limit time limit and
time limit with great
confidence

Students Score Students Score

Faculty: ____________________________________ Signature:
____________________________

Date of Evaluation: __________________________