MLA system examination – Chapter 6

Examiner / observer · 1 of 4

Cranial nerves

Preparation · Initial assessment

Agree supervision and any communication or chaperone support before starting. Agree which nerves are requested. Provide a correctly distanced acuity chart, eye cover, pen torch, 512 Hz tuning fork and sensory equipment; add other equipment only for the agreed task. Do not perform corneal, gag or positional tests on a peer merely to complete the checklist.

St Emlyn’s · MLA · Practice aid, not an official mark schemeObserver 1 of 4

Examiner / observer · 2 of 4

Cranial nerves

Optic nerve · III, IV, VI, V and VII

St Emlyn’s · MLA · Practice aid, not an official mark schemeObserver 2 of 4

Examiner / observer · 3 of 4

Cranial nerves

VIII · IX, X, XI and XII

VIII

Asks about hearing change and tinnitus; considers otoscopy when indicated.

Screens each ear and uses 512 Hz Rinne/Weber tests when appropriate.

Considers Dix–Hallpike only for suitable, safe assessment of brief positional vertigo.

Does not use HINTS independently as an untrained student to exclude stroke. Key step

IX, X, XI and XII

Asks about dysphagia and assesses voice and palatal elevation together.

If gag testing is discussed, identifies IX as mainly afferent and X as efferent; does not use it alone to judge swallowing safety. Key step

Tests shoulder shrug and head turning against resistance on both sides.

Inspects the protruded tongue for wasting or fasciculation and compares strength against each cheek.

Selects any fundus, eye, ear or wider neurological assessment for the findings and brief.

St Emlyn’s · MLA · Practice aid, not an official mark schemeObserver 3 of 4

Examiner / observer · 4 of 4

Cranial nerves

Close

Restores comfort and privacy, offers help with dressing and thanks the patient.

Ask the candidate

How would you present your findings and their significance? Describe abnormalities and whether they fit a single nerve, several nerves or a wider pattern. State uncertainty and appropriate further assessment; acute focal or central/uncertain vestibular findings require urgent review.

What would you do next, and why? Explain the important uncertainty, a relevant next assessment and when help is needed. State what you could not assess.

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St Emlyn’s · MLA · Practice aid, not an official mark schemeObserver 4 of 4

Cranial nerves

Your task

Starting information

Cranial nerves

Cranial nerves

Preparation

Initial assessment

Cranial nerves

Optic nerve

III, IV, VI, V and VII

Cranial nerves

VIII

IX, X, XI and XII

Cranial nerves

Close

Ask the candidate

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