Purple= graded aspect. Always say the cranial nerve number & name!
Red = FNPS script.
(black in parentheses)= patient script.
Sanitize hands. Hello, my name is and I will be assessing you today. I need you sitting up for the exam.
HEAD AND FACE Inspects facial skin – note abnormal lesions; Inspect head for size, symmetry, midline position
I will begin by inspecting your face, and I don't see any discolorations, or any lesions and your head is midline and
symmetrical.
Palpates lymph nodes of the head and neck: Preauricular, Postauricular, Occipital, Tonsillar,
Submandibular, submental, Anterior Cervical, Posterior Cervical, Supraclavicular (verbalize these) PPOTSS AC PC S
I will palpate your lymph nodes. First, I will begin with the preauricular lymph nodes, right in front of the ear, and
postauricular, right behind the ear. Then I will palpate your occipital lymph nodes in the back of the head. And then
I will move forward and palpate your tonsillar lymph nodes.
Come under the jawline, the submandibular lymph nodes, and the submental. Now I will go to the anterior cervical
lymph nodes, and the posterior cervical lymph nodes. And I will end with the supraclavicular lymph nodes right
about the clavicles. I do not feel any enlargement, and they are equal bilaterally
CN 5 (Trigeminal) Motor – palpate over the masseter muscle as patient clenches jaw
I will test the trigeminal nerve, which is cranial nerve number five. It has a motor component, and I will palpate
over the masseter muscle as you clench your jaw. And I don't feel any distortions, and you have great strength
CN 5 (Trigeminal) Sensory – light touch sensation to forehead, cheeks, chin, nose (patient closes eyes)
Now I am testing the sensory portion of the Trigeminal nerve, which is cranial nerve 5. Please close your eyes and
let me know where you feel me touch. Forehead, right cheek, left cheek, chin, nose. You have correctly identified
where you are being touched.
CN 7 (Facial) Inspect for facial symmetry with smile, frown, raise eyebrows, puff cheeks, pucker lips
Next, I will test your facial nerve, which is cranial nerve number seven. And I will ask you to do some facial
expressions. Please begin with a smile, and I see that it is symmetrical. Next, frown for me. OK. Now raise your
eyebrows and go ahead and puff up your cheeks, and I notice they’re equal bilaterally. And now I want you to
pucker your lips, very tight pucker. All of your expressions are bilaterally symmetrical.
EAR Inspect outer ear for skin lesions and symmetry
I’m will inspect your ears for any nodules or any skin lesions. I look at both ears and note that they are symmetrical
without any nodules or lesions. Now I am going to look inside your ear canal with the otoscope.
Inspect auditory canal and TM (using otoscope). Palpate pinnae and tragus for nodules & tenderness.
1
, I'm will pull your auricle up and back. Your external auditory canal is clear, there's no swelling, redness, drainage or
cerumen. The tympanic membrane is pearly gray, and there is no effusion in the middle ear.
I will do the same for your other ear, pull the auricle up and back, looking into the external auditory canal. I see it is
clear without cerumen, swelling, redness, or drainage. Your tympanic membrane is pearly grey, and there's no fluid
in the external auditory canal. You have normal eardrums and ears.
I'm going to palpate your pinna and tragus for any nodules or tenderness. No nodules or tenderness are noted.
CN 8 (Acoustic) Whisper Test (whisper words out of sight, and patient repeats words back) Test one ear at a time!
I will be testing your acoustic nerve, which is cranial nerve number eight, and that is your hearing.
I will be performing a whisper test, so I'm going to ask you to cover one of your ears.
Now, I will stand behind you, cover my mouth, and whisper three words. One, two, three. (One, two, three.)
And let's do the other side. Four, five, six. (Four, five, six.) Your hearing is intact bilaterally.
EYE Inspects sclera and conjunctiva
I will examine your eyes and begin with looking at your conjunctiva. I notice that they're pink and clear, no
drainage or lesions. And I also note that your sclera is white and clear.
CN 2 (Optic) Assess gross visual acuity and peripheral/central vision
Now I'm going to test cranial nerve number two, the optic nerve, and this covers central vision.
And I will use this Snellen eye pocket chart. I'll stand six feet away and ask you to cover one eye.
Now read the lowest line possible. (LTFPH). Repeat with the other eye. (LTFPH). And with both eyes? (LTFPH).
And you have normal vision, 20/20 in the left eye, right eye, and with both eyes.
And now I will check cranial nerve number two, the optic nerve again, covers peripheral vision.
I would like you to stand up, so we are at the same eye level. Please look straight ahead and keep your head still.
First, do you see my hands now? (No.) Let me know when you do. (Yes).
Now I'm going to come from above, do you see them now? (No.) Let me know when you do. (Yes).
Now come from below, do you see them now? (No.) Let me know when you do. (Yes). OK, thank you, and you can
have a seat. Your peripheral vision is normal.
CN 2 (Optic) Check pupillary response to light [PERRL]
Now I'm going to continue and check cranial nerve number two again, the optic nerve, for your pupil response to
light. And I'm using the ophthalmoscope head and turning on my light. And I want you to just stare at my
nose. Now I will come from the side with my light source, and I notice that the pupil constricts, and then I will check
the other eye as well. And your pupils are about two to three millimeters, and they respond to light equally.
CN 3, 4, 6 (Oculomotor, Trochlear, Abducens) Test for conjugate gaze with EOM (Extra Ocular Movement)
Now I will be checking cranial nerves number three, which is the ocular motor, cranial nerve number four, which is
the trochlear, and cranial nerve number six, which is the abducens. And in doing so, I will choose a star or an H
pattern, and this is checking the extraocular muscles of the eye.
So if you will follow my finger, with your eyes only. Thank you, and all EOMs are intact equally.
NOSE Inspect nose midline & straight. Assess nasal turbinates & septum (using light source). Palpates frontal &
maxillary sinuses
Inspecting your nose, I see that it is midline without visible obstruction, fracture, or swelling.
I will insert my speculum of the otoscope inside your nose. And I will tip your nose up with my thumb. And I'll look
inside your left turbinates, and I note pink and moist turbinates without swelling or bogginess and the septum is
midline. I will angle anteriorly, and I see that your septum is straight, there's no deviation.
Let me inspect the other side. Looking at the septum anteriorly, or medially, and I see a straight septum, and the
turbinates are nice and pink, and healthy, there's no swelling or bogginess.
2
Red = FNPS script.
(black in parentheses)= patient script.
Sanitize hands. Hello, my name is and I will be assessing you today. I need you sitting up for the exam.
HEAD AND FACE Inspects facial skin – note abnormal lesions; Inspect head for size, symmetry, midline position
I will begin by inspecting your face, and I don't see any discolorations, or any lesions and your head is midline and
symmetrical.
Palpates lymph nodes of the head and neck: Preauricular, Postauricular, Occipital, Tonsillar,
Submandibular, submental, Anterior Cervical, Posterior Cervical, Supraclavicular (verbalize these) PPOTSS AC PC S
I will palpate your lymph nodes. First, I will begin with the preauricular lymph nodes, right in front of the ear, and
postauricular, right behind the ear. Then I will palpate your occipital lymph nodes in the back of the head. And then
I will move forward and palpate your tonsillar lymph nodes.
Come under the jawline, the submandibular lymph nodes, and the submental. Now I will go to the anterior cervical
lymph nodes, and the posterior cervical lymph nodes. And I will end with the supraclavicular lymph nodes right
about the clavicles. I do not feel any enlargement, and they are equal bilaterally
CN 5 (Trigeminal) Motor – palpate over the masseter muscle as patient clenches jaw
I will test the trigeminal nerve, which is cranial nerve number five. It has a motor component, and I will palpate
over the masseter muscle as you clench your jaw. And I don't feel any distortions, and you have great strength
CN 5 (Trigeminal) Sensory – light touch sensation to forehead, cheeks, chin, nose (patient closes eyes)
Now I am testing the sensory portion of the Trigeminal nerve, which is cranial nerve 5. Please close your eyes and
let me know where you feel me touch. Forehead, right cheek, left cheek, chin, nose. You have correctly identified
where you are being touched.
CN 7 (Facial) Inspect for facial symmetry with smile, frown, raise eyebrows, puff cheeks, pucker lips
Next, I will test your facial nerve, which is cranial nerve number seven. And I will ask you to do some facial
expressions. Please begin with a smile, and I see that it is symmetrical. Next, frown for me. OK. Now raise your
eyebrows and go ahead and puff up your cheeks, and I notice they’re equal bilaterally. And now I want you to
pucker your lips, very tight pucker. All of your expressions are bilaterally symmetrical.
EAR Inspect outer ear for skin lesions and symmetry
I’m will inspect your ears for any nodules or any skin lesions. I look at both ears and note that they are symmetrical
without any nodules or lesions. Now I am going to look inside your ear canal with the otoscope.
Inspect auditory canal and TM (using otoscope). Palpate pinnae and tragus for nodules & tenderness.
1
, I'm will pull your auricle up and back. Your external auditory canal is clear, there's no swelling, redness, drainage or
cerumen. The tympanic membrane is pearly gray, and there is no effusion in the middle ear.
I will do the same for your other ear, pull the auricle up and back, looking into the external auditory canal. I see it is
clear without cerumen, swelling, redness, or drainage. Your tympanic membrane is pearly grey, and there's no fluid
in the external auditory canal. You have normal eardrums and ears.
I'm going to palpate your pinna and tragus for any nodules or tenderness. No nodules or tenderness are noted.
CN 8 (Acoustic) Whisper Test (whisper words out of sight, and patient repeats words back) Test one ear at a time!
I will be testing your acoustic nerve, which is cranial nerve number eight, and that is your hearing.
I will be performing a whisper test, so I'm going to ask you to cover one of your ears.
Now, I will stand behind you, cover my mouth, and whisper three words. One, two, three. (One, two, three.)
And let's do the other side. Four, five, six. (Four, five, six.) Your hearing is intact bilaterally.
EYE Inspects sclera and conjunctiva
I will examine your eyes and begin with looking at your conjunctiva. I notice that they're pink and clear, no
drainage or lesions. And I also note that your sclera is white and clear.
CN 2 (Optic) Assess gross visual acuity and peripheral/central vision
Now I'm going to test cranial nerve number two, the optic nerve, and this covers central vision.
And I will use this Snellen eye pocket chart. I'll stand six feet away and ask you to cover one eye.
Now read the lowest line possible. (LTFPH). Repeat with the other eye. (LTFPH). And with both eyes? (LTFPH).
And you have normal vision, 20/20 in the left eye, right eye, and with both eyes.
And now I will check cranial nerve number two, the optic nerve again, covers peripheral vision.
I would like you to stand up, so we are at the same eye level. Please look straight ahead and keep your head still.
First, do you see my hands now? (No.) Let me know when you do. (Yes).
Now I'm going to come from above, do you see them now? (No.) Let me know when you do. (Yes).
Now come from below, do you see them now? (No.) Let me know when you do. (Yes). OK, thank you, and you can
have a seat. Your peripheral vision is normal.
CN 2 (Optic) Check pupillary response to light [PERRL]
Now I'm going to continue and check cranial nerve number two again, the optic nerve, for your pupil response to
light. And I'm using the ophthalmoscope head and turning on my light. And I want you to just stare at my
nose. Now I will come from the side with my light source, and I notice that the pupil constricts, and then I will check
the other eye as well. And your pupils are about two to three millimeters, and they respond to light equally.
CN 3, 4, 6 (Oculomotor, Trochlear, Abducens) Test for conjugate gaze with EOM (Extra Ocular Movement)
Now I will be checking cranial nerves number three, which is the ocular motor, cranial nerve number four, which is
the trochlear, and cranial nerve number six, which is the abducens. And in doing so, I will choose a star or an H
pattern, and this is checking the extraocular muscles of the eye.
So if you will follow my finger, with your eyes only. Thank you, and all EOMs are intact equally.
NOSE Inspect nose midline & straight. Assess nasal turbinates & septum (using light source). Palpates frontal &
maxillary sinuses
Inspecting your nose, I see that it is midline without visible obstruction, fracture, or swelling.
I will insert my speculum of the otoscope inside your nose. And I will tip your nose up with my thumb. And I'll look
inside your left turbinates, and I note pink and moist turbinates without swelling or bogginess and the septum is
midline. I will angle anteriorly, and I see that your septum is straight, there's no deviation.
Let me inspect the other side. Looking at the septum anteriorly, or medially, and I see a straight septum, and the
turbinates are nice and pink, and healthy, there's no swelling or bogginess.
2
