[ASMR] Real Person Cranial Nerve Examination (Medical Exam Roleplay)

Hi there, welcome back

Hi, how are you?

Good. How can I help you today?

I basically hit the back of my head

last night, and so I thought I would

come in for a check up

What time last night did you...

It was around 4:30am

4:30am? Okay

Ya, I'm sorry to hear that

but we can definitely get it fully

checked out for you

Can you tell me more about what happened?

So I wanted to go to the kitchen

to grab some water and

it was dark, so while I was getting up

I hit the back of my head on my headboard

You hit it pretty hard? - Yes

What happened after?

What were your symptoms?

I felt pretty dizzy and

the pain was really painful

Where was it painful?

Right over here

Right back here? - Yes

In the beginning, how painful

would you say it was from 1 to 10?

1 being very little pain and 10

being the most pain that you've ever had

I would say around 6

Did you have any loss of consciousness?

Any memory loss at that time?

No, just feeling really dizzy

Are you dizzy now?

Now I'm not, but I do have a

pounding headache

The headache from 1 to 10

how would you rate it?

I would say it's a 6.5

When did this headache start?

It started... I think around 2pm

after lunch

So was it pretty gradual then?

Or would you say... Ya, okay

Alright

When the headache first started

how bad was it?

I would say it was around 7

7 at 2pm

Now it's around 5pm so

A little bit better than before? Okay

Are you feeling okay right now?

Do you wanna lie down?

Ya, I'm not dizzy or anything

I just... my head just hurts

Just the headache, okay

Have you ever had a head injury

like this before?

I haven't, no

Have you had any nausea or vomitting

since the incident?

I did feel nauseous

but I haven't vomited

When did you feel nauseous?

I felt nauseous around an hour after

I hit my head

So around 5 - 5am

Or 5:30 rather

Right now or even back then

did you have any blurred vision

any sensitivity to sound or to light?

I would say sensitivity to light

Definitely get that checked out

But no blurred vision - No

Any confusion? - No

You said no memory loss and

no loss of consciousness, that's all good

Have you had any seizures? - No

How is your mood right now?

Are you feeling any anxiety, irritability

or depression?

I do feel a little bit of irritability

just because my head does hurt

For sure, that's understandable

Are you feeling fatigued? - Ya

From 1 to 10, how would you rate it?

A 5 - 5 out of 10 fatigue, okay

Are there any other symptoms

that I should know about?

Such as slurred speech for example

No, no other symptoms

Alright

I'm gonna go ahead and get started

with your physical exams

Do you have any questions for me

before we get started? - No

Just putting on a new cover slip here

So I want you to put that in your mouth

under your tongue, close your mouth

Good, you can hold onto that

Just gonna take your pulse

Take a look

Temperature's normal, no fever

Gonna take your blood pressure

Just gonna go around your arm

Please raise your hand

and pump your fist 10 times for me

Just relax your hand, good

Blood pressure's a little low

but that might just be normal for you

So I'm gonna start by

inspecting your scalp okay

So... checking the temporal arteries

are not enlarged, so that's good

Come on this side

Just feeling for any enlargements

swelling - It hurts

Right back here? - Mhmhm

I'm just gonna percuss as well

Let me know if you feel any pain

Ya - Back there? Okay

On this side

Back here as well? - Mhmhmm

And here? - Ya

What about down here? - A little bit

Alright, can you please turn around?

So I'm just going to check your neck

see if there's any pain along

the vertebrae

Let me know, any pain? Tenderness?

No?

A little bit tender just cause

my neck

Just trying to see if you've injured

any part of your spine at all

Which it doesn't seem like there's...

If there was, you would be

screaming right now

We're gonna do some range of motion

Can you... Ya, go as far as you can, good

This way. Let me know if you feel any discomfort

Then come back

Is that okay? - Mhmhmm

Other way, forward

Good. Now rotate towards this hand

Okay, back

Okay, you can turn back around

Just inspecting the rest of your face

I don't see any pallor

No toxic appearance

Just checking your skin to see

if you've injured any other parts of you

Do you notice any other part

that's injured? - No

I also want to take a look back here too

to see if there's any

what we call the battle sign

which is bruising and hemorrhaging there

Which can suggest baseless skull fracture

You don't have that

Take a look at your eyes as well

Okay, good

So I'm going to do a few things to

assess your cognitive abilities right now

I want you to remember 3 words

bed, phone, and time okay?

I'm gonna ask you a few questions right now

Do you know what time it is?

It's around 5? - Okay, good

Do you know where we are?

Doctor's office - Good

What is your career?

I work in marketing

Why are you here?

I hit my head last night and

I have a pretty bad headache

because of it - Okay perfect

Alright, do you remember those 3 words

from earlier?

Bed, and then phone, time

Perfect

Now we're gonna start

what is called the cranial nerve exam

Have you heard of it before?

No I haven't

So basically we're assessing

12 cranial nerves

that are within your skull

Just to see if your injury has impacted or

caused any lesions of those nerves ok?

Any problems with that at all

So I want you to close your eyes please

I'm going to bring a scent near your nose

and just let me know what you smell ok?

Sort of a citrus scent

Perfect, it's grapefruit

Keep your eyes closed, 2nd smell

What's that?

Is it peppermint? - Mhmhmm, perfect

You can open up your eyes now

The next test we're doing is

for the optic nerve

So I'm gonna test your visual acuity

Can you please cover this eye over here? Good

Then, we're just going to have you

read the lowest line that you can

So can you read the lowest line here?

4 2 8 7 3 9

And the arrows

or the directions

E W M

Perfect, and then the

O O X

Perfect. Can you switch to the other eye

and read the same line backwards

X O O M W E

9 3 7 8 2 4

Perfect, so you have 20/20 vision

Very good

I'm just gonna check your eyes really quick

Just look straight ahead please

Just making sure that it's able to

constrict, also gonna check your...

Look straight ahead again

This side

Good

No problems there

Now we're gonna do a peripheral visual test

So can you just turn a little bit

towards me? Good

So I'm gonna have you cover this eye, yup

and look straight into my eye

Let me know when you can see

my wiggling fingers

Yup

Keep the same eye

Look straight in my eye

Let me know when you can see it

Good, let's switch to the other eye

Look straight into my eye again

Let me know when you can see it

Yup

No, look into my eye, one more time

Yup - Good

So for olfactory and optic nerve

are both working very well

We're gonna move on to

oculomotor trochlear and abducens

For this one, we're doing a H test

So I want you to look

right at the tip of my pen here

Don't move your head

Just move your eyes

Checking to see if there's any

nystagmus, any lag

which I don't see any...

Very good

Next we're gonna check your

5th cranial nerve

So for this one, I'm actually gonna have

you move your jaw, so

I'm gonna have you move your jaw like this

So resist against this hand here

Good, other way

and down, perfect, good

Up here as well

Can you clench your teeth?

Clench your teeth

Very good, relax

The next one is going to be sensory

So it's gonna be a little bit complicated

but basically this is what

you're supposed to feel

So this will be light

Just say light and this is sharp

That's sharp

So I'm gonna put that on

different parts of your face

You're gonna point at it

and tell me whether it's light

or sharp

Do I close my eyes?

Close your eyes

Light

Can you point out where I...? Perfect

Sharp - Good

Light - Good

Sharp - Good

Light - Great

You can open up your eyes

So cranial nerve #5 is intact

Doing well

Next we're gonna do a couple of facial

expressions for the facial nerve

I want you first to raise your eyebrows

like this, good

I want you to close your eyes

as shut as possible, don't let me open them

Show your teeth, good

Puff out your cheeks

Very good

Next is the auditory nerve

So for this one, I'm testing your hearing ok?

I'm gonna whisper a 2 syllable word

on each side

When I whisper on this side

you have to close this side ok?

Or I can do it for you actually

You're just gonna tell me what you hear

Apple - Apple

Baseball - Baseball

Very good

For this one, I'm going to strike

the tuning fork

Put it up here and you're gonna

let me know which ear you

hear it in first or both at the same time

This one

Let's try that again

This one - That one? Okay

Right, now we're gonna do

the Rinne test

So what I'm gonna do is put this

Actually, just need to move

your hair slightly

We're gonna put the tuning fork

on your mastoid process

Let me know when you stop hearing the sound

and I'll bring it forward

Let me know when you hear it

when you stop hearing it okay?

Please close your eyes

I can hear it

Let me know when you stop hearing it

Stopped

Do you hear it?

Let me know when you stop hearing it

Stopped - Good

Other side

Do you hear it?

Let me know when you stop hearing it

Stopped

Do you hear it?

Let me know when you stop hearing it

Stopped - Very good

Auditory function is great

For the next one, I'm just gonna have you

say "ahh" and I'm gonna look inside ok?

Open up your mouth

Say "ahhh"

Very good, uvula is in midline

Your soft palate was able to

rise symmetrically as well

Now I want to see you swallow for me

Ya actually, ya you can go ahead

and swallow, very good

No hoarseness or nasal quality

Swallow are both symmetrical

Uvula midline

Soft palate symmetrical rise

Good

Next we're gonna do the

spinal accessory nerve

So for this one, I'm gonna have you

actually turn your neck into my hand

Like turn your head into my hand, like this

as hard as you can, a bit more

Very good, other one

This side

Very good

Now I want you to...

I'm actually just gonna palpate first

if there's any atrophy

Then please shrug into my hands

Very good, okay you can relax

The final test

I'm gonna be checking for your tongue function

So please open up your mouth

and bring your tongue from side to side

And up

On your... the roof of your mouth

and down, very good

So that was hypoglossal nerve

Doing very well

I'm gonna check for your coordination

For this one, I want you to do rapid

hand movements like this

as fast as you can okay?

Faster

Very good

Now you're gonna do...

You're gonna touch your nose with your

index finger and then touch my finger

and go back and forth as fast as you can

Okay, good

You can look at my finger too

Other side

Very good

Great cerebellar function

I'm gonna check a few of your

deep tendon reflexes

Gonna check this one here

So just relax

Relax as much as you can

Relax right into me, good

Other side

Relax right into... More, good

Very good

This way

Good

Just relax as much as you can

Very good

Then I'm just going to lower this slightly

Just relax again

Very good

So I'm going to be checking

some of your myotomes

so your muscles

I've already checked this one up here so

if you can please resist into my hands

Very good

Then back into my hands, good

Resist up here, so like this

Then resist, good

And down, very good

Grab my fingers

Squeeze as tight as you can

Very good

Press into my hands

Press into my hands up here

So press into my hands with your big toe

Press into my hands again, down

Very good

Alright, so I've completed all of your exams

Do you have any questions for me?

No, I don't

So with the exams, I've noticed that you

don't have any abnormalities of your

cranial nerves

All of the exams came back negative

The only thing I found was that you

were having that pain back here

on percussion and palpation, okay?

Also because you're having dizziness

you're having a headache and you felt

a bit faint at first as well

There might be a minor concussion

but it's definitely not a severe head injury

So what I prescribe for you right now is

as much rest as possible

Don't do anything that's mentally exerting

Don't watch TV, try to limit your screen time

reading, any of that

Just kind of lie down and

just try to relax for the next 2 days

Then we're gonna follow up after that

In the meantime, I'll give you a

prescription for pain medication

for your headache okay?

Alright, do you have any other questions?

No, thank you very much

No problem

I'll be right back with the prescription okay?

Sure