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Home / Complete focused neurologic examination
11-minute physical-examination master page

Complete focused neurologic examination

Perform a focused neurologic examination efficiently, localize an acute deficit, recognize stroke mimics, communicate findings clearly and activate time-critical care without delaying imaging.

Candidate instructions

Sudden focal weakness — focused neurologic examination

Your task

Perform a focused neurologic examination on a 67-year-old patient with sudden right-sided weakness and speech difficulty. At the end, localize the lesion, state the leading diagnosis and dangerous alternatives, and explain your immediate investigations and management. You have 11 minutes.

Information available at entry
HR 88/min irregularBP 176/94 mm HgRR 18/minSpO₂ 97% room airGlucose 6.8 mmol/L
Safety priority: Confirm ABC stability and bedside glucose immediately. If stroke is suspected, establish the exact last-known-well time and activate the stroke pathway early; do not delay urgent CT/vascular imaging to finish a lengthy neurologic examination.

What examiners expect

  • Introduction, identity check, explanation, consent and hand hygiene.
  • Immediate assessment of consciousness, airway/breathing/circulation and glucose.
  • Brief higher-function and speech assessment.
  • Cranial-nerve screen focused on pupils, visual fields, eye movements and facial asymmetry.
  • Motor examination comparing tone, power and pronator drift side-to-side.
  • Focused sensory, coordination and neglect testing.
  • Gait only if safe and clinically appropriate.
  • Clear localization, stroke differential, urgent imaging and reperfusion-pathway escalation.
Timed rehearsal

Run the complete station in 11 minutes

Perform the patient-facing examination efficiently, then reserve the final 90–120 seconds for synthesis, differential, investigations, management and safety.

Review procedureOpen practice library
Station time
11:00

Ready for an 11-minute attempt.

Complete procedure

Exact 11-minute examination sequence

Use the sequence as a flexible performance framework. Patient safety and the task on the door always take priority over completing every maneuver.

0:00–0:40

1. Stability, glucose and stroke timing

Say: “Before I begin, I want to make sure you are medically stable. I would confirm your vital signs, bedside glucose and the exact time you were last known well.”
  • Assess ABCs and consciousness.
  • Confirm bedside glucose.
  • Identify last-known-well time and anticoagulant use if available.
  • Activate urgent stroke response when appropriate.
0:40–1:15

2. Introduce, identify and consent

Say: “Hello, my name is ____. Could I confirm your full name and date of birth? I have been asked to perform a focused neurologic examination. Is that okay?”
  • Use simple language if aphasia is present.
  • Do not mistake aphasia for lack of capacity without assessment.
1:15–2:00

3. General neurologic observation and higher function

Say: “Can you tell me your name and where we are? Please follow this one-step command.”
  • Assess alertness and attention.
  • Listen for dysarthria versus aphasia.
  • Test comprehension and naming briefly.
  • Look for gaze preference and neglect.
2:00–3:10

4. Cranial nerves — focused screen

Say: “Please look straight ahead and tell me when you see my fingers.”
  • Pupils and gross visual acuity if relevant.
  • Visual fields by confrontation.
  • Extraocular movements and nystagmus.
  • Facial sensation and facial symmetry.
  • Palate/tongue only if indicated and safe.
3:10–5:10

5. Upper-limb motor examination

Say: “Please hold both arms out with your palms up and close your eyes.”
  • Pronator drift.
  • Tone if time permits.
  • Power: shoulder abduction, elbow flexion/extension, wrist/finger movements.
  • Compare sides and grade meaningful weakness.
  • Reflexes when localization requires them.
5:10–6:40

6. Lower-limb motor examination

Say: “Please lift each leg off the bed and push against my hands.”
  • Hip flexion, knee extension/flexion, ankle dorsiflexion/plantarflexion.
  • Compare sides.
  • Assess reflexes/plantar response when useful for localization.
6:40–7:35

7. Sensation and cortical sensory function

Say: “Does this feel the same on both sides?”
  • Light touch face, arm and leg.
  • Look for hemisensory loss.
  • Test extinction/neglect with double simultaneous stimulation when appropriate.
7:35–8:20

8. Coordination

Say: “Touch your nose and then my finger.”
  • Finger-nose testing.
  • Heel-shin if safe.
  • Interpret apparent ataxia in the context of weakness.
8:20–8:50

9. Gait only if safe

Say: “If it is safe, I would assess standing and gait with assistance.”
  • Do not walk a patient with acute major weakness, instability or suspected large stroke.
  • State that gait is deferred if unsafe.
8:50–9:20

10. Completion and comfort

Say: “Thank you. I will help you get comfortable. I would complete any remaining examination only if it would not delay urgent stroke care.”
  • Cover patient and clean hands.
  • Consider cardiovascular examination for rhythm/embolism source after acute priorities.
9:20–11:00

11. Present, localize and activate care

Say: “This is an acute left hemispheric syndrome, most consistent with a left MCA stroke, with aphasia and right face/arm-predominant weakness.”
  • State stability and localization first.
  • Name stroke mimics including hypoglycemia and seizure/Todd paresis.
  • Urgent non-contrast CT plus vascular imaging.
  • Assess thrombolysis and thrombectomy eligibility under local protocol.
Interpretation

High-yield finding patterns

Finding patternClinical interpretation
Aphasia + right face/arm weaknessDominant left hemisphere, commonly left MCA territory
Left neglect + right/left field deficit patternNondominant hemisphere/cortical involvement depending on side
Pure motor hemiparesisPossible lacunar/internal capsule lesion
Crossed face-body findingsBrainstem localization
Bilateral leg weakness with sensory levelSpinal cord rather than hemispheric stroke
Clinical reasoning

Prioritized differential

  1. Acute ischemic stroke
  2. Intracranial hemorrhage
  3. Hypoglycemia/metabolic disturbance
  4. Seizure with Todd paresis
  5. Migraine with neurologic aura
  6. Functional neurologic disorder after urgent organic causes excluded

Presentation formula

Start with stability, then the key positive and negative findings, localization or syndrome, leading diagnosis, and the most dangerous alternative that must be excluded.

Avoid: a long unranked list. Explain which finding makes each top diagnosis more or less likely.
Targeted tests

Investigations

Immediate bedside glucose and ECG

Urgent non-contrast CT head

CTA head/neck ± perfusion imaging according to local stroke pathway

CBC, electrolytes/creatinine, coagulation studies and other bloodwork without delaying imaging/reperfusion decisions

Further cardiac/vascular work-up after stabilization

Immediate plan

Management and disposition

  1. Activate the stroke team/code stroke immediately.
  2. Maintain airway/oxygenation and treat hypoglycemia or other reversible mimics.
  3. Determine last-known-well time, baseline function, anticoagulant use and contraindications.
  4. Assess IV thrombolysis eligibility under current local protocol.
  5. Assess mechanical thrombectomy eligibility when large-vessel occlusion is suspected/confirmed.
  6. Avoid unnecessary blood-pressure lowering before reperfusion decisions unless specifically indicated.
  7. Admit to an appropriate stroke pathway and monitor for deterioration, hemorrhage, dysphagia and aspiration risk.

Safety-netting

State exactly what would trigger urgent reassessment, specialist escalation, monitored care or admission. Do not hide emergency actions inside a generic “follow up” statement.

  • Checks bedside glucose
  • Identifies last-known-well time
  • Activates stroke pathway early
  • Avoids delaying CT/vascular imaging for a prolonged exam
  • Recognizes anticoagulant timing as relevant
  • Localizes deficit correctly
Self-assessment

Critical-action checklist

Use this after a timed attempt. These actions carry disproportionate safety value.

0 / 8 completed
0 / 8 critical actions completed
Evidence and next practice

References and linked learning

Reference starting points

Educational preparation only. Patient care must follow current patient-specific assessment, local policy and current guidelines.

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