Level of consciousness is the most sensitive indicator of neurologic change, and it is assessed before anything else because the rest of the exam depends on it. Score a Glasgow Coma Scale in its components, compare it with the last check, screen the acutely confused patient with the CAM, and turn a cranial nerve finding into a location.
Score the best response in each category. Start with the least invasive stimulus and escalate only as needed — normal voice, loud voice, touch, then a central painful stimulus.
Compare with the last check
Delirium is the finding students miss most, because a quietly hypoactive delirious patient looks like a cooperative one. Tick what you actually found.
Confusion Assessment Method (CAM)
Mini-Cog
Three unrelated words to remember, a clock-drawing task (“draw a clock face with all the numbers, then set the hands to ten past eleven”), then recall the three words.
Test them in numerical order so you never skip one. Read the finding, then choose the nerve or nerve group it points to.