| Course | PA 528 Comprehensive Clinical Module Neurology |
|---|---|
| Week | 3 |
| Paper type | Cranial nerve deficit map |
| Length | About 670 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 528 Week 3
Cranial Nerve Deficit Map: Twelve Rows in Testing Order for B.T., Normal Rows Kept In, and a Convergence Sentence Placing Every Abnormal Finding Above the Nuclei on the Right
Student Name
Chamberlain University
PA 528: Comprehensive Clinical Module Neurology
Instructor Name
Month Day, Year
Cranial Nerve Deficit Map: Twelve Rows in Testing Order for B.T., Normal Rows Kept In, and a Convergence Sentence Placing Every Abnormal Finding Above the Nuclei on the Right
The Map
Table 1
Cranial Nerve Findings in Testing Order
| Nerve | Test | Finding | Side | Structure implicated |
|---|---|---|---|---|
| I | Not tested | Not tested in the acute setting | Not applicable | None |
| II | Fields by confrontation, single and double stimuli | Full to single targets; left field extinguished on double stimuli | Left | Right parietal attention, not the optic pathway |
| III, IV, VI | Pursuit, saccades, head turning | Rightward gaze preference; full range when the head is turned | Both | Right frontal eye field, above the nuclei |
| V | Light touch and pinprick on the face; corneal reflex | Reduced pinprick on the left face; corneal reflex present both sides | Left | Right sensory cortex or thalamic fibers |
| VII | Forehead wrinkle, eye closure, smile | Left lower face weak; forehead and eye closure normal | Left | Corticobulbar fibers above the nucleus |
| VIII | Finger rub | Heard both sides | Both | Normal |
| IX, X | Palate elevation, gag | Palate rises in the midline; gag present | Both | Normal |
| XI | Shoulder shrug, head turning | Shrug slightly weak on the left; head turning strong | Left | Corticobulbar fibers, mild |
| XII | Tongue protrusion | Deviates to the left; no wasting or twitching | Left | Corticobulbar fibers to the left nucleus |
Note. Note. Legend: Side means the side of the finding. Structure implicated names the highest structure that explains the row. Normal rows are kept to show they were examined.
The Convergence Sentence
Every abnormal row lies on the left and every implicated structure lies above the cranial nerve nuclei on the right, in the cortex or the corticobulbar fibers leaving it, which places the problem in the right hemisphere rather than in any nerve or nucleus.
Normal Rows Stay In
The normal rows matter. Hearing, palate and gag are normal, which argues against a brainstem lesion near the eighth to tenth nerve nuclei. The corneal reflex is present on both sides, which means the trigeminal nerve and its brainstem connections work, even though pinprick on the face is reduced. Leaving these rows out would hide the evidence that the brainstem is intact.
Nucleus or Nerve
Three rows could be mistaken for nerve or nucleus problems. The facial weakness spares the forehead, which nerve and nucleus lesions do not. The tongue deviates without wasting or twitching; a lesion of the hypoglossal nucleus or nerve would, over weeks, cause wasting and fasciculation on the weak side. Because a quick head turn still drives the eyes fully to the left, the nuclei and nerves that move the eyes must be working. In all three, the finding is supranuclear.
What the Map Adds to the Localization
The map confirms the side and level found in the motor and sensory examination, and adds that the brainstem is functioning. It also records a baseline: the eye movements and facial strength will be rechecked at 24 hours, since a new crossed finding would suggest the clot has extended into the posterior circulation, an unlikely but serious change. The NIH Stroke Scale's facial and gaze items match the map (Brott et al., 1989).
Limits
Smell was not tested, as is usual in an acute stroke assessment. Visual fields were tested by confrontation only; formal perimetry later may show a field defect that confrontation missed. Swallowing was screened separately before any food or drink, as the stroke guideline recommends (Powers et al., 2019).
Repeat at 24 Hours
At 24 hours the map was redone with the same tests in the same order. The gaze preference had lessened, the facial weakness and tongue deviation were unchanged, and no new rows had become abnormal. No crossed sign appeared, so the brainstem remained uninvolved.
References
Brott, T., Adams, H. P., Jr., Olinger, C. P., Marler, J. R., Barsan, W. G., Biller, J., Spilker, J., Holleran, R., Eberle, R., & Hertzberg, V. (1989). Measurements of acute cerebral infarction: A clinical examination scale. Stroke, 20(7), 864-870. https://doi.org/10.1161/01.STR.20.7.864
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V., & Tirschwell, D. L. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12), e344-e418. https://doi.org/10.1161/STR.0000000000000211
Reading the PA 528 Week 3 instructions
For the third week you produce a cranial nerve map. Present it as a table or diagram, one row per nerve tested in the order you tested them, with the finding, the side and the structure each row implicates. Keep normal rows in; they show what was examined and what is intact. Add a legend explaining the columns or symbols. Beneath the map, write a single sentence stating where the abnormal rows converge. Then explain any finding that could be mistaken for a nerve or nucleus problem and show why it is supranuclear, or the reverse. Say what the map adds to the overall localization and when it should be repeated. Note what was not tested and why. Cite the scale or guideline that frames the assessment.
Inside the PA 528 Week 3 example
Table 1 runs from the olfactory nerve, not tested acutely, through the hypoglossal nerve, with findings such as full fields to single targets but left extinction, a rightward gaze preference with full range on head turning, reduced pinprick on the left face with intact corneal reflexes, lower facial weakness sparing the forehead and a tongue deviating left without wasting. A legend explains the columns. The convergence sentence places every abnormal row above the nuclei on the right. A section explains why normal hearing, palate and corneal reflexes show the brainstem is intact. The nucleus-or-nerve section treats face, tongue and gaze in turn. Later sections link the map to the NIH Stroke Scale, record a 24-hour repeat with no new rows and note untested smell and the swallow screen.
PA 528 Week 3 rubric: what full points look like
Marks on this map depend on completeness and order. A map that lists only abnormal nerves, or rearranges them out of testing order, loses the largest share because a grader cannot tell what was examined. Faculty then check the legend; a figure without one is marked down. Credit goes to a single convergence sentence that names side and level. The nucleus-or-nerve reasoning is weighted heavily, since confusing supranuclear and nuclear findings is the commonest error. Normal rows should be used as evidence, not merely listed. A repeat plan and stated limits earn smaller marks. Diagnosis beyond the localization is not expected and can cost points if it replaces reasoning. Supporting sources should be cited correctly.
PA 528 Week 3 help from the desk
A frequent problem with cranial nerve maps is dropping the normal nerves to save space. Send your examination findings and the format your section wants, table or diagram, and the map built for you would list every nerve in testing order with finding, side and implicated structure, plus a legend. A convergence sentence states where the abnormal rows meet. Findings that could be supranuclear or nuclear are reasoned through one by one. The map is tied to your overall localization, with a repeat plan and the limits of what was tested. If your case involves a brainstem lesion with crossed findings, the reasoning reverses accordingly. Check each finding against your own examination notes before you use the layout.
Get a PA-528 Week 3 example written to your instructions
Send the assignment sheet, the figure template if one is handed out, and the examination findings in the classroom's own wording. A custom example is mapped to those nerves and returned inside 24-48h, and the first one costs nothing. Say whether a drawn diagram or a table is expected, because the two are graded on different things.
More PA 528 papers and MPAS samples
- PA 528 Week 1: Lesion Localization Post
- PA 528 Week 2: Lesion Localization Exercise
- PA 528 Week 4: Motor Neuron Brief
- PA 528 Week 5: Seizure Semiology Write-up
- PA 528 Week 6: Episodic Symptom Timeline
- PA 528 Week 7: Stroke Syndrome Correlation
- PA 528 Week 8: Neuroimaging Request Brief
- PA 526 Week 3: GI Alarm Feature Checklist
- PA 524 Week 3: Urinalysis Interpretation
- PA 522 Week 3: Paired Hormone Interpretation
- PA 520 Week 3: Obstructive Versus Restrictive Memo
PA 528 Week 3 questions, answered
Does the map have to be drawn by hand?
Almost never. A table built in a word processor satisfies most sections and is easier to grade than a photograph of a sketch. Where a drawn figure is specifically asked for, the example supplies a clean labeled outline rather than an artwork. Send the assignment wording and the example matches the form your classroom names.
How much prose goes with the figure?
Enough to carry the argument, usually a few short paragraphs. The table states what was found and the prose says what the set of findings means, which is the half that earns the higher points. An example keeps them separate so a grader marking from a rubric row can find each one without reading the other first.
My case only involves two or three nerves. Is that enough?
It is usually the point. A small affected set with a clear boundary localizes better than a long one, and assignments are often written that way deliberately. The example works from the pair or the trio to the place where only those run together, then names the neighboring nerves left alone and explains what their being spared removes from the list.
Where can I find a free PA 528 Week 3 sample paper?
This page carries the full PA 528 Week 3 cranial nerve map, every nerve in testing order with normal rows kept and abnormal rows converging above the nuclei.
Why does the tongue deviation in the PA 528 Week 3 sample count as supranuclear?
The tongue deviates without wasting or twitching, which a nucleus or nerve lesion would produce over weeks, so the cause lies in the corticobulbar fibers above.