FCCS FCCS Neurological Assessment 1 — Questions and Answers
Question 1: The Glasgow Coma Scale (GCS) assesses which three components?
- Pupils, motor, verbal
- Eye opening, verbal response, motor response (Correct answer)
- Reflexes, cognition, behavior
- Orientation, memory, motor
Correct answer: Eye opening, verbal response, motor response
The GCS evaluates eye opening (1–4), verbal response (1–5), and motor response (1–6) for a maximum score of 15.
Question 2: A GCS score of 8 or less indicates what clinical concern?
- Mild cognitive impairment
- Inability to protect the airway — consider intubation (Correct answer)
- Moderate concussion
- Psychiatric disorder
Correct answer: Inability to protect the airway — consider intubation
GCS ≤ 8 is associated with inability to maintain airway patency and loss of protective reflexes, typically necessitating intubation.
Question 3: Which finding on neurological exam suggests herniation syndrome?
- Bilateral small reactive pupils
- Unilateral dilated, fixed pupil with ipsilateral hemiparesis (Correct answer)
- Bilateral symmetric hyperreflexia
- Nystagmus on lateral gaze
Correct answer: Unilateral dilated, fixed pupil with ipsilateral hemiparesis
Uncal herniation compresses CN III, causing ipsilateral pupil dilation and ptosis, and compresses the contralateral cerebral peduncle causing ipsilateral hemiparesis (Kernohan's notch).
Question 4: What is the target PaCO2 range in a patient with suspected elevated intracranial pressure (ICP)?
- 25–30 mmHg
- 35–45 mmHg (Correct answer)
- 50–55 mmHg
- 20–25 mmHg
Correct answer: 35–45 mmHg
Normal PaCO2 (35–45 mmHg) is maintained to avoid hypercapnia (vasodilation worsening ICP) without prophylactic hyperventilation which risks ischemia.
Question 5: Cushing's triad (hypertension, bradycardia, irregular respirations) signals which emergency?
- Septic shock
- Impending brainstem herniation (Correct answer)
- Hypertensive urgency
- Massive hemorrhage
Correct answer: Impending brainstem herniation
Cushing's triad is a late sign of rising ICP with impending brainstem herniation requiring immediate intervention.
Question 6: Which sedation scale is most commonly used to assess depth of sedation in ICU patients?
- Wong-Baker FACES Scale
- Richmond Agitation-Sedation Scale (RASS) (Correct answer)
- Ramsay Scale (original version)
- Numeric Rating Scale (NRS)
Correct answer: Richmond Agitation-Sedation Scale (RASS)
The RASS is the most validated and widely used tool for assessing sedation depth in mechanically ventilated ICU patients, ranging from -5 (unarousable) to +4 (combative).
FCCS FCCS Neurological Assessment 1
The Glasgow Coma Scale (GCS) assesses which three components?