Neurological Assessment Flashcards

In the Glasgow Coma Scale (GCS), what does a total score of 15 indicate?

Answer: Fully alert and oriented — normal neurological status

A GCS of 15 (E4V5M6) indicates normal eye opening, verbal, and motor responses — the patient is fully awake and oriented.

Which cranial nerve is assessed by asking a patient to follow your finger through the six cardinal positions of gaze?

Answer: Cranial nerves III, IV, and VI (oculomotor, trochlear, abducens)

The six cardinal positions of gaze test the function of CN III, IV, and VI — the three nerves controlling extraocular eye movements.

A positive Babinski sign (upward fanning of toes when the plantar surface of the foot is stroked) in an adult indicates:

Answer: Upper motor neuron (UMN) lesion — pathological in adults

A Babinski sign is normal in infants but indicates an upper motor neuron lesion (corticospinal tract damage) in adults — it is always pathological in individuals over 2 years.

During cranial nerve assessment, which test evaluates CN II (optic nerve) function?

Answer: Visual acuity, visual fields, and pupillary light reflex (afferent limb)

CN II carries visual information; assessment includes visual acuity, visual field testing, and the afferent limb of the pupillary light reflex.

The Romberg test assesses:

Answer: Proprioception and posterior column function of the spinal cord

The Romberg test distinguishes between proprioceptive (posterior column) ataxia and cerebellar ataxia — a positive result occurs only when eyes are closed, indicating proprioceptive deficit.

When testing the biceps reflex, which nerve root is being assessed?

Answer: C5–C6

The biceps reflex (tapping the biceps tendon at the antecubital fossa) tests the C5–C6 nerve roots.

In a neurological exam, what does the finger-nose test assess?

Answer: Cerebellar coordination (intention tremor and dysmetria)

The finger-nose test detects cerebellar dysfunction — past-pointing (dysmetria) and tremor that worsens as the target approaches indicate cerebellar pathology.

A patient presents with acute onset of right-sided facial droop involving both the upper and lower face, including the forehead. This most likely indicates:

Answer: Right-sided lower motor neuron (LMN) facial nerve palsy — Bell's palsy or peripheral CN VII lesion

LMN CN VII palsy affects all ipsilateral facial muscles including the forehead; UMN lesions spare the forehead due to bilateral cortical representation of the upper face.

What is the purpose of testing for pronator drift during a neurological examination?

Answer: To detect subtle upper motor neuron weakness in the upper limbs

Pronator drift occurs when a subtle UMN lesion causes the outstretched arm to pronate and drift downward — it reveals weakness before it is apparent on formal strength testing.

When assessing light touch and pinprick sensation, a dermatome pattern of sensory loss suggests:

Answer: Nerve root (radicular) pathology — disc herniation or spinal cord level lesion

Dermatomal sensory loss (a band or region corresponding to a specific nerve root distribution) indicates radicular pathology at that spinal level.

Which finding on neurological examination is most consistent with Parkinson's disease?

Answer: Resting tremor, cogwheel rigidity, bradykinesia, and shuffling gait

Parkinson's disease presents with the classic tetrad: resting tremor (pill-rolling), rigidity (cogwheel or lead-pipe), bradykinesia (slowness), and postural instability.

In the context of OSCE neurological assessment, what does PERLA stand for?

Answer: Pupils Equal and Reactive to Light and Accommodation

PERLA documents that both pupils are equal in size and react normally to both light (direct and consensual) and accommodation.

A patient walks with a high-stepping gait, slapping the foot onto the floor. This gait pattern is most consistent with:

Answer: Foot drop due to common peroneal nerve palsy or L4–L5 nerve root lesion

Foot drop causes inability to dorsiflex the foot, producing a high-stepping gait to avoid tripping, with the foot slapping down on footstrike.

Which of the following correctly describes the difference between UMN and LMN signs?

Answer: UMN lesion: spasticity, hyperreflexia, upgoing plantar response; LMN lesion: flaccidity, hyporeflexia, fasciculations, muscle atrophy

UMN lesions disrupt inhibitory control, causing spasticity and brisk reflexes; LMN lesions disrupt the final motor pathway, causing flaccid weakness, wasting, and absent reflexes.

During an OSCE station assessing neck stiffness, a positive Kernig's sign indicates:

Answer: Meningeal irritation — inability to extend the knee when the hip is flexed to 90°, causing pain

Kernig's sign tests for meningeal irritation: with the patient supine and the hip flexed to 90°, resistance or pain when extending the knee indicates meningitis.

Which cognitive function is assessed using the Mini-Mental State Examination (MMSE)?

Answer: Orientation, registration, attention/calculation, recall, and language/constructional ability

The MMSE is a 30-point cognitive screening tool assessing orientation, short-term memory, attention, recall, and language, commonly used to screen for dementia.

Which assessment approach should be used first when a patient presents with acute onset neurological deficits?

Answer: ABCDE approach to ensure airway, breathing, circulation, disability (neurological), and exposure are assessed and stabilized

The ABCDE approach prioritizes life-threatening problems first; neurological assessment (Disability = D) occurs after airway, breathing, and circulation are secured.

What does a NIHSS (National Institutes of Health Stroke Scale) score primarily measure?

Answer: The severity of neurological deficits in acute stroke to guide treatment decisions

The NIHSS quantifies neurological deficits across 11 items (consciousness, gaze, vision, facial palsy, motor, ataxia, sensory, language, speech, neglect) to guide acute stroke management.

When assessing motor strength using the MRC (Medical Research Council) scale, what does a grade of 3/5 indicate?

Answer: Active movement against gravity but not against any additional resistance

MRC grade 3 = the patient can move the limb through full range of motion against gravity, but any added resistance overcomes the movement.

What is the significance of the 'Battle's sign' in head injury assessment?

Answer: Bruising over the mastoid process (behind the ear), suggesting a base of skull fracture

Battle's sign (mastoid bruising) indicates blood has tracked from a base of skull fracture to the mastoid region — it typically appears 24–72 hours after injury.