OSCE Neurological Assessment Flashcards

A patient with Parkinson's disease is asked to walk across the room. Which gait abnormality would you most likely observe?

Answer: Shuffling gait with reduced arm swing and festination

Parkinson's disease produces a shuffling, festinating gait with reduced arm swing, stooped posture, and difficulty initiating movement due to basal ganglia dysfunction.

During a neurological OSCE, you test for the presence of clonus at the ankle. Sustained clonus (>5 beats) most likely indicates:

Answer: Upper motor neuron lesion

Sustained clonus indicates pathological hyperreflexia due to an upper motor neuron lesion releasing inhibition on the stretch reflex arc.

A patient demonstrates pronator drift when asked to hold arms outstretched with palms up and eyes closed. What does this indicate?

Answer: Subtle contralateral upper motor neuron weakness

Pronator drift occurs when subtle corticospinal tract weakness allows the arm to pronate and drift downward, indicating a contralateral UMN lesion.

When performing the NIHSS in a stroke OSCE scenario, which domain assesses visual fields?

Answer: Item 3 — visual fields

NIHSS Item 3 assesses visual fields in each quadrant using confrontation, scored 0 (normal) to 3 (bilateral blindness).

A patient has loss of pain and temperature from the level of T4 bilaterally with preserved proprioception. Which spinal cord syndrome best explains this?

Answer: Anterior cord syndrome

Anterior cord syndrome causes bilateral loss of pain and temperature (spinothalamic tracts) while preserving dorsal column function (proprioception and vibration).

During the OSCE, you test two-point discrimination on the fingertip. Normal two-point discrimination at the fingertip is approximately:

Answer: 3–5 mm

Normal fingertip two-point discrimination is 3–5 mm, reflecting the high density of mechanoreceptors; on the back it may be 40–70 mm.

A patient presents with sudden bilateral leg weakness, saddle anaesthesia, and urinary retention. Which neurological emergency does this describe?

Answer: Cauda equina syndrome

Cauda equina syndrome presents with saddle anaesthesia, bilateral lower limb weakness, and sphincter dysfunction requiring emergency MRI and surgical decompression.