OSCE Neurological Assessment 2 — Questions and Answers
Question 1: A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' What is the priority assessment action?
- Perform a lumbar puncture immediately
- Assess for nuchal rigidity and photophobia (Correct answer)
- Order an MRI of the brain
- Administer analgesics and reassess in 30 minutes
Correct answer: Assess for nuchal rigidity and photophobia
Sudden severe headache requires immediate assessment for meningeal irritation signs (nuchal rigidity, photophobia) to evaluate for subarachnoid hemorrhage or meningitis.
Question 2: When assessing the oculomotor nerve (CN III), which finding indicates a complete palsy?
- Lateral gaze deviation with ptosis
- Medial gaze palsy with intact pupil
- Down-and-out eye position with ptosis and dilated pupil (Correct answer)
- Vertical nystagmus with diplopia
Correct answer: Down-and-out eye position with ptosis and dilated pupil
CN III palsy produces a 'down-and-out' eye position due to unopposed CN IV and VI action, along with ptosis and a dilated, non-reactive pupil from loss of parasympathetic fibers.
Question 3: During neurological assessment, a patient can identify objects placed in their hand by touch alone with eyes closed on the left but not the right. This deficit is called:
- Astereognosis (Correct answer)
- Agraphesthesia
- Proprioceptive loss
- Hemianesthesia
Correct answer: Astereognosis
Astereognosis is the inability to identify objects by touch alone, indicating a lesion in the contralateral parietal cortex processing somatosensory information.
Question 4: A patient has weakness of shoulder abduction and elbow flexion but preserved elbow extension and wrist function. Which nerve root level is most likely affected?
- C4
- C5-C6 (Correct answer)
- C7-C8
- T1
Correct answer: C5-C6
C5-C6 nerve root involvement explains weakness of shoulder abduction (deltoid, C5) and elbow flexion (biceps, C5-C6) while sparing C7-innervated triceps and wrist extensors.
Question 5: Which scale is most appropriate for rapidly communicating a patient's level of consciousness in a trauma setting?
- Mini-Mental State Examination (MMSE)
- Glasgow Coma Scale (GCS) (Correct answer)
- National Institutes of Health Stroke Scale (NIHSS)
- Abbreviated Mental Test Score (AMTS)
Correct answer: Glasgow Coma Scale (GCS)
The Glasgow Coma Scale evaluates eye opening, verbal response, and motor response and is the standard tool for rapid, reproducible consciousness assessment in trauma.
Question 6: During Romberg testing, a patient stands steadily with eyes open but sways and falls when eyes are closed. This indicates dysfunction of which system?
- Cerebellar system
- Vestibular system
- Proprioceptive/posterior column system (Correct answer)
- Motor cortex
Correct answer: Proprioceptive/posterior column system
A positive Romberg sign (stable with eyes open, unstable with eyes closed) indicates loss of proprioception from posterior column dysfunction, since vision compensates for the deficit.
Question 7: A patient demonstrates the ability to speak fluently but cannot repeat phrases and has poor comprehension. Where is the lesion most likely located?
- Broca's area (inferior frontal gyrus)
- Wernicke's area (superior temporal gyrus) (Correct answer)
- Arcuate fasciculus
- Angular gyrus
Correct answer: Wernicke's area (superior temporal gyrus)
Wernicke's aphasia presents with fluent but paraphasic speech, impaired comprehension, and impaired repetition due to a lesion in the left superior temporal gyrus.
OSCE Neurological Assessment 2
A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' What is the priority assessment action?