OSCE OSCE Neurological Assessment 2 — Questions and Answers
Question 1: When assessing the Babinski sign, which finding is considered abnormal in an adult?
- Plantar flexion of the big toe
- Extension of the big toe with fanning of other toes (Correct answer)
- No movement of the toes
- Flexion of all toes equally
Correct answer: Extension of the big toe with fanning of other toes
In adults, a positive Babinski sign (upgoing plantar reflex) — extension of the hallux with fanning of toes — indicates an upper motor neuron lesion.
Question 2: A patient presents with loss of pain and temperature sensation on the right side of the body and loss of proprioception on the left side. Which spinal cord syndrome does this represent?
- Central cord syndrome
- Anterior cord syndrome
- Brown-Séquard syndrome (Correct answer)
- Posterior cord syndrome
Correct answer: Brown-Séquard syndrome
Brown-Séquard syndrome results from hemisection of the spinal cord, causing ipsilateral loss of proprioception and contralateral loss of pain and temperature.
Question 3: During cranial nerve testing, the patient cannot wrinkle the forehead or close the eye on the right side, but facial expression is intact below the eye. Which lesion is most likely?
- Right upper motor neuron (UMN) lesion
- Left upper motor neuron (UMN) lesion
- Right lower motor neuron (LMN) lesion (Correct answer)
- Left lower motor neuron (LMN) lesion
Correct answer: Right lower motor neuron (LMN) lesion
A right LMN lesion (e.g., Bell's palsy) affects all ipsilateral facial muscles including forehead; UMN spares the forehead due to bilateral cortical representation.
Question 4: Which Romberg test finding indicates a sensory (proprioceptive) rather than a cerebellar ataxia?
- Ataxia present with eyes open and closed equally
- Ataxia worsens significantly when eyes are closed (Correct answer)
- Ataxia improves when eyes are closed
- No change in balance with eye closure
Correct answer: Ataxia worsens significantly when eyes are closed
A positive Romberg test (marked worsening with eye closure) indicates reliance on visual compensation for proprioceptive loss, not cerebellar pathology.
Question 5: When testing deep tendon reflexes, a grade of 4+ indicates:
- Normal brisk reflex
- Absent reflex
- Hyperreflexia with clonus (Correct answer)
- Reduced but present reflex
Correct answer: Hyperreflexia with clonus
On the standard 0–4+ scale, 4+ denotes hyperactive reflexes with clonus, suggesting upper motor neuron pathology.
Question 6: A patient has a right homonymous hemianopia. Where is the most likely lesion?
- Right optic nerve
- Optic chiasm
- Left optic tract or visual cortex (Correct answer)
- Right optic tract
Correct answer: Left optic tract or visual cortex
Right homonymous hemianopia (loss of right visual field in both eyes) results from a left-sided lesion in the optic tract, radiation, or occipital cortex.
Question 7: During the OSCE, you assess sensation using a 128 Hz tuning fork. This primarily tests which sensory modality?
- Pain and temperature
- Light touch via spinothalamic tract
- Vibration sense via dorsal columns (Correct answer)
- Crude pressure sensation
Correct answer: Vibration sense via dorsal columns
A 128 Hz tuning fork tests vibration sense, which is carried by the dorsal columns (posterior funiculus) of the spinal cord.
OSCE OSCE Neurological Assessment 2
When assessing the Babinski sign, which finding is considered abnormal in an adult?