OSCE OSCE Neurological Assessment 3 — Questions and Answers
Question 1: A patient demonstrates an intention tremor that worsens as the hand approaches a target during the finger-nose test. Which structure is most likely affected?
- Basal ganglia
- Cerebellum (Correct answer)
- Dorsal columns
- Corticospinal tract
Correct answer: Cerebellum
Intention tremor that worsens near the target is a hallmark of cerebellar dysfunction, particularly affecting the ipsilateral hemisphere.
Question 2: When testing CN III, IV, and VI, you ask a patient to follow your finger in an 'H' pattern. A patient cannot abduct the left eye. Which nerve is most likely affected?
- Left CN III
- Left CN IV
- Left CN VI (Correct answer)
- Right CN VI
Correct answer: Left CN VI
CN VI (abducens) controls lateral rectus muscle; its palsy prevents ipsilateral eye abduction, causing medial deviation (esotropia).
Question 3: A patient scores 2 on the GCS eye-opening subscale. What does this indicate?
- Spontaneous eye opening
- Eyes open to voice
- Eyes open to pain only (Correct answer)
- No eye opening
Correct answer: Eyes open to pain only
GCS eye-opening score of 2 indicates eyes open only to painful stimuli; 1 = none, 3 = to voice, 4 = spontaneous.
Question 4: In assessing gait during a neurological OSCE, which gait pattern is characterised by circumduction of the leg with a stiff, extended knee?
- Parkinsonian gait
- Hemiplegic (spastic) gait (Correct answer)
- Steppage gait
- Ataxic gait
Correct answer: Hemiplegic (spastic) gait
Hemiplegic (spastic) gait involves circumduction of the affected stiff, extended leg due to increased tone from an upper motor neuron lesion.
Question 5: When assessing the gag reflex, the afferent limb is carried by which cranial nerve?
- CN V
- CN VII
- CN IX (Correct answer)
- CN XII
Correct answer: CN IX
The afferent limb of the gag reflex is CN IX (glossopharyngeal), while the efferent limb is CN X (vagus).
Question 6: A 65-year-old patient presents with sudden onset of the 'worst headache of their life.' Which neurological examination finding would most urgently suggest subarachnoid haemorrhage?
- Bilateral papilloedema
- Meningism (neck stiffness and positive Kernig's sign) (Correct answer)
- Bilateral extensor plantar responses
- Horizontal nystagmus
Correct answer: Meningism (neck stiffness and positive Kernig's sign)
Meningism — neck stiffness, Kernig's sign, and Brudzinski's sign — indicates meningeal irritation from blood, strongly suggesting subarachnoid haemorrhage.
Question 7: A patient with a T10 complete spinal cord injury would be expected to have preserved motor function in which muscle group?
- Hip flexors (Correct answer)
- Ankle dorsiflexors
- Intrinsic foot muscles
- Anal sphincter
Correct answer: Hip flexors
Hip flexors (iliopsoas, L1–L3) are above the T10 level; a T10 injury spares motor function above this level including hip flexion.
OSCE OSCE Neurological Assessment 3
A patient demonstrates an intention tremor that worsens as the hand approaches a target during the finger-nose test.
Which structure is most likely affected?