OSCE OSCE Neurological Assessment 4 — Questions and Answers
Question 1: During coordination testing, dysdiadochokinesia refers to:
- Inability to maintain balance with eyes closed
- Impaired rapid alternating movements of the hands (Correct answer)
- Excessive sway during tandem gait
- Loss of position sense at the fingers
Correct answer: Impaired rapid alternating movements of the hands
Dysdiadochokinesia is the inability to perform rapid alternating movements (e.g., pronation/supination), indicating ipsilateral cerebellar dysfunction.
Question 2: A patient has ptosis, miosis, and anhidrosis on the right side of the face. Which condition does this suggest?
- Right CN III palsy
- Right Horner's syndrome (Correct answer)
- Right CN VII palsy
- Left Horner's syndrome
Correct answer: Right Horner's syndrome
Horner's syndrome (ptosis, miosis, anhidrosis) on the right results from disruption of the ipsilateral sympathetic pathway.
Question 3: When testing proprioception, you passively move a patient's great toe up or down and ask them to identify the direction. The patient is incorrect 7 out of 10 times. Which tract is most likely affected?
- Spinothalamic tract
- Dorsal columns (posterior funiculus) (Correct answer)
- Spinocerebellar tract
- Corticospinal tract
Correct answer: Dorsal columns (posterior funiculus)
Joint position sense (proprioception) is transmitted via the dorsal columns; impairment suggests posterior funiculus dysfunction.
Question 4: A patient recovering from Guillain-Barré syndrome is most likely to show which pattern of reflexes?
- Hyperreflexia with clonus
- Normal reflexes throughout
- Diminished or absent deep tendon reflexes (Correct answer)
- Asymmetric reflexes with upgoing plantars
Correct answer: Diminished or absent deep tendon reflexes
Guillain-Barré syndrome is an acute inflammatory polyneuropathy causing LMN signs including areflexia or hyporeflexia.
Question 5: During fundoscopy in the OSCE, you observe blurring of the optic disc margins with loss of the central cup. This finding is called:
- Optic atrophy
- Papilloedema (Correct answer)
- Arteriovenous nipping
- Hollenhorst plaque
Correct answer: Papilloedema
Papilloedema is swelling of the optic disc due to raised intracranial pressure, presenting with blurred margins and loss of the physiological cup.
Question 6: A patient presents with sudden onset of dysarthria, dysphagia, ipsilateral facial sensory loss, contralateral limb sensory loss, and ipsilateral Horner's syndrome. Which syndrome does this represent?
- Weber's syndrome
- Lateral medullary (Wallenberg) syndrome (Correct answer)
- Locked-in syndrome
- Millard-Gubler syndrome
Correct answer: Lateral medullary (Wallenberg) syndrome
Lateral medullary (Wallenberg) syndrome results from PICA territory infarction and presents with crossed sensory deficits, dysarthria, dysphagia, and ipsilateral Horner's.
Question 7: In the OSCE, you assess the corneal reflex. The afferent limb is carried by which division of the trigeminal nerve?
- V1 (ophthalmic) (Correct answer)
- V2 (maxillary)
- V3 (mandibular)
- CN VII motor branch
Correct answer: V1 (ophthalmic)
The corneal reflex afferent limb is carried by V1 (ophthalmic division) of CN V; the efferent limb is CN VII causing eye closure.
OSCE OSCE Neurological Assessment 4
During coordination testing, dysdiadochokinesia refers to: