Neuro OSCE

Question 1

Categories of the Neuro OSCE (8)

Answer 1

1. Wash hands
2. Cranial nerves
3. Motor system
4. Reflexes
5. Sensory system
6. Coordination
7. Gait/station
8. Wash hands

Question 2

What are the steps of the Cranial Nerve exam?

Answer 2

(1. Wash hands)
2. Assess visual fields
3. Fundus exam (CN 2)
4. Pupil response to light - direct and consensual (stand to the side) (CN 2, 3)
5. Check for all 6 cardinal positions of gaze (make H) + near reaction (CN 3, 4, 6)
6. Test both sides of the forehead (CN 5 - ophthalmic)
7. Test both sides superficial to the maxillary sinuses (CN 5 - maxillary division)
8. Test both sides superficial to the mandibles (CN 5 - mandibular division)
9. Ask patient to raise both eyebrows or frown/wrinkle forehead (CN 7)
10. Ask patient to smile and show your teeth (CN 7)
11. Assess auditory division of CN 8 (finger rub by ear, ask patient to point)
12. Ask patient to say ah (CN 10, 9-ish), USE LIGHT SOURCE TO LOOK IN MOUTH
13. Assess ability to cough (turn your head - CN 10)
14. Assess trapezius muscle strength (CN 11)
15. Assess SCM strength (CN 11)
16. Assess hypoglossal nerve (CN 12 - stick out tongue)

Question 3

Key points of fundus exam.

Answer 3

1. RRR/LLL
2. Come in at an angle
3. Turn the lights off and crack the door

Question 4

What are the steps of the motor system exam?

Answer 4

1. Assess muscle tone in upper limbs (resistance to passive ROM)
2. Assess muscle strength of upper extremities
   a. Shoulder abduction
   b. Elbow flexion
   c. Elbow extension
   d. Wrist flexion
   e. Wrist extenion
   f. Hand grip
   MAY HAVE PATIENT LAY OR BE SEATED
3. Assess limb tone in lower limbs (resistance to passive ROM)
4. Assess muscle strength of the lower extremities
   a. Hip flexion
   b. Knee flexion
   c. Knee extension
   d. Ankle dorsiflexion
   e. Ankle plantar flexion

Question 5

What are the steps of the reflex exam?

Answer 5

1. Biceps (C5, C6)
2. Triceps (C7, C8)
3. Brachioradialis (C5, C6)
4. Knee (L2-4)
5. Ankle (S1)
6. Plantar response (outer part, swing over to the ball of the foot)

Question 6

What are the steps of the sensory system exam?

Answer 6

1. Assess light touch in all four extremities (cotton/swab)
2. Assess pain in all four extremities (splintered cotton tip)
3. Assess position sense in all four extremities (finger and toe up and down)
4. Assess vibration sense in all four extremities (distal bone prominence)

Question 7

What are the steps of the coordination exam?

Answer 7

1. Finger-to-nose-to-finger
2. Fine finger movements
3. Heel-to-knee-to-shin

Question 8

What are the steps of gait/station?

Answer 8

Patient is standing

1. Romberg test (feet together)
2. Normal gait
3. Tandem gait

WASH HANDS