OSCE

Question 1

What are you assessing for when performing the swinging torch test?

Answer 1

RAPD

Relative afferent pupillary defect

Question 2

What is seen in RAPD?

Answer 2

Pupils dilate when light shines during swinging torch test

Question 3

What would a third (occulomotor) nerve palsy cause?

Answer 3

Down and out eye

Vertical and horizontal diplopia

Question 4

What would a fourth (trochlear) nerve palsy cause?

Answer 4

Vertical elements to diplopia
Right eye is up and out
Difficulty in depression of eye in adduction
Reading and going down stairs

Question 5

What would a sixth (abducens) nerve palsy cause?

Answer 5

Abbduction unachievable
Horizontal diplopia
Abnormal head postures to minimise diplopia

Question 6

What are cerebellar signs?

Answer 6

D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremour
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia

Question 7

What is the management for a TIA?

Answer 7

Asprin and seen by TIA clinic within 24 hours

Question 8

What is the management for a TIA if a patient is on warfarin?

Answer 8

Urgent CT to rule out haemorrhage