Cerebellar OSCE Exam

Question 1

What 7 things should you do as part of your introduction?

Answer 1

Wash hands
Introduce yourself
Confirm pt details
Explain examination
Gain consent
Achieve appropriate exposure
Ask if pt has any pain anywhere before you begin

Question 2

What should you look for around the bed?

Answer 2

Any mobility aids

eg. Wheelchair / walking stick

Question 3

On general inspection, what might the patient’s posture be?

Answer 3

Truncal ataxia

Question 4

On observing the pt’s normal gait, what are the 4 things you should be looking for?

Answer 4

1. Stance: broad based gait is noted in cerebellar disease.
2. Stability: staggering / slow & unsteady
   In unilateral cerebellar disease, there is deviation to the side of the lesion due to hypotonia.
3. Tandem (‘heel to toe’) walking: exaggerates unsteadiness
4. Romberg’s test: Feet together, hands by sides, close eyes. *Be ready to support patient, in case they are unsteady.

Question 5

What type of speech is characteristic of cerebellar dysfunction?

Answer 5

Slurred staccato speech

Question 6

Which 2 phrases should you ask the pt to repeat if you suspect cerebellar dysfunction?

Answer 6

“British constitution”

“Baby hippopotamus”

Question 7

How would you assess a patient for nystagmus?

Answer 7

1. Ask pt to keep their head still & follow your finger with their eyes.
2. Move your finger throughout the axes of vision.
3. Look for multiple beats of nystagmus

Question 8

What is ‘physiological nystagmus’?

Answer 8

Nystagmus at the extremes of gaze.

Question 9

Give 2 other examples of disturbances of gaze notes in cerebellar disease.

Answer 9

Dysmetric saccades

Impaired smooth pursuit

Question 10

How would you assess the tone of a pt’s arms?

Answer 10

1. Support pt’s arm by holding their hand & elbow.
2. Ask pt to relax & allow you to fully control their arm.
3. Move the arm’s muscle groups through their full range of movements.
4. Is the motion smooth or is there some resistance?

Question 11

How is tone affected in cerebellar disease?

Answer 11

Hypotonia may be seen.

Question 12

Describe how you’d carry out a ‘finger to nose’ test.

Answer 12

1. Ask pt to touch their nose with the tip of their index finger, the touch your fingertip.
2. Position your finger so the pt has to fully outstretch their arm to reach it.
3. Ask them to continue to do this finger to nose motion as fast as they can manage.

Question 13

Describe what you’d see with an ‘intention tremor’ on the ‘finger to nose’ test.

Answer 13

As the pt gets closer to a target, the tremor worsens at the end points of a deliberate movement.

Question 14

How would you assess for dysdiadochokinesia?

Answer 14

1. Demonstrate patting the palm of your hand with the back/palm of your other hand to the pt.
2. Ask pt to mimic this rapid alternating movement.
3. Then have the pt repeat this mvt on their other hand.

Question 15

If a patient is unable to perform the test assessing dysdiadochokinesia, what does this suggest?

Answer 15

Cerebellar ataxia.

Question 16

How would you assess for the rebound phenomenon?

Answer 16

Whilst the pt’s arms are outstretched & their eyes are closed:

1. Ask pt to keep their arms in that position as you press down on their arm.
2. Release your hand.

Question 17

What is a ‘positive test’ for the rebound phenomenon & what does this suggest?

Answer 17

The pt’s arm shoots up above the position it originally was.
Suggestive of cerebellar disease.

Question 18

To assess tone in the legs, what would you instruct the pt to do?

Answer 18

Ask pt to keep their legs fully relaxed & ‘floppy’ throughout your assessment.

Question 19

What 2 tests would you use to assess leg tone?

Answer 19

Leg roll: roll the pt’s leg & watch the foot. it should flop independently of the leg.

Leg lift: briskly lift leg off the bed at the knee joint. The heel should remain in contact with the bed.

Question 20

How is tone in the legs affected in cerebellar disease?

Answer 20

Hypotonia.

*note: if you’ve already assessed tone in the upper limbs, you don’t need to assess lower limbs, also.

Question 21

Which nerves are involved in the Knee jerk reflex?

Answer 21

L3, L4

Question 22

What might you expect in a knee jerk reflex of a pt who has cerebellar disease?

Answer 22

‘Pendular reflexes’

The leg keeps swinging after you elicit the knee reflex.

Question 23

How would you test co-ordination in a cerebellar exam?

Answer 23

Heel-to-shin test

“Run your heel down the other leg from the knee, and repeat in a smooth motion”.

Question 24

What might you expect in the ‘Heel to shin’ test of a pt with cerebellar disease?

Answer 24

A coarse side to side tremor of the leg or foot may be noted.

Question 25

To complete the examination, what 3 steps should you take?

Answer 25

Thank patient
Wash hands
Summarise findings

Question 26

Suggest 2 further assessments & investigations

Answer 26

Perform a full neurological examination, including:

• Cranial Nerves
• Upper & Lower limbs

Question 27

If indicated, what imaging might be appropriate?

Answer 27

CT / MRI

Question 28

What does the pneumonic ‘DANISH’ stand for?

* helps to remind you of key parts of the cerebellar exam

Answer 28

Dysdiadochokinesia
Ataxia (gait & posture) 
Nystagmus
Intention tremor
Slurred, staccato speech
Hypotonia / Heel-shin test