OPH OSCE

Question 1

What is the assumption of the visual field test by confrontation technique?

Answer 1

That my visual fields are normal

Question 2

What is a scotoma?

Answer 2

Loss of or diminished visual acuity in a spot surrounded by otherwise normal visual field.

Question 3

What are some causes of ptosis?

Answer 3

• Oculomotor n (III) lesion – complete ptosis
• Sympathetic lesion – partial ptosis (Horner’s syndrome)

Question 4

What would you expect if there is a unilateral lesion in the optic nerve during pupillary light reflex assessment?

Answer 4

No direct or consensual response

Question 5

What is the expected response if there is a unilateral lesion in the oculomotor nerve?

Answer 5

No direct response, but consensual response present

Question 6

What occurs if there is a contralateral lesion in the oculomotor nerve?

Answer 6

Direct but no consensual response

Question 7

What is the response if there is a contralateral lesion in the optic nerve?

Answer 7

Direct & consensual response

Question 8

Why is the corneal reflex important?

Answer 8

Important for protecting the eyes

Question 9

What nerves are involved in the afferent and efferent pathways of the corneal reflex?

Answer 9

• Afferent = ophthalmic branch of V (V1)
• Efferent = facial n (VII)

Question 10

What is the expected response of the corneal reflex?

Answer 10

Reflex blinking in BOTH eyes (direct & consensual)

Question 11

What are the afferent and efferent pathways of the jaw reflex?

Answer 11

• Afferent = mandibular branch of V (V3)
• Efferent = trigeminal motor root

Question 12

What would you expect if there was weakness of the jaw muscle on one side?

Answer 12

Jaw deviates towards affected side

Question 13

What is the sensory component of the facial nerve (VII)?

Answer 13

Taste to the anterior 2/3 of the tongue

Question 14

Describe the cortical innervation of the facial motor nucleus.

Answer 14

• Upper face: bilateral – equal
• Lower face: contralateral ONLY

Question 15

What is the clinical consequence of an UMN lesion in the facial motor nucleus?

Answer 15

Upper face – spared; Lower face – contralateral paralysis

Question 16

What is the clinical consequence of an LMN lesion in the facial motor nucleus?

Answer 16

Ipsilateral paralysis + atrophy of BOTH upper & lower face

Question 17

What is emotional hypermimia?

Answer 17

Activation of facial motor nucleus by involuntary pathways feeding into the nucleus

Question 18

When may you consider examining the vestibular function of VIII?

Answer 18

Assessment of abnormalities of gait and balance and for comatose patients

Question 19

What are you looking for in the assessment of IX and X?

Answer 19

• Hoarseness/dysphonia
• Dysarthria
• Uvula deviation
• Sip of water response

Question 20

What is the afferent pathway of the gag reflex?

Answer 20

Afferent = IX

Question 21

What is the efferent pathway of the gag reflex?

Answer 21

Efferent = X

Question 22

What component of the accessory nerve innervates the SCM and trapezius?

Answer 22

Fibres arising from the spinal accessory nucleus (spinal root of XI)

Question 23

What is the clinical consequence of an UMN lesion affecting the SCM and trapezius?

Answer 23

Trapezius – contralateral weakness

Question 24

What is the clinical consequence of an LMN lesion affecting the SCM and trapezius?

Answer 24

Ipsilateral paralysis & atrophy of BOTH SCM & trapezius

Question 25

Describe the cortical innervation of the hypoglossal nucleus.

Answer 25

Bilateral – contralateral predominance

Question 26

What is the clinical consequence of an UMN lesion in the hypoglossal nucleus?

Answer 26

Contralateral weakness; slight deviation of tongue away from side of lesion

Question 27

What is the clinical consequence of an LMN lesion in the hypoglossal nucleus?

Answer 27

Ipsilateral paralysis + atrophy; tongue protrudes towards affected side