Free medical quiz

Lower Limb Neurological OSCE Examination Quiz

Focused SBA-style practice, followed by the answer and explanation for every question.

Free now: 7 questions
Full bank: 54 questions
Answers: Explained

Free question

Try one with the answer

A question from this quiz. Answer it to see the explanation students get.

On a lower limb neurological examination you find symmetrical distal loss of vibration and pinprick sensation in both feet, reduced ankle reflexes and preserved power. What is the most appropriate way to complete the examination and present the next steps?

Summarise a length-dependent sensory neuropathy, assess gait, complete the wider neurological and spine examination, and investigate likely causes with nerve conduction studies. Summarise a dorsal column lesion in the thoracic cord, assess gait, complete the wider neurological and spine examination, and arrange MRI of the thoracic spine. Summarise a cauda equina syndrome, assess gait, complete the wider neurological and spine examination, and arrange urgent MRI of the lumbar spine. Summarise an isolated peroneal neuropathy at the fibular head, assess gait, complete the wider neurological and spine examination, and arrange nerve conduction studies. Summarise a sensory neuropathy, assess gait, complete the wider neurological and spine examination, and request an MRI of the brain as the next investigation.

A Summarise a length-dependent sensory neuropathy, assess gait, complete the wider neurological and spine examination, and investigate likely causes with nerve conduction studies. ✓
B Summarise a dorsal column lesion in the thoracic cord, assess gait, complete the wider neurological and spine examination, and arrange MRI of the thoracic spine.
C Summarise a cauda equina syndrome, assess gait, complete the wider neurological and spine examination, and arrange urgent MRI of the lumbar spine.
D Summarise an isolated peroneal neuropathy at the fibular head, assess gait, complete the wider neurological and spine examination, and arrange nerve conduction studies.
E Summarise a sensory neuropathy, assess gait, complete the wider neurological and spine examination, and request an MRI of the brain as the next investigation.

The answer is A: Summarise a length-dependent sensory neuropathy, assess gait, complete the wider neurological and spine examination, and investigate likely causes with nerve conduction studies.

Explanation

Why A is correct

See Completing the Examination. Option A is correct. Symmetrical loss of vibration and pinprick in both feet, with reduced ankle reflexes and normal power, fits a length-dependent sensory neuropathy. In a peripheral neuropathy (disease of the nerves outside the brain and spinal cord) the longest nerves are affected first and at their furthest ends, so the feet are involved before the hands, and the ankle reflexes fade first. To complete the examination, after thanking the patient and washing your hands, you summarise the pattern and then say what else you would do: assess gait if you have not already, examine the upper limbs and cranial nerves, and examine the back and spine. You would then look for the cause, for example with blood glucose and HbA1c (to look for diabetes, a common cause), vitamin B12 and folate levels, and arrange nerve conduction studies, which measure how well the nerves carry electrical signals.

Pattern: symmetrical loss of vibration and pinprick in both feet with reduced ankle reflexes suggests a length-dependent sensory neuropathy.
Completing the examination: summarise, then assess gait, the upper limbs, the cranial nerves and the spine.
Tests: glucose and HbA1c, vitamin B12 and folate, and nerve conduction studies.

Why the other options are incorrect

B. Summarise a dorsal column lesion in the thoracic cord, assess gait, complete the wider neurological and spine examination, and arrange MRI of the thoracic spine.: A thoracic dorsal column lesion would impair vibration and proprioception while sparing pinprick, because pain travels in the spinothalamic tract, so it cannot explain the combined sensory loss and reduced ankle reflexes here.
C. Summarise a cauda equina syndrome, assess gait, complete the wider neurological and spine examination, and arrange urgent MRI of the lumbar spine.: Cauda equina syndrome would usually cause saddle anaesthesia, sphincter disturbance and often asymmetric leg symptoms, whereas this patient has a symmetrical length-dependent sensory loss, so urgent lumbar MRI is not the best next step.
D. Summarise an isolated peroneal neuropathy at the fibular head, assess gait, complete the wider neurological and spine examination, and arrange nerve conduction studies.: An isolated peroneal neuropathy at the fibular head causes unilateral foot drop and sensory loss in the peroneal distribution, not the symmetrical distal loss in both feet described here, so this summary would localise the lesion incorrectly.
E. Summarise a sensory neuropathy, assess gait, complete the wider neurological and spine examination, and request an MRI of the brain as the next investigation.: A brain MRI does not investigate a length-dependent peripheral neuropathy; the next steps are blood tests for metabolic causes and nerve conduction studies, so this plan stops at the wrong investigation.

Medium

With Premium, questions you miss become Revision Coach flashcards, scheduled for review.

Question preview

What you will practise

More questions from this set. Start the quiz to answer them and see each explanation.

1
On the heel-to-shin test, which finding most suggests a cerebellar lesion?
2
Which gait pattern is most typically described as small shuffling steps, reduced arm swing, a stooped posture, and difficulty starting to walk and turning?

Need wider coverage?

Explore every OSCE topic set, or build a tailored mixed session.

Browse subject quizzes