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Home / Station 29: Focused neurologic examination for stroke

NAC OSCE preparation

Station 29: Focused neurologic examination for stroke

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Focused neurologic examination for stroke

11 minutes

Discipline: Physical Examination
Station type: Focused neurologic exam
Setting: Emergency department resuscitation area

Your task

Perform a focused neurologic examination for sudden weakness, then summarize and state immediate actions.

Information available at entry

HR 88/min irregularBP 176/94 mm HgRR 18/minSpO₂ 97% room airGlucose 6.8 mmol/L

Coach prompt: Localize an acute hemispheric deficit and activate time-critical stroke care.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 29 of 30

Standardized-patient profile

NameMs. Olivia Chen

Age67

Pronounsshe/her

RolePatient

Demeanour: Alert but frustrated by speech difficulty.

Opening statement: “My right arm suddenly stopped working.”

History and standardized-patient responses

Information available on request

Candidate explores	Standardized-patient response
Last known well	55 minutes ago.
Anticoagulation	Apixaban for atrial fibrillation; last dose this morning.
Symptoms	Abrupt aphasia and right face/arm weakness; no seizure.
Baseline	Independent, modified Rankin 0.

Physical findings

Expressive aphasia with preserved alertness.
Right lower facial weakness sparing forehead.
Right arm power 1/5, right leg 4/5; left side 5/5.
Right arm drift not testable due to weakness.
Reduced right-sided sensation with mild neglect.
Visual fields: right homonymous hemianopia.
No meningismus.

Examiner prompts

Localization?

Left cerebral hemisphere, likely left middle cerebral artery territory.

Immediate imaging?

Non-contrast head CT plus vascular imaging according to local acute-stroke protocol.

Treatment issue?

Activate stroke team; assess thrombectomy eligibility. Recent apixaban affects thrombolysis eligibility and requires exact timing/renal function/local protocol.

Differential diagnosis

Acute left MCA ischemic stroke
Intracranial hemorrhage
Postictal Todd paralysis
Hypoglycemia
Migraine with aura
Functional neurologic disorder

Investigations

Immediate non-contrast CT head
CTA head/neck or local vascular imaging
CBC, electrolytes, creatinine, coagulation testing and type/screen without delaying imaging
ECG and troponin as appropriate

Management

Activate stroke code
Maintain airway/oxygenation; treat hypoglycemia if present
Urgent reperfusion eligibility assessment
Consider mechanical thrombectomy for large-vessel occlusion
Avoid unnecessary BP lowering before reperfusion decision
Swallow screen before oral intake
Stroke-unit care

Communication behaviours

Use yes/no questions for aphasia
Explain actions to patient despite communication difficulty
Update support person without delaying care

Critical safety actions

Time last known well precisely
Do not delay CT/stroke team
Do not give food, drink or oral medication before swallow screen

Model closing summary

This is an acute left hemispheric syndrome, most consistent with a left middle cerebral artery stroke, with aphasia, right face and arm-predominant weakness, sensory neglect and a right visual-field deficit. Last known well was 55 minutes ago, so I would activate the stroke team immediately, obtain non-contrast CT and vascular imaging, clarify apixaban timing and renal function, and assess both thrombolysis under protocol and mechanical thrombectomy eligibility without delay.

Common pitfalls

Completing a lengthy full neurologic exam before activation
Assuming anticoagulation excludes all reperfusion
Aggressively lowering blood pressure without indication
Failing to assess glucose

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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