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Home / Station 5: Sudden focal weakness

NAC OSCE preparation

Station 5: Sudden focal weakness

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

Sudden focal weakness

11 minutes

Discipline: Emergency & Clinical Safety
Station type: Acute management + oral questions
Setting: Emergency department

Your task

Assess briefly and state immediate management. The examiner will provide findings and oral questions.

Information available at entry

HR 92/min irregularBP 178/96 mm HgRR 18/minSpO₂ 97%T 36.9°CGlucose 6.2 mmol/L

Coach prompt: Activate the stroke pathway and avoid preventable delay.

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 5 of 30

Standardized-patient profile

NameMr. Robert Chen

Age72

Pronounshe/him

RolePatient with spouse

Demeanour: Alert, frustrated by dysarthria.

Opening statement: “His wife says he was normal at breakfast, then suddenly could not move his right arm.”

History and standardized-patient responses

Time/baseline

Candidate explores	Standardized-patient response
Last known well	09:10; symptoms noted 09:25; current time 10:05.
Onset	Sudden and maximal at onset.
Baseline	Independent with no prior cognitive impairment.

Symptoms

Candidate explores	Standardized-patient response
Deficits	Right facial and arm weakness with slurred speech.
Other	No seizure, severe headache, vomiting or trauma.

Eligibility

Candidate explores	Standardized-patient response
Anticoagulant	Apixaban; timing of last dose uncertain.
Bleeding/surgery	No recent surgery, major bleeding or prior ICH.
Background	Hypertension and atrial fibrillation.

Physical findings

Right facial droop, right arm drift and dysarthria.
Airway protected.
Irregularly irregular rhythm.

Examiner prompts

Diagnosis?

Acute stroke, likely left hemispheric ischemic stroke until imaging excludes hemorrhage.

Immediate actions?

Stroke code, last-known-well, focused neurologic assessment, glucose, urgent non-contrast CT and vascular imaging, monitoring/IV access and stroke-team consultation.

Blood pressure?

Do not lower routinely or aggressively; targets depend on reperfusion eligibility and other emergencies.

Apixaban effect?

Clarify dose timing and renal function; it affects thrombolysis eligibility but does not automatically exclude thrombectomy.

Differential diagnosis

Acute ischemic stroke
Intracranial hemorrhage
Hypoglycemia
Postictal deficit
Migraine
Structural lesion

Investigations

Point-of-care glucose
Immediate non-contrast CT head
Vascular imaging ± perfusion per pathway
CBC, electrolytes, renal function and coagulation
ECG/monitoring

Management

Stroke-code activation
Reperfusion assessment
Airway and supportive care
Swallow screen before oral intake
Secondary prevention/rehabilitation after diagnosis

Communication behaviours

Address patient directly despite speech difficulty
Use simple questions and allow response time
Explain that imaging determines treatment

Critical safety actions

Last-known-well, glucose and imaging are time-critical
Do not delay for complete history
Account for anticoagulation without assuming all reperfusion is impossible

Model closing summary

This patient has an acute left hemispheric stroke syndrome beginning less than an hour ago. I would activate the stroke code, confirm last-known-well and anticoagulant timing, maintain airway and monitoring, obtain urgent non-contrast CT and vascular imaging, and involve the stroke team immediately for thrombolysis/thrombectomy assessment. Glucose is normal; he remains NPO until swallow screening.

Common pitfalls

Calling it TIA while deficits persist
Outpatient imaging
Oral medication before swallow screen
Aggressive BP lowering without pathway guidance

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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