OSPE Gross & Histology

Instructions to the Students: Answer the following questions based on the procedure being performed in
the picture.
Questions:

1. Name the procedure being performed in the picture (0.5)

2. Name 3 purposes for which this procedure is done (0.5)

3. What should be the position of the patient while

performing this procedure (1)

4. List the structures pierced by the needle in this procedure

in an order (1)

5. Name the vertebral level at which this procedure is done

and why? (1)

Marks: 4 Time: 4 min

Instructions to the Students: A 40 year old lady was brought to the hospital by her son for the burn
injuries she sustained during cooking to the tips of fingers of both her hands. She reported not having
any pain associated with the injury. Neurological examination revealed no other neurological deficits.
Discriminative touch and position sense were intact. MRI revealed cystic dilatation of the cervical central
canal.

Questions:
1. Name the clinical condition that describes the above case. (1)

2. Give reasons for bilateral loss of pain and temperature sensation in

her fingers. (1)

3. Give reasons why discriminative touch & position sense are intact. (1)

4. For her fingers to be affected, at what level of the spinal cord do you
expect the dilatation of central canal to be present? (1)

Marks: 4 Time: 4 min

Instructions to the Students: A 60 year old lady arrived with a stomping gait to the neurologist and
presented with history of pins and needles in her feet, and difficulty in walking in the dark. Neurological
examination revealed impaired sense of position & vibration and Romberg’s sign was positive. Answer the
following questions referring to the picture.

Questions:

1. Name the affected tract in the above case. (1)

2. Give the anatomical basis for stomping gait. (0.5)

3. Give reason for difficulty in walking in the dark and positive

Romberg’s sign. (1)

4. Name the sites of I, II & III order neurons for this pathway. (1.5)

Marks: 4 Time: 4 min

Instructions: A 45y old man following a stab injury to his back, revealed on neurological examination:
a. Weakness, hyperreflexia, positive Babinski’s sign in left lower limb
b. Fasciculations in his lower trunk muscles
c. Impaired senses of vibration and position in his left lower limb &
d. Impaired sense of pain & temperature in his right lower limb.

Questions:

1. Name the clinical condition that describes the above case. (1)

2. Give reasons for a, b, c & d described above. (0.5+0.5+0.5+1)

3. At what level of the spinal cord do you expect the lesion to be

present? (0.5)

Marks: 4 Time: 4 min

Instructions: A 55 year old lady presents with a history of slurring of speech, difficulty in swallowing,
hoarseness of voice, and rotatory vertigo. She also complained of difficulty in walking & maintaining
balance. On examination, it was observed that she had loss of pain and temperature sensation on the left
half of her face and the right half of her body. Her left eye revealed pupillary constriction & mild ptosis.
Answer the following questions based on the picture.

Questions:

1. Name the clinical syndrome. (0.5)

2. Which artery is commonly affected in this case? (0.5)
3. Identify the level of section shown in the picture. (0.5)
4. Name the affected structure that results in the following symptoms:
a. Loss of pain and temperature sensation on left half of her face (0.5)
b. Loss of pain and temperature sensation on the right half of her body. (0.5)
c. Slurred speech, difficulty in swallowing & hoarseness of voice (0.5)
d. Rotatory vertigo, difficulty in walking & maintaining balance. (0.5)
e. Pupillary constriction & mild ptosis. (0.5)

Marks: 4 Time: 4 min

Instructions: A 60y old lady presents with weakness of muscles in right upper & lower limbs. Examination
revealed loss of sensation of discriminative touch & vibration in the right half of her body and the tongue
was deviating to the left when asked to protrude. Answer the following questions based on the picture.

Questions:

1. Name the clinical syndrome. (0.5)

2. Which artery is commonly affected in this case? (0.5)
3. Which side is the lesion in the above case & why? (0.5 + 1)

4. Name the affected structure that results in the following symptoms:

a. Weakness in right upper & lower limbs (0.5)
b. Loss of sensation in right half of her body (0.5)
c. Tongue deviating to the left side (0.5)

Marks: 4 Time: 4 min Blocks of affected areas shown by arrows bilaterally

Instructions: A 45y old lady came to the emergency room in the morning with complaints of weakness in
her right upper & lower limbs and double vision. Examination showed facial palsy on the left half of the
face and inability of the left eye to abduct. Answer the following questions referring to the picture shown
(area of lesion shown by the arrow).

Questions:

1. Name the structure affected that contributes to weakness in her right limbs. (0.5)

2. Name the structures affected that contributes to double vision. (0.5)

3. Identify the section of the brainstem shown here (1)

4. Identify A & B in the picture. (0.5 + 0.5)

5. Give the anatomical basis for weakness of limbs on the right side
and weakness of facial muscles on the left side. (1) A

Marks: 4 Time: 4 min B

Instructions to the Students: A 65 year old lady presents with weakness of left half of her body and double
vision, with her right eye positioned down and out. Examination revealed left lower facial weakness & left
sided Parkinsonism rigidity. Answer the following questions based on the picture showing the affected
area marked with orange circle.

Questions:

1. Name the clinical syndrome. (0.5)

2. Identify the level of section shown in the picture. (1)

3. Give the anatomical basis for weakness in left half of her body. (1)

4. Give the anatomical basis for down and out position of the right eye. (1)

5. Give the anatomical basis for left lower facial weakness & Parkinsonism rigidity. (0.5)

Marks: 4 Time: 4 min

Instructions to the Students: A young lady presented with clumsy movements, altered speech & gait.
Examination revealed intention tremors, decomposition of movements, dysmetria and inability to perform
rapid alternating movements. Answer the following questions based on the picture.

Questions:

1. Which part of the brain is affected? (0.5)

2. Name the parts of the affected organ. (0.5)

3. Name the functional lobe & zone of the organ involved in this case. (1)

4. Name the arteries supplying the affected organ. (1)

5. Name three functions of the affected organ. (1)

Marks: 4 Time: 4 min

Instructions to the Students: A 65 year old hypertensive man presented with weakness of left arm & leg
and left lower face. CT showed lacunar infarct. Answer the following questions based on the pictures (Right
side is an indicative picture showing the section of brain).

Questions:

1. Name the structure involved with its parts. (1)

2. Name the likely affected part based with reasons. (1)

3. Why is left lower face affected & upper face spared? (1)

4. Name the arteries supplying the area. (1)

Marks: 4 Time: 4 min

Instructions: A 65y old man came with complaints of weakness and loss of sensation in his right upper
limb & altered speech. Examination revealed (a) UMN type of lesion in the right upper limb, (b) cortical
sensory loss with astereognosis and hemi neglect, (c) global aphasia and (d) deviation of both the eyes to
the left side. Answer the following questions referring to the picture.

Questions:

1. Name the artery likely to be having a lesion in the above case. (1)

2. Give the anatomical basis for a, b, c & d. (0.5 + 0.5 + 1 + 1)

Marks: 4 Time: 4 min

Instructions: Read these four case scenarios and name the sites of lesion in the visual pathway.
a. A 10y old child presents with complete blindness and absence of light reflex in his right eye.
b. A 35y old lady was able to see from central part of her visual field & not from peripheral field on both sides.
c. A 50y old man could read only from left half of the clock & see things in the left half of the field of vision.
d. A 75y old man presented with tunnel vision.

Questions:

1. Name the sites of lesion in cases of a, b, c & d and give

anatomical basis for your answers (1 + 1 + 1 + 1)

Marks: 4 Time: 4 min

Instructions: A 70y old man presented with stooped posture, shuffling gait & pill-rolling type of resting
tremors. Answer the following questions based on the picture.

Questions:

1. Name the clinical condition. (1)

2. Name the likely affected structure, pathway and neurotransmitter. (1.5)

3. Name the parts of the basal ganglia. (1.5)

Marks: 4 Time: 4 min

Instructions to the Students: A 2m old baby was brought to the hospital with complaints of enlarged head
and sluggishness. Fontanelle were full. Setting sun eye sign indicated a peri-aqueductal lesion. CT
confirmed block at the cerebral aqueduct with enlarged lateral & III ventricles. Answer the following
questions based on the condition shown in the picture.
Questions:
1. What is the clinical condition known as? (0.5)
2. Name the passages connecting (a) lateral & III ventricle, (b) III & IV
ventricle & (c) IV ventricle & subarachnoid space. (0.5 + 0.5 + 0.5)
3. Name the arteries forming the choroid plexuses of lateral & fourth
ventricles with their origin. (0.5 + 0.5)
4. Name the sites of location of choroid plexus in lateral & III
ventricles. (0.5 + 0.5)
Marks: 4 Time: 4 min