The Glasgow Structured Approach
to Assessment of the Glasgow Coma Scale

Correct answers are highlighted in bold font.

Q1. What are the three components of the Glasgow Coma Scale?

C is correct. The component parts of the Scale are:- Eyes, Verbal, Motor.

Q2. Each of the three components of the GCS have a number of steps. Which of these are the correct combinations?

C is correct. In the Eye component there are 4 steps, in the Verbal 5 steps and in the Motor 6 steps.

Q3. What possible sequence of responses is assessed in the eye component?

A is correct. The sequences of increasing impairment in the eye component are:- Spontaneous, To Sound, To Pressure, None.

Q4. In each component of the GCS the ‘Best Response’ is,

C is correct. The best response is that which is normal for that component: spontaneous for eyes, orientated for verbal and obey commands for motor.

Q5. When assessing a patient, you should:

B is correct. The sequence in assessment is: Check, Observe, Stimulate

Q6. When assessing a patient, what is the reason for the CHECK step in the assessment?

B is correct. Before making observations you should check to identify factors that may interfere with the assessment.

Q7. If when you approach the patient they are awake and looking at you, how would you record this on the Glasgow Coma Scale?

A is correct. Spontaneous eye opening is present if the patient is considered able to look at something without stimulation.

Q8. You are called to see a patient who has fallen through a plate glass door. As you approach the patient you observe that their eyes are extremely swollen and they are unable to open them. How would you record the eye component of the scale?

C is correct. If some local physical factor precludes the patient being able to make a response, that component of the scale is not testable (NT).

Q9. A 45 year old man called Hamish is admitted to the Emergency Department on Sunday 1 January 2014 after being assaulted. When you ask the patient to tell you his name, where he is and what the date is, he answers, Hamish, Hospital, December. How would you record this finding?

B is correct . If the person is not able to say correctly, for whatever reason, even what month it is, they are rated as confused.

Q10. You are assessing the motor component of a patient’s GCS. They are unable to obey commands but bend their elbow when their finger nail bed is stimulated. What do you do next?

C is correct. If a patient bends their elbow when the finger is stimulated, the next step in assessing the motor response is to test if they can localise to a trapezius pinch.

Q11. A patient reacts to supraorbital pressure by moving their hand up to his face. How would you record this response?

C is correct. If a patient brings their hand up above their clavicle in response to either trapezius pinch or supra-orbital notch pressure the rating is Localising.

Q12. Normal flexion, where a patients elbow bends and their arm moves rapidly away from their body and from a stimulus, is given what number in the Glasgow Coma Scale?

B is correct Normal flexion is allocated a number of Motor 4.

Q13. If you were told by a colleague that their assessment of a patient’s GCS was E2, V3, M5, How would you interpret this?

B is correct. If the colleague has used the numbers correctly they mean that the patient’s eyes open to pressure, they can utter some words but do not form sentences, and they are able to localise to trapezius pinch. But you should ask them to confirm this is the case by using the words, which should be used in preference to numbers for this purpose.

Q14. In which of these scenarios of assessment of the motor component of the GCS is the best response on the patient’s right-hand side?

A is correct. Localising represents less impairment than flexion so the response on the right side is the better.