A 45-year-old man is brought to the emergency after a fall. He opens his eyes to voice, speaks inappropriate words, and withdraws his arm when a painful stimulus is applied. What is his GCS score?

1. A

   13

2. B

   11

3. C

   10

4. D

   8

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

• The Glasgow Coma Scale (GCS) assesses level of consciousness through three components: Eye Opening, Verbal Response, and Motor Response.
• The patient's response 'opens eyes to voice' scores 3 points (E3).
• The response 'speaks inappropriate words' scores 3 points (V3).
• The response 'withdraws his arm when a painful stimulus is applied' scores 4 points (M4).
• The total GCS score is the sum of these components: E3 + V3 + M4 = 10.
• A score of 10 falls into the category of a moderate head injury (GCS 9-12).

Why Other Options Were Wrong

• Option A: A score of 13 is incorrect. This would imply a higher level of function, such as being confused (V4) and localizing to pain (M5), which would total E3 + V4 + M5 = 12. The patient's responses do not support this higher score.
• Option B: A score of 11 is incorrect. This would require a higher score in one category, for instance, localizing pain (M5) instead of withdrawing (M4). The patient's documented response is withdrawal.
• Option D: A score of 8 is incorrect. This would indicate a more severe injury, such as making only incomprehensible sounds (V2) and showing abnormal flexion (M3). The patient's responses are at a higher level than this.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Calculation and interpretation of the Glasgow Coma Scale (GCS) score as background academic context rather than a clinical decision trigger.
• Nurses use the GCS frequently in emergency, ICU, and neurological settings to get a quick, objective measure of a patient's neurological status and level of consciousness.
• A declining GCS score is a critical finding that indicates worsening neurological function and requires immediate notification of the physician and potential intervention.
• What if the patient's motor response was 'abnormal flexion' (decorticate posturing) instead of withdrawal? The motor score would drop from 4 to 3, making the total GCS score 9 (E3+V3+M3). This would still be a moderate injury but closer to the severe category, indicating a more severe brain insult.

How to Approach the Question

• First, identify that the question is asking for a Glasgow Coma Scale (GCS) score.
• Break down the patient's presentation into the three GCS components: Eye Opening, Verbal Response, and Motor Response.
• Analyze the 'Eye Opening' response: The patient 'opens his eyes to voice'. Recall or look up the GCS chart to find the score for this response (Score = 3).
• Analyze the 'Verbal Response': The patient 'speaks inappropriate words'. Find the corresponding score (Score = 3).
• Analyze the 'Motor Response': The patient 'withdraws his arm when a painful stimulus is applied'. Find the corresponding score (Score = 4).
• Sum the scores from the three components: 3 (Eyes) + 3 (Verbal) + 4 (Motor) = 10. Select the option that matches this total.

Concept Tested & Keywords

• Concept Tested: Calculation and interpretation of the Glasgow Coma Scale (GCS) score.
• Stem keywords: Glasgow Coma Scale, GCS score, fall, emergency, head injury
• Lead-in keywords: What is his GCS score
• Clinical cues: Opens eyes to voice
• Clinical cues: speaks inappropriate words

Question ID

Qwrpu53vdTGB_ZEFLfOCfb

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 412-414

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) p. 196-198

E6 Medicine Harrison 22e Part 2 p. 1475-1477