Neurological Assessment and GCS Questions

The Glasgow Coma Scale is one of the few things in the CBT you genuinely need to know by number. It measures conscious level in a standard way so that any clinician reading the score understands the same thing, and it turns up in head injury, deterioration and neurological questions.

The three components

The GCS scores three responses:

• Eye opening, out of 4.
• Verbal response, out of 5.
• Best motor response, out of 6.

Added together they give a total between 3 and 15. A fully alert, oriented person who obeys commands scores 15. Knowing which component carries which maximum is worth memorising, because questions test it directly.

Score	Eye opening (E)	Verbal response (V)	Motor response (M)
6	—	—	Obeys commands
5	—	Oriented	Localises to pain
4	Spontaneous	Confused	Normal flexion (withdrawal)
3	To speech	Inappropriate words	Abnormal flexion
2	To pain	Incomprehensible sounds	Extension
1	None	None	None

Why the floor is 3

A common trap is the lowest possible score. Each component scores a minimum of 1, even when there is no response, because you always record a value. So the lowest total is 1 plus 1 plus 1, which is 3, not 0. A GCS of 3 means deep unconsciousness with no response at all.

The critical threshold: 8

The single most important number is 8. At a GCS of 8 or below, a person may not be able to protect their own airway, which risks obstruction or aspiration. It is a critical threshold that prompts urgent senior and anaesthetic or critical care assessment, often summarised in the phrase “GCS of 8, intubate.” A patient whose score has fallen to 7 needs an urgent response, not a wait to see if it drops further.

Best response, and the trend

Two scoring habits matter. You always record the best response the patient can make, especially for motor, because that most reliably reflects brain function. And you watch the trend across repeated checks. A GCS that falls over successive assessments suggests deterioration, and in head injury may reflect rising pressure inside the skull. A downward trend can matter as much as any single reading, so a falling score is escalated promptly. Next: care planning and goal setting. Five GCS scenarios first.