Family Medicine EOR Neurology Exam
(2026/2027) | QUESTIONS AND ANSWERS
Physician Assistant (PA) Family Medicine End of Rotation (EOR) Neurology Examination |
Core Domains: Neurological History & Physical Examination, Headache Disorders (Migraine,
Tension, Cluster), Seizure Disorders & Epilepsy, Cerebrovascular Disease (Stroke & TIA),
Neurodegenerative Disorders (Dementia, Parkinson's), Peripheral Neuropathy & Pain
Syndromes, Multiple Sclerosis & Demyelinating Diseases, CNS Infections, and Neurological
Emergencies | Physician Assistant Education Focus | Specialty-Specific EOR Exam Format
Exam Structure
The Family Medicine EOR Neurology exam for the 2026/2027 academic cycle is a 75-question,
multiple-choice question (MCQ) examination.
Introduction
This Family Medicine EOR Neurology exam guide for the 2026/2027 cycle prepares Physician
Assistant students for the neurology-focused End of Rotation examination. The content assesses
the diagnosis, management, and appropriate referral of common neurological conditions
encountered in a primary care setting, emphasizing a patient-centered approach within the
family medicine scope of practice.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green,
followed by detailed rationales that integrate presentation, diagnostic criteria (e.g., DSM-6,
clinical guidelines), initial pharmacologic and non-pharmacologic treatment, and indications for
specialist referral.
Question 1: A 32-year-old woman presents with recurrent episodes of severe unilateral
throbbing headache lasting 4–72 hours, associated with nausea, photophobia, and
phonophobia. She reports complete relief with sleep. Which of the following is the most
appropriate acute treatment for moderate to severe attacks?
(A) Acetaminophen
(B) Ibuprofen
(C) Sumatriptan
(D) Amitriptyline
,(E) Propranolol
Correct Answer: (C) Sumatriptan
Rationale: This patient meets ICHD-3 criteria for migraine without aura. For moderate to
severe migraines or those unresponsive to NSAIDs/acetaminophen, triptans (e.g., sumatriptan)
are first-line acute therapy. They are serotonin (5-HT1B/1D) receptor agonists that cause
vasoconstriction and inhibit neuropeptide release. Acetaminophen and ibuprofen may be used
for mild attacks. Amitriptyline and propranolol are preventive agents, not acute treatments.
Triptans are contraindicated in patients with cardiovascular disease or hemiplegic/basilar
migraine.
Question 2: A 68-year-old man presents with sudden-onset right-sided weakness and slurred
speech that resolved completely within 30 minutes. He has a history of atrial fibrillation and
hypertension. Which of the following is the most appropriate next step in management?
(A) Start aspirin 81 mg daily
(B) Order outpatient carotid ultrasound
(C) Admit for stroke protocol and initiate anticoagulation
(D) Reassure and schedule follow-up in 1 week
(E) Start clopidogrel 75 mg daily
Correct Answer: (C) Admit for stroke protocol and initiate anticoagulation
Rationale: This patient had a transient ischemic attack (TIA) in the context of atrial
fibrillation—a high-risk cardioembolic source. Per AHA/ASA guidelines, patients with TIA due
to AF should be evaluated urgently (ideally within 24–48 hours) and often require
hospitalization for risk stratification (e.g., ABCD² score ≥4), neuroimaging (MRI preferred), and
initiation of anticoagulation (e.g., apixaban, rivaroxaban) after ruling out hemorrhage. Aspirin
alone is insufficient for cardioembolic TIA. Outpatient workup is inappropriate in high-risk
cases.
Question 3: A 74-year-old woman is brought in by her daughter due to progressive memory
loss over 18 months, including forgetting appointments, getting lost in familiar places, and
,difficulty managing medications. She has no focal neurologic deficits. MMSE score is 20/30.
Which of the following is the most likely diagnosis?
(A) Vascular dementia
(B) Lewy body dementia
(C) Alzheimer disease
(D) Normal pressure hydrocephalus
(E) Frontotemporal dementia
Correct Answer: (C) Alzheimer disease
Rationale: Alzheimer disease is the most common cause of dementia, characterized by
insidious onset and progressive decline in episodic memory (especially recent recall), followed
by language, visuospatial, and executive dysfunction. Absence of focal signs, stepwise decline
(vascular), parkinsonism/hallucinations (Lewy body), gait apraxia/incontinence (NPH), or early
personality changes (FTD) supports this diagnosis. MRI may show hippocampal atrophy.
Cholinesterase inhibitors (donepezil) are first-line symptomatic treatment; referral to neurology
is appropriate for confirmation and management planning.
Question 4: A 45-year-old man presents with bilateral burning pain and numbness in his feet
for 6 months. He has type 2 diabetes mellitus with HbA1c of 9.2%. Neurologic exam shows
reduced sensation to light touch and vibration in a stocking distribution and absent ankle
reflexes. Which of the following is the most appropriate initial management step?
(A) Start gabapentin
(B) Order nerve conduction studies
(C) Optimize glycemic control
, (D) Prescribe amitriptyline
(E) Refer to neurology immediately
Correct Answer: (C) Optimize glycemic control
Rationale: This patient has classic distal symmetric polyneuropathy due to poorly controlled
diabetes. While symptomatic treatment (e.g., gabapentin, duloxetine, amitriptyline) is important
for pain, the cornerstone of management is optimizing glycemic control to slow progression.
HbA1c >9% indicates suboptimal control. Nerve conduction studies are not routinely needed if
clinical picture is typical. Referral is indicated only if atypical features (e.g., asymmetric, rapid
progression, motor predominance) suggest alternative etiology.
Question 5: A 28-year-old woman presents with recurrent episodes of severe periorbital pain
lasting 30–90 minutes, always on the right side, accompanied by ipsilateral lacrimation and
nasal congestion. Attacks occur nightly for 2 weeks, then stop for months. Which of the
following is the most effective acute treatment?
(A) Oral sumatriptan
(B) Subcutaneous sumatriptan
(C) High-flow oxygen via non-rebreather mask
(D) Naproxen
(E) Verapamil
Correct Answer: (C) High-flow oxygen via non-rebreather mask
Rationale: This describes cluster headache—unilateral, severe, short-duration attacks with
autonomic features (lacrimation, rhinorrhea), occurring in clusters separated by remission
periods. High-flow oxygen (100%, 12–15 L/min via non-rebreather) is first-line acute therapy
and aborts attacks in ~70% of patients within 15 minutes. Subcutaneous sumatriptan is also
effective but oxygen is preferred due to safety and non-pharmacologic nature. Verapamil is used
for prevention, not acute treatment.
(2026/2027) | QUESTIONS AND ANSWERS
Physician Assistant (PA) Family Medicine End of Rotation (EOR) Neurology Examination |
Core Domains: Neurological History & Physical Examination, Headache Disorders (Migraine,
Tension, Cluster), Seizure Disorders & Epilepsy, Cerebrovascular Disease (Stroke & TIA),
Neurodegenerative Disorders (Dementia, Parkinson's), Peripheral Neuropathy & Pain
Syndromes, Multiple Sclerosis & Demyelinating Diseases, CNS Infections, and Neurological
Emergencies | Physician Assistant Education Focus | Specialty-Specific EOR Exam Format
Exam Structure
The Family Medicine EOR Neurology exam for the 2026/2027 academic cycle is a 75-question,
multiple-choice question (MCQ) examination.
Introduction
This Family Medicine EOR Neurology exam guide for the 2026/2027 cycle prepares Physician
Assistant students for the neurology-focused End of Rotation examination. The content assesses
the diagnosis, management, and appropriate referral of common neurological conditions
encountered in a primary care setting, emphasizing a patient-centered approach within the
family medicine scope of practice.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green,
followed by detailed rationales that integrate presentation, diagnostic criteria (e.g., DSM-6,
clinical guidelines), initial pharmacologic and non-pharmacologic treatment, and indications for
specialist referral.
Question 1: A 32-year-old woman presents with recurrent episodes of severe unilateral
throbbing headache lasting 4–72 hours, associated with nausea, photophobia, and
phonophobia. She reports complete relief with sleep. Which of the following is the most
appropriate acute treatment for moderate to severe attacks?
(A) Acetaminophen
(B) Ibuprofen
(C) Sumatriptan
(D) Amitriptyline
,(E) Propranolol
Correct Answer: (C) Sumatriptan
Rationale: This patient meets ICHD-3 criteria for migraine without aura. For moderate to
severe migraines or those unresponsive to NSAIDs/acetaminophen, triptans (e.g., sumatriptan)
are first-line acute therapy. They are serotonin (5-HT1B/1D) receptor agonists that cause
vasoconstriction and inhibit neuropeptide release. Acetaminophen and ibuprofen may be used
for mild attacks. Amitriptyline and propranolol are preventive agents, not acute treatments.
Triptans are contraindicated in patients with cardiovascular disease or hemiplegic/basilar
migraine.
Question 2: A 68-year-old man presents with sudden-onset right-sided weakness and slurred
speech that resolved completely within 30 minutes. He has a history of atrial fibrillation and
hypertension. Which of the following is the most appropriate next step in management?
(A) Start aspirin 81 mg daily
(B) Order outpatient carotid ultrasound
(C) Admit for stroke protocol and initiate anticoagulation
(D) Reassure and schedule follow-up in 1 week
(E) Start clopidogrel 75 mg daily
Correct Answer: (C) Admit for stroke protocol and initiate anticoagulation
Rationale: This patient had a transient ischemic attack (TIA) in the context of atrial
fibrillation—a high-risk cardioembolic source. Per AHA/ASA guidelines, patients with TIA due
to AF should be evaluated urgently (ideally within 24–48 hours) and often require
hospitalization for risk stratification (e.g., ABCD² score ≥4), neuroimaging (MRI preferred), and
initiation of anticoagulation (e.g., apixaban, rivaroxaban) after ruling out hemorrhage. Aspirin
alone is insufficient for cardioembolic TIA. Outpatient workup is inappropriate in high-risk
cases.
Question 3: A 74-year-old woman is brought in by her daughter due to progressive memory
loss over 18 months, including forgetting appointments, getting lost in familiar places, and
,difficulty managing medications. She has no focal neurologic deficits. MMSE score is 20/30.
Which of the following is the most likely diagnosis?
(A) Vascular dementia
(B) Lewy body dementia
(C) Alzheimer disease
(D) Normal pressure hydrocephalus
(E) Frontotemporal dementia
Correct Answer: (C) Alzheimer disease
Rationale: Alzheimer disease is the most common cause of dementia, characterized by
insidious onset and progressive decline in episodic memory (especially recent recall), followed
by language, visuospatial, and executive dysfunction. Absence of focal signs, stepwise decline
(vascular), parkinsonism/hallucinations (Lewy body), gait apraxia/incontinence (NPH), or early
personality changes (FTD) supports this diagnosis. MRI may show hippocampal atrophy.
Cholinesterase inhibitors (donepezil) are first-line symptomatic treatment; referral to neurology
is appropriate for confirmation and management planning.
Question 4: A 45-year-old man presents with bilateral burning pain and numbness in his feet
for 6 months. He has type 2 diabetes mellitus with HbA1c of 9.2%. Neurologic exam shows
reduced sensation to light touch and vibration in a stocking distribution and absent ankle
reflexes. Which of the following is the most appropriate initial management step?
(A) Start gabapentin
(B) Order nerve conduction studies
(C) Optimize glycemic control
, (D) Prescribe amitriptyline
(E) Refer to neurology immediately
Correct Answer: (C) Optimize glycemic control
Rationale: This patient has classic distal symmetric polyneuropathy due to poorly controlled
diabetes. While symptomatic treatment (e.g., gabapentin, duloxetine, amitriptyline) is important
for pain, the cornerstone of management is optimizing glycemic control to slow progression.
HbA1c >9% indicates suboptimal control. Nerve conduction studies are not routinely needed if
clinical picture is typical. Referral is indicated only if atypical features (e.g., asymmetric, rapid
progression, motor predominance) suggest alternative etiology.
Question 5: A 28-year-old woman presents with recurrent episodes of severe periorbital pain
lasting 30–90 minutes, always on the right side, accompanied by ipsilateral lacrimation and
nasal congestion. Attacks occur nightly for 2 weeks, then stop for months. Which of the
following is the most effective acute treatment?
(A) Oral sumatriptan
(B) Subcutaneous sumatriptan
(C) High-flow oxygen via non-rebreather mask
(D) Naproxen
(E) Verapamil
Correct Answer: (C) High-flow oxygen via non-rebreather mask
Rationale: This describes cluster headache—unilateral, severe, short-duration attacks with
autonomic features (lacrimation, rhinorrhea), occurring in clusters separated by remission
periods. High-flow oxygen (100%, 12–15 L/min via non-rebreather) is first-line acute therapy
and aborts attacks in ~70% of patients within 15 minutes. Subcutaneous sumatriptan is also
effective but oxygen is preferred due to safety and non-pharmacologic nature. Verapamil is used
for prevention, not acute treatment.
