NEUROLOGY EXAM 2025/2026 VERIFIED
QUESTIONS AND ANSWERS WITH
EXPLANATIONS
History & Physical/Neurology
A 73 year-old male presents to the clinic with his wife. His wife has noticed that he has developed a
resting tremor in his right hand and a shuffling gait over the last year. What finding on physical
examination would support your suspected diagnosis?
Answers
A. Chorea
B. Dystonia
C. Masked facies
D. Hyperreflexia
Explanations
(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. The patient symptoms are consistent with Parkinsonism. Physical exam findings include masked
facies, micrographia, decreased arm swing, and monotonous speech.
(u) D. See C for explanation.
History & Physical/Neurology
A patient with an upper motor neuron lesion would exhibit which of the following findings?
Answers
A. Fasciculations
,B. Areflexia
C. Muscular atrophy
D. Spasticity
Explanations
(u) A. Fasciculations, areflexia and muscle atrophy are consistent with lower motor neuron lesions.
(u) B. See A for explanations.
(u) C. See A for explanation.
(c) D. Spasticity is an upper motor neuron lesion finding.
Diagnostic Studies/Neurology
What test is the single most useful test in establishing the diagnosis of multiple sclerosis?
Answers
A. Cerebral spinal fluid cell count and protein level
B. Cerebral spinal fluid immunoglobulin studies
C. Evoked potentials
D. Magnetic Resonance Imaging
Explanations
(u) A. While cerebral spinal fluid cell count, protein levels, and immunoglobins may be abnormal they are
not specific for multiple sclerosis.
(u) B. See A for explanation.
(u) C. Evoked potentials are most useful in the detection of subclinical involvement of neuropathways in
MS, but does not establish the diagnosis.
(c) D. The presence of plaques on MRI is a key finding in establishing the diagnosis of MS.
Diagnostic Studies/Neurology
,A 22 year-old male presents to the clinic complaining of excessive daytime somnolence and strong
desires to sleep at inappropriate times. He came in today because he had an episode of "feeling paralyzed"
as he was falling asleep yesterday. What is the most appropriate diagnostic test to confirm this patient's
diagnosis?
Answers
A. MRI of the brain
B. Electroencephalogram
C. Multiple sleep latency test
D. Overnight polysomnography
Explanations
(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. Multiple sleep latency test is required to observe the abrupt transition to REM sleep and establish
the diagnosis of narcolepsy.
(u) D. See C for explanation.
Diagnosis/Neurology
A 54 year-old male smoker presents to the clinic complaining of frequent vague headaches with
associated vomiting that awaken him from sleep occasionally and have been present upon awakening for
about two weeks. The headache typically resolves about an hour into his morning routine. The patient is
afebrile. What is the most likely cause of this patient's headaches?
Answers
A. Cluster headaches
B. Depression
C. Glioblastoma
D. Giant cell arteritis
Explanations
(u) A. Cluster headaches can awaken patients, but are not usually "vague".
, (u) B. See C for explanation.
(c) C. Morning headaches associated with vomiting are indicative of increased intracranial pressure and
raise concern of a CNS tumor such as a glioblastoma.
(u) D. Giant cell arteritis presents in the older patient with headache in the temporal region and loss of
vision.
Diagnosis/Neurology
A 28 year-old female presents to the clinic complaining of a "prickly sensation" that started bilaterally in
her feet two days ago and difficulty walking. She now has the dysesthesia from her mid-thigh down to her
toes. On physical examination she has diminished pain and temperature sensation, absent reflexes, loss of
proprioception in her legs bilaterally, and muscle strength is 1+/5+ in the lower extremities and 5+/5+ in
the upper extremities. What is the most likely diagnosis?
A. Guillain-Barré syndrome
B. Multiple sclerosis
C. Myasthenia gravis
D. Spinal cord compression
Explanations
(c) A. The pattern of sensory, motor and reflex findings is consistent with the pathophysiology of
peripheral nerve demyelination that occurs in Guillain-Barré syndrome.
(u) B. Multiple sclerosis does not present as a symmetrical ascending paralysis.
(u) C. Patients with myasthenia gravis tend to have intermittent symptoms that affect proximal and
extraocular muscles most notably and it also lacks sensory involvement.
(u) D. Although the exact type of cord transection can alter the pattern of motor and sensory findings a
patient with spinal cord compression who is not in spinal shock would have hyperreflexia instead of
areflexia.
Diagnosis/Neurology
QUESTIONS AND ANSWERS WITH
EXPLANATIONS
History & Physical/Neurology
A 73 year-old male presents to the clinic with his wife. His wife has noticed that he has developed a
resting tremor in his right hand and a shuffling gait over the last year. What finding on physical
examination would support your suspected diagnosis?
Answers
A. Chorea
B. Dystonia
C. Masked facies
D. Hyperreflexia
Explanations
(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. The patient symptoms are consistent with Parkinsonism. Physical exam findings include masked
facies, micrographia, decreased arm swing, and monotonous speech.
(u) D. See C for explanation.
History & Physical/Neurology
A patient with an upper motor neuron lesion would exhibit which of the following findings?
Answers
A. Fasciculations
,B. Areflexia
C. Muscular atrophy
D. Spasticity
Explanations
(u) A. Fasciculations, areflexia and muscle atrophy are consistent with lower motor neuron lesions.
(u) B. See A for explanations.
(u) C. See A for explanation.
(c) D. Spasticity is an upper motor neuron lesion finding.
Diagnostic Studies/Neurology
What test is the single most useful test in establishing the diagnosis of multiple sclerosis?
Answers
A. Cerebral spinal fluid cell count and protein level
B. Cerebral spinal fluid immunoglobulin studies
C. Evoked potentials
D. Magnetic Resonance Imaging
Explanations
(u) A. While cerebral spinal fluid cell count, protein levels, and immunoglobins may be abnormal they are
not specific for multiple sclerosis.
(u) B. See A for explanation.
(u) C. Evoked potentials are most useful in the detection of subclinical involvement of neuropathways in
MS, but does not establish the diagnosis.
(c) D. The presence of plaques on MRI is a key finding in establishing the diagnosis of MS.
Diagnostic Studies/Neurology
,A 22 year-old male presents to the clinic complaining of excessive daytime somnolence and strong
desires to sleep at inappropriate times. He came in today because he had an episode of "feeling paralyzed"
as he was falling asleep yesterday. What is the most appropriate diagnostic test to confirm this patient's
diagnosis?
Answers
A. MRI of the brain
B. Electroencephalogram
C. Multiple sleep latency test
D. Overnight polysomnography
Explanations
(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. Multiple sleep latency test is required to observe the abrupt transition to REM sleep and establish
the diagnosis of narcolepsy.
(u) D. See C for explanation.
Diagnosis/Neurology
A 54 year-old male smoker presents to the clinic complaining of frequent vague headaches with
associated vomiting that awaken him from sleep occasionally and have been present upon awakening for
about two weeks. The headache typically resolves about an hour into his morning routine. The patient is
afebrile. What is the most likely cause of this patient's headaches?
Answers
A. Cluster headaches
B. Depression
C. Glioblastoma
D. Giant cell arteritis
Explanations
(u) A. Cluster headaches can awaken patients, but are not usually "vague".
, (u) B. See C for explanation.
(c) C. Morning headaches associated with vomiting are indicative of increased intracranial pressure and
raise concern of a CNS tumor such as a glioblastoma.
(u) D. Giant cell arteritis presents in the older patient with headache in the temporal region and loss of
vision.
Diagnosis/Neurology
A 28 year-old female presents to the clinic complaining of a "prickly sensation" that started bilaterally in
her feet two days ago and difficulty walking. She now has the dysesthesia from her mid-thigh down to her
toes. On physical examination she has diminished pain and temperature sensation, absent reflexes, loss of
proprioception in her legs bilaterally, and muscle strength is 1+/5+ in the lower extremities and 5+/5+ in
the upper extremities. What is the most likely diagnosis?
A. Guillain-Barré syndrome
B. Multiple sclerosis
C. Myasthenia gravis
D. Spinal cord compression
Explanations
(c) A. The pattern of sensory, motor and reflex findings is consistent with the pathophysiology of
peripheral nerve demyelination that occurs in Guillain-Barré syndrome.
(u) B. Multiple sclerosis does not present as a symmetrical ascending paralysis.
(u) C. Patients with myasthenia gravis tend to have intermittent symptoms that affect proximal and
extraocular muscles most notably and it also lacks sensory involvement.
(u) D. Although the exact type of cord transection can alter the pattern of motor and sensory findings a
patient with spinal cord compression who is not in spinal shock would have hyperreflexia instead of
areflexia.
Diagnosis/Neurology
