Barkley Neurological Practice ACTUAL
EXAM ALL QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Cerebrovascular Disorders (Questions 1-15)
Question 1
A 70-year-old man reports a progressively worsening tremor when his hands are at rest, along
with rigidity and a slow, shuffling gait. Which diagnosis is most likely?
A. Essential tremor
B. Parkinson's disease
C. Normal pressure hydrocephalus
D. Amyotrophic lateral sclerosis
Correct Answer: B
Rationale: The classic triad of Parkinson's disease is resting tremor, rigidity, and bradykinesia.
Postural instability and shuffling gait are additional features .
Question 2
A patient presents to the ER with sudden loss of consciousness and motor function. The NP in
the ER diagnosed a TIA. The patient is experiencing right-sided weakness and numbness. Carotid
studies reveal both the left and right carotid arteries are approximately 92-95% occluded. Which
statement is true regarding this patient?
A. The left carotid will be explored, and the team will want to see if there is improvement
B. The right carotid will be explored first due to contralateral symptoms
,C. Both carotids will be explored simultaneously
D. Medical management alone is indicated due to bilateral disease
Correct Answer: A
Rationale: Right-sided weakness localizes to the left hemisphere. With bilateral high-grade
carotid stenosis, the symptomatic side (left) is typically explored first. The team will assess for
improvement before proceeding with contralateral intervention .
Question 3
A patient presents with acute onset right-sided weakness, facial droop, and aphasia. CT head is
negative for hemorrhage. What is the most appropriate next step?
A. Aspirin 324 mg
B. IV alteplase (tPA)
C. Endovascular thrombectomy
D. Observation
Correct Answer: B
Rationale: This patient presents with acute ischemic stroke within the treatment window. IV
alteplase (tPA) is indicated when CT is negative for hemorrhage and symptoms began within 4.5
hours.
Question 4
What is the strongest indicator of functional impairment at discharge following a neurological
event?
A. Motor deficit severity
B. Cognitive impairment
C. Age
D. Presence of aphasia
Correct Answer: B
Rationale: Cognitive impairment is the strongest predictor of functional impairment at
discharge following a neurological event .
Question 5
A 68-year-old woman with atrial fibrillation presents with sudden onset of left-sided weakness
,and visual field deficit. What is the most likely etiology?
A. Large vessel atherosclerosis
B. Embolic stroke
C. Lacunar stroke
D. Intracranial hemorrhage
Correct Answer: B
Rationale: Atrial fibrillation is a major risk factor for embolic stroke. The thrombus forms in the
left atrium and embolizes to the cerebral circulation.
Question 6
Which of the following defines a Transient Ischemic Attack (TIA)?
A. Acute cerebral insufficiency with permanent neurologic deficit
B. Acute cerebral insufficiency lasting less than 24 hours without residual defects
C. Acute cerebral insufficiency lasting more than 24 hours with residual defects
D. Progressive neurologic decline over weeks
Correct Answer: B
Rationale: A TIA is defined as acute cerebral insufficiency lasting less than 24 hours without
residual neurologic deficits and is a sign of impending CVA .
Question 7
A patient with a closed head injury is on a ventilator. ABG shows pH 7.30, pO2 60, pCO2 35, FiO2
40%. What is the most appropriate intervention?
A. Increase FiO2
B. Increase PEEP
C. Decrease respiratory rate
D. Obtain head CT
Correct Answer: A
Rationale: In a patient with a closed head injury, the pO2 of 60 is below target on FiO2 40%.
Increasing FiO2 improves oxygenation. PaCO2 of 35 is appropriate for neuroprotection .
Question 8
A patient with a complete spinal cord transection is recovering. What is expected during the
, recovery phase?
A. Decreased deep tendon reflexes
B. Increased deep tendon reflexes
C. Flaccid paralysis permanently
D. Sensory return before motor return
Correct Answer: B
Rationale: After complete spinal cord transection, the recovery phase is characterized by
increased deep tendon reflexes (hyperreflexia) due to loss of upper motor neuron inhibition.
Neurological improvement begins proximally .
Question 9
A patient is being discharged s/p craniotomy and is noted to be ataxic and holding onto the wall
while walking. What is the most appropriate intervention?
A. Consult physical therapy
B. Prescribe a walker
C. Order a brain MRI
D. Increase anticonvulsant dose
Correct Answer: A
Rationale: Ataxia and gait instability following craniotomy require physical therapy consultation
for gait training and fall prevention .
Question 10
Which cranial nerves are associated with eye movement?
A. CN I, II, III
B. CN III, IV, VI
C. CN II, III, IV
D. CN IV, V, VI
Correct Answer: B
Rationale: Cranial nerves III (oculomotor), IV (trochlear), and VI (abducens) are responsible for
eye movements. CN III controls most extraocular muscles, CN IV controls the superior oblique,
and CN VI controls the lateral rectus .
EXAM ALL QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Cerebrovascular Disorders (Questions 1-15)
Question 1
A 70-year-old man reports a progressively worsening tremor when his hands are at rest, along
with rigidity and a slow, shuffling gait. Which diagnosis is most likely?
A. Essential tremor
B. Parkinson's disease
C. Normal pressure hydrocephalus
D. Amyotrophic lateral sclerosis
Correct Answer: B
Rationale: The classic triad of Parkinson's disease is resting tremor, rigidity, and bradykinesia.
Postural instability and shuffling gait are additional features .
Question 2
A patient presents to the ER with sudden loss of consciousness and motor function. The NP in
the ER diagnosed a TIA. The patient is experiencing right-sided weakness and numbness. Carotid
studies reveal both the left and right carotid arteries are approximately 92-95% occluded. Which
statement is true regarding this patient?
A. The left carotid will be explored, and the team will want to see if there is improvement
B. The right carotid will be explored first due to contralateral symptoms
,C. Both carotids will be explored simultaneously
D. Medical management alone is indicated due to bilateral disease
Correct Answer: A
Rationale: Right-sided weakness localizes to the left hemisphere. With bilateral high-grade
carotid stenosis, the symptomatic side (left) is typically explored first. The team will assess for
improvement before proceeding with contralateral intervention .
Question 3
A patient presents with acute onset right-sided weakness, facial droop, and aphasia. CT head is
negative for hemorrhage. What is the most appropriate next step?
A. Aspirin 324 mg
B. IV alteplase (tPA)
C. Endovascular thrombectomy
D. Observation
Correct Answer: B
Rationale: This patient presents with acute ischemic stroke within the treatment window. IV
alteplase (tPA) is indicated when CT is negative for hemorrhage and symptoms began within 4.5
hours.
Question 4
What is the strongest indicator of functional impairment at discharge following a neurological
event?
A. Motor deficit severity
B. Cognitive impairment
C. Age
D. Presence of aphasia
Correct Answer: B
Rationale: Cognitive impairment is the strongest predictor of functional impairment at
discharge following a neurological event .
Question 5
A 68-year-old woman with atrial fibrillation presents with sudden onset of left-sided weakness
,and visual field deficit. What is the most likely etiology?
A. Large vessel atherosclerosis
B. Embolic stroke
C. Lacunar stroke
D. Intracranial hemorrhage
Correct Answer: B
Rationale: Atrial fibrillation is a major risk factor for embolic stroke. The thrombus forms in the
left atrium and embolizes to the cerebral circulation.
Question 6
Which of the following defines a Transient Ischemic Attack (TIA)?
A. Acute cerebral insufficiency with permanent neurologic deficit
B. Acute cerebral insufficiency lasting less than 24 hours without residual defects
C. Acute cerebral insufficiency lasting more than 24 hours with residual defects
D. Progressive neurologic decline over weeks
Correct Answer: B
Rationale: A TIA is defined as acute cerebral insufficiency lasting less than 24 hours without
residual neurologic deficits and is a sign of impending CVA .
Question 7
A patient with a closed head injury is on a ventilator. ABG shows pH 7.30, pO2 60, pCO2 35, FiO2
40%. What is the most appropriate intervention?
A. Increase FiO2
B. Increase PEEP
C. Decrease respiratory rate
D. Obtain head CT
Correct Answer: A
Rationale: In a patient with a closed head injury, the pO2 of 60 is below target on FiO2 40%.
Increasing FiO2 improves oxygenation. PaCO2 of 35 is appropriate for neuroprotection .
Question 8
A patient with a complete spinal cord transection is recovering. What is expected during the
, recovery phase?
A. Decreased deep tendon reflexes
B. Increased deep tendon reflexes
C. Flaccid paralysis permanently
D. Sensory return before motor return
Correct Answer: B
Rationale: After complete spinal cord transection, the recovery phase is characterized by
increased deep tendon reflexes (hyperreflexia) due to loss of upper motor neuron inhibition.
Neurological improvement begins proximally .
Question 9
A patient is being discharged s/p craniotomy and is noted to be ataxic and holding onto the wall
while walking. What is the most appropriate intervention?
A. Consult physical therapy
B. Prescribe a walker
C. Order a brain MRI
D. Increase anticonvulsant dose
Correct Answer: A
Rationale: Ataxia and gait instability following craniotomy require physical therapy consultation
for gait training and fall prevention .
Question 10
Which cranial nerves are associated with eye movement?
A. CN I, II, III
B. CN III, IV, VI
C. CN II, III, IV
D. CN IV, V, VI
Correct Answer: B
Rationale: Cranial nerves III (oculomotor), IV (trochlear), and VI (abducens) are responsible for
eye movements. CN III controls most extraocular muscles, CN IV controls the superior oblique,
and CN VI controls the lateral rectus .
