Barkley Neurological Exam PRACTICE
QUESTIONS |ORIGINAL QUESTIONS &
ANSWERS |DETAILED RATIONALES
|HINTED COMPLETE EXAM PREP
GRADED A+*INSTANT DOWNLOAD PDF
1.
A 68-year-old man develops sudden right facial droop, right arm
weakness, and expressive aphasia. Symptoms began 45 minutes ago.
CT head shows no hemorrhage. Which intervention is most time-
sensitive if no contraindications exist?
A. Aspirin only
B. Heparin infusion
C. IV thrombolytic therapy
D. Carotid endarterectomy
Rationale: In an eligible patient with acute ischemic stroke presenting
within the appropriate treatment window, IV thrombolysis should be
considered promptly after hemorrhage is excluded.
2.
Which finding most strongly suggests an upper motor neuron lesion?
A. Fasciculations
B. Muscle atrophy
C. Decreased deep tendon reflexes
D. Spasticity and hyperreflexia
Rationale: Upper motor neuron lesions typically produce weakness,
increased tone, hyperreflexia, and pathologic reflexes.
3.
,A patient with suspected bacterial meningitis has fever, headache,
neck stiffness, and altered mental status. What is the priority?
A. Wait for lumbar puncture results
B. Obtain MRI before treatment
C. Begin empiric antimicrobial therapy promptly
D. Administer oral corticosteroids only
Rationale: Suspected bacterial meningitis is a neurologic emergency.
Antimicrobial treatment should not be substantially delayed for
diagnostic procedures.
4.
Which cranial nerve is responsible for most tongue motor function?
A. CN V
B. CN VII
C. CN IX
D. CN XII
Rationale: The hypoglossal nerve controls motor movement of the
tongue.
5.
A patient has resting tremor, bradykinesia, rigidity, and postural
instability. Which diagnosis is most likely?
A. Essential tremor
B. Huntington disease
C. Parkinson disease
D. Cerebellar ataxia
Rationale: Bradykinesia plus rigidity and resting tremor are classic
features of Parkinson disease.
6.
,Which neurotransmitter deficiency is most closely associated with
Parkinson disease?
A. Acetylcholine
B. GABA
C. Serotonin
D. Dopamine
Rationale: Parkinson disease involves degeneration of dopaminergic
neurons in the substantia nigra pars compacta.
7.
A patient experiences unilateral pulsating headache with nausea and
photophobia lasting 12 hours. Which diagnosis is most likely?
A. Tension headache
B. Cluster headache
C. Migraine
D. Temporal arteritis
Rationale: Pulsating unilateral headache accompanied by nausea and
photophobia is characteristic of migraine.
8.
Which headache feature warrants urgent evaluation for a secondary
cause?
A. Headache associated with mild nausea
B. Long-standing identical headaches
C. Headache relieved by sleep
D. Sudden thunderclap headache
Rationale: A thunderclap headache reaching maximal intensity
rapidly may indicate subarachnoid hemorrhage or another serious
secondary cause.
9.
, Which finding is characteristic of a cerebellar lesion?
A. Spasticity
B. Aphasia
C. Dysmetria
D. Hemianopia
Rationale: Dysmetria, ataxia, intention tremor, and impaired
coordination are characteristic of cerebellar dysfunction.
10.
A patient cannot abduct the right eye. Which cranial nerve is
affected?
A. CN III
B. CN IV
C. CN VI
D. CN VII
Rationale: The abducens nerve innervates the lateral rectus muscle,
which abducts the eye.
11.
Which cranial nerve mediates facial sensation and motor function of
mastication?
A. CN II
B. CN V
C. CN VII
D. CN VIII
Rationale: The trigeminal nerve provides facial sensation and motor
innervation to the muscles of mastication.
12.
A patient has unilateral facial weakness involving the forehead and
lower face. Which condition is most likely?
QUESTIONS |ORIGINAL QUESTIONS &
ANSWERS |DETAILED RATIONALES
|HINTED COMPLETE EXAM PREP
GRADED A+*INSTANT DOWNLOAD PDF
1.
A 68-year-old man develops sudden right facial droop, right arm
weakness, and expressive aphasia. Symptoms began 45 minutes ago.
CT head shows no hemorrhage. Which intervention is most time-
sensitive if no contraindications exist?
A. Aspirin only
B. Heparin infusion
C. IV thrombolytic therapy
D. Carotid endarterectomy
Rationale: In an eligible patient with acute ischemic stroke presenting
within the appropriate treatment window, IV thrombolysis should be
considered promptly after hemorrhage is excluded.
2.
Which finding most strongly suggests an upper motor neuron lesion?
A. Fasciculations
B. Muscle atrophy
C. Decreased deep tendon reflexes
D. Spasticity and hyperreflexia
Rationale: Upper motor neuron lesions typically produce weakness,
increased tone, hyperreflexia, and pathologic reflexes.
3.
,A patient with suspected bacterial meningitis has fever, headache,
neck stiffness, and altered mental status. What is the priority?
A. Wait for lumbar puncture results
B. Obtain MRI before treatment
C. Begin empiric antimicrobial therapy promptly
D. Administer oral corticosteroids only
Rationale: Suspected bacterial meningitis is a neurologic emergency.
Antimicrobial treatment should not be substantially delayed for
diagnostic procedures.
4.
Which cranial nerve is responsible for most tongue motor function?
A. CN V
B. CN VII
C. CN IX
D. CN XII
Rationale: The hypoglossal nerve controls motor movement of the
tongue.
5.
A patient has resting tremor, bradykinesia, rigidity, and postural
instability. Which diagnosis is most likely?
A. Essential tremor
B. Huntington disease
C. Parkinson disease
D. Cerebellar ataxia
Rationale: Bradykinesia plus rigidity and resting tremor are classic
features of Parkinson disease.
6.
,Which neurotransmitter deficiency is most closely associated with
Parkinson disease?
A. Acetylcholine
B. GABA
C. Serotonin
D. Dopamine
Rationale: Parkinson disease involves degeneration of dopaminergic
neurons in the substantia nigra pars compacta.
7.
A patient experiences unilateral pulsating headache with nausea and
photophobia lasting 12 hours. Which diagnosis is most likely?
A. Tension headache
B. Cluster headache
C. Migraine
D. Temporal arteritis
Rationale: Pulsating unilateral headache accompanied by nausea and
photophobia is characteristic of migraine.
8.
Which headache feature warrants urgent evaluation for a secondary
cause?
A. Headache associated with mild nausea
B. Long-standing identical headaches
C. Headache relieved by sleep
D. Sudden thunderclap headache
Rationale: A thunderclap headache reaching maximal intensity
rapidly may indicate subarachnoid hemorrhage or another serious
secondary cause.
9.
, Which finding is characteristic of a cerebellar lesion?
A. Spasticity
B. Aphasia
C. Dysmetria
D. Hemianopia
Rationale: Dysmetria, ataxia, intention tremor, and impaired
coordination are characteristic of cerebellar dysfunction.
10.
A patient cannot abduct the right eye. Which cranial nerve is
affected?
A. CN III
B. CN IV
C. CN VI
D. CN VII
Rationale: The abducens nerve innervates the lateral rectus muscle,
which abducts the eye.
11.
Which cranial nerve mediates facial sensation and motor function of
mastication?
A. CN II
B. CN V
C. CN VII
D. CN VIII
Rationale: The trigeminal nerve provides facial sensation and motor
innervation to the muscles of mastication.
12.
A patient has unilateral facial weakness involving the forehead and
lower face. Which condition is most likely?
