NEUROLOGY PRACTICE QUESTIONS AND ACCURATE
ANSWERS UPDATED 2025 GRADED A+
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 - correct answer 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 - correct answer 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 - correct answer 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 - correct answer 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 - correct answer 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 - correct answer 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
A 51 year-old female presents to the clinic complaining of intermittent sharp pain that
originates at the corner of her mouth and radiates toward her ipsilateral eye. She
notes "everything makes it worse" including touching the area, talking and eating.
What is the most likely diagnosis?
Answers
A. Bell's palsy
B. Cluster headache
C. Post-herpetic neuralgia
D. Trigeminal neuralgia - correct answer Explanations
(u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. This is the classic presentation for trigeminal neuralgia (tic douloureux).
Health Maintenance/Neurology
A 45 year-old man presents for a routine appointment. He tells you his mother and
father have both had ischemic strokes in their 70's. He does not smoke. His blood
pressure is 128/80 mmHg, pulse 78/minutes and regular, respiratory rate of
12/minute. What diagnostic studies would you order to further evaluate this patient's
risk of stroke?
Answers
A. Electrocardiogram
B. Fasting lipid profile
C. Carotid Doppler ultrasound
D. MRI with gadolinium - correct answer Explanations
(u) A. The main risk factor assessed by ECG is atrial fibrillation and this patient's
regular pulse confirms he is currently not in atrial fibrillation
(c) B. Hyperlipidemia is a known risk factors for stroke that can be modified with
treatment.
(u) C. The patient does not have signs or symptoms of carotid stenosis at this point.
(u) D. An MRI with gadolinium would be useful in evaluating for the presence of
Berry aneurysms, but the history of ischemic strokes does not raise the concern of
an aneurysm.
Clinical Intervention/Neurology
ANSWERS UPDATED 2025 GRADED A+
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 - correct answer 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 - correct answer 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 - correct answer 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 - correct answer 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 - correct answer 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 - correct answer 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
A 51 year-old female presents to the clinic complaining of intermittent sharp pain that
originates at the corner of her mouth and radiates toward her ipsilateral eye. She
notes "everything makes it worse" including touching the area, talking and eating.
What is the most likely diagnosis?
Answers
A. Bell's palsy
B. Cluster headache
C. Post-herpetic neuralgia
D. Trigeminal neuralgia - correct answer Explanations
(u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. This is the classic presentation for trigeminal neuralgia (tic douloureux).
Health Maintenance/Neurology
A 45 year-old man presents for a routine appointment. He tells you his mother and
father have both had ischemic strokes in their 70's. He does not smoke. His blood
pressure is 128/80 mmHg, pulse 78/minutes and regular, respiratory rate of
12/minute. What diagnostic studies would you order to further evaluate this patient's
risk of stroke?
Answers
A. Electrocardiogram
B. Fasting lipid profile
C. Carotid Doppler ultrasound
D. MRI with gadolinium - correct answer Explanations
(u) A. The main risk factor assessed by ECG is atrial fibrillation and this patient's
regular pulse confirms he is currently not in atrial fibrillation
(c) B. Hyperlipidemia is a known risk factors for stroke that can be modified with
treatment.
(u) C. The patient does not have signs or symptoms of carotid stenosis at this point.
(u) D. An MRI with gadolinium would be useful in evaluating for the presence of
Berry aneurysms, but the history of ischemic strokes does not raise the concern of
an aneurysm.
Clinical Intervention/Neurology
