NR 507 — CNS Brain Disorders, Convulsions,
Headaches & Cranial Nerves (100 questions +
answers with brief rationales)
1. A patient arrives with sudden-onset right-sided weakness, facial droop,
and slurred speech that began 45 minutes ago. Which is the most
important immediate action?
A. Obtain a chest x-ray
B. Prepare for CT scan of the head without contrast
C. Administer aspirin immediately
D. Start broad-spectrum antibiotics
Answer: B. Rationale: CT without contrast is required urgently to
distinguish ischemic vs hemorrhagic stroke before thrombolytic therapy.
2. Which cranial nerve is tested by asking the patient to identify smells?
A. CN I (olfactory)
B. CN II (optic)
C. CN V (trigeminal)
D. CN VII (facial)
Answer: A. Rationale: Olfactory nerve mediates smell.
3. A generalized tonic-clonic seizure lasting 7 minutes requires which priority
action?
A. Time the seizure and ensure airway patency; prepare IV
benzodiazepine
B. Hold the patient down to prevent injury
C. Place a tongue depressor in mouth
D. Start broad-spectrum antibiotics
Answer: A. Rationale: Seizure >5 min risks status epilepticus—secure
airway and give IV lorazepam.
4. Which statement best describes aura in focal seizures?
A. Loss of consciousness for >1 hour
B. A repetitive motor movement after the seizure
C. A subjective sensory or experiential phenomenon preceding seizure
D. Permanent memory loss
Answer: C. Rationale: Aura is a focal-onset sensory/psychic sign
preceding clinical seizure.
5. A client with suspected bacterial meningitis should have which test
performed urgently?
A. Serum TSH
B. Lumbar puncture after CT head (if indicated)
C. EEG
,NR 507 — CNS Brain Disorders, Convulsions,
Headaches & Cranial Nerves (100 questions +
answers with brief rationales)
D. Carotid Doppler
Answer: B. Rationale: CSF analysis is diagnostic; CT head precedes LP if
increased ICP or focal signs.
6. Which medication is the first-line abortive therapy for acute migraine
without contraindications?
A. Sumatriptan (a triptan)
B. Propranolol
C. Topiramate
D. Amitriptyline
Answer: A. Rationale: Triptans acutely abort migraine by serotonin
receptor agonism causing vasoconstriction.
7. Damage to cranial nerve VII causes which clinical finding?
A. Ipsilateral facial paralysis (Bell’s palsy)
B. Loss of accommodation reflex
C. Inability to shrug shoulders
D. Loss of smell
Answer: A. Rationale: Facial nerve controls muscles of facial expression.
8. A focal seizure with preserved awareness is called:
A. Absence seizure
B. Simple partial seizure
C. Complex partial seizure
D. Tonic-clonic seizure
Answer: B. Rationale: Simple partial (focal aware) seizures do not impair
consciousness.
9. A patient with Parkinson disease reports “on-off” motor fluctuations. This
is most related to:
A. Cardiac arrhythmias
B. Long-term levodopa therapy and dopaminergic fluctuations
C. Excess acetylcholine levels
D. Infection
Answer: B. Rationale: Motor fluctuations arise from long-term levodopa
pharmacodynamics.
10. In assessing increased intracranial pressure (ICP), which triad
(Cushing’s response) is most worrisome?
A. Fever, tachycardia, sweating
B. Hypertension with widened pulse pressure, bradycardia, irregular
respirations
, NR 507 — CNS Brain Disorders, Convulsions,
Headaches & Cranial Nerves (100 questions +
answers with brief rationales)
C. Hypotension, tachycardia, hyperventilation
D. Hypothermia, tachypnea, diarrhea
Answer: B. Rationale: Cushing triad indicates elevated ICP and
impending herniation.
11. Which anticonvulsant is commonly used for generalized tonic-clonic
and focal seizures and requires monitoring of serum levels?
A. Levetiracetam
B. Phenytoin
C. Lamotrigine
D. Diazepam
Answer: B. Rationale: Phenytoin requires serum monitoring for toxicity
and therapeutic window.
12. A patient with cluster headaches most often describes pain as:
A. Bilateral, dull ache behind eyes
B. Severe unilateral periorbital pain with autonomic features
C. Diffuse pressure with neck stiffness
D. Throbbing bilateral pain relieved by sleep
Answer: B. Rationale: Cluster headaches are severe unilateral periorbital
with lacrimation and nasal congestion.
13. Which cranial nerve is evaluated by testing visual acuity and visual
fields?
A. CN II (optic)
B. CN III (oculomotor)
C. CN VIII (vestibulocochlear)
D. CN IX (glossopharyngeal)
Answer: A. Rationale: Optic nerve mediates vision.
14. Status epilepticus is defined as seizure activity lasting:
A. >30 seconds
B. >2 minutes
C. >5 minutes or recurrent seizures without regaining baseline
D. >24 hours
Answer: C. Rationale: Most definitions use >5 minutes as threshold for
status epilepticus requiring treatment.
15. A patient with a recent ischemic stroke is started on alteplase. Which
contraindication must be excluded first?
A. Hypertension controlled with IV meds
B. Recent major surgery or bleeding within 3 months
Headaches & Cranial Nerves (100 questions +
answers with brief rationales)
1. A patient arrives with sudden-onset right-sided weakness, facial droop,
and slurred speech that began 45 minutes ago. Which is the most
important immediate action?
A. Obtain a chest x-ray
B. Prepare for CT scan of the head without contrast
C. Administer aspirin immediately
D. Start broad-spectrum antibiotics
Answer: B. Rationale: CT without contrast is required urgently to
distinguish ischemic vs hemorrhagic stroke before thrombolytic therapy.
2. Which cranial nerve is tested by asking the patient to identify smells?
A. CN I (olfactory)
B. CN II (optic)
C. CN V (trigeminal)
D. CN VII (facial)
Answer: A. Rationale: Olfactory nerve mediates smell.
3. A generalized tonic-clonic seizure lasting 7 minutes requires which priority
action?
A. Time the seizure and ensure airway patency; prepare IV
benzodiazepine
B. Hold the patient down to prevent injury
C. Place a tongue depressor in mouth
D. Start broad-spectrum antibiotics
Answer: A. Rationale: Seizure >5 min risks status epilepticus—secure
airway and give IV lorazepam.
4. Which statement best describes aura in focal seizures?
A. Loss of consciousness for >1 hour
B. A repetitive motor movement after the seizure
C. A subjective sensory or experiential phenomenon preceding seizure
D. Permanent memory loss
Answer: C. Rationale: Aura is a focal-onset sensory/psychic sign
preceding clinical seizure.
5. A client with suspected bacterial meningitis should have which test
performed urgently?
A. Serum TSH
B. Lumbar puncture after CT head (if indicated)
C. EEG
,NR 507 — CNS Brain Disorders, Convulsions,
Headaches & Cranial Nerves (100 questions +
answers with brief rationales)
D. Carotid Doppler
Answer: B. Rationale: CSF analysis is diagnostic; CT head precedes LP if
increased ICP or focal signs.
6. Which medication is the first-line abortive therapy for acute migraine
without contraindications?
A. Sumatriptan (a triptan)
B. Propranolol
C. Topiramate
D. Amitriptyline
Answer: A. Rationale: Triptans acutely abort migraine by serotonin
receptor agonism causing vasoconstriction.
7. Damage to cranial nerve VII causes which clinical finding?
A. Ipsilateral facial paralysis (Bell’s palsy)
B. Loss of accommodation reflex
C. Inability to shrug shoulders
D. Loss of smell
Answer: A. Rationale: Facial nerve controls muscles of facial expression.
8. A focal seizure with preserved awareness is called:
A. Absence seizure
B. Simple partial seizure
C. Complex partial seizure
D. Tonic-clonic seizure
Answer: B. Rationale: Simple partial (focal aware) seizures do not impair
consciousness.
9. A patient with Parkinson disease reports “on-off” motor fluctuations. This
is most related to:
A. Cardiac arrhythmias
B. Long-term levodopa therapy and dopaminergic fluctuations
C. Excess acetylcholine levels
D. Infection
Answer: B. Rationale: Motor fluctuations arise from long-term levodopa
pharmacodynamics.
10. In assessing increased intracranial pressure (ICP), which triad
(Cushing’s response) is most worrisome?
A. Fever, tachycardia, sweating
B. Hypertension with widened pulse pressure, bradycardia, irregular
respirations
, NR 507 — CNS Brain Disorders, Convulsions,
Headaches & Cranial Nerves (100 questions +
answers with brief rationales)
C. Hypotension, tachycardia, hyperventilation
D. Hypothermia, tachypnea, diarrhea
Answer: B. Rationale: Cushing triad indicates elevated ICP and
impending herniation.
11. Which anticonvulsant is commonly used for generalized tonic-clonic
and focal seizures and requires monitoring of serum levels?
A. Levetiracetam
B. Phenytoin
C. Lamotrigine
D. Diazepam
Answer: B. Rationale: Phenytoin requires serum monitoring for toxicity
and therapeutic window.
12. A patient with cluster headaches most often describes pain as:
A. Bilateral, dull ache behind eyes
B. Severe unilateral periorbital pain with autonomic features
C. Diffuse pressure with neck stiffness
D. Throbbing bilateral pain relieved by sleep
Answer: B. Rationale: Cluster headaches are severe unilateral periorbital
with lacrimation and nasal congestion.
13. Which cranial nerve is evaluated by testing visual acuity and visual
fields?
A. CN II (optic)
B. CN III (oculomotor)
C. CN VIII (vestibulocochlear)
D. CN IX (glossopharyngeal)
Answer: A. Rationale: Optic nerve mediates vision.
14. Status epilepticus is defined as seizure activity lasting:
A. >30 seconds
B. >2 minutes
C. >5 minutes or recurrent seizures without regaining baseline
D. >24 hours
Answer: C. Rationale: Most definitions use >5 minutes as threshold for
status epilepticus requiring treatment.
15. A patient with a recent ischemic stroke is started on alteplase. Which
contraindication must be excluded first?
A. Hypertension controlled with IV meds
B. Recent major surgery or bleeding within 3 months
