Neurology, Psychiatry &
Behavioral Exam 2026 Edition
1.
A 68-year-old man suddenly develops right-sided weakness and
expressive aphasia while eating breakfast. He has atrial
fibrillation and is not taking anticoagulation. CT of the head
shows no hemorrhage. Which vascular territory is most likely
affected?
A. Left posterior cerebral artery
B. Right middle cerebral artery
C. Left middle cerebral artery
D. Right anterior cerebral artery
Answer: C. Left middle cerebral artery
The dominant hemisphere is usually the left hemisphere. A left
middle cerebral artery infarction can produce contralateral
right-sided weakness, particularly of the face and arm, along
with expressive aphasia when Broca's area is involved.
,2.
A 24-year-old woman experiences recurrent episodes of
unilateral throbbing headaches associated with nausea,
photophobia, and visual scintillations. Neurologic examination
is normal between episodes. What is the most likely diagnosis?
A. Cluster headache
B. Tension-type headache
C. Migraine with aura
D. Trigeminal neuralgia
Answer: C. Migraine with aura
Migraine with aura is characterized by recurrent headaches
preceded or accompanied by reversible neurologic symptoms,
commonly visual phenomena. Nausea and photophobia
strongly support migraine.
3.
A 72-year-old man develops resting tremor, bradykinesia,
rigidity, and a shuffling gait. Which neurotransmitter deficiency
is primarily responsible?
A. Serotonin
B. GABA
,C. Dopamine
D. Acetylcholine
Answer: C. Dopamine
Parkinson disease results from degeneration of dopaminergic
neurons in the substantia nigra pars compacta, causing reduced
dopamine signaling within the basal ganglia.
4.
A 31-year-old woman has episodes of neurologic dysfunction
separated in time and affecting different parts of the central
nervous system. MRI demonstrates multiple periventricular
white-matter lesions. Which diagnosis is most likely?
A. Guillain-Barré syndrome
B. Multiple sclerosis
C. Amyotrophic lateral sclerosis
D. Huntington disease
Answer: B. Multiple sclerosis
Multiple sclerosis is an immune-mediated demyelinating
disease of the central nervous system characterized by
neurologic deficits disseminated in time and space.
, 5.
A 19-year-old college student has a generalized tonic-clonic
seizure lasting 90 seconds. He returns to baseline after a
postictal period. Which finding most strongly supports a true
epileptic seizure rather than syncope?
A. Rapid recovery
B. Preceding lightheadedness
C. Lateral tongue biting
D. Occurrence while standing
Answer: C. Lateral tongue biting
Lateral tongue biting is highly suggestive of a generalized tonic-
clonic seizure. Syncope typically produces rapid recovery and
may be preceded by lightheadedness or visual dimming.
6.
A patient presents with fever, severe headache, neck stiffness,
and photophobia. Which CSF profile is most consistent with
acute bacterial meningitis?
A. Low protein, low glucose, lymphocytic predominance
B. Normal protein, normal glucose, few cells
C. High protein, low glucose, neutrophilic predominance
D. High glucose, eosinophilic predominance
Behavioral Exam 2026 Edition
1.
A 68-year-old man suddenly develops right-sided weakness and
expressive aphasia while eating breakfast. He has atrial
fibrillation and is not taking anticoagulation. CT of the head
shows no hemorrhage. Which vascular territory is most likely
affected?
A. Left posterior cerebral artery
B. Right middle cerebral artery
C. Left middle cerebral artery
D. Right anterior cerebral artery
Answer: C. Left middle cerebral artery
The dominant hemisphere is usually the left hemisphere. A left
middle cerebral artery infarction can produce contralateral
right-sided weakness, particularly of the face and arm, along
with expressive aphasia when Broca's area is involved.
,2.
A 24-year-old woman experiences recurrent episodes of
unilateral throbbing headaches associated with nausea,
photophobia, and visual scintillations. Neurologic examination
is normal between episodes. What is the most likely diagnosis?
A. Cluster headache
B. Tension-type headache
C. Migraine with aura
D. Trigeminal neuralgia
Answer: C. Migraine with aura
Migraine with aura is characterized by recurrent headaches
preceded or accompanied by reversible neurologic symptoms,
commonly visual phenomena. Nausea and photophobia
strongly support migraine.
3.
A 72-year-old man develops resting tremor, bradykinesia,
rigidity, and a shuffling gait. Which neurotransmitter deficiency
is primarily responsible?
A. Serotonin
B. GABA
,C. Dopamine
D. Acetylcholine
Answer: C. Dopamine
Parkinson disease results from degeneration of dopaminergic
neurons in the substantia nigra pars compacta, causing reduced
dopamine signaling within the basal ganglia.
4.
A 31-year-old woman has episodes of neurologic dysfunction
separated in time and affecting different parts of the central
nervous system. MRI demonstrates multiple periventricular
white-matter lesions. Which diagnosis is most likely?
A. Guillain-Barré syndrome
B. Multiple sclerosis
C. Amyotrophic lateral sclerosis
D. Huntington disease
Answer: B. Multiple sclerosis
Multiple sclerosis is an immune-mediated demyelinating
disease of the central nervous system characterized by
neurologic deficits disseminated in time and space.
, 5.
A 19-year-old college student has a generalized tonic-clonic
seizure lasting 90 seconds. He returns to baseline after a
postictal period. Which finding most strongly supports a true
epileptic seizure rather than syncope?
A. Rapid recovery
B. Preceding lightheadedness
C. Lateral tongue biting
D. Occurrence while standing
Answer: C. Lateral tongue biting
Lateral tongue biting is highly suggestive of a generalized tonic-
clonic seizure. Syncope typically produces rapid recovery and
may be preceded by lightheadedness or visual dimming.
6.
A patient presents with fever, severe headache, neck stiffness,
and photophobia. Which CSF profile is most consistent with
acute bacterial meningitis?
A. Low protein, low glucose, lymphocytic predominance
B. Normal protein, normal glucose, few cells
C. High protein, low glucose, neutrophilic predominance
D. High glucose, eosinophilic predominance
