NEURO NBME EXAM STUDY GUIDE
2026 COMPLETE QUESTIONS WITH
CORRECT DETAILED ANSWERS ||
100% GUARANTEED PASS
<RECENT VERSION>
Neuro 1
1. An 84-year-old man is evaluated for a 5-year history of a gradually
worsening gait and a 2-year history of cognitive impairment and urinary
incontinence. Twelve years ago, he sustained a closed head injury that
caused a mild traumatic subarachnoid hemorrhage and a 5-hour loss of
consciousness. Medications include zolpidem (when needed as a sleep aid)
and a daily multivitamin.
On physical examination, temperature is 36.2 °C (97.2 °F), blood pressure is
128/78 mm Hg, pulse rate is 76/min, respiration rate is 14/min, and BMI is
27. The patient's gait is slow and unsteady and is marked by small, shuffling
steps. His level of alertness, speech, posture, arm swing, and muscle tone are
all normal, and he has no tremor. He scores 24/30 on the Folstein Mini-
Mental State Examination, losing one point in the orientation portion for
incorrectly stating today's date, three points in the serial calculation portion,
and t - ANSWER ✔ B
The triad of gait apraxia, dementia, and urinary incontinence, especially when
accompanied by enlarged ventricles, is suggestive of normal pressure
hydrocephalus.
, This patient exhibits the classic triad of gait impairment (specifically, gait
apraxia), dementia, and urinary incontinence that typifies the potentially
reversible syndrome of normal pressure hydrocephalus (NPH). This triad of
symptoms eventually occurs in most patients with dementia, and the
diagnosis of NPH is often considered but much less often proved to be the
correct diagnosis. In this patient, however, strong evidence supports a
diagnosis of NPH, including the MRI evidence of ventriculomegaly.
Although Alzheimer dementia (AD) is also associated with cognitive
impairment and impaired gait, gait does not improve after removal of
cerebrospinal fluid in AD as it does in NPH. AD is so common in elderly
patients with cognitive impairment that excluding it as a cause can delay the
diagnosis of NPH; this delay may help explain some of the eventual shunt
failures that occur even in patients with well-diagnosed NPH. Therefore,
recognizing reversible dementia syndromes as soon as possible is imperative
because of the therapeutic opportunity these syndromes represent.
The only symptom this patient has that is shared by patients with Parkinson
disease is a shuffling gait. Otherwise, his presentation—normal posture, arm
swing, and muscle tone and the absence of a tremor—is quite different.
Likewise, this patient has no history of or symptoms suggesting stroke or
vascular disease, such as sudden onset of neurologic signs or symptoms,
which makes vascular dementia unlikely. Although coincident vascular,
Alzheimer-type, and Parkinson-type pathology is a common finding in
autopsy studies, even in neurologically unimpaired healthy elderly adults,
this fact should
2. Neuro 2
An 18-year-old male college student is evaluated for a single generalized
tonic-clonic seizure that began when he was asleep in his dormitory and
resolved uneventfully. He has no history of head trauma, meningitis, or prior
seizure and no family history of epilepsy. He takes no medications.
,Results of physical examination, including a neurologic examination, are
normal.
Results of laboratory studies, including a complete blood count, a serum
electrolyte panel, and a urine toxicology screen, are also normal.
An MRI of the brain and an electroencephalogram show no abnormalities.
Which of the following is the most appropriate management of this patient's
seizure?
A Initiate no drug therapy at this time
B Initiate therapy with carbamazepine
C Initiate therapy with lamotrigine
D Initiate therapy with valproic acid
E Refer for epilepsy surgery evaluation - ANSWER ✔ A
Unless special circumstances exist, drug therapy is generally not started in
patients with a single unprovoked seizure.
Drug therapy should not be initiated in this patient at this time. After a single
unprovoked seizure, the risk of recurrence in the subsequent 2 years has
been reported to be 30% to 40%. The risk of recurrence is greatest in
patients with status epilepticus on presentation, with an identifiable
underlying neurologic cause, or with abnormal results on an
electroencephalogram (EEG). Patients with a partial seizure who are age 65
years or older or who have a family history of epilepsy may also be in a
higher-risk category. The appropriate recommendation for this young
patient, who has experienced a single idiopathic seizure but has no personal
or family history of epilepsy, no identified neurologic cause of his seizure,
and normal results on an EEG, is that no medication be started. As with all
medical treatment recommendations, patient preference must be taken into
, account, and some patients in the low-risk group may elect to start therapy
after a single seizure, particularly if they have a high-risk occupation. If a
second seizure occurs in the future, the recurrence risk is greater than 60%,
and antiepileptic medical therapy should be recommended at that time.
Of note, driver's license privileges are restricted in every state in the United
States for persons who have experienced a seizure. Specific restrictions vary
by state, with typical requirements of a seizure-free period of 3 to 12 months
in order to again operate a motor vehicle; a few states make exceptions for a
single seizure. Reinstatement of driving privileges depends on demonstrating
freedom from seizures for the specified period and there being a reasonable
expectation of future seizure control. Initiation of antiepileptic medication
LP with elevated RBCs and WBCs (mostly lymphocytes)
+ elevated temperature
+ FND
+ normal CT
3. EEG shows repetitive complexes over the right temporal region - ANSWER
✔ HSV encephalitis
- confirm dx via PCR of CSF for HSV
acute onset eye pain & headache
+ blurred vision
+ diffuse redness of conjunctiva w/ circumcorneal prominence
+ pupil is midrange and nonreactive to lgiht
4. Likely dx - ANSWER ✔ Acute angle closure gluacoma
- tonemetry is next step in magement
2026 COMPLETE QUESTIONS WITH
CORRECT DETAILED ANSWERS ||
100% GUARANTEED PASS
<RECENT VERSION>
Neuro 1
1. An 84-year-old man is evaluated for a 5-year history of a gradually
worsening gait and a 2-year history of cognitive impairment and urinary
incontinence. Twelve years ago, he sustained a closed head injury that
caused a mild traumatic subarachnoid hemorrhage and a 5-hour loss of
consciousness. Medications include zolpidem (when needed as a sleep aid)
and a daily multivitamin.
On physical examination, temperature is 36.2 °C (97.2 °F), blood pressure is
128/78 mm Hg, pulse rate is 76/min, respiration rate is 14/min, and BMI is
27. The patient's gait is slow and unsteady and is marked by small, shuffling
steps. His level of alertness, speech, posture, arm swing, and muscle tone are
all normal, and he has no tremor. He scores 24/30 on the Folstein Mini-
Mental State Examination, losing one point in the orientation portion for
incorrectly stating today's date, three points in the serial calculation portion,
and t - ANSWER ✔ B
The triad of gait apraxia, dementia, and urinary incontinence, especially when
accompanied by enlarged ventricles, is suggestive of normal pressure
hydrocephalus.
, This patient exhibits the classic triad of gait impairment (specifically, gait
apraxia), dementia, and urinary incontinence that typifies the potentially
reversible syndrome of normal pressure hydrocephalus (NPH). This triad of
symptoms eventually occurs in most patients with dementia, and the
diagnosis of NPH is often considered but much less often proved to be the
correct diagnosis. In this patient, however, strong evidence supports a
diagnosis of NPH, including the MRI evidence of ventriculomegaly.
Although Alzheimer dementia (AD) is also associated with cognitive
impairment and impaired gait, gait does not improve after removal of
cerebrospinal fluid in AD as it does in NPH. AD is so common in elderly
patients with cognitive impairment that excluding it as a cause can delay the
diagnosis of NPH; this delay may help explain some of the eventual shunt
failures that occur even in patients with well-diagnosed NPH. Therefore,
recognizing reversible dementia syndromes as soon as possible is imperative
because of the therapeutic opportunity these syndromes represent.
The only symptom this patient has that is shared by patients with Parkinson
disease is a shuffling gait. Otherwise, his presentation—normal posture, arm
swing, and muscle tone and the absence of a tremor—is quite different.
Likewise, this patient has no history of or symptoms suggesting stroke or
vascular disease, such as sudden onset of neurologic signs or symptoms,
which makes vascular dementia unlikely. Although coincident vascular,
Alzheimer-type, and Parkinson-type pathology is a common finding in
autopsy studies, even in neurologically unimpaired healthy elderly adults,
this fact should
2. Neuro 2
An 18-year-old male college student is evaluated for a single generalized
tonic-clonic seizure that began when he was asleep in his dormitory and
resolved uneventfully. He has no history of head trauma, meningitis, or prior
seizure and no family history of epilepsy. He takes no medications.
,Results of physical examination, including a neurologic examination, are
normal.
Results of laboratory studies, including a complete blood count, a serum
electrolyte panel, and a urine toxicology screen, are also normal.
An MRI of the brain and an electroencephalogram show no abnormalities.
Which of the following is the most appropriate management of this patient's
seizure?
A Initiate no drug therapy at this time
B Initiate therapy with carbamazepine
C Initiate therapy with lamotrigine
D Initiate therapy with valproic acid
E Refer for epilepsy surgery evaluation - ANSWER ✔ A
Unless special circumstances exist, drug therapy is generally not started in
patients with a single unprovoked seizure.
Drug therapy should not be initiated in this patient at this time. After a single
unprovoked seizure, the risk of recurrence in the subsequent 2 years has
been reported to be 30% to 40%. The risk of recurrence is greatest in
patients with status epilepticus on presentation, with an identifiable
underlying neurologic cause, or with abnormal results on an
electroencephalogram (EEG). Patients with a partial seizure who are age 65
years or older or who have a family history of epilepsy may also be in a
higher-risk category. The appropriate recommendation for this young
patient, who has experienced a single idiopathic seizure but has no personal
or family history of epilepsy, no identified neurologic cause of his seizure,
and normal results on an EEG, is that no medication be started. As with all
medical treatment recommendations, patient preference must be taken into
, account, and some patients in the low-risk group may elect to start therapy
after a single seizure, particularly if they have a high-risk occupation. If a
second seizure occurs in the future, the recurrence risk is greater than 60%,
and antiepileptic medical therapy should be recommended at that time.
Of note, driver's license privileges are restricted in every state in the United
States for persons who have experienced a seizure. Specific restrictions vary
by state, with typical requirements of a seizure-free period of 3 to 12 months
in order to again operate a motor vehicle; a few states make exceptions for a
single seizure. Reinstatement of driving privileges depends on demonstrating
freedom from seizures for the specified period and there being a reasonable
expectation of future seizure control. Initiation of antiepileptic medication
LP with elevated RBCs and WBCs (mostly lymphocytes)
+ elevated temperature
+ FND
+ normal CT
3. EEG shows repetitive complexes over the right temporal region - ANSWER
✔ HSV encephalitis
- confirm dx via PCR of CSF for HSV
acute onset eye pain & headache
+ blurred vision
+ diffuse redness of conjunctiva w/ circumcorneal prominence
+ pupil is midrange and nonreactive to lgiht
4. Likely dx - ANSWER ✔ Acute angle closure gluacoma
- tonemetry is next step in magement
