Facts read from aanpcert.org and 2 more · last checked Nov 7, 2026
Neurology on the family exam is less about rare syndromes than about sorting: which headache needs a scan today, which dizziness comes from the inner ear, which facial droop is a stroke.
Practice questions
60 questions written to the FNP-C outline; each choice is explained once you pick.
Headache: migraine, tension-type and cluster patterns, red flags, acute and preventive treatment.
Vascular: TIA, stroke syndromes, aneurysm signs.
Dizziness: vestibular versus cardiovascular causes, positional vertigo.
Cranial nerves: facial palsy, eye movement disorders.
Demyelinating and movement disorders: relapsing neurologic deficits, parkinsonism, gait change with cognitive decline.
Infection and language: encephalitis, aphasia types.
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14 adult neurology questions
0 / 14 answered14 questions
Tap an option: why each one is right or wrong appears under it.
Adult neurology
A 72-year-old woman has 3 weeks of a new right temporal headache, pain in her jaw when chewing, and fatigue. Her right temporal artery is tender with a reduced pulse. ESR is 84 mm/h. Her vision is currently normal. Which is the most appropriate next step?
Waiting for a biopsy before steroids risks sudden permanent vision loss; the biopsy stays diagnostic for at least 1 to 2 weeks after steroids start.
New temporal headache, jaw claudication, a tender artery, and a high ESR in an older adult are giant cell arteritis; high-dose prednisone starts the same day, and temporal artery biopsy or ultrasound follows.
A triptan treats migraine; using it here misses giant cell arteritis, and triptans constrict arteries.
MRI of the brain does not diagnose GCA, and following up without treatment leaves vision at risk.
A 72-year-old man has a shuffling gait with reduced arm swing, stooped posture, and difficulty initiating steps. This gait pattern most suggests which condition?
Spinal stenosis causes leg pain with walking relieved by bending forward (neurogenic claudication).
Cerebellar ataxia causes a wide-based, staggering gait, not a narrow shuffling one with reduced arm swing.
A shuffling gait with reduced arm swing, stooped posture, and trouble starting to walk is the parkinsonian gait, from basal ganglia dopamine loss.
Peripheral neuropathy causes a steppage or sensory ataxic gait that worsens in the dark.
A 60-year-old reports brief episodes of spinning triggered by rolling over in bed, each lasting under a minute, with no hearing loss. Which bedside test best confirms the suspected benign paroxysmal positional vertigo?
The Romberg test assesses proprioception and does not provoke the positional vertigo of BPPV.
The cover-uncover test detects strabismus.
The Weber test lateralizes hearing loss; it does not provoke positional vertigo.
The Dix-Hallpike maneuver reproduces vertigo with a burst of torsional, upbeating nystagmus after a short delay, which confirms posterior canal BPPV.
A 71-year-old man develops sudden speech difficulty. He speaks fluently in full sentences, but his words are often wrong or nonsensical, he cannot follow simple commands, and he seems unaware of his errors. Articulation is clear. Which deficit is present?
Dysarthria is a motor problem with articulation; his articulation is clear and his language content is abnormal.
Fluent but meaningless speech with poor comprehension and unawareness of errors is Wernicke (receptive) aphasia from a posterior superior temporal lesion.
Broca aphasia causes effortful, nonfluent speech with relatively preserved comprehension and awareness of errors.
Conduction aphasia leaves comprehension relatively intact and mainly impairs repetition.
A 45-year-old woman has progressive leg weakness and numbness, urinary urgency, and an episode of painful blurred vision in one eye last year. There is a sensory level at T6, lower-extremity hyperreflexia, and bilateral Babinski signs. Which test is most appropriate to confirm the suspected diagnosis?
Cord signs plus a past episode of painful monocular vision loss (optic neuritis) suggest a demyelinating disease; MRI of the brain and spinal cord shows lesions separated in space and time.
Oligoclonal bands support MS, but lumbar puncture is not the first test and cannot exclude a compressive cord lesion.
Nerve conduction studies test peripheral nerves; a sensory level, hyperreflexia, and Babinski signs localize to the spinal cord.
Visual evoked potentials can show prior optic neuritis but are rarely needed when MRI is available.
A 26-year-old woman with migraine without aura is prescribed sumatriptan 50 mg for attacks that NSAIDs do not relieve. Which instruction about using it is most appropriate?
Triptans are acute drugs; daily use causes medication-overuse headache and does not prevent attacks.
Triptans work best taken early in the attack, and sumatriptan can be repeated once after 2 hours if the headache returns.
Using a triptan on 10 or more days a month risks medication-overuse headache.
Waiting until the pain is severe reduces how well triptans work.
A 42-year-old woman woke up with drooping of the right side of her mouth and difficulty closing her right eye. She has no limb weakness, speech difficulty, or rash. Which examination finding best indicates a peripheral (lower motor neuron) facial nerve lesion rather than a stroke?
The upper face has bilateral cortical input, so a stroke spares the forehead; inability to wrinkle the forehead indicates a peripheral (lower motor neuron) facial nerve lesion.
Weak eye closure can occur in both, though it is usually more marked in peripheral lesions.
A flattened nasolabial fold occurs with both central and peripheral facial weakness.
Mouth droop occurs with both stroke and Bell palsy.
A 58-year-old woman has a sudden severe headache and double vision. Her left eyelid droops, the left eye rests down and out, and the left pupil is dilated and poorly reactive. What is the most likely cause?
Horner syndrome causes mild ptosis with a small (miotic) pupil, the opposite of this pupil.
Microvascular third nerve palsy in diabetes usually spares the pupil; a dilated pupil means compression of the outer parasympathetic fibers.
A third nerve palsy with a dilated pupil and sudden severe headache is a compressive lesion, classically a posterior communicating artery aneurysm, and needs emergency vascular imaging.
Myasthenia gravis can cause ptosis and diplopia, but it never affects the pupil.
A 40-year-old office worker has tension-type headaches three to four times weekly related to prolonged computer use. Over-the-counter ibuprofen helps individual episodes. What is the most appropriate initial management plan?
Triptans are for migraine; they are not effective for tension-type headache.
Frequent tension-type headache is managed with ergonomic and stress measures and by limiting acute analgesics to fewer than about 10 to 15 days a month to avoid medication-overuse headache.
Daily opioids are not recommended for primary headache; they cause dependence and medication-overuse headache.
Activity restriction does not help tension-type headache and reduces function.
A 26-year-old woman has double vision when looking to the left. On leftward gaze, her right eye does not move past midline while her left eye shows horizontal nystagmus; convergence is intact. She had an episode of leg numbness 1 year ago. What is the most likely diagnosis?
Failure of the adducting eye with nystagmus of the abducting eye and intact convergence is internuclear ophthalmoplegia; in a young adult with a previous neurologic episode it suggests multiple sclerosis.
A third nerve palsy impairs convergence too and usually causes ptosis; intact convergence localizes the lesion to the medial longitudinal fasciculus.
Thyroid eye disease restricts eye movements mechanically, often with proptosis and lid retraction, not this pattern.
Myasthenia can mimic almost any eye movement pattern, but it fatigues and does not cause nystagmus of the abducting eye with preserved convergence.
A 72-year-old man is brought in for 6 months of a progressively slow, shuffling, magnetic gait, new urinary incontinence, and declining attention and memory. He has no headache, and fundoscopy shows no papilledema. MRI demonstrates ventriculomegaly out of proportion to cortical sulcal atrophy. What is the most likely diagnosis?
A magnetic gait, urinary incontinence, and cognitive decline with ventricles enlarged out of proportion to the sulci are normal pressure hydrocephalus, which may improve with shunting.
Alzheimer disease starts with memory loss; gait and continence stay normal until late.
Idiopathic intracranial hypertension causes headache and papilledema in younger, usually obese, women.
Vascular dementia follows strokes with a stepwise course and shows infarcts or white matter disease rather than isolated ventriculomegaly.
A 27-year-old woman has 3 days of fever and headache, and today she is confused, speaking in odd phrases, and had a generalized seizure. Temperature is 38.9 °C. CSF shows 110 WBC/µL (90% lymphocytes), 180 RBC/µL, protein 85 mg/dL, and normal glucose. MRI shows T2 hyperintensity in the left temporal lobe. What is the most likely diagnosis?
Subarachnoid hemorrhage starts with a sudden thunderclap headache, not 3 days of fever, and the MRI would not show temporal lobe edema.
Viral meningitis causes headache and neck stiffness without confusion, seizures, or temporal lobe changes on MRI.
Bacterial meningitis causes a neutrophil-predominant CSF with low glucose, not lymphocytes with normal glucose.
Fever, confusion, seizure, a lymphocytic CSF with red cells, and temporal lobe hyperintensity point to HSV encephalitis; IV acyclovir starts at once while CSF HSV PCR is pending.
A 55-year-old man has migraine without aura. NSAIDs no longer relieve his attacks. He had a myocardial infarction 2 years ago. Which acute treatment is most appropriate?
Ergotamine is a vasoconstrictor and is contraindicated after myocardial infarction.
Butalbital combinations cause medication-overuse headache and dependence and are not recommended for migraine.
Gepants such as rimegepant do not constrict blood vessels and are an option for acute migraine when triptans are contraindicated by coronary disease.
Triptans constrict coronary arteries and are contraindicated after myocardial infarction.
A running total sits here; it fills in after your last pick.
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Neurology traps
A thunderclap headache handled as migraine. A headache that peaks within a minute needs emergency noncontrast CT, with further testing such as lumbar puncture if the scan is negative (ACEP clinical policy on headache, 2019).
Missing medication-overuse headache. ICHD-3 counts simple analgesics on 15 or more days a month, or triptans and combination analgesics on 10 or more, for over 3 months.
A TIA booked for next week. Transient deficits need urgent evaluation with brain and vascular imaging, the same day where possible (AHA scientific statement on TIA evaluation in the emergency department, 2023).
Antivirals alone for Bell palsy. Oral corticosteroids started within 72 hours of onset are the treatment; antiviral monotherapy is not recommended (AAO-HNS 2013).
Opioids for painful diabetic neuropathy. ADA lists gabapentinoids, SNRIs, tricyclics and sodium channel blockers as initial options, not opioids (Standards of Care 2026).
Dopamine agonists first for restless legs. The AASM 2024 guideline advises against their standard use because of augmentation, and starts with iron studies and iron replacement when stores are low.
Is dementia tested under neurology or under older adults?
Either can appear on the exam. On this site, cognitive testing and dementia types are taught on older adults.
Does the family exam ask about stroke thrombolysis?
The primary-care task is to recognize the stroke, note when the patient was last known well and call emergency services. Thrombolysis decisions are made in the hospital.