Neurology Prometric exam questions with answers

1. Question 1Cerebrovascular Disordersmedium

   A 66-year-old man presents 6 hours after an episode of right hand weakness and dysarthria lasting 40 minutes, now resolved. His ABCD2 score is 5 and CT brain is normal. He has no atrial fibrillation. Which antiplatelet regimen is most appropriate?

   1. AWarfarin with a target INR of 2 to 3
   2. BAspirin alone, continued indefinitely
   3. CAspirin plus clopidogrel for 12 months
   4. DAspirin plus clopidogrel for 21 days, then a single antiplatelet agent
   Show answer and explanation▾

   Answer: D. Aspirin plus clopidogrel for 21 days, then a single antiplatelet agent

   For high-risk TIA or minor ischaemic stroke, the CHANCE and POINT trials showed that short-term dual antiplatelet therapy started within 24 hours reduces early recurrent stroke, with most benefit in the first 3 weeks; continuing beyond about 21 days increases bleeding without clear additional benefit. Aspirin alone is less effective in the early high-risk period. Anticoagulation is not indicated without a cardioembolic source.

2. Question 2Cerebrovascular Disordershard

   A 28-year-old woman taking a combined oral contraceptive has 4 days of progressive headache and then a focal seizure. MRI with venography shows superior sagittal sinus thrombosis with a small haemorrhagic venous infarct. What is the most appropriate management?

   1. AAspirin 300 mg daily
   2. BWithhold anticoagulation because of the haemorrhage
   3. CAnticoagulation with weight-adjusted low-molecular-weight heparin
   4. DSystemic intravenous alteplase
   Show answer and explanation▾

   Answer: C. Anticoagulation with weight-adjusted low-molecular-weight heparin

   Anticoagulation is the treatment of cerebral venous thrombosis even when there is a haemorrhagic venous infarct, because the bleeding results from venous congestion and anticoagulation halts thrombus propagation; LMWH is preferred in the acute phase. Withholding anticoagulation is the classic error. Systemic thrombolysis is not recommended and aspirin is not an adequate treatment. The oestrogen-containing contraceptive should be stopped.

3. Question 3Epilepsy and Paroxysmal Disordersmedium

   A 40-year-old man remains in generalised convulsive status epilepticus after two adequate doses of intravenous lorazepam given 5 minutes apart. What is the most appropriate next step?

   1. ACarbamazepine via nasogastric tube
   2. BA third dose of intravenous lorazepam
   3. CIntravenous levetiracetam, fosphenytoin or valproate
   4. DIntravenous magnesium sulfate
   Show answer and explanation▾

   Answer: C. Intravenous levetiracetam, fosphenytoin or valproate

   Status epilepticus that persists after two doses of benzodiazepine is established status and needs a second-line intravenous antiseizure medication; the ESETT trial found levetiracetam, fosphenytoin and valproate similarly effective. Further benzodiazepine doses add respiratory depression with little extra benefit. Enteral drugs act too slowly, and magnesium is for eclampsia.

4. Question 4Epilepsy and Paroxysmal Disordershard

   A 19-year-old woman has morning myoclonic jerks, two generalised tonic-clonic seizures on waking after sleep deprivation, and 4 to 6 Hz generalised polyspike-and-wave discharges on EEG. She may wish to become pregnant in future. What is the most appropriate first-line antiseizure medication?

   1. ACarbamazepine
   2. BSodium valproate
   3. CLevetiracetam
   4. DPhenytoin
   Show answer and explanation▾

   Answer: C. Levetiracetam

   This is juvenile myoclonic epilepsy. Valproate is highly effective but carries major teratogenic and neurodevelopmental risks and should not be started in women who could become pregnant unless other options fail, so levetiracetam (or lamotrigine, which may worsen myoclonus) is preferred. Carbamazepine and phenytoin can aggravate myoclonic and absence seizures in genetic generalised epilepsies.

5. Question 5Cephalgia and Headache Disordersmedium

   A 27-year-old woman with a BMI of 36 kg/m2 has 2 months of daily headache and transient visual obscurations. She has bilateral papilloedema, normal MRI and MR venography, and a lumbar puncture opening pressure of 34 cmH2O with normal CSF constituents. Visual fields show only enlarged blind spots. What is the most appropriate management?

   1. ALong-term oral corticosteroids
   2. BWeight management and acetazolamide
   3. CUrgent optic nerve sheath fenestration
   4. DRegular therapeutic lumbar punctures
   Show answer and explanation▾

   Answer: B. Weight management and acetazolamide

   Idiopathic intracranial hypertension without threatened vision is managed with a structured weight-loss programme and acetazolamide, with close monitoring of visual fields and acuity. Surgical or interventional procedures such as CSF diversion, venous stenting or optic nerve sheath fenestration are reserved for fulminant or progressive visual loss. Corticosteroids cause weight gain, and repeated lumbar punctures are not a sustainable treatment.

6. Question 6Cephalgia and Headache Disorderseasy

   A 42-year-old woman with migraine now has headache on 20 days per month and has used sumatriptan on 14 days per month for the past 6 months. Which additional diagnosis should be considered?

   1. AHemicrania continua
   2. BMedication-overuse headache
   3. CNew daily persistent headache
   4. DChronic tension-type headache
   Show answer and explanation▾

   Answer: B. Medication-overuse headache

   Under ICHD-3, regular use of triptans on 10 or more days per month for more than 3 months in someone with headache on 15 or more days per month meets the criteria for medication-overuse headache. Management includes education, withdrawal of the overused medication and starting preventive treatment. New daily persistent headache is daily from a clearly remembered onset, and hemicrania continua is a strictly unilateral headache responsive to indometacin.

7. Question 7Neuromuscular Disordersmedium

   A 34-year-old man has 5 days of ascending weakness and areflexia after a diarrhoeal illness. He cannot walk unaided, and his forced vital capacity has fallen from 3.4 L to 2.1 L over 12 hours. Which treatment is most appropriate?

   1. AOral pyridostigmine
   2. BIntravenous methylprednisolone 1 g daily for 5 days
   3. COral prednisolone 60 mg daily
   4. DIntravenous immunoglobulin 2 g/kg over 5 days
   Show answer and explanation▾

   Answer: D. Intravenous immunoglobulin 2 g/kg over 5 days

   Guillain-Barre syndrome in a patient unable to walk independently is treated with intravenous immunoglobulin or plasma exchange, which are equally effective; his falling vital capacity also warrants close monitoring in a high-dependency setting. Corticosteroids, intravenous or oral, do not improve outcome in GBS. Pyridostigmine is a treatment for myasthenia gravis.

8. Question 8Neuromuscular Disordershard

   A 64-year-old smoker has proximal leg weakness, a dry mouth and erectile dysfunction. Reflexes are reduced at rest but increase after 10 seconds of maximal voluntary contraction. Nerve conduction studies show low compound muscle action potential amplitudes at rest. Which finding would confirm the most likely diagnosis?

   1. AAn increment of at least 100% in CMAP amplitude after brief exercise or high-frequency stimulation
   2. BProlonged distal motor latencies with conduction block
   3. CRaised serum acetylcholine receptor antibody titres
   4. DMyotonic discharges on needle electromyography
   Show answer and explanation▾

   Answer: A. An increment of at least 100% in CMAP amplitude after brief exercise or high-frequency stimulation

   Proximal weakness, autonomic symptoms and post-exercise facilitation of reflexes suggest Lambert-Eaton myasthenic syndrome, a presynaptic disorder caused by P/Q-type voltage-gated calcium channel antibodies. The neurophysiological hallmark is a low baseline CMAP that increases by 100% or more after brief maximal exercise or 20 to 50 Hz stimulation. Acetylcholine receptor antibodies indicate myasthenia gravis, and patients need screening for small cell lung cancer.

9. Question 9Neuro-Immunological and Demyelinating Disorderseasy

   A 32-year-old woman has transverse myelitis with an MRI lesion extending over 5 contiguous vertebral segments, and a previous episode of severe optic neuritis. Which antibody test is most important?

   1. AAquaporin-4 IgG
   2. BAnti-Hu (ANNA-1) antibody
   3. CAnti-NMDA receptor antibody
   4. DAnti-GAD65 antibody
   Show answer and explanation▾

   Answer: A. Aquaporin-4 IgG

   A longitudinally extensive transverse myelitis spanning three or more vertebral segments plus severe optic neuritis is typical of neuromyelitis optica spectrum disorder, and aquaporin-4 IgG is the key diagnostic antibody (with MOG-IgG tested if negative). The distinction from multiple sclerosis matters because some MS therapies can worsen NMOSD. NMDA receptor antibodies cause encephalitis, and anti-Hu is a paraneoplastic marker.

10. Question 10Neuro-Infectious Disorderseasy

    A 52-year-old woman has 2 days of fever, confusion and an olfactory hallucination followed by a seizure. MRI shows right medial temporal T2 hyperintensity, and CSF shows a lymphocytic pleocytosis. What is the most appropriate immediate treatment?

    1. AOral valaciclovir at standard zoster doses
    2. BNo treatment until the CSF HSV PCR result is available
    3. CIntravenous aciclovir 10 mg/kg every 8 hours
    4. DIntravenous ceftriaxone alone
    Show answer and explanation▾

    Answer: C. Intravenous aciclovir 10 mg/kg every 8 hours

    Herpes simplex encephalitis is suggested by fever, altered behaviour, temporal lobe seizures and medial temporal MRI changes, and intravenous aciclovir (adjusted for renal function) must be started immediately because delay worsens mortality and morbidity. Waiting for PCR confirmation is the main avoidable error. Oral antivirals do not achieve adequate CNS levels for initial treatment, and ceftriaxone does not treat viral encephalitis.

11. Question 11Movement Disordersmedium

    A 19-year-old man has a 6-month history of a wing-beating tremor, dysarthria, declining school performance and mildly raised transaminases. Which pair of investigations is most useful for initial screening for the likely diagnosis?

    1. ADaT-SPECT imaging and serum ferritin
    2. BSerum caeruloplasmin and slit-lamp examination for Kayser-Fleischer rings
    3. CHTT CAG repeat testing and brain MRI
    4. DSerum total copper alone and EEG
    Show answer and explanation▾

    Answer: B. Serum caeruloplasmin and slit-lamp examination for Kayser-Fleischer rings

    A young person with a movement disorder, psychiatric or cognitive change and liver abnormalities should be investigated for Wilson disease, with serum caeruloplasmin, slit-lamp examination for Kayser-Fleischer rings and 24-hour urinary copper as first-line tests. Kayser-Fleischer rings are present in almost all patients with neurological Wilson disease. Serum total copper is often low and misleading on its own, and DaT-SPECT and HTT testing address other conditions.

12. Question 12Cognitive Disordershard

    A 63-year-old woman has a 3-month history of rapidly progressive dementia, ataxia and startle-sensitive myoclonus. Diffusion-weighted MRI shows cortical ribboning and caudate hyperintensity. Which CSF test has the highest specificity for the likely diagnosis?

    1. AReal-time quaking-induced conversion (RT-QuIC)
    2. B14-3-3 protein
    3. CTotal tau protein
    4. DOligoclonal bands
    Show answer and explanation▾

    Answer: A. Real-time quaking-induced conversion (RT-QuIC)

    The presentation is typical of sporadic Creutzfeldt-Jakob disease, and CSF RT-QuIC, which detects misfolded prion protein seeding activity, has specificity close to 100% and is included in current diagnostic criteria. Protein 14-3-3 and total tau are markers of rapid neuronal injury and are raised in other conditions such as stroke, encephalitis and seizures. Oligoclonal bands suggest intrathecal inflammation.

13. Question 13Clinical Neurophysiology, Neuroanatomical Localization and Neuroimagingeasy

    After a stab wound to the back, a 25-year-old man has right leg weakness and loss of vibration and joint position sense on the right, with loss of pain and temperature sensation on the left below the T10 level. Where is the lesion?

    1. ALeft hemisection of the spinal cord
    2. BAnterior spinal cord
    3. CCentral spinal cord
    4. DRight hemisection of the spinal cord
    Show answer and explanation▾

    Answer: D. Right hemisection of the spinal cord

    In a spinal cord hemisection, the corticospinal tract and dorsal columns are affected on the side of the lesion, causing ipsilateral weakness and loss of proprioception and vibration, while the crossed spinothalamic tract causes contralateral loss of pain and temperature a level or two below. The findings therefore localise to the right side. Anterior cord syndrome spares the dorsal columns, and central cord syndrome mainly affects the arms.

14. Question 14Neurology of Systemic Diseases (including Nutritional, Metabolic and Toxic)medium

    A 45-year-old woman with alcohol use disorder and malnutrition has a serum sodium of 112 mmol/L of uncertain duration. Which correction limit is recommended to reduce her risk of osmotic demyelination?

    1. ANo more than 8 mmol/L in any 24-hour period
    2. BUp to 2 mmol/L per hour sustained over 24 hours
    3. CNo more than 15 mmol/L in the first 24 hours
    4. DNo more than 20 mmol/L in the first 48 hours
    Show answer and explanation▾

    Answer: A. No more than 8 mmol/L in any 24-hour period

    Alcohol use disorder, malnutrition and hypokalaemia increase the risk of osmotic demyelination syndrome, so correction of chronic hyponatraemia in such high-risk patients should not exceed 8 mmol/L in 24 hours. Faster rises, as in the other options, carry an unacceptable risk of pontine and extrapontine myelinolysis. If overcorrection occurs, it can be re-lowered with free water and desmopressin.

15. Question 15Neuro-oncology, Neuro-ophthalmology, Neuro-otology and Sleep Neurologymedium

    A 22-year-old student has excessive daytime sleepiness and episodes of sudden knee buckling when laughing, with preserved consciousness. Which test result would support a diagnosis of narcolepsy type 1?

    1. ARaised CSF hypocretin-1 concentration
    2. BMean sleep latency of 8 minutes or less with two or more sleep-onset REM periods
    3. CMean sleep latency of 15 minutes with no sleep-onset REM periods
    4. DApnoea-hypopnoea index of 30 events per hour
    Show answer and explanation▾

    Answer: B. Mean sleep latency of 8 minutes or less with two or more sleep-onset REM periods

    Excessive sleepiness with cataplexy and a multiple sleep latency test showing mean sleep latency of 8 minutes or less with at least two sleep-onset REM periods supports narcolepsy type 1; a low (not raised) CSF hypocretin-1 is an alternative diagnostic criterion. An overnight polysomnogram first excludes other causes of sleepiness such as obstructive sleep apnoea, which an AHI of 30 would indicate. A normal mean sleep latency argues against narcolepsy.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.