Pance Neurology - Final Test Review (Qns & Ans) - 2025, Exams of Nursing

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Neurology

Final Test Review

(Questions & Solutions)

1. A 68-year-old man awakes with right hemiparesis and global aphasia. Noncontrast CT is negative for hemorrhage. He was last normal 90 minutes ago. Next step? A) Administer IV tPA B) Start aspirin and observe C) Obtain MRI before treatment D) Lower his blood pressure immediately ANS: A Rationale: IV thrombolysis within 3–4.5 hours of ischemic stroke onset improves outcomes and is indicated if no hemorrhage.
2. A 55-year-old with atrial fibrillation on warfarin presents with acute left‐sided weakness. INR is 2.5. CT shows left MCA infarct. Best secondary prevention? A) Resume warfarin once stable B) Switch to aspirin only C) Start a direct thrombin inhibitor D) Discontinue all anticoagulation ANS: A Rationale: Therapeutic warfarin should be resumed to prevent cardioembolic stroke in AF patients once risk of hemorrhagic transformation is low.
3. A 45-year-old with sudden “worst headache” and nuchal rigidity. CT shows subarachnoid blood. Next diagnostic step? A) CT angiography B) Lumbar puncture C) MRI brain D) Carotid Doppler ANS: A Rationale: In SAH confirmed on CT, CTA identifies aneurysm location before surgical or endovascular therapy.

crossing suture lines. Diagnosis? A) Subdural hematoma B) Epidural hematoma C) Intracerebral hemorrhage D) Subarachnoid hemorrhage ANS: A Rationale: Subdural hematomas present days later as crescentic collections; epidural are biconvex and acute.

8. A 20-year-old boxer has repeated head trauma and develops mood changes, memory loss, and parkinsonism years later. This describes: A) Chronic traumatic encephalopathy B) Concussion C) Acute subdural hematoma D) Diffuse axonal injury ANS: A Rationale: CTE results from repeated concussions, causing progressive neuropsychiatric and motor deficits. 9 – 11. Cranial Nerve Palsies
9. A diabetic with acute right ptosis, “down and out” eye, and mydriasis. Which nerve is involved? A) Oculomotor nerve (III) B) Trochlear nerve (IV) C) Abducens nerve (VI) D) Facial nerve (VII) ANS: A Rationale: Oculomotor palsy causes ptosis, eye deviation, and pupillary dilation in compressive lesions.
10. A 45-year-old patient has unilateral facial droop including the forehead. Which nerve? A) Facial nerve (VII) B) Hypoglossal nerve (XII)

C) Trigeminal nerve (V) D) Glossopharyngeal nerve (IX) ANS: A Rationale: Bell’s palsy (VII) causes LMN facial paralysis affecting forehead and lower face.

11. A patient with diplopia has left eye adduction weakness on horizontal gaze. Which nerve lesion? A) Left abducens (VI) B) Trochlear (IV) C) Oculomotor (III) D) Accessory (XI) ANS: A Rationale: Abducens palsy prevents lateral rectus function, causing inability to abduct the eye and diplopia. 12 – 14. Encephalopathic Disorders
12. A cirrhotic patient develops asterixis, confusion, and hyperreflexia. Which lab helps confirm hepatic encephalopathy? A) Elevated ammonia level B) Elevated CK C) Elevated troponin D) Low creatinine ANS: A Rationale: Hyperammonemia correlates with hepatic encephalopathy severity in liver failure.
13. A malnourished alcoholic has confusion, ataxia, and ophthalmoplegia. Immediate therapy? A) IV thiamine B) Folate C) Glucose only D) Diazepam ANS: A

Treatment? A) NSAIDs and relaxation techniques B) Triptans C) Propranolol D) IV magnesium ANS: A Rationale: Tension headaches respond to NSAIDs, analgesics, and stress‐ reduction therapies.

18. A sudden-onset thunderclap headache suggests: A) Subarachnoid hemorrhage B) Migraine C) Tension headache D) Cluster headache ANS: A Rationale: Thunderclap headache peaks within seconds, highly suggestive of SAH requiring urgent imaging. 19 – 21. Infectious Disorders
19. A 50-year-old immunocompromised presents with fever, headache, confusion; MRI shows temporal lobe lesions. Likely agent? A) HSV-1 encephalitis B) Cryptococcus neoformans C) West Nile virus D) CMV ANS: A Rationale: HSV-1 encephalitis targets temporal lobes, causing hemorrhagic necrosis on MRI.
20. A neonatal meningitis case with gram-positive bacilli—most likely? A) Listeria monocytogenes B) Neisseria meningitidis C) Streptococcus pneumoniae D) Haemophilus influenzae

ANS: A

Rationale: Listeria is a gram-positive rod causing meningitis in neonates and elderly/immunocompromised.

21. A 25-year-old with rash, fever, stiff neck. Kernig and Brudzinski signs positive. Next step? A) Obtain CSF via lumbar puncture B) Start high-dose steroids only C) CT scan only D) Oral antibiotics ANS: A Rationale: Suspected bacterial meningitis requires prompt LP and CSF analysis before or after immediate antibiotics. 22 – 24. Movement Disorders
22. A 65-year-old with resting tremor, rigidity, and bradykinesia. First-line therapy? A) Levodopa/carbidopa B) Baclofen C) Gabapentin D) Amitriptyline ANS: A Rationale: Levodopa/carbidopa remains the most effective initial treatment for Parkinson’s disease motor symptoms.
23. A 40-year-old has a postural tremor relieved by small amounts of alcohol, family history positive. Diagnosis? A) Essential tremor B) Parkinson’s disease C) Cerebellar tremor D) Psychogenic tremor ANS: A Rationale: Essential tremor is an action/postural tremor, often hereditary and alcohol-responsive.

next step? A) Laryngoscopic excision and radiation B) Proton pump inhibitor therapy C) Bronchodilators D) Systemic steroids only ANS: A Rationale: Laryngeal SCC requires surgical excision with radiation depending on stage. 28 – 30. Nerve Disorders

28. A 40-year-old develops ascending paralysis after Campylobacter infection. Nerve conduction shows slowed velocity. Diagnosis? A) Guillain–Barré syndrome B) Myasthenia gravis C) Lambert–Eaton syndrome D) CIDP ANS: A Rationale: GBS presents with post-infectious ascending paralysis and slowed conduction on EMG.
29. A diabetic with stocking‐glove sensory loss and decreased ankle reflexes. Diagnosis? A) Diabetic peripheral neuropathy B) ALS C) CIDP D) Carpal tunnel ANS: A Rationale: Symmetric distal sensory polyneuropathy in DM is hallmark of diabetic neuropathy.
30. A 35-year-old with wrist numbness, positive Phalen and Tinel tests, and slowed median nerve conduction. Treatment? A) Carpal tunnel release B) Gabapentin

C) IVIG

D) Physical therapy only ANS: A Rationale: Moderate-to-severe carpal tunnel syndrome often requires surgical decompression for relief. 31 – 33. Neurocognitive Disorders

31. A 75-year-old with progressive memory loss, difficulty with ADLs, MRI showing hippocampal atrophy. Diagnosis? A) Alzheimer disease B) Vascular dementia C) Normal pressure hydrocephalus D) Frontotemporal dementia ANS: A Rationale: Alzheimer’s features progressive short-term memory decline and hippocampal atrophy on imaging.
32. A 68-year-old with stepwise cognitive decline, focal deficits, and multiple infarcts on MRI. Diagnosis? A) Vascular dementia B) Alzheimer disease C) Lewy body dementia D) Wernicke’s encephalopathy ANS: A Rationale: Multi-infarct dementia presents with stepwise decline and cerebrovascular lesions.
33. An ICU patient with fluctuating consciousness, hallucinations, and inattention over hours. Diagnosis? A) Delirium B) Dementia C) Depression D) Psychosis ANS: A

37. A 50-year-old with dry mouth, constipation, autonomic dysfunction, and muscle weakness improves on repeated stimulation. Diagnosis? A) Lambert–Eaton myasthenic syndrome B) Myasthenia gravis C) Eaton-Lambert D) Chronic inflammatory demyelinating polyneuropathy ANS: A Rationale: LEMS shows facilitation (improved strength) with repeated stimulation due to presynaptic calcium channel autoantibodies. 38 – 40. Seizure Disorders
38. A 20-year-old college student has episodes of staring, 3 Hz generalized spike-wave on EEG, triggered by hyperventilation. Diagnosis? A) Absence seizures B) Tonic‐clonic seizures C) Focal seizures D) Myoclonic seizures ANS: A Rationale: Absence seizures present with brief lapses, 3 Hz spike-wave, and hyperventilation provocation.
39. A 30-year-old with convulsive seizures and postictal confusion. MRI shows left mesial temporal sclerosis. Diagnosis? A) Mesial temporal lobe epilepsy B) Generalized epilepsy C) Absence epilepsy D) Psychogenic nonepileptic seizures ANS: A Rationale: MTS on MRI localizes a focal epilepsy often causing complex partial and secondary generalized seizures.
40. A hospitalized patient with status epilepticus not responding to lorazepam. Next step? A) IV fosphenytoin

B) Oral diazepam C) IV levetiracetam only D) Observation ANS: A Rationale: After benzodiazepines fail in status epilepticus, phenytoin or fosphenytoin is first‐line second agent. Cerebrovascular Disorders A 68-year-old man presents with sudden onset right-sided weakness and aphasia. CT head is negative for hemorrhage. What is the most appropriate next step? A) Initiate IV alteplase B) Begin prophylactic phenytoin C) Start IV mannitol D) Immediate surgical craniotomy ANS: A Rationale: IV alteplase is indicated in acute ischemic stroke within 4.5 hours of onset, with no evidence of intracranial hemorrhage on CT.

2. A 55-year-old woman with atrial fibrillation develops left-sided hemiparesis. Which artery is most likely occluded? A) Anterior cerebral artery B) Middle cerebral artery C) Posterior inferior cerebellar artery D) Basilar artery ANS: B Rationale: The middle cerebral artery supplies the lateral aspect of the cerebral hemisphere and is commonly involved in embolic strokes causing hemiparesis.
3. A 60-year-old man presents with sudden onset of vertigo, vomiting, and ipsilateral facial numbness with contralateral body numbness. Which syndrome is most likely? A) Lateral medullary (Wallenberg) syndrome B) Medial medullary syndrome C) Weber syndrome D) Locked-in syndrome ANS: A Rationale: Lateral medullary syndrome

lesion is a classic finding in epidural hematoma.

8. Symptoms of increased intracranial pressure following TBI include all except: A) Papilledema B) Bradycardia C) Hypertension D) Miosis ANS: D Rationale: Miosis is not a typical sign; Cushing's triad features hypertension, bradycardia, and irregular respirations. Cranial Nerve Palsies
9. A patient with inability to abduct the right eye likely has a lesion of which nerve? A) CN II B) CN III C) CN IV D) CN VI ANS: D Rationale: CN VI (abducens) innervates the lateral rectus muscle responsible for abduction.
10. Which cranial nerve is most commonly affected in idiopathic intracranial hypertension (IIH)? A) CN II B) CN IV C) CN VI D) CN VII ANS: C Rationale: CN VI palsy occurs due to its long intracranial course and susceptibility to increased ICP. Encephalopathic Disorders
11. An elderly man on dialysis presents with asterixis, confusion, and high BUN. What is the most likely diagnosis? A) Hepatic encephalopathy B) Uremic encephalopathy C) Hypertensive encephalopathy D) Wernicke encephalopathy ANS: B Rationale: Elevated BUN in a patient with renal failure suggests uremic encephalopathy.

12. Which of the following features differentiates delirium from dementia? A) Insidious onset B) Personality changes C) Fluctuating level of consciousness D) Progressive impairments over months ANS: C Rationale: Delirium is characterized by an acute, fluctuating course with disturbances of consciousness. Headaches
13. A 35-year-old woman with unilateral throbbing headache, photophobia, nausea, and aura is most likely having: A) Tension headache B) Cluster headache C) Migraine headache D) Temporal arteritis ANS: C Rationale: Migraines are typically unilateral with photophobia, nausea, and sometimes aura.
14. Which is the best abortive therapy for cluster headaches? A) Oral sumatriptan B) Inhaled oxygen C) NSAIDs D) Propranolol ANS: B Rationale: Inhaled 100% oxygen is highly effective in aborting acute cluster headache attacks. Infectious Disorders
15. A college student develops fever, headache, neck stiffness, and photophobia. CSF findings: elevated opening pressure, low glucose, high protein, neutrophilic pleocytosis. What is the most likely causative organism? A) Streptococcus pneumoniae B) Coxsackievirus C) Cryptococcus neoformans D) Mycobacterium tuberculosis ANS: A Rationale: Bacterial (pyogenic)

can induce/exacerbate parkinsonism. Neoplasms

20. A 45-year-old with new headache, seizures, and ring-enhancing lesion in the left frontal lobe on MRI. What is the most likely diagnosis? A) Meningioma B) Low-grade glioma C) Glioblastoma multiforme D) Schwannoma ANS: C Rationale: GBM often presents as a rapidly growing, ring-enhancing lesion with necrosis and pronounced symptoms.
21. Which primary brain tumor is most likely to present with hearing loss and tinnitus? A) Pituitary adenoma B) Medulloblastoma C) Vestibular schwannoma D) Ependymoma ANS: C Rationale: Vestibular schwannoma (acoustic neuroma) affects CN VIII, causing hearing loss and tinnitus.
22. In adults, the most common location of metastatic brain tumors is: A) Cerebellum B) Brainstem C) Cerebral cortex (gray-white junction) D) Hypothalamus ANS: C Rationale: Metastatic tumors often localize at the gray-white matter junction of the cortex due to vascular supply. Nerve Disorders
23. A 35-year-old woman develops unilateral facial weakness, loss of taste anterior two-thirds of tongue, hyperacusis, and drooping of the mouth. The most probable diagnosis is: A) Bell’s palsy B) Myasthenia gravis C) Guillain-Barré syndrome D) Stroke ANS: A Rationale: Bell’s palsy is an acute, idiopathic facial (CN VII) palsy with these classic features.

24. Entrapment of the median nerve at the carpal tunnel presents most typically with: A) Weakness of the opponens pollicis B) Dorsal hand numbness C) Inability to extend the wrist D) Loss of sensation of the entire forearm ANS: A Rationale: Carpal tunnel impairs function of the median-innervated thenar muscles.
25. A patient with progressive ascending weakness after a respiratory infection, with loss of DTRs, most likely has: A) Myasthenia gravis B) Amyotrophic lateral sclerosis C) Guillain-Barré syndrome D) Polymyositis ANS: C Rationale: GBS features acute ascending paralysis and areflexia post-infection. Neurocognitive Disorders
26. A 70-year-old presents with progressive memory loss, difficulty performing daily tasks, and word-finding difficulty over a year. What is the most likely diagnosis? A) Vascular dementia B) Alzheimer’s disease C) Lewy body dementia D) Normal pressure hydrocephalus ANS: B Rationale: Insidious memory and linguistic decline are classical for Alzheimer's disease.
27. Which finding is most characteristic of dementia with Lewy bodies? A) Stepwise cognitive decline B) Prominent visual hallucinations C) Early personality change D) Disinhibition ANS: B Rationale: Visual hallucinations and fluctuating cognition are typical of Lewy body dementia.
28. Which of the following is NOT a feature of normal pressure hydrocephalus?