Certification in Neurology Exam Prep
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Free Neurology Practice Questions

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The Neurology exam has 400 questions and runs 7 hours 10 minutes.

These 10 free Neurology questions are organized by exam domain, so you can see how each part of the Certification in Neurology blueprint is tested. Reveal the answer and explanation under each question.

Domain 1: Headache and pain disorders (4-6%)

Question 1

A four-month diary from a 36-year-old woman with an eight-year history of migraine documents headache on 20 days each month. On 12 days, the pain is throbbing, worsens with routine activity, and is accompanied by nausea and photophobia; the other headache days are milder. She takes sumatriptan on 14 days and naproxen on 6 days each month. Headache frequency increased gradually rather than becoming continuous on a memorable day. Examination, including fundoscopy, is normal. Which diagnostic formulation accounts for the diary?

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Correct answer: C - Chronic migraine with triptan-overuse headache

Domain 2: Epilepsy and episodic disorders (8-12%)

Question 2

Parents bring a video of their 5-month-old daughter having clusters of brief head drops with flexion of the trunk and arms shortly after waking. She has become less interactive and has stopped reaching for toys. EEG shows a disorganized, high-amplitude background with multifocal spikes. Her records document a cardiac rhabdomyoma and multiple cortical tubers, and examination reveals several hypomelanotic macules. She has received no antiseizure treatment. Which medication is the preferred initial treatment for her spasms?

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Correct answer: A - Vigabatrin

Domain 3: Sleep disorders (3-5%)

Question 3

A sleep laboratory reports a mean sleep latency of 4.6 minutes and three sleep-onset REM periods in a 16-year-old referred for four months of daytime sleepiness. A subsequently reviewed two-week sleep diary shows sleep from approximately 1:00 a.m. to 6:00 a.m. on school nights and 2:00 a.m. to 11:00 a.m. on weekends. The polysomnogram preceding the nap test recorded only 6.1 hours of sleep, without sleep apnea. He reports no cataplexy and takes no medication. What is the appropriate interpretation and follow-up?

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Correct answer: D - Document adequate, regular sleep and repeat testing if sleepiness persists

Domain 5: Vascular neurology (8-12%)

Question 4

At 10:20, a previously independent 61-year-old accountant develops abrupt difficulty speaking while discussing a spreadsheet. At 11:35, he follows commands and walks normally but cannot name common objects or communicate in sentences. His NIH Stroke Scale score is 3. Noncontrast CT shows no hemorrhage or established infarction; CT angiography shows no large-vessel occlusion. Blood pressure is 164/92 mm Hg, glucose is 108 mg/dL, platelet count is normal, and INR is 1.0. He takes no anticoagulant and has no other thrombolysis exclusion. Which treatment is indicated now?

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Correct answer: B - Intravenous thrombolysis for the persistent disabling language deficit

Domain 6: Neuromuscular diseases (9-13%)

Question 5

The referral reads "possible motor neuron disease." Over nine months, a 47-year-old man has developed right finger-extension weakness followed by weakness of the left hand. There is mild focal wasting and occasional fasciculation, but no sensory loss, bulbar dysfunction, spasticity, or extensor plantar response. Nerve conduction studies demonstrate definite motor conduction block in two nerves at non-entrapment sites, with normal sensory responses across the same segments. Which therapy offers the best prospect of improving his weakness?

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Correct answer: D - Intravenous immunoglobulin

Domain 7: Movement disorders (8-12%)

Question 6

Home videos and a medication diary clarify the main problem in a 62-year-old man with Parkinson disease: flowing, involuntary movements of the trunk and arms appear about 45 minutes after each levodopa dose, when his rigidity and slowness are least noticeable. The movements fade before the next dose. Attempts to reduce individual levodopa doses produce unacceptable bradykinesia. He has normal cognition, no hallucinations, and normal renal function. Which adjunct most directly targets the troublesome movements?

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Correct answer: C - Amantadine

Domain 8: Demyelinating diseases (7-11%)

Question 7

During a febrile urinary tract infection, a 32-year-old woman with multiple sclerosis experiences a return of the left-leg heaviness that accompanied a remote attack. She has otherwise been stable on glatiramer acetate for three years. No new neurologic symptoms develop. After antibiotics and antipyretics, her temperature normalizes and her examination returns completely to its previous baseline within 18 hours. How should her neurologic treatment be handled?

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Correct answer: A - Continue glatiramer acetate and complete treatment of the infection

Domain 11: Neuro-ophthalmologic and neuro-otologic disorders (2-4%)

Question 8

Horizontal eye-movement testing in a 68-year-old with acute diplopia shows that neither eye can look left. On attempted right gaze, the right eye abducts with nystagmus, but the left eye does not adduct. Convergence and vertical movements are preserved. The horizontal vestibulo-ocular reflex also fails to move either eye leftward. Which paired structures best localize the lesion?

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Correct answer: B - Left abducens nucleus and left medial longitudinal fasciculus

Domain 12: Metabolic diseases, nutritional deficiency states, and disorders due to toxins, drugs, and physical agents (3-5%)

Question 9

Nine years after gastric bypass, a 54-year-old woman develops progressive imbalance and numb feet. She takes an over-the-counter zinc supplement every day. Examination reveals impaired joint-position sense at the toes, brisk knee reflexes, absent ankle reflexes, and bilateral extensor plantar responses. MRI shows symmetric posterior-column signal abnormality without compression. Blood testing identifies anemia and neutropenia; vitamin B12 and methylmalonic acid concentrations are normal. Which deficiency best unifies the neurologic and hematologic abnormalities?

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Correct answer: A - Copper deficiency

Domain 14: Behavioral neurology and neurocognitive disorders (7-9%)

Question 10

A 73-year-old man is accompanied to a cognitive assessment by his wife, who brings a written timeline of his symptoms. Eighteen months ago, he began getting lost in familiar places and needed help managing bills. His wife describes striking variations in attention, sometimes within the same afternoon. Ten months ago, he began seeing unfamiliar children in the living room. Bradykinesia and rigidity appeared four months ago. The hallucinations preceded any dopaminergic medication, and there is no acute illness or delirium. What is the most likely diagnosis?

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Correct answer: C - Dementia with Lewy bodies

The rest of the Neurology blueprint

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