Which triad is assessed first to judge global brain function before proceeding with the rest of the neurologic examination?

A. Naming, repetition, praxis
B. Alertness, attention, cooperation
C. Mood, affect, judgment
D. Strength, tone, reflexes

B. Alertness, attention, cooperation

Which network is most critical for maintaining normal alertness?

A. Basal ganglia and cerebellum
B. Hippocampus and amygdala
C. Frontal eye fields bilaterally
D. Reticular formation, thalamus, cerebrum

D. Reticular formation, thalamus, cerebrum

A patient speaks fluently and follows commands but cannot count backward or recite months in reverse order. Which domain is primarily impaired?

A. Attention
B. Orientation
C. Registration
D. Cooperation

A. Attention

Marked deficits in attention and cooperation during the interview may arise from which general processes?

A. Cerebellar lesions or dementia
B. Peripheral neuropathy or dementia
C. Focal lesions or dementia
D. Hippocampal sclerosis or dementia

C. Focal lesions or dementia

Asking a patient for full name, current location, and date primarily tests which cognitive function?

A. Working memory
B. Long-term memory
C. Motor planning
D. Visuospatial neglect

B. Long-term memory

Short-term memory on bedside mental-status testing is most closely associated with which system?

A. Limbic system
B. Basal ganglia
C. Vestibular system
D. Spinocerebellar system

A. Limbic system

After ensuring the material was initially registered, which method best tests recent memory?

A. Immediate digit repetition
B. Instant item recognition
C. Months backward immediately
D. Story recall after 3–5 minutes

D. Story recall after 3–5 minutes

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A patient accurately registers a short story, completes distraction tasks, but cannot recall it 4 minutes later. Which lesion location is most consistent?

A. Posterior parietal cortex
B. Medial temporal-diencephalic limbic circuit
C. Primary motor cortex
D. Lateral medullary tegmentum

B. Medial temporal-diencephalic limbic circuit

Which bedside task most directly assesses attention during the initial mental-status screening?

A. Months backward recitation
B. Delayed story recall
C. Stating full name
D. Giving today’s date

A. Months backward recitation

After bilateral medial temporal injury, a patient remembers childhood but cannot form new memories after hospitalization. Which deficit is present?

A. Retrograde amnesia
B. Anterograde amnesia
C. Expressive aphasia
D. Hemi-neglect

B. Anterograde amnesia

After a head injury, a patient cannot recall the collision or events immediately before it, but can learn new information during rehab. Which deficit is present?

A. Retrograde amnesia
B. Anterograde amnesia
C. Finger agnosia
D. Acalculia

A. Retrograde amnesia

Asking a patient about a major historical event most directly assesses:

A. Immediate memory
B. Working memory
C. Recent memory
D. Remote memory

D. Remote memory

Language testing during the mental-status exam primarily localizes to which hemisphere in most people?

A. Right non-dominant hemisphere
B. Cerebellar hemisphere
C. Left dominant hemisphere
D. Medial temporal lobe

C. Left dominant hemisphere

During spontaneous speech, a patient says “fork” when shown a spoon. This is best described as:

A. Paraphasic error
B. Neologism
C. Perseveration
D. Echolalia

A. Paraphasic error

A patient uses made-up words during otherwise fluent conversation. This finding is called:

A. Dysarthria
B. Palilalia
C. Agraphia
D. Neologisms

D. Neologisms

Which abnormality in spontaneous speech should specifically raise concern for dominant hemisphere dysfunction?

A. Major grammatical errors
B. Cogwheel rigidity
C. Intention tremor
D. Visual extinction

A. Major grammatical errors

Besides spontaneous speech, which additional function should be assessed when screening the dominant hemisphere?

A. Construction
B. Comprehension
C. Finger counting
D. Neglect testing

B. Comprehension

Asking a patient to name objects, repeat words, read, and write most directly tests the:

A. Limbic memory circuit
B. Non-dominant parietal lobe
C. Cerebellar vermis
D. Left dominant hemisphere

D. Left dominant hemisphere

These bedside language tasks assess the hemisphere containing which classic cortical language regions?

A. Broca and Wernicke areas
B. Caudate and putamen
C. Mamillary and geniculate bodies
D. Precentral and postcentral gyri

A. Broca and Wernicke areas

Gerstmann syndrome most strongly localizes to the:

A. Right non-dominant parietal lobe
B. Left occipital association cortex
C. Left dominant parietal lobe
D. Medial frontal cortex

C. Left dominant parietal lobe

Which set best matches Gerstmann syndrome?

A. Apraxia, neglect, extinction, anosognosia
B. Ataxia, dysmetria, tremor, nystagmus
C. Agraphia, acalculia, aphasia, apraxia
D. Agraphia, acalculia, finger agnosia, right-left confusion

D. Agraphia, acalculia, finger agnosia, right-left confusion

A patient can speak and follow commands but cannot write a sentence despite intact hand strength. This deficit is:

A. Aphasia
B. Agraphia
C. Apraxia
D. Alexia

B. Agraphia

Inability to perform mathematical calculations on bedside testing is termed:

A. Dysgraphia
B. Agraphia
C. Acalculia
D. Astereognosis

C. Acalculia

A patient cannot identify or name individual fingers when asked. This finding is:

A. Finger agnosia
B. Ideomotor apraxia
C. Tactile extinction
D. Prosopagnosia

A. Finger agnosia

Dominant parietal lobe dysfunction often occurs together with:

A. Visual agnosia
B. Aphasia
C. Hemiballismus
D. Nystagmus

B. Aphasia

A patient with a right parietal lesion ignores food on the left side of the tray. This syndrome is:

A. Alexia
B. Finger agnosia
C. Acalculia
D. Hemi-neglect

D. Hemi-neglect

On double simultaneous stimulation, a patient detects a left-sided touch alone but ignores it when both sides are touched together. This phenomenon is:

A. Confabulation
B. Extinction
C. Echolalia
D. Perseveration

B. Extinction

A patient with left hemiplegia insists nothing is wrong with the left side of the body. This unawareness is:

A. Aphasia
B. Apraxia
C. Agraphia
D. Anosognosia

D. Anosognosia

A patient with non-dominant parietal damage omits the left half of a clock when drawing it. This most strongly reflects failure of:

A. Construction tasks
B. Remote memory
C. Repetition testing
D. Finger naming

A. Construction tasks

A patient with suspected frontal lobe dysfunction is asked to copy an alternating sequence of shapes but keeps drawing the same figure repeatedly. This abnormality is best termed:

A. Extinction
B. Perseveration
C. Echolalia
D. Finger agnosia

B. Perseveration

Difficulty with sequencing tasks during the mental-status exam most strongly suggests dysfunction of the:

A. Frontal lobe
B. Occipital cortex
C. Cerebellar vermis
D. Medial temporal lobe

A. Frontal lobe

Which bedside finding is most consistent with frontal dysfunction?

A. Loss of vibration sense
B. Repeated motor set failure
C. Impaired odor recognition
D. Inability to name fingers

B. Repeated motor set failure

Failure of the Luria Manual Sequence Task most directly reflects impaired:

A. Visual memory
B. Language comprehension
C. Motor sequencing
D. Olfactory acuity

C. Motor sequencing

A patient cannot sustain successive learned motor acts during examination, despite understanding instructions and having full strength. This is most consistent with:

A. Motor impersistence
B. Dysdiadochokinesia
C. Hemineglect
D. Asterixis

A. Motor impersistence

The Auditory Go-No-Go test primarily assesses a patient’s ability to:

A. Retain verbal information
B. Suppress inappropriate movements
C. Recognize environmental sounds
D. Alternate hand movements rapidly

B. Suppress inappropriate movements

A patient with frontal disease is apathetic and has markedly reduced initiative and poor judgment formation. This syndrome is called:

A. Abulia
B. Alexia
C. Agraphia
D. Akathisia

A. Abulia

In the mental-status exam, abulia refers to a reduction in the ability to:

A. Smell familiar odors
B. Perform calculations
C. Make judgments
D. Repeat phrases

C. Make judgments

Apraxia is best defined as the loss of the ability to carry out skilled movements despite preserved:

A. Reflexes and tone
B. Desire and physical ability
C. Memory and judgment
D. Smell and language

B. Desire and physical ability

A patient understands the command, has full strength, and wants to comply, but cannot perform a learned gesture. Which diagnosis best fits?

A. Apraxia
B. Dysarthria
C. Hemiballismus
D. Ataxia

A. Apraxia

Apraxia is not explained by which of the following?

A. Higher-order planning failure
B. Nonlocalizable dysfunction
C. Language comprehension intactness
D. Upper motor neuron lesion

D. Upper motor neuron lesion

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During the final global assessment, which additional domains should be revisited besides apraxia?

A. Tone, bulk, fasciculations
B. Logic, hallucinations, mood
C. Pupils, fields, fundi
D. Gait, stance, tandem

B. Logic, hallucinations, mood

Delusions and hallucinations on exam should prompt consideration of what often-forgetten issues?

A. Psychiatric or neurological disease
B. Frontal tumors or neurological disease
C. Toxic or metabolic causes
D. Pure cerebellar dysfunction

C. Toxic or metabolic causes

Routine testing of cranial nerve I is generally avoided unless:

A. Aphasia is suspected
B. Specific pathology is suspected
C. Memory loss is severe
D. Parietal signs are present

B. Specific pathology is suspected

Loss of smell may result from which of the following?

A. Obstruction, nerve, intracranial lesion
B. Cerebellum, pons, caudate
C. Retina, chiasm, tract
D. Thalamus, medulla, cortex

A. Obstruction, nerve, intracranial lesion

Early loss of smell is classically associated with:

A. Huntington and ALS
B. Alzheimer and Parkinson disease
C. Myasthenia and Guillain-Barré
D. Epilepsy and migraine

B. Alzheimer and Parkinson disease

A patient with progressive anosmia has no nasal congestion. Which mechanism still remains plausible?

A. Nasal obstruction only
B. Peripheral nerve cause
C. Poor cooperation only
D. Dominant parietal lesion

B. Peripheral nerve cause

Funduscopic examination with an ophthalmoscope is primarily used to evaluate for damage to the:

A. Retina and retinal vessels
B. Lens and ciliary body
C. Cornea and conjunctiva
D. Iris and trabecular meshwork

A. Retina and retinal vessels

A bedside eye chart assessment of each eye most directly tests:

A. Stereopsis
B. Visual acuity
C. Accommodation
D. Pupillary reactivity

B. Visual acuity

Which additional bedside visual function is specifically included along with acuity and fields in this exam framework?

A. Corneal reflex
B. Jaw jerk
C. Color vision
D. Caloric response

C. Color vision

When red appears less vivid in one eye than the other, this asymmetry suggests dysfunction of:

A. CN II
B. CN III
C. CN IV
D. CN VI

A. CN II

Double simultaneous visual stimulation showing failure to report one side despite seeing each side alone suggests:

A. Papilledema
B. Hippus
C. Hemi-neglect
D. Ophthalmoplegia

C. Hemi-neglect

Visual extinction is tested by asking the patient to report:

A. Light brightness only
B. Finger number seen
C. Color of examiner’s glove
D. Whether eyes are aligned

B. Finger number seen

Pupillary light responses primarily assess which cranial nerves together?

A. II and III
B. III and IV
C. IV and VI
D. II and VI

A. II and III

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Failure of the consensual response can result from which lesion pair?

A. Ipsilateral III, ipsilateral IV
B. Contralateral II, ipsilateral VI
C. Ipsilateral II, contralateral III
D. Contralateral III, ipsilateral IV

C. Ipsilateral II, contralateral III

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An impaired direct pupillary response may result from:

A. Contralateral II lesion
B. Ipsilateral II lesion
C. Contralateral VI lesion
D. Bilateral IV lesions

B. Ipsilateral II lesion

Which structure, if paralyzed, can impair either direct or consensual constriction in the affected eye?

A. Dilator muscle
B. Lateral rectus
C. Sphincter muscle
D. Levator palpebrae

C. Sphincter muscle

A decreased direct response caused by CN II dysfunction is best termed:

A. Argyll Robertson pupil
B. Afferent pupillary defect
C. Tonic pupil
D. Efferent pupillary defect

B. Afferent pupillary defect

Which bedside maneuver is used to demonstrate an afferent pupillary defect?

A. Cover-uncover test
B. Corneal stimulation
C. Swinging light test
D. Doll’s eye test

C. Swinging light test

Brief normal oscillations in pupil size during examination are called:

A. Horner waves
B. Hippus
C. Nystagmus
D. Mydriasis

B. Hippus

Which pupillary response is tested by having the patient shift gaze to a near object?

A. Visual extinction
B. Direct light response
C. Consensual response
D. Accommodation response

D. Accommodation response

Sparing of accommodation with absent light response most strongly suggests a lesion in the:

A. Internal capsule
B. Pretectal region
C. Lateral geniculate
D. Optic tract

B. Pretectal region

In the provided framework, impairment of the consensual response may reflect a lesion involving the brain’s:

A. Red nucleus
B. Edinger-Westphal region
C. Mamillary body
D. Superior cerebellar peduncle

B. Edinger-Westphal region

Extraocular movement testing of cranial nerves III, IV, and VI is performed by asking the patient to:

A. Blink rapidly
B. Fixate one eye
C. Turn the head
D. Look all directions

D. Look all directions

While testing ocular motility, the examiner should ensure the patient’s:

A. Jaw remains clenched
B. Head does not move
C. Eyes stay closed first
D. Pupils are pharmacologically dilated

B. Head does not move

Having the patient track a target across horizontal and vertical planes primarily assesses:

A. Saccadic suppression
B. Smooth pursuit
C. Optokinetic nystagmus
D. Visual extinction

B. Smooth pursuit

Convergence is tested by asking the patient to:

A. Read distant letters
B. Follow lateral movement
C. Fixate a near target
D. Alternate eye closure

C. Fixate a near target

Failure of both eyes to remain fixed on the same target during convergence indicates:

A. Dysconjugate gaze
B. Visual neglect
C. Hippus
D. Red desaturation

A. Dysconjugate gaze

Dysconjugate gaze during convergence commonly produces:

A. Ptosis
B. Photophobia
C. Diplopia
D. Miosis

C. Diplopia

A patient has normal acuity but misses stimuli in one hemifield only during simultaneous bilateral presentation. This most strongly suggests:

A. Cataract
B. CN II palsy
C. Retinal detachment
D. Visual extinction

D. Visual extinction

A patient is asked to rapidly shift gaze from the examiner’s finger to a penlight across the room. Which type of eye movement is being tested?

A. Smooth pursuit
B. Saccades
C. Vestibular drift
D. Convergence

B. Saccades

Saccades are best defined as eye movements used to:

A. Track moving targets smoothly
B. Maintain fixation during head turn
C. Rapidly refixate between targets
D. Constrict pupils to near objects

C. Rapidly refixate between targets

Optokinetic nystagmus is commonly tested by:

A. Covering one eye alternately
B. Swinging a flashlight between eyes
C. Moving a near target inward
D. Moving parallel stripes past gaze

D. Moving parallel stripes past gaze

During optokinetic nystagmus testing, the patient is instructed to:

A. Follow one stripe, then next
B. Blink after each stripe
C. Count each visible stripe
D. Keep eyes fixed centrally

A. Follow one stripe, then next

Optokinetic nystagmus normally contains which two components?

A. Direct and consensual phases
B. Afferent and efferent phases
C. Fast and slow phases
D. Light and near phases

C. Fast and slow phases

Bedside optokinetic testing is especially useful for detecting impaired:

A. Facial sensation or asymmetric saccades
B. Smooth movement or asymmetric saccades
C. Pupillary constriction or asymmetric saccades
D. Corneal sensation or asymmetric saccades

B. Smooth movement or asymmetric saccades

Spontaneous abnormal nystagmus on exam may suggest:

A. Dominant parietal dysfunction
B. Isolated retinal detachment
C. Pure peripheral neuropathy
D. Toxic metabolite buildup

D. Toxic metabolite buildup

In a comatose patient, eye movement may be assessed using:

A. Oculocephalic or caloric testing
B. Cover-uncover or caloric testing
C. Near response or caloric testing
D. Ishihara plate or caloric testing

A. Oculocephalic or caloric testing

Facial sensation in cranial nerve testing can be screened using:

A. Tuning fork or pinwheel
B. Tongue blade or swab
C. Cotton wisp or sharp object
D. Penlight or ophthalmoscope

C. Cotton wisp or sharp object

Simultaneous bilateral facial stimuli are used to test for:

A. Jaw jerk
B. Corneal reflex
C. Facial paresis
D. Tactile extinction

D. Tactile extinction

The corneal reflex depends on which afferent-efferent pair?

A. V afferent, VII efferent
B. VII afferent, V efferent
C. II afferent, III efferent
D. V afferent, VI efferent

A. V afferent, VII efferent

The corneal reflex is elicited by:

A. Tapping the nasal bridge
B. Stroking the eyelashes
C. Touching the sclera
D. Touching the cornea lightly

D. Touching the cornea lightly

A patient feels corneal touch but does not blink. According to the provided framework, this pattern usually suggests:

A. Left parietal lesion
B. Right parietal lesion
C. Left cerebellar lesion
D. Right cerebellar lesion

B. Right parietal lesion

The jaw jerk reflex is tested by:

A. Tapping jaw with mouth open
B. Stroking chin with cotton
C. Clenching teeth against resistance
D. Tapping forehead while biting

A. Tapping jaw with mouth open

The jaw jerk reflex evaluates muscles of mastication carried by:

A. CN VII only
B. CN V3 only
C. CN IX only
D. CN XII only

B. CN V3 only

In the jaw jerk reflex, CN V3 serves which role?

A. Both afferent and efferent
B. Afferent only
C. Efferent only
D. Neither pathway

A. Both afferent and efferent

Hyperreflexia of the jaw jerk most strongly suggests:

A. Lower motor neuron lesion
B. Peripheral nerve entrapment
C. Upper motor neuron lesion
D. Neuromuscular junction failure

C. Upper motor neuron lesion

Cranial nerve VII alone can be screened initially by looking for:

A. Dysphagia with phonation
B. Sensory extinction
C. Pupillary asymmetry
D. Facial asymmetry at rest

D. Facial asymmetry at rest

Bilateral facial weakness that may be subtle on examination is termed:

A. Hemifacial spasm
B. Bell phenomenon
C. Facial diplegia
D. Jaw dystonia

C. Facial diplegia

Unilateral facial weakness is often best demonstrated by asking the patient to:

A. Open mouth widely
B. Protrude the tongue
C. Shrug both shoulders
D. Smile or make faces

D. Smile or make faces

Cranial nerve VII can also be tested by applying which tastes to each side of the tongue?

A. Salt and quinine
B. Sugar and lemon juice
C. Vinegar and coffee
D. Peppermint and soap

B. Sugar and lemon juice

A lower motor neuron lesion of cranial nerve VII classically causes weakness of the:

A. Contralateral face, forehead spared
B. Ipsilateral lower face only
C. Contralateral whole face
D. Ipsilateral face including forehead

D. Ipsilateral face including forehead

An upper motor neuron facial lesion typically causes weakness of the:

A. Contralateral face, forehead spared
B. Ipsilateral face, forehead involved
C. Ipsilateral lower face only
D. Bilateral face equally

A. Contralateral face, forehead spared

Hearing for cranial nerve VIII can be screened by:

A. Whispering into both ears
B. Tuning fork at vertex
C. Light noise, then side localization
D. Asking for spoken repetition

C. Light noise, then side localization

In a patient with vertigo, specific bedside maneuvers may help distinguish:

A. Retinal from cortical loss
B. Peripheral from central lesions
C. LMN from UMN weakness
D. CN V from CN VII lesions

B. Peripheral from central lesions

The vestibulo-ocular reflex is especially helpful to test in patients with limitation of:

A. Smell or taste
B. Pupillary constriction
C. Corneal sensation
D. Horizontal or vertical gaze

D. Horizontal or vertical gaze

The oculocephalic maneuver is performed by:

A. Turning head rapidly, eyes open
B. Pressing eyelids during fixation
C. Moving target toward the nose
D. Flashing light between pupils

A. Turning head rapidly, eyes open

Normal doll’s eyes are present when the eyes:

A. Move with head rotation
B. Shift opposite with head turn
C. Converge during head turning
D. Oscillate with equal amplitude

B. Shift opposite head turn

According to the material, the only way to test CN VIII in a comatose patient is with the:

A. Corneal reflex
B. Jaw jerk maneuver
C. Oculocephalic maneuver
D. Swinging light test

C. Oculocephalic maneuver

Unilateral cranial nerve VIII deficits are most often produced by:

A. Cortical lesions
B. Brainstem infarcts
C. Metabolic encephalopathy
D. Peripheral lesions

D. Peripheral lesions

Which cranial nerve set is involved in articulation and may contribute to dysarthria?

A. 2, 3, 4, 6
B. 1, 8, 11, 12
C. 5, 7, 9, 10, 12
D. 3, 5, 8, 10

C. 5, 7, 9, 10, 12

A patient has slurred, poorly pronounced speech but intact word choice and comprehension. This pattern is most consistent with:

A. Aphasia
B. Dysarthria
C. Apraxia
D. Neologism

B. Dysarthria

Which speech deficit reflects abnormal word choice rather than abnormal pronunciation?

A. Aphasia
B. Dysarthria
C. Hypophonia
D. Dysphonia

A. Aphasia

Cranial nerve XI is tested most directly by asking the patient to:

A. Smile and close eyes
B. Shrug shoulders and turn head
C. Protrude tongue and swallow
D. Open jaw and bite down

B. Shrug shoulders and turn head

Weakness of which muscle is specifically assessed when the patient turns the head during CN XI testing?

A. Temporalis
B. Deltoid
C. Sternocleidomastoid
D. Trapezius

C. Sternocleidomastoid

In contralateral upper motor neuron lesions, the sternocleidomastoid is often:

A. Completely denervated
B. Hypertonic and fasciculating
C. Partially spared
D. Atrophic bilaterally

C. Partially spared

Partial sparing of the sternocleidomastoid with contralateral upper motor neuron lesions is said to resemble the sparing pattern seen with:

A. CN 2 and pupil
B. CN 8 and hearing
C. CN 9 and palate
D. CN 5 and forehead

D. CN 5 and forehead

Examination of CN XII includes looking at the resting tongue for:

A. Rigidity and tremor
B. Ptosis and nystagmus
C. Atrophy and fasciculations
D. Spasticity and clonus

C. Atrophy and fasciculations

A lower motor neuron lesion of CN XII causes tongue weakness on the:

A. Ipsilateral side
B. Contralateral side
C. Bilateral sides equally
D. Midline only

A. Ipsilateral side

An upper motor neuron lesion affecting CN XII causes tongue weakness on the:

A. Ipsilateral side
B. Contralateral side
C. Bilateral sides equally
D. Side of fasciculations

B. Contralateral side

A patient’s tongue shows quivering movements while resting on the mouth floor. These movements are best described as:

A. Clonus
B. Chorea
C. Fasciculations
D. Athetosis

C. Fasciculations

Which finding on tongue inspection most strongly favors a lower motor neuron lesion?

A. Hyperreflexia
B. Atrophy with fasciculations
C. Contralateral neglect
D. Spared protrusion only

B. Atrophy with fasciculations

The first step of the motor exam includes observing for:

A. Sensory extinction and graphesthesia
B. Twitches, tremors, posture
C. Gag, palate, uvula
D. Visual acuity and fields

B. Twitches, tremors, posture

Involuntary movements seen on general motor observation may suggest lesions involving the:

A. Basal ganglia or cerebellum
B. Retina or optic tract
C. Dorsal columns
D. Peripheral sensory nerves

A. Basal ganglia or cerebellum

Involuntary movements may also occur with:

A. Pure language disorders
B. Toxic or metabolic conditions
C. Isolated retinal disorders
D. Meningeal irritation only

B. Toxic or metabolic conditions

Fasciculations are often best seen in which locations?

A. Forearm, calf, tongue base
B. Intrinsic hand, shoulder, thigh
C. Neck, abdomen, face
D. Hip, back, chest

B. Intrinsic hand, shoulder, thigh

Palpation tenderness during the motor exam may suggest:

A. Myositis
B. Myasthenia
C. Neuropathy
D. Radiculopathy

A. Myositis

A rubbery muscle texture due to pseudohypertrophy is most suggestive of:

A. Myositis
B. Muscular dystrophy
C. Myotonic dystrophy
D. Polymyalgia rheumatica

B. Muscular dystrophy

When testing tone, the examiner should move each limb:

A. Against maximal resistance
B. At several joints
C. Only at the wrist
D. Only at the ankle

B. At several joints

Abnormal tone can help distinguish between upper and lower motor neuron lesions because:

A. Sensory tracts decussate twice
B. Motor tracts are crossed
C. Cerebellar tracts are uncrossed
D. Reflexes never localize lesions

B. Motor tracts are crossed

In the acute setting, upper motor neuron lesions may initially present with:

A. Hyperreflexia and spasticity only
B. Flaccidity with decreased reflexes
C. Fasciculations and atrophy
D. Resting tremor and rigidity

B. Flaccidity with decreased reflexes

Over time, an acute upper motor neuron lesion classically evolves toward:

A. Persistent areflexia only
B. Hyperreflexia and increased tone
C. Progressive fasciculations only
D. Complete sensory loss only

B. Hyperreflexia and increased tone

Which finding is generally absent in typical upper motor neuron lesions, especially early on?

A. Weakness
B. Hyperreflexia
C. Fasciculations
D. Increased tone

C. Fasciculations

In the acute setting, upper motor neuron lesions usually do not show:

A. Atrophy
B. Weakness
C. Decreased tone initially
D. Decreased reflexes initially

A. Atrophy

A patient has increased tone, awkward fine finger movements, and impaired toe tapping. This pattern may suggest a lesion involving the:

A. Basal ganglia
B. Dominant temporal lobe
C. Occipital cortex
D. Peripheral sensory nerve

A. Basal ganglia

Drift testing is primarily used to look for:

A. Loss of vibration
B. Involuntary arm deviation
C. Facial asymmetry
D. Tongue fasciculation

B. Involuntary arm deviation

Strength testing of individual muscle groups is most useful because patterns of weakness can localize lesions to the:

A. Retina or lens
B. White matter, segment, nerve
C. Basal ganglia only
D. Neuromuscular junction only

B. White matter, segment, nerve

Proper strength testing requires the examiner to isolate the target muscle and support it from the:

A. Distal side
B. Lateral side
C. Proximal side
D. Opposite limb

C. Proximal side

Which statement best describes proper manual muscle testing technique?

A. Test multiple muscles together
B. Support distally and bilaterally
C. Compare sides simultaneously
D. Isolate muscle and test bilaterally

D. Isolate muscle and test bilaterally

A deep tendon reflex is elicited by using a reflex hammer to:

A. Stretch a tendon
B. Compress a joint
C. Stimulate the periosteum
D. Irritate the muscle belly

A. Stretch a tendon

A reflex cannot initially be obtained in an anxious patient. Which maneuver is appropriate according to the provided framework?

A. Ask for slight contraction
B. Repeat with pain stimulus
C. Test only one side
D. Have patient hold breath

A. Ask for slight contraction

Repetitive rhythmic contraction of a muscle after stretch is termed:

A. Fasciculation
B. Clonus
C. Myokymia
D. Athetosis

B. Clonus

Clonus is most likely to be seen when reflexes are:

A. Absent
B. Delayed
C. Brisk
D. Exhausted

C. Brisk

Hyperreflexia may include “spreading,” meaning:

A. Both pupils constrict
B. Unrelated muscles also respond
C. Reflex fades with repetition
D. Only the target muscle contracts

B. Unrelated muscles also respond

Reflex testing can be especially useful for lesion localization in patients with:

A. Cataracts or glaucoma
B. Aphasia or neglect
C. Coma or spinal injury
D. Migraine or tinnitus

C. Coma or spinal injury

Stroking the abdominal wall above the umbilicus should produce abdominal contraction mediated primarily by:

A. T6–T8
B. T8–T10
C. T10–T12
D. L1–L2

B. T8–T10

Abdominal contraction elicited below the umbilicus primarily tests:

A. T8–T10
B. T10–T12
C. L1–L2
D. S2–S4

B. T10–T12

Stroking the upper thigh skin normally elicits the cremasteric reflex mediated by:

A. T10–T12
B. L1–L2
C. L4–L5
D. S2–S4

B. L1–L2

The cremasteric reflex is best elicited by stimulating the:

A. Lower abdomen
B. Plantar foot
C. Perianal skin
D. Upper thigh skin

D. Upper thigh skin

Pressure on the bulbocavernous region should produce anal contraction mediated by:

A. L1–L2
B. L3–L4
C. S1–S2
D. S2–S4

D. S2–S4

The bulbocavernous reflex is identified by observing:

A. Plantar flexion
B. Anal contraction
C. Thigh adduction
D. Abdominal tightening

B. Anal contraction

Sharp pressure in the perianal area is used to test the:

A. Cremasteric reflex
B. Jaw jerk
C. Anal wink
D. Hoffman's sign

C. Anal wink

The anal wink reflex primarily assesses which spinal segments?

A. T10–T12
B. L1–L2
C. L4–S1
D. S2–S4

D. S2–S4

Hoffman's sign indicates heightened reflex activity involving the:

A. Toe extensors
B. Jaw closers
C. Finger flexors
D. Wrist extensors

C. Finger flexors

A positive Hoffman's sign most directly reflects:

A. Finger flexor hyperreflexia
B. Lower motor weakness
C. Sacral areflexia
D. Cerebellar dysmetria

A. Finger flexor hyperreflexia

In the provided motor exam sequence, drift testing is best classified as part of assessing:

A. Sensory/postural holding
B. Coordination/postural holding
C. Strength/postural holding
D. Visual field extinction

C. Strength/postural holding

A patient has asymmetric weakness isolated to muscles supplied by a single peripheral nerve. Which component of the exam most directly helped localize this pattern?

A. Bilateral plantar testing
B. Individual muscle strength testing
C. Abdominal reflex testing
D. Oculocephalic testing

B. Individual muscle strength testing

A patient with bifrontal damage begins exhibiting grasp and sucking behaviors during examination. These findings are best classified as re-emergence of:

A. Primitive reflexes
B. Cerebellar release signs
C. Sensory neglect signs
D. Brainstem startle responses

A. Primitive reflexes

Which reflex pair is specifically listed as primitive reflexes that may re-emerge with frontal lobe lesions?

A. Corneal and gag
B. Root and suck
C. Cremasteric and anal wink
D. Jaw jerk and Hoffman

B. Root and suck

Repeated tapping between the eyes while the patient tries to keep the eyes open is testing the:

A. Palmomental reflex
B. Corneal reflex
C. Glabellar response
D. Doll’s eye reflex

C. Glabellar response

Continued blinking during repeated glabellar tapping is abnormal and is called:

A. Bell phenomenon
B. Myerson’s sign
C. Argyll sign
D. Hoffman’s sign

B. Myerson’s sign

Myerson’s sign is classically noted in:

A. Myasthenia gravis
B. Parkinson disease
C. Cerebellar stroke
D. Temporal lobe epilepsy

B. Parkinson disease

The palmomental reflex is elicited by scraping the:

A. Forehead skin
B. Cornea lightly
C. Thenar eminence
D. Plantar surface

C. Thenar eminence

A positive palmomental reflex produces contraction of the ipsilateral:

A. Buccinator muscle
B. Mentalis muscle
C. Masseter muscle
D. Sternocleidomastoid

B. Mentalis muscle

Primitive reflexes such as grasp, snout, root, and suck most strongly suggest dysfunction of the:

A. Frontal lobe
B. Occipital lobe
C. Basal ganglia
D. Medial temporal lobe

A. Frontal lobe

Abnormal posturing responses are associated with damage to the:

A. Ascending sensory pathways
B. Descending motor pathways
C. Spinocerebellar tracts
D. Visual association cortex

B. Descending motor pathways

Characterized by stiff, flexed arms bent inward toward the chest, clenched fists, and extended legs

A. Decorticate posturing
B. Decerebrate posturing
C. Palmomental response
D. Myerson’s sign

A. Decorticate posturing

Characterized by rigid extension of the arms and legs, adducted shoulders, pronated forearms, and flexed fingers:

A. Decorticate posturing
B. Decerebrate posturing
C. Palmomental response
D. Myerson’s sign

B. Decerebrate posturing

Cerebellar dysfunction often presents primarily with impaired:

A. Language and naming
B. Coordination and gait
C. Facial sensation and hearing
D. Memory and orientation

B. Coordination and gait

Ataxia is best described as:

A. Pure weakness of extremities
B. Abnormal coordination movements
C. Loss of muscle bulk
D. Isolated tremor at rest

B. Abnormal coordination movements

Which description best matches ataxic movements in the provided material?

A. Fine rhythmic resting tremor
B. Brief shock-like jerks
C. Medium-large irregular oscillations
D. Slow writhing distal movements

C. Medium-large irregular oscillations

Ataxia commonly occurs together with:

A. Aphasia
B. Overshoot
C. Hemineglect
D. Rigidity

B. Overshoot

Appendicular ataxia is most associated with lesions of the:

A. Cerebellar hemispheres
B. Midline cerebellar vermis
C. Basal ganglia output nuclei
D. Dorsal columns

A. Cerebellar hemispheres

Which bedside test is specifically listed for upper-limb appendicular coordination?

A. Romberg test
B. Jaw jerk test
C. Finger-to-nose test
D. Glabellar test

C. Finger-to-nose test

Which bedside test is specifically listed for lower-limb coordination?

A. Heel-to-shin test
B. Toe-walk test
C. Plantar response test
D. Tandem stance test

A. Heel-to-shin test

Tests of appendicular coordination incorporate many sensory and motor subsystems and assess how well they:

A. Cross in the medulla
B. Function together
C. Inhibit reflexes
D. Generate language

B. Function together

Truncal ataxia primarily affects:

A. Distal finger movements
B. Proximal gait musculature
C. Tongue and palate
D. Ocular fixation only

B. Proximal gait musculature

Truncal ataxia is most strongly associated with a lesion of the:

A. Cerebellar hemisphere
B. Midline cerebellar vermis
C. Dominant parietal lobe
D. Internal capsule

B. Midline cerebellar vermis

A patient has severe instability of stance and gait with relatively spared finger-to-nose testing. This pattern most strongly suggests:

A. Appendicular ataxia
B. Truncal ataxia
C. Pure sensory aphasia
D. Frontal release syndrome

B. Truncal ataxia

Which pair of systems can be uncovered by Romberg testing in this framework?

A. Cerebellar or vestibular
B. Corticospinal or spinothalamic
C. Limbic or frontal
D. Optic or oculomotor

A. Cerebellar or vestibular

Subtle gait abnormalities may be accentuated during examination by asking the patient to:

A. Walk on toes or heels
B. Stand with eyes closed
C. March with arms crossed
D. Hop on one foot

A. Walk on toes or heels

A patient can simulate stepping movements normally while supine but cannot initiate walking when upright. This pattern is most consistent with:

A. Truncal ataxia
B. Gait apraxia
C. Foot drop
D. Sensory extinction

B. Gait apraxia

Which bedside tool is specifically listed for testing fine touch?

A. Cotton swab
B. Safety pin
C. Cold metal
D. Tuning fork

A. Cotton swab

Pain sensation in the sensory exam can be tested using the:

A. Sharp scalpel edge
B. Cotton-tipped applicator
C. Dull safety pin end
D. Reflex hammer handle

C. Dull safety pin end

Temperature sensation is specifically assessed using:

A. Warm water vial
B. Cold metal
C. Ice pack
D. Alcohol pad

B. Cold metal

Two-point discrimination is tested using:

A. Cotton and tuning fork
B. Safety pin and swab
C. Penlight and calipers
D. Calipers or bent paper clip

D. Calipers or bent paper clip

Graphesthesia is tested by asking the patient with eyes closed to identify:

A. A finger touched twice
B. A number of pinpricks
C. A letter drawn on palm
D. A vibrating metal surface

C. A letter drawn on palm

Graphesthesia is considered a test of:

A. Primary nociception
B. Higher cortical sensation
C. Vestibular function
D. Lower motor output

B. Higher cortical sensation

Stereognosis is tested by asking the patient to close the eyes and identify:

A. The direction of toe movement
B. Easy objects in hand
C. A letter on skin
D. The site of vibration

B. Easy objects in hand

Higher-order sensory testing differs from primary sensory testing because it assesses:

A. Brainstem reflex arcs
B. Cortical sensory processing
C. Muscle bulk and tone
D. Vestibulo-ocular pathways

B. Cortical sensory processing

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A patient has impaired vibration in the toes, intact pinprick, and preserved graphesthesia. Which statement is most accurate?

A. Deficit must be cortical
B. Sensory lesions localize widely
C. This excludes peripheral nerve
D. Only dermatomes are relevant

B. Sensory lesions localize widely

A complete sensory exam in this framework should include primary modalities plus:

A. Palatal and gag reflexes
B. Higher cortical sensation tests
C. Primitive frontal reflexes
D. Forced heel-to-toe gait

B. Higher cortical sensation tests

Before beginning the neurologic examination in a comatose patient, the clinician should first:

A. Check plantar responses
B. Obtain EEG immediately
C. Complete general exam
D. Test extraocular movements

C. Complete general exam

Coma is best defined as:

A. Eyes open, no movement
B. Unarousable unresponsiveness with eyes closed
C. Sleep with intact arousal
D. Mutism with preserved tracking

B. Unarousable unresponsiveness with eyes closed

In the notes, coma is described as:

A. A fixed all-or-none state
B. A behavioral language disorder
C. A peripheral motor syndrome
D. A continuum of responsiveness

D. A continuum of responsiveness

Which documentation style is preferred when describing coma severity?

A. Use one-word labels only
B. Describe responses to stimuli
C. Record imaging first
D. Report reflexes only

B. Describe responses to stimuli

Damage to which structure can directly impair consciousness?

A. Caudate nucleus
B. Reticular formation
C. Precentral gyrus
D. Cerebellar vermis

B. Reticular formation

Which additional lesion pattern can impair consciousness?

A. Unilateral occipital lesion
B. Bilateral thalamic injury
C. Isolated CN XII palsy
D. Lumbar root compression

B. Bilateral thalamic injury

Which nonstructural process can also cause coma-like depressed consciousness?

A. Toxic or metabolic disturbance
B. Isolated radial neuropathy
C. Retinal hemorrhage
D. Myasthenic ptosis

A. Toxic or metabolic disturbance

A patient has profoundly decreased responsiveness, but the eyes are open, appear normal, and may even move. This is most consistent with:

A. Catatonia
B. Locked-in syndrome
C. Akinetic mutism
D. True coma

C. Akinetic mutism

Markedly decreased responsiveness associated with psychiatric illness is most consistent with:

A. Catatonia
B. Akinetic mutism
C. Delirium
D. Locked-in syndrome

A. Catatonia

A conscious patient can perceive sensation but cannot perform motor actions because of a brainstem lesion. This syndrome is:

A. Akinetic mutism
B. Locked-in syndrome
C. Catatonia
D. Abulia

B. Locked-in syndrome

Besides brainstem injury, locked-in syndrome may also result from:

A. Basal ganglia hemorrhage
B. Bilateral occipital infarcts
C. Peripheral neuromuscular blockade
D. Thalamic pain syndrome

C. Peripheral neuromuscular blockade

In a comatose patient, ophthalmoscopic evidence of papilledema most strongly suggests:

A. Raised intracranial pressure
B. Opiate intoxication
C. Pontine lesion
D. Peripheral neuropathy

A. Raised intracranial pressure

Blink-to-threat is used mainly to obtain a rough bedside estimate of:

A. Color vision
B. Pupillary symmetry
C. Visual fields
D. Accommodation

C. Visual fields

According to the notes, blink-to-threat is most appropriate in:

A. Fully cooperative patients
B. Noncooperative conscious patients
C. Deeply comatose patients
D. Intubated, paralyzed patients

B. Noncooperative conscious patients

Blink-to-threat is performed by:

A. Flashing light into pupil
B. Touching the cornea
C. Moving a hand toward eye
D. Rotating the head rapidly

C. Moving a hand toward eye

In coma, pupillary light responses are particularly useful because toxic or metabolic causes usually:

A. Produce blown pupils
B. Spare the pupils
C. Cause pinpoint fixed pupils
D. Abolish corneal reflexes

B. Spare the pupils

Bilaterally blown pupils in coma should raise concern for:

A. Midbrain lesion or herniation
B. Opiate overdose only
C. Pontine ischemia only
D. Temporal lobe seizure

A. Midbrain lesion or herniation

Bilaterally small but reactive pupils are classically associated with:

A. Midbrain compression
B. Pontine lesions
C. Opiate overdose
D. Frontal lobe lesions

B. Pontine lesions

Bilateral pinpoint pupils in an unresponsive patient most strongly suggest:

A. Opiate overdose
B. Thalamic infarction
C. Cerebellar hemorrhage
D. Temporal encephalitis

A. Opiate overdose

Absent doll’s eyes in a comatose patient suggests dysfunction of the:

A. Cerebellum
B. Brainstem
C. Basal ganglia
D. Visual cortex

B. Brainstem

In caloric testing, cold water in one ear should classically produce a fast phase of nystagmus toward the:

A. Same side
B. Opposite side
C. Upward direction
D. Downward direction

B. Opposite side

In many comatose patients, the fast phase of caloric nystagmus may be absent, leaving only:

A. Vertical drift away
B. Slow deviation to cold ear
C. Bilateral convergence
D. Blink suppression

B. Slow deviation to cold ear

Presence of an oculocephalic or caloric eye movement response indicates preserved:

A. Cerebellar hemisphere function
B. Peripheral facial function
C. Brainstem function
D. Cortical language function

C. Brainstem function

A preserved corneal reflex in coma should produce:

A. Facial grimacing
B. Jaw deviation
C. Tongue protrusion
D. Shoulder elevation

A. Facial grimacing

During airway management, preserved lower cranial nerve reflex function may already be noted because the gag response is often observed during:

A. Funduscopic examination
B. Intubation
C. Caloric testing
D. Plantar stimulation

B. Intubation

Abnormal posturing in coma most strongly suggests damage to:

A. Ascending sensory pathways
B. Descending motor pathways
C. Peripheral motor nerves
D. Vestibular nuclei only

B. Descending motor pathways

Posturing responses in coma may involve which muscle groups?

A. Axial muscles only
B. Distal muscles only
C. Flexor or extensor groups
D. Facial muscles only

C. Flexor or extensor groups

A comatose patient extends the arms and legs in response to pain. This pattern most strongly localizes to the:

A. Cerebral cortex only
B. Midbrain or above
C. Lower brainstem
D. Spinal cord only

C. Lower brainstem

A patient demonstrates decorticate posturing to noxious stimulation. This pattern is usually associated with lesions:

A. In lower brainstem
B. At midbrain and above
C. In cervical roots
D. Only in cerebellum

B. At midbrain and above

Which statement best distinguishes posturing from a pain-withdrawal reflex?

A. Posturing avoids the stimulus
B. Withdrawal is always bilateral
C. Posturing moves toward pain
D. Withdrawal requires cortex

C. Posturing moves toward pain

Lower-limb flexor posturing involving hip, knee, and ankle flexion is called:

A. Clonus
B. Triple flexion
C. Decerebration
D. Motor impersistence

B. Triple flexion

Triple flexion can occur even without a functional:

A. Spinal cord
B. Cerebellum
C. Brainstem
D. Basal ganglia

C. Brainstem

In the comatose patient, coordination and gait are generally:

A. Fully assessable
B. Usually not testable
C. Best bedside localizers
D. Tested before reflexes

B. Usually not testable

On palpation of the skull after trauma, a palpable discontinuity of cranial bone is called:

A. Battle’s sign
B. Hemotympanum
C. Bony step-off
D. Raccoon eyes

C. Bony step-off

Clear fluid leaking from the nose after head trauma most strongly suggests:

A. Ethmoid skull-base fracture
B. Temporal bone fracture only
C. Isolated nasal cartilage injury
D. Frontal lobe contusion only

A. Ethmoid skull-base fracture

CSF otorrhea after head trauma most strongly points to fracture involving the:

A. Ethmoid bone
B. Temporal bone
C. Zygomatic arch
D. Mandibular condyle

B. Temporal bone

Dark blood seen behind the tympanic membrane after cranial trauma is termed:

A. CSF rhinorrhea
B. Battle’s sign
C. Bony step-off
D. Hemotympanum

D. Hemotympanum

Bruising over the mastoid process after trauma is known as:

A. Raccoon eyes
B. Battle’s sign
C. Triple flexion
D. Hemotympanum

B. Battle’s sign

Dark periorbital bruising after a basilar skull fracture is called:

A. Bony step-off
B. CSF otorrhea
C. Raccoon eyes
D. Decorticate posturing

C. Raccoon eyes

To diagnose brain death, there must be no evidence of function in the:

A. Cerebellum
B. Cortex
C. Brainstem
D. Spinal cord

C. Brainstem

Which bedside physiologic study must be included in brain death assessment according to the material?

A. Romberg test
B. Caloric test
C. Hoover test
D. Jaw jerk

B. Caloric test

During the apnea test, brain death is supported when the patient:

A. Hyperventilates off ventilator
B. Stops moving all limbs
C. Shows no respirations despite high pCO2
D. Develops pinpoint pupils only

C. Shows no respirations despite high pCO2

Which finding would argue against brain death?

A. Absent caloric response
B. No spontaneous respirations
C. Flat EEG tracing
D. Posturing to stimulus

D. Posturing to stimulus

Which reflex activity may still be present in brain death because it is brain-independent?

A. Corneal reflex
B. Triple flexion
C. Gag reflex
D. Pupillary light response

B. Triple flexion

Deep tendon reflexes may still persist in brain death because they are mediated primarily by the:

A. Brainstem
B. Cortex
C. Spinal cord
D. Cerebellum

C. Spinal cord

Which test pair is specifically described as confirmatory for brain death?

A. EEG and angiogram
B. EMG and MRI
C. CT and LP
D. PET and audiogram

A. EEG and angiogram

A patient develops weakness and numbness after emotional stress, but no focal neurologic lesion is found. This most strongly suggests:

A. Somatization disorder
B. Conversion disorder
C. Malingering
D. Factitious disorder

B. Conversion disorder

A patient has many shifting physical complaints over time affecting multiple organ systems. This pattern is most consistent with:

A. Conversion disorder
B. Locked-in syndrome
C. Somatization disorder
D. Catatonia

C. Somatization disorder

Which group is specifically listed as psychogenic neurologic presentations?

A. Coma, amnesia, seizures
B. Aphasia, apraxia, neglect
C. Tremor, rigidity, bradykinesia
D. Ptosis, diplopia, dysphagia

A. Coma, amnesia, seizures

Which distinction best separates factitious disorder from malingering?

A. Internal reward vs external gain
B. Weakness vs sensory loss
C. Acute vs chronic onset
D. Brainstem vs cortical signs

A. Internal reward vs external gain

In the hand-drop test for pseudocoma, the examiner raises the hand above the head and releases it. A truly comatose patient would be expected to:

A. Flinch away quickly
B. Bat the hand aside
C. Not avoid the face
D. Open the eyes

C. Not avoid the face

Saccadic eye movements should generally be absent in true coma. Their presence should raise concern for:

A. Brain death
B. Locked-in syndrome
C. Pontine hemorrhage
D. Opiate overdose

B. Locked-in syndrome

During repeated strength testing, inconsistent or variable resistance is most suggestive of:

A. Cerebellar ataxia
B. Upper motor lesion
C. Psychogenic weakness
D. Peripheral neuropathy

C. Psychogenic weakness

Which bedside sensory claim is specifically unreliable because the structure resonates?

A. Vibration over sternum
B. Pain over tibia
C. Cold over forearm
D. Light touch on palm

A. Vibration over sternum