AMC MCQ Neurology and Mental Health — Questions and Answers
Question 1: A 68-year-old presents with sudden right-sided weakness and expressive aphasia that resolves completely within 45 minutes. CT brain is normal. What is the most appropriate immediate management?
- Commence aspirin and arrange urgent specialist assessment (Correct answer)
- Reassure and discharge as symptoms resolved
- Commence warfarin immediately
- Repeat CT in 24 hours only
Correct answer: Commence aspirin and arrange urgent specialist assessment
A resolving focal deficit is a transient ischaemic attack, requiring antiplatelet therapy and urgent assessment to prevent stroke.
Question 2: A 24-year-old woman reports recurrent episodes of intense fear, palpitations, sweating and a sense of impending doom lasting about 10 minutes, with no medical cause found. What is the most likely diagnosis?
- Panic disorder (Correct answer)
- Generalised anxiety disorder
- Phaeochromocytoma
- Hyperthyroidism
Correct answer: Panic disorder
Recurrent discrete episodes of intense fear peaking within minutes, with no organic cause, characterise panic disorder.
Question 3: A patient with Parkinson's disease develops worsening tremor and rigidity after being started on a new medication for nausea. Which drug is the most likely cause?
- Metoclopramide (Correct answer)
- Ondansetron
- Domperidone
- Cyclizine
Correct answer: Metoclopramide
Metoclopramide is a central dopamine antagonist that crosses the blood-brain barrier and worsens parkinsonism.
Question 4: A 30-year-old man with schizophrenia on haloperidol develops fever, muscle rigidity, autonomic instability and a markedly raised creatine kinase. What is the diagnosis?
- Neuroleptic malignant syndrome (Correct answer)
- Serotonin syndrome
- Malignant hyperthermia
- Acute dystonia
Correct answer: Neuroleptic malignant syndrome
Fever, rigidity, autonomic instability and raised CK in a patient on antipsychotics indicate neuroleptic malignant syndrome.
Question 5: A 55-year-old presents with the 'worst headache of my life' that began suddenly. CT brain is normal at 12 hours. What is the next most appropriate investigation?
- Lumbar puncture looking for xanthochromia (Correct answer)
- Reassure and discharge
- MRI of the lumbar spine
- EEG
Correct answer: Lumbar puncture looking for xanthochromia
A thunderclap headache with a normal CT requires lumbar puncture to detect xanthochromia from subarachnoid haemorrhage.
Question 6: A 40-year-old woman reports two weeks of persistent low mood, anhedonia, early morning waking, poor appetite and thoughts that life is not worth living. What is the most appropriate first action?
- Assess suicide risk in detail (Correct answer)
- Prescribe a hypnotic and review in a month
- Refer for dietary advice
- Recommend increased exercise only
Correct answer: Assess suicide risk in detail
Any disclosure of thoughts that life is not worth living mandates a detailed suicide risk assessment.
Question 7: A 70-year-old man has a resting tremor, bradykinesia and cogwheel rigidity that began on one side. What is the most likely diagnosis?
- Idiopathic Parkinson's disease (Correct answer)
- Essential tremor
- Cerebellar tremor
- Benign physiological tremor
Correct answer: Idiopathic Parkinson's disease
Asymmetric resting tremor with bradykinesia and rigidity is the classic triad of idiopathic Parkinson's disease.
Question 8: A 22-year-old presents with foot drop and weakness of ankle dorsiflexion after sitting cross-legged for a prolonged period. Which nerve is most likely affected?
- Common peroneal (fibular) nerve (Correct answer)
- Tibial nerve
- Femoral nerve
- Sciatic nerve
Correct answer: Common peroneal (fibular) nerve
Compression of the common peroneal nerve at the fibular head causes foot drop and impaired dorsiflexion.
Question 9: A 19-year-old student has had six months of excessive worry about many areas of life, restlessness, muscle tension and difficulty concentrating most days. What is the most likely diagnosis?
- Generalised anxiety disorder (Correct answer)
- Panic disorder
- Obsessive-compulsive disorder
- Adjustment disorder
Correct answer: Generalised anxiety disorder
Persistent, excessive, hard-to-control worry across multiple domains for at least six months defines generalised anxiety disorder.
Question 10: A patient develops a sudden severe headache, neck stiffness, photophobia and a third nerve palsy. What is the most likely underlying cause?
- Ruptured posterior communicating artery aneurysm (Correct answer)
- Migraine with aura
- Tension-type headache
- Cluster headache
Correct answer: Ruptured posterior communicating artery aneurysm
A painful third nerve palsy with meningism strongly suggests a posterior communicating artery aneurysm causing subarachnoid haemorrhage.
Question 11: A 60-year-old with long-standing alcohol use presents confused, with ophthalmoplegia and ataxia. What is the most appropriate immediate treatment?
- Intravenous thiamine before any glucose (Correct answer)
- Intravenous glucose alone
- Oral folic acid
- Benzodiazepine sedation only
Correct answer: Intravenous thiamine before any glucose
Wernicke's encephalopathy requires parenteral thiamine before glucose to avoid precipitating irreversible damage.
Question 12: A 35-year-old man believes he is being followed by government agents, hears voices commenting on his actions, and has shown social withdrawal for the past eight months. What is the most likely diagnosis?
- Schizophrenia (Correct answer)
- Bipolar affective disorder
- Delusional disorder
- Schizoaffective disorder
Correct answer: Schizophrenia
Persistent delusions, third-person auditory hallucinations and functional decline beyond a month indicate schizophrenia.
Question 13: A 28-year-old woman with multiple sclerosis develops acute painful loss of vision in one eye with reduced colour vision. What is the most likely diagnosis?
- Optic neuritis (Correct answer)
- Central retinal artery occlusion
- Acute angle-closure glaucoma
- Retinal detachment
Correct answer: Optic neuritis
Painful monocular visual loss with impaired colour vision in a young patient with MS is typical of optic neuritis.
Question 14: A 75-year-old develops gradual cognitive decline with prominent early memory loss and no focal neurological signs. What is the most likely diagnosis?
- Alzheimer's disease (Correct answer)
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia
Correct answer: Alzheimer's disease
Insidious progressive memory loss without early focal deficits is most consistent with Alzheimer's disease.
Question 15: A 25-year-old presents with ascending symmetrical limb weakness and absent reflexes two weeks after a diarrhoeal illness. What is the most appropriate immediate concern to monitor?
- Respiratory function (forced vital capacity) (Correct answer)
- Blood glucose level
- Liver function tests
- Visual acuity
Correct answer: Respiratory function (forced vital capacity)
Guillain-Barré syndrome can cause respiratory muscle failure, so vital capacity must be monitored closely.
Question 16: A 70-year-old woman has a new headache, scalp tenderness, jaw claudication and a raised ESR. What is the most appropriate immediate management?
- Start high-dose corticosteroids immediately (Correct answer)
- Await temporal artery biopsy before treating
- Prescribe simple analgesia only
- Arrange routine outpatient review
Correct answer: Start high-dose corticosteroids immediately
Suspected giant cell arteritis requires immediate corticosteroids to prevent irreversible blindness, without waiting for biopsy.
Question 17: A 16-year-old has recurrent intrusive thoughts of contamination and spends hours washing his hands, recognising the behaviour as excessive. What is the most likely diagnosis?
- Obsessive-compulsive disorder (Correct answer)
- Generalised anxiety disorder
- Specific phobia
- Schizophrenia
Correct answer: Obsessive-compulsive disorder
Intrusive obsessions and time-consuming compulsions that the person recognises as excessive define OCD.
Question 18: A 48-year-old presents with a unilateral facial droop affecting the forehead, with no limb weakness. What is the most likely diagnosis?
- Bell's palsy (lower motor neurone facial palsy) (Correct answer)
- Ischaemic stroke
- Multiple sclerosis
- Myasthenia gravis
Correct answer: Bell's palsy (lower motor neurone facial palsy)
Forehead involvement indicates a lower motor neurone facial palsy, most commonly idiopathic Bell's palsy.
Question 19: A patient with a witnessed generalised tonic-clonic seizure has now been convulsing continuously for more than five minutes. What is the most appropriate first-line drug?
- Intravenous or buccal benzodiazepine (Correct answer)
- Oral phenytoin
- Intravenous mannitol
- Intramuscular haloperidol
Correct answer: Intravenous or buccal benzodiazepine
Status epilepticus is treated first with a benzodiazepine to terminate the seizure.
Question 20: An elderly man develops fluctuating cognition, recurrent visual hallucinations and spontaneous parkinsonism. What is the most likely diagnosis?
- Lewy body dementia (Correct answer)
- Alzheimer's disease
- Vascular dementia
- Normal pressure hydrocephalus
Correct answer: Lewy body dementia
Fluctuating cognition, vivid visual hallucinations and parkinsonism are the core features of Lewy body dementia.
Question 21: A 40-year-old woman reports fatigable weakness with drooping eyelids and double vision that worsen through the day. What is the most likely diagnosis?
- Myasthenia gravis (Correct answer)
- Multiple sclerosis
- Guillain-Barré syndrome
- Motor neurone disease
Correct answer: Myasthenia gravis
Fatigable ptosis and diplopia that worsen with activity are characteristic of myasthenia gravis.
AMC MCQ Neurology and Mental Health
A 68-year-old presents with sudden right-sided weakness and expressive aphasia that resolves completely within 45 minutes.
CT brain is normal.
What is the most appropriate immediate management?
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Sources & references
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- amc.org.au — Eligibility, passing score, retake policy, test delivery, exam format, score validity, fees · verified Oct 2026
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