American Board of Psychiatry and Neurology Neurological Examination and Conditions 1 — Questions and Answers
Question 1: What cranial nerves are tested during a standard neurological examination?
- All 12 cranial nerves (I-XII), testing smell, vision, eye movement, facial sensation/motor, hearing, taste, palate, voice, neck muscles, and tongue (Correct answer)
- Only the optic nerve
- Cranial nerves are not part of the neurological exam
- Only motor nerves
Correct answer: All 12 cranial nerves (I-XII), testing smell, vision, eye movement, facial sensation/motor, hearing, taste, palate, voice, neck muscles, and tongue
The neurological exam systematically tests all 12 cranial nerves: I (olfactory), II (optic), III/IV/VI (oculomotor), V (trigeminal), VII (facial), VIII (vestibulocochlear), IX/X (glossopharyngeal/vagus), XI (accessory), XII (hypoglossal).
Question 2: What is the difference between upper motor neuron (UMN) and lower motor neuron (LMN) lesions?
- UMN causes spasticity, hyperreflexia, and Babinski sign; LMN causes flaccidity, areflexia, fasciculations, and muscle atrophy (Correct answer)
- They produce identical symptoms
- UMN only affects the legs
- LMN only affects the arms
Correct answer: UMN causes spasticity, hyperreflexia, and Babinski sign; LMN causes flaccidity, areflexia, fasciculations, and muscle atrophy
UMN lesions (brain, spinal cord) cause spastic paralysis, increased reflexes, positive Babinski sign, and clonus. LMN lesions (anterior horn cells, peripheral nerves) cause flaccid paralysis, decreased reflexes, fasciculations, and muscle wasting.
Question 3: What is the Glasgow Coma Scale and what does it measure?
- A 3-15 point scale measuring consciousness through eye opening, verbal response, and motor response (Correct answer)
- A scale measuring pain levels
- A depression screening tool
- A measure of cognitive ability
Correct answer: A 3-15 point scale measuring consciousness through eye opening, verbal response, and motor response
The GCS rates consciousness on a 3-15 scale: Eye opening (1-4), Verbal response (1-5), Motor response (1-6). Score 15 = fully conscious, 3 = deep coma. Used for traumatic brain injury and altered consciousness assessment.
Question 4: What are the common types of headache and their distinguishing features?
- Tension (bilateral, pressing), migraine (unilateral, pulsating, with aura), cluster (severe unilateral orbital pain with autonomic symptoms) (Correct answer)
- All headaches are the same type
- Only migraines are clinically significant
- Headache type cannot be differentiated clinically
Correct answer: Tension (bilateral, pressing), migraine (unilateral, pulsating, with aura), cluster (severe unilateral orbital pain with autonomic symptoms)
Tension headaches present as bilateral, pressing pain. Migraines are typically unilateral, pulsating, with nausea and photophobia, sometimes preceded by aura. Cluster headaches cause severe unilateral orbital pain with lacrimation and nasal congestion.
Question 5: What are the cardinal features of Parkinson's disease?
- Resting tremor, rigidity, bradykinesia, and postural instability (TRAP) (Correct answer)
- Only tremor
- Rapid involuntary movements
- Sudden onset paralysis
Correct answer: Resting tremor, rigidity, bradykinesia, and postural instability (TRAP)
Parkinson's disease is characterized by the TRAP mnemonic: Tremor (at rest, pill-rolling), Rigidity (cogwheel type), Akinesia/Bradykinesia (slowness of movement), and Postural instability, resulting from dopaminergic neuron loss in the substantia nigra.
Question 6: What is the role of neuroimaging in neurological assessment?
- CT for acute stroke and trauma; MRI for detailed brain structure; functional imaging for specific clinical questions (Correct answer)
- Neuroimaging replaces the clinical examination entirely
- Only CT scanning is used in neurology
- Imaging is never needed in neurological assessment
Correct answer: CT for acute stroke and trauma; MRI for detailed brain structure; functional imaging for specific clinical questions
CT is preferred for acute emergencies (hemorrhage, trauma). MRI provides superior soft tissue detail for tumors, MS, and structural abnormalities. Functional imaging (PET, fMRI) evaluates metabolism and brain activity for specific indications.
American Board of Psychiatry and Neurology Neurological Examination and Conditions 1
What cranial nerves are tested during a standard neurological examination?