Neurology

Sample questions.

8 free neurology questions with answers and explanations. MedRelay's full question bank covers every NREMT domain, plus live scenarios that grade the decision, not just the answer.

1. Question 1

   You respond to a 71-year-old female who her son says has been increasingly confused over the past 3 weeks since she started a new blood pressure medication (hydrochlorothiazide). She is confused today. BGL is 88, HR 76, BP 112/68, GCS 12. She is on a low-sodium diet and has been drinking large amounts of water. She has no fever. What electrolyte abnormality should you suspect?

   • A.Hyponatremia from HCTZ-induced sodium wasting combined with excessCorrect
   • B.Hyperglycemia — check a repeat blood glucose
   • C.Hyperkalemia — the diet change caused elevated potassium
   • D.This is dementia progression — no acute treatment needed

   Why:Correct. Hyponatremia is a classic complication of hydrochlorothiazide in elderly patients — especially those on low-sodium diets and drinking excess water. Symptoms: confusion, weakness, seizure (at severe levels). BGL is normal so hypoglycemia is not the cause. Sodium correction at the hospital (carefully — rapid correction causes osmotic demyelination syndrome). Priority 1 transport.

2. Question 2

   At a hotel room, a 40-year-old male has one-sided weakness that resolved before you arrived. What is appropriate?

   • A.Cancel evaluation
   • B.Treat as possible TIACorrect
   • C.Give glucose only
   • D.No transport advice

   Why:Correct. Resolved stroke-like symptoms may represent TIA and still require evaluation.

3. Question 3

   At a restaurant, a 31-year-old male head injury patient vomits and becomes harder to arouse. What does this suggest?

   • A.Routine fatigue
   • B.Neurologic deteriorationCorrect
   • C.Simple nausea
   • D.Safe refusal

   Why:Correct. Vomiting and declining mental status after head injury suggest worsening neurologic status.

4. Question 4

   You respond to a 45-year-old male who woke up this morning unable to move his right arm and leg. He went to sleep at 11 PM and was found at 7 AM with right-sided weakness. His wife says he was completely normal when he went to bed. He has a history of AF and takes warfarin. He has difficulty speaking but can understand commands. What is the significance of the last known well time being 11 PM the previous night for thrombolytic eligibility?

   • A.Document last-known-well timeCorrect
   • B.The time does not matter — all strokes get tPA
   • C.His warfarin makes last known well time irrelevant
   • D.All AF patients with stroke receive the same

   Why:Correct. Last known well time 8 hours ago: outside standard 4.5-hour IV tPA window. However mechanical thrombectomy may still be available up to 24 hours for large vessel occlusion at comprehensive stroke centers. Communicating last known well time is critical — it determines eligibility for all treatments. His warfarin also likely contraindicates tPA independently. Priority 1 comprehensive stroke center.

5. Question 5

   You are treating a 22-year-old male who was assaulted and has a head laceration. He was briefly unconscious at the scene but is now GCS 15 and talking normally. En route he falls asleep and you cannot wake him. His left pupil has become larger than his right and sluggishly reactive. HR has dropped from 88 to 56. His BP has risen from 132/84 to 180/60. What is occurring?

   • A.He fell asleep because he is tired — this is normal post-trauma
   • B.Epidural hematoma with the classic lucid interval followedCorrect
   • C.Hypoglycemia — administer oral glucose
   • D.He is seizing — administer oxygen

   Why:Correct. The lucid interval followed by rapid deterioration with Cushing's Triad (rising BP, falling HR, changing respirations) and a unilateral blown pupil is the classic presentation of epidural hematoma from middle meningeal artery injury. This is a neurosurgical emergency with minutes to hours to intervention. Do NOT hyperventilate.

6. Question 6

   You respond to a 67-year-old male who is confused. His wife says he has been increasingly forgetful for 3 months. Today he had a generalized tonic-clonic seizure lasting 2 minutes followed by post-ictal confusion. He has lost 5 kg over 2 months and has daily headaches. GCS is 11. BP is 148/88. BGL is 92. What does new-onset seizure with progressive cognitive decline and constitutional symptoms in an older adult suggest?

   • A.A structural brain lesionCorrect
   • B.Late-onset idiopathic epilepsy — common over age 60
   • C.Alzheimer's disease — seizures are common in late dementia
   • D.Medication-induced seizure from new prescriptions

   Why:Correct. New-onset seizure over 50 + progressive cognitive decline + weight loss + daily headaches = intracranial mass lesion until proven otherwise. Frontal lobe tumors classically cause personality change, cognitive decline, and seizures. Metastatic disease is common at this age. GBM (glioblastoma) and metastases are the leading diagnoses. Priority 1 CT-capable transport.

7. Question 7

   You respond to a 25-year-old male who was involved in a fight and received multiple blows to the head. He is conscious and oriented with GCS 15. He has a 4 cm laceration to his scalp that is bleeding moderately. His pupils are equal and reactive. He has no focal neurological deficits. He refuses transport because he feels fine. He is with friends who say they will watch him. What specific instructions are critical for the sign-off of this patient?

   • A.He is GCS 15 so no specific instructions are needed
   • B.Tell him not to sleep for 24 hours
   • C.Provide return precautions verbally and in writingCorrect
   • D.Tell him the injury was minor and he will be fine

   Why:Correct. Head trauma return precautions are critical when patients refuse transport. Intracranial hemorrhage can develop hours after an apparently minor head injury — this is the lucid interval phenomenon. Specific warning signs must be given verbally and in writing, communicated to both the patient and his companions. Document that you provided these instructions.

8. Question 8

   You respond to a 44-year-old male with a severe headache. He reports the headache started gradually 4 hours ago on his left side and has built slowly to 8/10 intensity. He has had similar headaches before. He is nauseated and sensitive to light. He is lying in a dark room. GCS is 15. BP is 138/84. No focal neurological deficits. How does the onset pattern of this headache help distinguish it from subarachnoid hemorrhage?

   • A.This headache built gradually over 4 hoursCorrect
   • B.Both conditions have identical onset patterns
   • C.Migraines always cause fever — the absence of fever means SAH
   • D.A gradual onset headache can still be SAH

   Why:Correct. Migraine vs SAH onset pattern: SAH headache reaches maximum intensity INSTANTLY at onset — the thunderclap. Migraine builds gradually over minutes to hours. Additional migraine features: prior identical headaches (SAH is typically novel and unique), unilateral location, nausea, photophobia, relief in dark quiet environment. The gradual onset and prior similar headaches strongly favor migraine. Transport is still appropriate to confirm — especially if any features are atypical.