Free Practice Questions for UKOM Sp.N (Neurology)

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Exam Review

Key Facts: UKOM Sp.N (Neurology) Exam

CBT

Current national knowledge-assessment component confirmed

Kolegium Neurologi Indonesia examination reporting

OSCE

Current national performance-assessment component confirmed

Kolegium Neurologi Indonesia examination reporting

Not published

Current item count, station count and passing standard

Official sources reviewed

Sp.N

Official specialist medical title conferred upon successful registration

Konsil Kesehatan Indonesia (KKI)

UKOM Sp.N (formerly Sp.S) is the mandatory national exit examination for Indonesian neurology residents administered by Kolegium Neurologi Indonesia (KNI) and KKI. Candidates must pass both a Computer-Based Test (CBT) and an OSCE to earn the Sp.N credential and specialist STR. This resource is an independent English-language MCQ study adaptation developed by OpenExamPrep for self-study; it is not affiliated with or endorsed by Kolegium Neurologi Indonesia or PERDOSSI.

Sample UKOM Sp.N (Neurology) Practice Questions

Try these sample questions to review concepts for the UKOM Sp.N (Neurology) exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man presents to the emergency department 75 minutes after the sudden onset of right facial droop, right arm weakness, and severe expressive dysphasia. His baseline modified Rankin Scale (mRS) score is 0. Vital signs show blood pressure 160/90 mmHg, pulse 76 bpm, and blood glucose 118 mg/dL. Neurological examination reveals an NIHSS score of 12. Non-contrast head CT demonstrates an Alberta Stroke Program Early CT Score (ASPECTS) of 10 with no intracranial hemorrhage. What is the most appropriate next step in acute management?

A.Administer intravenous recombinant tissue plasminogen activator (alteplase) at 0.9 mg/kg (maximum 90 mg) with 10% given as a bolus over 1 minute

B.Administer oral aspirin 300 mg immediately and monitor blood pressure every 4 hours in the neurology ward

C.Withhold thrombolysis until an emergent brain MRI with diffusion-weighted imaging (DWI) confirms tissue salvageability

D.Infuse intravenous labetalol to lower systolic blood pressure below 120 mmHg prior to reperfusion therapy

Explanation: The patient presents with an acute ischemic stroke within the 4.5-hour therapeutic window without contraindications on non-contrast CT. Intravenous alteplase (0.9 mg/kg, maximum 90 mg; 10% given as an initial bolus over 1 minute followed by 90% infused over 60 minutes) is the standard first-line reperfusion therapy, which should be initiated without delaying for advanced MRI imaging.

2A patient presents 3.5 hours after onset of a disabling ischemic stroke. Which statement best reflects current selection for intravenous thrombolysis rather than the older ECASS-III trial exclusions?

A.Advanced age, severe stroke, or prior stroke with diabetes is not by itself an automatic exclusion solely because treatment occurs in the 3- to 4.5-hour window

B.Blood pressure above 185/110 mmHg is acceptable during alteplase infusion without treatment

C.Warfarin therapy with an INR of 2.0 does not affect alteplase eligibility

D.A normal non-contrast CT alone makes every wake-up stroke eligible for intravenous thrombolysis

Explanation: The extra exclusions used in the original ECASS-III trial—such as age over 80, very severe stroke, or the combination of previous stroke and diabetes—should not be taught as current categorical exclusions. Assess disabling deficit, time, imaging, blood pressure, anticoagulants, bleeding risk and local protocol. Selected wake-up or later-window patients require advanced imaging criteria rather than a normal noncontrast CT alone.

3A 64-year-old man arrives at the emergency department 2 hours after acute onset of right-sided hemiparesis and aphasia. His initial blood pressure is 200/115 mmHg. Non-contrast head CT is negative for hemorrhage. What is the target blood pressure threshold required prior to initiating intravenous alteplase, and what is the target during the first 24 hours post-infusion?

A.Systolic <185 mmHg and diastolic <110 mmHg prior to alteplase; maintained <180/105 mmHg for the first 24 hours

B.Systolic <160 mmHg and diastolic <90 mmHg prior to alteplase; maintained <140/90 mmHg for the first 24 hours

C.Systolic <220 mmHg and diastolic <120 mmHg prior to alteplase; maintained <185/110 mmHg for the first 24 hours

D.Systolic <140 mmHg and diastolic <80 mmHg prior to alteplase; maintained <130/80 mmHg for the first 24 hours

Explanation: According to international stroke guidelines, blood pressure must be carefully lowered to systolic <185 mmHg and diastolic <110 mmHg before initiating intravenous thrombolysis (using IV labetalol, nicardipine, or clevidipine). Following alteplase administration, blood pressure must be rigorously maintained below 180/105 mmHg for at least 24 hours to minimize the risk of symptomatic intracerebral hemorrhage.

4A 66-year-old woman with atrial fibrillation presents 2.5 hours after sudden collapse with left-sided hemiplegia, forced rightward eye deviation, and left spatial neglect (NIHSS score 19). CT angiography confirms an acute occlusion of the right proximal middle cerebral artery (M1 segment). Non-contrast CT reveals an ASPECTS score of 8. Her pre-stroke mRS is 0. She has received an IV alteplase bolus and infusion. What is the standard indication for endovascular mechanical thrombectomy in this patient?

A.Proceed directly to mechanical thrombectomy within 6 hours of onset regardless of whether IV alteplase has completed

B.Wait at least 60 minutes after completing the full alteplase infusion to determine if vessel recanalization occurs clinically

C.Cancel mechanical thrombectomy because mechanical intervention is contraindicated after systemic thrombolysis

D.Defer thrombectomy unless the ASPECTS score is 10 and the patient achieves complete motor improvement

Explanation: Guidelines based on the HERMES meta-analysis strongly recommend endovascular mechanical thrombectomy for patients presenting within 6 hours of onset with large vessel occlusion (ICA or proximal MCA M1), pre-stroke mRS 0-1, ASPECTS >=6, and NIHSS >=6. Eligible patients should receive IV thrombolysis and proceed immediately to mechanical thrombectomy without waiting to assess the clinical response to thrombolysis.

5A 79-year-old man was last seen well at 22:00 when going to bed. At 07:00 the following morning (9 hours later), his wife finds him unable to move his right side or speak. In the emergency department at 08:30 (10.5 hours from last known well), his NIHSS score is 18. CT angiography confirms a left M1 MCA occlusion. Brain CT perfusion (CTP) analyzed by automated software demonstrates an ischemic core volume of 18 mL and a total hypoperfused penumbra volume of 95 mL. Under the DAWN and DEFUSE 3 trial criteria, what is the best management strategy?

A.Proceed with emergency endovascular mechanical thrombectomy based on clinical-core and perfusion mismatch criteria

B.Withhold mechanical thrombectomy because the therapeutic window strictly closes at 6 hours from last known well

C.Administer off-label high-dose intravenous alteplase and infuse therapeutic intravenous heparin

D.Initiate aggressive permissive hypervolemic hemodilution therapy without invasive intervention

Explanation: Both the DAWN trial (6-24 hour window) and DEFUSE 3 trial (6-16 hour window) demonstrated substantial functional benefit from mechanical thrombectomy in selected patients with large vessel occlusion and salvageable ischemic tissue. This patient meets DEFUSE 3 criteria (ischemic core <70 mL, mismatch ratio >=1.8, absolute mismatch volume >=15 mL) and DAWN criteria (NIHSS >=10 with core <31 mL for age <80), making thrombectomy the standard of care.

6A 52-year-old previously healthy woman suffers a complete right middle cerebral artery infarction. At 30 hours post-ictus, she becomes progressively somnolent, her right pupil becomes sluggishly reactive, and repeat non-contrast head CT demonstrates complete right MCA territorial hypodensity with 8 mm of midline shift and compression of the ipsilateral lateral ventricle. Based on pooled randomized trial evidence (DECIMAL, DESTINY, HAMLET), what intervention significantly reduces mortality and improves functional outcomes when performed within 48 hours?

A.Decompressive hemicraniectomy with duraplasty (bone flap diameter >=12 cm)

B.High-dose intravenous methylprednisolone pulse therapy (1 g daily for 3 days)

C.Hyperventilation targeting PaCO2 <25 mmHg combined with therapeutic hypothermia (32°C)

D.Emergent stereotactic catheter aspiration of the ischemic infarcted parenchyma

Explanation: In malignant MCA infarction, pooled data from the DECIMAL, DESTINY, and HAMLET trials demonstrate that early decompressive hemicraniectomy (within 48 hours of onset, age <=60 years, bone flap diameter at least 12 cm with duraplasty) reduces mortality by approximately 50% and significantly increases the proportion of patients surviving with good functional outcome (mRS <=3 or <=4).

7A 68-year-old man receives IV alteplase for acute ischemic stroke. Forty-five minutes into the infusion, he develops sudden severe headache, nausea, acute projectile vomiting, acute blood pressure rise to 210/115 mmHg, and a decline in GCS from 14 to 8. What is the immediate sequence of medical management for suspected symptomatic intracerebral hemorrhage?

A.Stop alteplase, obtain emergency non-contrast CT and coagulation/fibrinogen studies, and give cryoprecipitate; use an antifibrinolytic when cryoprecipitate is unavailable or unsuitable

B.Continue alteplase at half-dose, administer IV furosemide, and obtain an elective brain MRI within 12 hours

C.Administer IV protamine sulfate immediately and initiate urgent hemodialysis

D.Perform immediate endotracheal intubation and infuse high-dose intravenous heparin to prevent reocclusion

Explanation: Stop alteplase and obtain emergency brain imaging, fibrinogen, coagulation studies, blood count and type-and-screen while supporting airway and blood pressure. Cryoprecipitate is the usual first-line hemostatic replacement with repeat fibrinogen measurement. Tranexamic acid or aminocaproic acid is an alternative or adjunct in selected circumstances, not an automatic second reversal drug for every patient.

8A 70-year-old man presents 8 hours after onset of left-sided weakness. He is not a candidate for thrombolysis or mechanical thrombectomy. In the stroke unit, his blood pressure is 195/105 mmHg. He has no chest pain, shortness of breath, aortic dissection, or acute heart failure. According to international stroke guidelines, how should his blood pressure be managed over the next 24 to 48 hours?

A.Permit hypertension unless blood pressure exceeds 220/120 mmHg, with gradual reduction by 15% over the first 24 hours if treatment is indicated

B.Immediately lower blood pressure with continuous IV nitroprusside to a normal target of <120/80 mmHg

C.Initiate aggressive sublingual nifedipine every 2 hours to maintain systolic blood pressure strictly between 130 and 140 mmHg

D.Administer high-dose loop diuretics and ACE inhibitors to normalize blood pressure within 2 hours of admission

Explanation: In acute ischemic stroke patients who do not receive reperfusion therapy and have no comorbid acute target organ damage, permissive hypertension up to 220/120 mmHg is recommended during the first 48 to 72 hours. If blood pressure exceeds 220/120 mmHg, lowering it cautiously by approximately 15% during the first 24 hours is considered safe to prevent hypoperfusion of the ischemic penumbra.

9A 61-year-old man presents 90 minutes after sudden severe headache and right hemiplegia. Emergent head CT reveals a 22 mL hypertensive hematoma in the left putamen with minimal surrounding edema and no hydrocephalus. His initial blood pressure is 185/105 mmHg. Based on the findings of the INTERACT-2 and ATACH-2 trials, what is the recommended acute systolic blood pressure (SBP) management strategy?

A.Lower SBP smoothly toward about 140 mmHg and maintain it in the 130-150 mmHg range, avoiding overshoot below 130 mmHg

B.Lower SBP aggressively to a target of 100 to 110 mmHg using continuous intravenous sodium nitroprusside

C.Maintain permissive hypertension up to 210 mmHg to preserve cerebral perfusion pressure around the hematoma

D.Do not treat blood pressure unless the mean arterial pressure (MAP) exceeds 180 mmHg

Explanation: For mild-to-moderate spontaneous ICH with presenting SBP 150-220 mmHg, smooth sustained reduction toward 140 mmHg and maintenance around 130-150 mmHg is safe and may be reasonable. Large variability and overshoot below 130 mmHg can be harmful. The approach must be individualized in very large or severe ICH or when cerebral perfusion is threatened.

10A 78-year-old woman is evaluated in the neurointensive care unit for an acute spontaneous intracerebral hemorrhage. Her Glasgow Coma Scale (GCS) score is 11. Head CT shows an intraparenchymal hematoma in the right thalamus measuring 35 mL with intraventricular hemorrhage (IVH) extension into the third and lateral ventricles. What is her ICH Score, and what is its clinical significance?

A.ICH Score of 3; a population-level severity and risk-stratification tool that must not determine treatment limitation by itself

B.ICH Score of 1; predictive of approximately 13% 30-day mortality

C.ICH Score of 5; predictive of 100% 30-day mortality

D.ICH Score of 0; predictive of 0% 30-day mortality

Explanation: The score is 3: one point for GCS 5-12, one for volume at least 30 mL and one for intraventricular hemorrhage; there are no points for infratentorial origin or age at least 80. The ICH Score supports standardized severity description and population risk stratification. It should not be used alone to predict an individual's outcome or justify early withdrawal of life-sustaining treatment.

About the UKOM Sp.N (Neurology) Exam

UKOM Sp.N (formerly Sp.S) is the official national exit competency examination for medical doctors completing their specialty training in neurology in Indonesia. Successful completion of both the CBT and OSCE components is mandatory to receive the specialist certificate of competence (Serkom) and obtain the specialist registration certificate (STR Spesialis Neurologi) from KKI.

Exam sponsor: Kolegium Neurologi Indonesia (KNI) / Konsil Kesehatan Indonesia (KKI) / PERDOSSI. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Current sources confirm a national Computer-Based Test (CBT) and a national Objective Structured Clinical Examination (OSCE). Publicly reviewed sources did not establish the detailed station tasks or whether the components are scored independently.

Time Limit

Not published in the official sources reviewed.

Passing Score

Not published in the official sources reviewed.

Exam / Certification Fees

Not published in the official sources reviewed.

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

25 of 100 practice questions (25%)

Cerebrovascular Diseases & Stroke

Acute ischemic stroke, thrombolysis, extended-window thrombectomy, ICH management, subarachnoid hemorrhage, vasospasm, CVST, and secondary stroke prevention.

20 of 100 practice questions (20%)

Epilepsy, Seizures & Sleep Disorders

ILAE classification, EEG waveforms, status epilepticus guidelines, pharmacogenomics, refractory epilepsy, autoimmune seizures, and sleep disorders.

20 of 100 practice questions (20%)

Neuro-Infections, Neuro-Immunology & Demyelinating Diseases

Bacterial and tuberculous meningitis, viral encephalitis, brain abscess, neurocysticercosis, multiple sclerosis, NMOSD, MOGAD, and ADEM.

20 of 100 practice questions (20%)

Movement Disorders, Neurodegenerative Diseases & Dementias

Parkinson disease, atypical parkinsonism, essential tremor, Huntington disease, dystonia, Alzheimer disease, frontotemporal dementia, and normal pressure hydrocephalus.

15 of 100 practice questions (15%)

Neuromuscular, Peripheral Nerve, Headache & Neuro-Trauma

Myasthenia gravis, Guillain-Barre syndrome, CIDP, motor neuron disease, primary headache disorders, trigeminal neuralgia, and spinal cord injury syndromes.

Preparing for the UKOM Sp.N (Neurology) Exam

What You Need to Know

Passing score: Not published in the official sources reviewed.
Assessment: Current sources confirm a national Computer-Based Test (CBT) and a national Objective Structured Clinical Examination (OSCE). Publicly reviewed sources did not establish the detailed station tasks or whether the components are scored independently.
Time limit: Not published in the official sources reviewed.
Exam / certification fees: Not published in the official sources reviewed. Official sources

Using Our Practice Resources

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UKOM Sp.N (Neurology): Suggested Study Strategy

1Prioritize high-yield hyperacute guidelines: memorize alteplase eligibility thresholds, the DAWN/DEFUSE-3 thrombectomy criteria, and the ESETT status epilepticus protocol.

2Review neurophysiology waveforms systematically: know how to identify 3 Hz spike-wave, PLEDs/LPDs, triphasic waves, and electrodiagnostic criteria for AIDP vs AMAN.

3Master diagnostic criteria for neurodegenerative and demyelinating diseases: 2017 McDonald criteria for MS, AQP4-IgG NMOSD, MDS clinical criteria for Parkinson disease, and Rascovsky criteria for bvFTD.

4Understand national Indonesian clinical protocols alongside international evidence, including local anti-TB meningitis regimens (2RHZE/10RH) and HLA-B*1502 screening for carbamazepine.

Frequently Asked Questions

What is UKOM Sp.N (formerly UKOM Sp.S)?

UKOM Sp.N is the national specialist competency exit examination (Ujian Nasional Kolegium Neurologi) for doctors completing their neurology residency in Indonesia. The degree abbreviation officially changed from Sp.S (Spesialis Saraf) to Sp.N (Spesialis Neurologi). Passing the exam is required to obtain the Sertifikat Kompetensi and STR Dokter Spesialis Neurologi.

What is the structure of the official UKOM Sp.N examination?

Current sources confirm national CBT and OSCE components. The official item count, station count, timing, option count, detailed station tasks, and component scoring rules were not published in the sources reviewed.

How is the passing score (NBL) determined?

The current Nilai Batas Lulus (NBL) and standard-setting method were not published in the official sources reviewed; candidates should confirm the sitting-specific rule with Kolegium Neurologi Indonesia.

Is this practice bank an official test or translation?

No. This practice question bank is an independent English-language study adaptation created by OpenExamPrep for self-study and clinical knowledge review. It does not contain official exam questions and does not replicate the practical stations of the national OSCE.

What are the primary topics covered in the CBT examination?

This independent practice bank allocates 25 questions to cerebrovascular disease and stroke, 20 each to epilepsy and sleep, neuro-infection and neuro-immunology, and movement and neurodegenerative disorders, and 15 to neuromuscular disease, headache, and neuro-trauma. These are practice-bank proportions, not claimed official exam weights.