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Free Practice Questions for Saudi Board Neurology

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Sample Saudi Board Neurology Practice Questions

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

1A 64-year-old male presents to the emergency department 2 hours after the acute onset of left-sided hemiplegia, left hemineglect, and right gaze preference. His blood pressure is 172/96 mmHg, serum glucose is 128 mg/dL, and international normalized ratio (INR) is 1.0. A non-contrast head CT demonstrates no acute hemorrhage and an ASPECTS score of 9. What is the most appropriate next step in the emergency management of this patient?
A.Administer intravenous thrombolysis immediately while initiating CT angiography and CT perfusion imaging
B.Lower blood pressure with intravenous labetalol to a target below 140/90 mmHg before administering alteplase
C.Withhold intravenous thrombolysis until non-invasive vascular imaging demonstrates a large vessel occlusion
D.Administer intravenous unfractionated heparin bolus followed by a continuous infusion
Explanation: This patient presents within the standard 4.5-hour therapeutic window for acute ischemic stroke without contraindications. Current AHA/ASA and international stroke guidelines mandate immediate administration of intravenous thrombolysis (alteplase or tenecteplase) once non-contrast head CT excludes hemorrhage and blood pressure is below 185/110 mmHg, without delaying thrombolytic therapy to obtain or interpret multimodal vascular imaging.
2A 71-year-old female was last seen well 10 hours ago before going to sleep. She awakens with severe aphasia and right-sided hemiparesis (NIHSS 16). Non-contrast CT shows no hemorrhage and an ASPECTS score of 8. CT angiography confirms an occlusion of the M1 segment of the left middle cerebral artery. CT perfusion demonstrates an ischemic core of 18 mL and a penumbral hypoperfusion volume of 94 mL. Which intervention is indicated based on established clinical trial evidence?
A.Mechanical thrombectomy
B.Intravenous alteplase at standard dose
C.Urgent carotid endarterectomy
D.Intravenous tirofiban infusion
Explanation: Based on the DAWN and DEFUSE-3 landmark clinical trials, endovascular mechanical thrombectomy is strongly recommended in patients with anterior circulation large vessel occlusion presenting in the 6-to-24 hour extended window who fulfill clinical-core or perfusion mismatch criteria. This patient has a small core (18 mL) and significant salvageable penumbra with M1 occlusion, meeting DEFUSE-3 inclusion criteria.
3A 58-year-old male with hypertension and hyperlipidemia experiences 20 minutes of sudden right arm weakness and expressive dysphasia that resolves completely before arrival. His ABCD2 score is 5. Brain MRI with DWI reveals a 4-mm punctate acute infarct in the left centrum semiovale, and CT angiography shows 40% stenosis of the left internal carotid artery. What is the most effective initial antiplatelet strategy for secondary stroke prevention?
A.Dual antiplatelet therapy with aspirin and clopidogrel for 21 days, followed by clopidogrel monotherapy
B.Lifelong dual antiplatelet therapy with aspirin and clopidogrel
C.Aspirin monotherapy indefinitely with no initial dual therapy period
D.Therapeutic oral anticoagulation with apixaban
Explanation: According to the CHANCE and POINT clinical trials and international stroke guidelines, patients presenting with high-risk TIA (ABCD2 score >= 4) or minor acute ischemic stroke (NIHSS <= 3) should receive dual antiplatelet therapy (DAPT) with aspirin and clopidogrel initiated within 24 hours and continued for 21 days, followed by single antiplatelet monotherapy. Prolonging DAPT beyond 21-90 days provides no incremental ischemic benefit while significantly increasing major bleeding complications.
4A 62-year-old woman presents with sudden onset of severe headache, vomiting, and a right third cranial nerve palsy with pupillary dilatation. Non-contrast head CT reveals hyperdensity throughout the basal cisterns consistent with Fisher Grade 3 subarachnoid hemorrhage. Which pharmacological agent should be initiated promptly to reduce the risk of secondary delayed cerebral ischemia and poor neurological outcome?
A.Oral nimodipine 60 mg every 4 hours
B.Intravenous nicardipine infusion titrated to systolic blood pressure <100 mmHg
C.Intravenous methylprednisolone 1 g daily for 3 days
D.Subcutaneous low-molecular-weight heparin at therapeutic anticoagulation dose
Explanation: Oral nimodipine (60 mg every 4 hours for 21 days) is a Class I, Level A guideline recommendation in aneurysmal subarachnoid hemorrhage. It has been proven in randomized clinical trials to reduce delayed cerebral ischemia (vasospasm-related infarction) and improve overall neurological outcomes through neuroprotective and microvascular mechanisms.
5A 52-year-old male with long-standing poorly controlled hypertension presents with stupor and left hemiplegia. A non-contrast head CT shows a 35 mL right putaminal hemorrhage with 4 mm of midline shift. His initial blood pressure is 215/120 mmHg. According to clinical trial data (INTERACT-2 and ATACH-2), what is the safest and most appropriate blood pressure management strategy?
A.Smoothly reduce systolic blood pressure to a target between 140 and 179 mmHg using intravenous labetalol or nicardipine
B.Rapidly reduce systolic blood pressure to below 120 mmHg within 30 minutes
C.Withhold all antihypertensive medications to maintain cerebral perfusion pressure above 80 mmHg
D.Maintain systolic blood pressure between 180 and 200 mmHg until neurosurgical evacuation
Explanation: AHA/ASA guidelines and ATACH-2/INTERACT-2 trials support acute lowering of systolic blood pressure to a target range of 140-179 mmHg (ideally around 140 mmHg) in spontaneous intracerebral hemorrhage. ATACH-2 demonstrated that ultra-aggressive reduction below 120 mmHg does not improve functional outcome and significantly increases renal adverse events and neurological deterioration.
6A 29-year-old postpartum female presents with severe progressive headache, fluctuating drowsiness, and bilateral papilledema. Magnetic resonance venography (MRV) reveals complete thrombosis of the superior sagittal and right transverse sinuses with small bilateral parasagittal hemorrhagic venous infarcts. What is the primary medical treatment of choice?
A.Therapeutic anticoagulation with low-molecular-weight heparin or unfractionated heparin
B.Urgent decompressive bilateral hemicraniectomy as first-line intervention
C.High-dose intravenous methylprednisolone pulse therapy
D.Withholding anticoagulation and treating solely with oral acetazolamide
Explanation: Therapeutic anticoagulation (with subcutaneous LMWH or IV unfractionated heparin) is the first-line treatment for cerebral venous sinus thrombosis, even in the presence of hemorrhagic venous infarction. Anticoagulation prevents thrombus propagation, facilitates recanalization, and reduces venous congestion, which actually halts further hemorrhagic transformation.
7A 68-year-old male recovers from a minor ischemic stroke causing right hand clumsiness. Duplex ultrasonography and CT angiography confirm 80% atherosclerotic stenosis of the symptomatic left internal carotid artery without intraluminal thrombus. He has an operative risk profile suitable for surgery. What is the recommended management and timing?
A.Carotid endarterectomy performed within 14 days of symptom onset
B.Delayed carotid endarterectomy performed after 3 months of optimal medical therapy
C.Long-term medical therapy alone without revascularization
D.Carotid artery stenting deferred until 6 months post-stroke
Explanation: For patients with symptomatic severe (70-99%) internal carotid artery stenosis who are stable after a non-disabling ischemic stroke or TIA, carotid endarterectomy (CEA) provides the greatest absolute risk reduction when performed expeditiously, ideally within 14 days of the index ischemic event. Delaying intervention beyond 2-4 weeks substantially reduces the protective benefit against recurrent stroke.
8A 78-year-old woman with mild cognitive impairment presents with an acute right lobar parietal hemorrhage. Gradient-echo (GRE) and susceptibility-weighted (SWI) MRI demonstrate multiple chronic cortical-subcortical microbleeds confined strictly to the cerebral lobes and cerebellum, sparing the basal ganglia, thalamus, and brainstem. What is the most likely underlying etiology?
A.Cerebral amyloid angiopathy
B.Hypertensive lipohyalinosis
C.Cavernous hemangiomatosis
D.Primary CNS angiitis
Explanation: Cerebral amyloid angiopathy (CAA) is characterized pathologically by beta-amyloid deposition within the media and adventitia of small-to-medium leptomeningeal and cortical arteries. According to the Boston Criteria v2.0 for probable CAA, the presence of multiple strictly lobar microbleeds, superficial siderosis, and lobar intracerebral hemorrhages in an elderly individual (age >= 50) without deep gray matter lesions is diagnostic.
9A 43-year-old female presents with sudden vertigo, ataxia, nausea, right-sided facial numbness, right Horner syndrome, right palatal weakness with hoarseness, and loss of pain and temperature sensation over the left arm and leg. Which vascular structure is most likely occluded?
A.Right posterior inferior cerebellar artery (PICA) or vertebral artery
B.Right anterior inferior cerebellar artery (AICA)
C.Right superior cerebellar artery (SCA)
D.Paramedian branch of the basilar artery
Explanation: This clinical presentation describes Wallenberg syndrome (lateral medullary syndrome), which features ipsilateral cerebellar ataxia, ipsilateral Horner syndrome, ipsilateral facial pain/temperature sensory loss (spinal trigeminal tract), ipsilateral dysphagia and hoarseness (nucleus ambiguus), vertigo and nystagmus (vestibular nuclei), and contralateral trunk/extremity spinothalamic sensory loss. It is caused by occlusion of the vertebral artery (most common, ~80%) or posterior inferior cerebellar artery (PICA).
10A 47-year-old male with a history of mechanical mitral valve replacement presents with an acute cardioembolic stroke involving the left anterior cerebral artery territory. Brain MRI shows a 12 mL acute non-hemorrhagic cortical infarct. Transthoracic echocardiogram reveals normal valve seating without thrombus. When should therapeutic anticoagulation with intravenous heparin or oral warfarin ideally be resumed?
A.Delay full anticoagulation for approximately 3 to 7 days, then resume based on neuroimaging exclusion of hemorrhagic transformation
B.Immediate full-dose therapeutic intravenous unfractionated heparin without delay
C.Permanently discontinue anticoagulation and switch exclusively to clopidogrel
D.Defer all anticoagulation for at least 6 months following any ischemic event
Explanation: In patients with acute ischemic stroke and high-risk mechanical heart valves, immediate full anticoagulation carries a significant risk of hemorrhagic transformation. Contemporary consensus and ESC/AHA guidelines recommend withholding full anticoagulation acutely for 3 to 7 days in moderate-sized ischemic infarcts, confirming the absence of hemorrhagic conversion on repeat neuroimaging, and then cautiously resuming therapeutic anticoagulation.

About the Saudi Board Neurology Exam

Independent English-language MCQ study adaptation by OpenExamPrep for Saudi Board Final Written Examination - Neurology (SCFHS). These questions practice selected clinical knowledge and decisions; additional study using the official scope is required. The bank does not simulate or replace the separate mandatory clinical/practical examination. Official assessment delivery languages are not confirmed by the written blueprint.

Exam sponsor: Saudi Commission for Health Specialties (SCFHS). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

Time Limit

Not published by SCFHS

Passing Score

70% (lowered to minimum 65% if pass rate under 70%)

Exam / Certification Fees

Not published by SCFHS

Exam sponsor website

Reported exam pass rate: Not published by SCFHS. SCFHS publishes no candidate pass rate. The blueprint instead sets the passing score at 70% and, if fewer than 70% of candidates pass before final approval, lowers that score one mark at a time until a 70% pass rate is reached or the score reaches 65%, whichever comes first; it is never lowered below 65%. Exam sponsor website

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

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.

12%

Cerebrovascular Diseases

Cerebrovascular Diseases in the official SCFHS written-examination scope.

12%

Epilepsy, Psychiatry and Sleep

Epilepsy, Psychiatry and Sleep in the official SCFHS written-examination scope.

14%

Neuromuscular and Related Disorders

Neuromuscular and Related Disorders in the official SCFHS written-examination scope.

10%

Demyelinating Disorders, Multiple Sclerosis and Spinal Cord

Demyelinating Disorders, Multiple Sclerosis and Spinal Cord in the official SCFHS written-examination scope.

10%

Movement Disorders

Movement Disorders in the official SCFHS written-examination scope.

7%

Dementia

Dementia in the official SCFHS written-examination scope.

8%

Pain and Headache

Pain and Headache in the official SCFHS written-examination scope.

7%

CNS Infection

CNS Infection in the official SCFHS written-examination scope.

5%

Neuro-ophthalmology

Neuro-ophthalmology in the official SCFHS written-examination scope.

5%

Neoplasia and Paraneoplasia

Neoplasia and Paraneoplasia in the official SCFHS written-examination scope.

5%

Trauma and Neurology of Systemic Diseases

Trauma and Neurology of Systemic Diseases in the official SCFHS written-examination scope.

5%

Pediatric Neurology, Nutritional and Metabolic Diseases

Pediatric Neurology, Nutritional and Metabolic Diseases in the official SCFHS written-examination scope.

Preparing for the Saudi Board Neurology Exam

What You Need to Know

  • Passing score: 70% (lowered to minimum 65% if pass rate under 70%)
  • Assessment: Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.
  • Time limit: Not published by SCFHS
  • Exam / certification fees: Not published by SCFHS Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

Saudi Board Neurology: Suggested Study Strategy

1Review high-yield clinical neuroanatomy and localization principles across brainstem, spinal cord, and peripheral nerves.
2Master acute management algorithms for acute ischemic stroke, status epilepticus, myasthenic crisis, and intracranial hypertension.
3Practice interpreting electrophysiological recordings (EEG patterns, NCS waveforms) and neuroimaging (MRI sequences, CT angiography).
4Focus on differentiating atypical parkinsonian syndromes and rapidly progressive cognitive decline presentations.
5Work through case-based multiple choice vignettes emphasizing diagnostic criteria and therapeutic decision points.

Frequently Asked Questions

What is the format of the official Saudi Board Neurology Final Written Examination?

Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

What is the passing score for the Saudi Board Neurology Final Written Exam?

The standard pass mark is 70%. In accordance with SCFHS regulations, if fewer than 70% of candidates achieve this score, the pass mark is lowered by one mark at a time to achieve a 70% pass rate, but it is never lowered below 65%.

Does this practice question bank include the clinical OSCE examination?

This bank is an independent English-language MCQ study adaptation for the written examination. It does not simulate or replace the separate mandatory final clinical/practical assessment. Consult the specialty clinical blueprint for its station formats and any structured oral or OSCE components.

Is OpenExamPrep affiliated with or endorsed by the Saudi Commission for Health Specialties (SCFHS)?

No. OpenExamPrep is an independent educational study platform. This practice question bank is not affiliated with, sponsored by, or endorsed by the Saudi Commission for Health Specialties (SCFHS).