All Practice Exams
100+ Free Neurology Shelf Practice Questions
NBME Clinical Science Subject Exam: Clinical Neurology practice questions are available now; exam metadata is being verified.
✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately
Not publicly standardized Pass Rate
100+ Questions
100% Free
1 / 100
Question 1
Score: 0/0
A 52-year-old cyclist has numbness of the small finger and ulnar half of the ring finger with weakness spreading the fingers apart. Wrist flexion is preserved. Which nerve is injured?
A
B
C
D
to track
Same family resources
Explore More NBME Medical School Assessments
Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.
2026 Statistics
Key Facts: Neurology Shelf Exam
110
Official Items
NBME Subject Examination Timing Chart
2 hr 45 min
Official Exam Time
NBME Subject Examination Timing Chart
60%-65%
Nervous System and Special Senses
NBME Clinical Neurology Content Outline
55%-60%
Diagnosis Task Weight
NBME Clinical Neurology Content Outline
25%-30%
Management Task Weight
NBME Clinical Neurology Content Outline
60%-65%
Ambulatory Site of Care
NBME Clinical Neurology Content Outline
100
Practice Questions Here
Open Exam Prep
For the Neurology shelf, master localization and emergency first moves: stroke reperfusion and hemorrhage triage, status epilepticus, meningitis and encephalitis, cord compression, myasthenic crisis, Guillain-Barre syndrome, dangerous headache, optic neuritis, acute vestibular syndromes, and common dementia or movement disorder patterns.
Sample Neurology Shelf Practice Questions
Try these sample questions to test your Neurology Shelf exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 72-year-old man develops sudden right facial droop, right arm weakness, and expressive aphasia 90 minutes after he was last known well. Blood pressure is 176/98 mm Hg, glucose is 104 mg/dL, platelet count is normal, and he takes no anticoagulants. Noncontrast head CT shows no hemorrhage. What is the next best step?
A.Administer intravenous alteplase
B.Start aspirin and discharge with neurology follow-up
C.Give intravenous heparin
D.Delay treatment until MRI confirms infarction
Explanation: This patient has an acute disabling ischemic stroke within the IV thrombolysis window and no major contraindication. Noncontrast CT is used first to exclude hemorrhage; treatment should not wait for infarct visualization on MRI.
2A 66-year-old woman is found with left hemiplegia and neglect 8 hours after she was last seen normal. CT shows no hemorrhage. CT angiography shows a right M1 middle cerebral artery occlusion, and perfusion imaging shows a small infarct core with a large penumbra. What is the best treatment?
A.Mechanical thrombectomy
B.Oral clopidogrel alone
C.Carotid endarterectomy today
D.High-dose dexamethasone
Explanation: Large vessel anterior circulation occlusion with salvageable tissue can be treated with endovascular thrombectomy beyond the IV thrombolysis window in selected patients. The mismatch pattern supports urgent thrombectomy.
3A 58-year-old man with long-standing hypertension develops severe occipital headache, vomiting, ataxia, and decreasing consciousness. CT shows a 4-cm cerebellar hemorrhage compressing the fourth ventricle with acute hydrocephalus. What is the next best step?
A.Urgent neurosurgical decompression with ventricular drainage
B.Lumbar puncture to measure opening pressure
C.Aspirin and permissive hypertension
D.Outpatient MRI in 1 week
Explanation: Large cerebellar hemorrhage with brainstem compression or hydrocephalus is a neurosurgical emergency. Posterior fossa decompression and ventricular drainage can prevent fatal herniation.
4A 69-year-old man has 12 minutes of right hand weakness and difficulty speaking that resolves before arrival. MRI shows no infarct. Carotid duplex shows 82% stenosis of the left internal carotid artery. What intervention most reduces future stroke risk?
A.Left carotid endarterectomy within the next 2 weeks
B.Long-term warfarin without further evaluation
C.Right carotid endarterectomy
D.Reassurance because symptoms resolved
Explanation: Symptomatic high-grade ipsilateral internal carotid stenosis is treated with carotid endarterectomy, ideally soon after the TIA if surgical risk is acceptable. This reduces recurrent ischemic stroke risk.
5A 63-year-old woman with diabetes and hypertension awakens with pure right face, arm, and leg weakness. Sensation, language, visual fields, and cortical function are intact. MRI shows a small infarct in the left posterior limb of the internal capsule. What is the most likely mechanism?
A.Lipohyalinosis of penetrating arteries
B.Embolus from a carotid plaque to the occipital cortex
C.Rupture of an anterior communicating artery aneurysm
D.Inflammatory demyelination of periventricular white matter
Explanation: Pure motor hemiparesis from a small internal capsule infarct is a lacunar stroke, usually due to lipohyalinosis or microatheroma of small penetrating arteries in patients with chronic hypertension or diabetes.
6A 61-year-old man has sudden vertigo, vomiting, hoarseness, dysphagia, left facial numbness, right body loss of pain and temperature, left Horner syndrome, and left limb ataxia. Which vessel is most likely occluded?
A.Left posterior inferior cerebellar artery
B.Left anterior cerebral artery
C.Right middle cerebral artery
D.Basilar artery causing locked-in syndrome
Explanation: Lateral medullary syndrome causes ipsilateral facial sensory loss, contralateral body pain-temperature loss, dysphagia, hoarseness, ataxia, and Horner syndrome. It is classically due to PICA or vertebral artery occlusion.
7A 45-year-old woman has the sudden worst headache of her life during exercise, followed by vomiting and neck stiffness. Blood pressure is 188/104 mm Hg. What is the best initial diagnostic test?
A.Noncontrast CT scan of the head
B.Electroencephalography
C.Carotid duplex ultrasonography
D.Sinus radiographs
Explanation: Thunderclap headache with meningismus suggests subarachnoid hemorrhage. Noncontrast head CT is the initial test; lumbar puncture is used if CT is negative and suspicion remains, especially after several hours.
8A 29-year-old woman 2 weeks postpartum has progressive headache, papilledema, a focal seizure, and left leg weakness. CT venography shows thrombosis of the superior sagittal sinus with a small hemorrhagic venous infarct. What is the best treatment?
A.Therapeutic anticoagulation with heparin
B.Withhold anticoagulation because hemorrhage is present
C.High-dose aspirin only
D.Emergent carotid stenting
Explanation: Cerebral venous sinus thrombosis is treated with therapeutic anticoagulation, even when a hemorrhagic venous infarct is present, because the primary problem is propagation of venous thrombosis.
9An 80-year-old man on warfarin has 3 weeks of worsening headache, confusion, and mild right-sided weakness after a minor fall. CT shows a crescent-shaped extra-axial collection crossing suture lines. Which vessel is usually injured?
A.Bridging veins
B.Middle meningeal artery
C.Anterior spinal artery
D.Lenticulostriate artery
Explanation: Subdural hematoma is due to tearing of bridging veins, often after minor trauma in older adults or anticoagulated patients. CT classically shows a crescent-shaped collection that can cross sutures.
10A 19-year-old man is struck in the temporal region by a baseball. He briefly loses consciousness, wakes up lucid, then becomes somnolent with a fixed dilated pupil. CT shows a biconvex extra-axial hematoma. What structure was most likely torn?
A.Middle meningeal artery
B.Superior sagittal sinus
C.Charcot-Bouchard microaneurysm
D.Anterior communicating artery aneurysm
Explanation: Epidural hematoma is usually caused by middle meningeal artery rupture after temporal bone trauma. A lucid interval and biconvex collection are classic clues.
About the Neurology Shelf Practice Questions
Verified exam format metadata for NBME Clinical Science Subject Exam: Clinical Neurology is pending. The practice questions above remain available while official exam length, timing, passing score, fee, and administrator details are reviewed.