# AMC MCQ Neurology Questions: 10 Free Practice MCQs

> 10 free AMC MCQ neurology questions with answers and explanations, from a bank of 15 neurology questions. Try them now, no sign up.

Canonical: https://medhub.one/practice/amc-mcq/neurology
Last updated: 2026-10-31

Neurology questions test pattern recognition under time pressure: sudden focal deficit, first seizure, a headache that is different, and the patient who cannot walk safely. The AMC MCQ expects a focused examination, the right first line imaging and immediate treatment where the window is short. Local answers follow the Australian stroke pathway, including thrombolysis and thrombectomy criteria.

## Where candidates lose marks

* Arranging outpatient imaging for a sudden focal deficit instead of the stroke pathway.
* Missing subarachnoid haemorrhage when the CT is normal and lumbar puncture is not arranged.
* Treating a first seizure as epilepsy without checking glucose, sodium and infection.
* Ignoring cauda equina or spinal cord compression red flags.

**Guideline to follow:** The AMC MCQ follows the Stroke Foundation living clinical guidelines for stroke management and the Australian and New Zealand Association of Neurologists guidance.

Ten AMC MCQ-style neurology questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 15 neurology questions and many more across every topic.

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1. 1 / 10  
A 48-year-old female typing clerk presents with a 3-month history of numbness and tingling in her thumb, index, and middle fingers of her right hand, which is worse at night. On examination, tapping over the volar wrist reproduces the paresthesia (positive Tinel's sign).  
What is the most likely diagnosis?  
Show answer

**Answer: D.** Carpal tunnel syndrome.

**Why:** Carpal tunnel syndrome is the most common entrapment neuropathy, caused by median nerve compression within the carpal tunnel. Symptoms involve numbness, paresthesia, and pain in the median nerve distribution (lateral 3.5 digits) and typically worsen at night. Tinel's sign and Phalen's test are useful clinical tests.

  * **A.** De Quervain's presents with radial wrist pain and a positive Finkelstein's test, not numbness in the median nerve distribution.
  * **B.** C8 radiculopathy would cause sensory loss in the little and ring fingers and motor weakness in hand intrinsics.
  * **C.** Cubital tunnel syndrome involves ulnar nerve compression at the elbow, causing numbness in the ring and little fingers.  
Sources: eTG Complete: Carpal Tunnel Syndrome
2. 2 / 10  
A 34-year-old man presents with a 3-day history of progressive, symmetric weakness in his legs, which has now ascended to involve his hands. He recalls having a diarrheal illness 3 weeks ago. On examination, he has absent deep tendon reflexes in the lower limbs.  
Which of the following diagnostic findings is most characteristic of Guillain-Barré Syndrome (GBS)?  
Show answer

**Answer: D.** CSF showing albuminocytologic dissociation (elevated protein with normal white cell count)

**Why:** Guillain-Barré Syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy. The classic cerebrospinal fluid (CSF) analysis demonstrates albuminocytologic dissociation: elevated protein levels (due to significant nerve root inflammation) with a normal white blood cell count. This distinguishes GBS from infectious myelitis or meningitis.

  * **A.** This indicates an infectious meningitis or encephalitis, whereas GBS CSF typically shows normal cell counts.
  * **B.** Demyelinating plaques in the CNS are characteristic of Multiple Sclerosis, not Guillain-Barré Syndrome (which is a PNS disease).
  * **C.** This decremental response is characteristic of Myasthenia Gravis, not GBS.  
Sources: eTG complete, Neurology; Brain (Scientific Journal) Guidelines on GBS Diagnosis
3. 3 / 10  
A 24-year-old man is brought to the Emergency Department in active generalized tonic-clonic status epilepticus. He has been seizing for 15 minutes. Intravenous access is established. He has not received any medication prior to arrival.  
According to the Therapeutic Guidelines (eTG), what is the most appropriate initial pharmacological therapy?  
Show answer

**Answer: A.** Intravenous Midazolam 5-10 mg (or intravenous Diazepam 5-10 mg)

**Why:** The initial treatment for status epilepticus is a rapid-acting benzodiazepine. Under Australian guidelines, this is typically intravenous midazolam (5-10 mg) or intravenous diazepam (5-10 mg), repeated once after 5 minutes if seizures continue. If IV access is unavailable, IM midazolam is an acceptable first-line alternative.

  * **B.** Phenytoin is a second-line antiepileptic drug used if benzodiazepines fail; it does not act fast enough for initial status management.
  * **C.** Levetiracetam is used as a second-line maintenance agent, not as the primary rapid-acting drug for terminating status epilepticus.
  * **D.** Adrenaline is indicated for anaphylaxis or cardiac arrest, and has no place in the management of seizures.  
Sources: eTG complete, Neurology, Status Epilepticus; Australian Medicines Handbook (AMH)
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5. 4 / 10  
A 42-year-old man presents to the Emergency Department with an abrupt, severe headache that peaked within 2 minutes of onset. He describes it as a 'thunderclap' sensation. A non-contrast CT brain performed 4 hours after the onset of the headache is reported as normal.  
What is the most appropriate next step in the diagnostic pathway to rule out subarachnoid hemorrhage (SAH)?  
Show answer

**Answer: D.** Perform a lumbar puncture (LP) at least 12 hours after the onset of the headache

**Why:** A non-contrast CT brain is highly sensitive (>95%) for subarachnoid hemorrhage when performed within 6 hours of headache onset. If the CT is normal but clinical suspicion is high, a lumbar puncture must be performed to check for xanthochromia. The LP should be delayed until at least 12 hours after headache onset to allow sufficient time for RBC lysis and bilirubin formation (xanthochromia).

  * **A.** A normal CT brain does not fully exclude SAH; a secondary cause must be actively ruled out.
  * **B.** Contrast enhancement can obscure subarachnoid blood and is not useful in the acute diagnosis of SAH.
  * **C.** MRI is not a replacement for lumbar puncture in this clinical pathway and is less sensitive for acute subarachnoid blood.  
Sources: eTG complete, Neurology; ACEM Guidelines on Thunderclap Headache
6. 5 / 10  
A 2-year-old girl has a generalised tonic-clonic seizure lasting 8 minutes during a febrile illness. She is fully back to her baseline within 30 minutes, the seizure does not recur during the same illness, and there are no focal features or previous afebrile seizures.  
How should this seizure be classified?  
Show answer

**Answer: A.** Simple febrile seizure

**Why:** Classification determines the need for further assessment. A simple febrile seizure is generalised, lasts less than 15 minutes, is followed by complete recovery within 1 hour and does not recur within the same illness. Complex features are focal onset, duration over 15 minutes, altered mental state beyond 1 hour or recurrence within the same illness. A prolonged febrile seizure lasts more than 30 minutes, and an afebrile seizure occurs without a documented fever.

  * **B.** Complex features are focal onset, duration over 15 minutes, altered mental state beyond 1 hour or recurrence within the same illness, none of which occurred here.
  * **C.** A prolonged febrile seizure lasts more than 30 minutes, whereas this seizure lasted only 8 minutes.
  * **D.** An afebrile seizure occurs without a documented fever, and this child had a clear febrile illness at the time of the event.  
Sources: RCH Clinical Practice Guideline: Febrile seizure (The Royal Children's Hospital Melbourne, last updated February 2026)
7. 6 / 10  
A 65-year-old taxi driver attends his GP clinic 2 weeks after being discharged from hospital following an acute ischaemic stroke. He has resolved neurological deficits and normal vitals.  
What is the most appropriate advice regarding his driving status under Austroads guidelines?  
Show answer

**Answer: B.** He must not drive commercial vehicles for at least 3 months and requires specialist clearance.

**Why:** Commercial drivers face stricter fitness-to-drive criteria than private drivers. Following a stroke, commercial drivers are suspended for a minimum of 3 months and require specialist evaluation before returning to drive.

  * **A.** A mandatory suspension period applies regardless of symptom resolution.
  * **C.** Restricted licenses do not bypass the mandatory commercial suspension.
  * **D.** Commercial driving can be resumed after 3 months subject to clearance.  
Sources: Austroads Assessing Fitness to Drive Guidelines
8. 7 / 10  
A 58-year-old farmer in northern Western Australia presents during autumn with a 4-day history of high fever, severe headache, neck stiffness, and progressive confusion. On exam, he is febrile (39.2°C) and has mild tremor.  
What is the most likely pathogen responsible for this acute neurological presentation?  
Show answer

**Answer: B.** Murray Valley Encephalitis virus.

**Why:** Murray Valley Encephalitis (MVE) virus is a mosquito-borne flavivirus endemic to northern Australia and occasionally parts of southeastern Australia. It causes severe neuroinvasive disease, including meningitis and encephalitis, presenting with fever, headache, neck stiffness, and altered mental state.

  * **A.** Hendra virus is transmitted from horses and presents with respiratory distress or severe encephalitis, but has specific exposure history.
  * **C.** Lyssavirus requires a history of bat bite/scratch and presents with rabies-like symptoms.
  * **D.** Ross River virus causes epidemic polyarthritis and rash, but not acute severe encephalitis.  
Sources: Australian Government Department of Health: Vector-Borne Diseases
9. 8 / 10  
A 2-year-old girl is brought to the emergency department after experiencing a generalised tonic-clonic seizure at home that lasted 3 minutes. Her temperature was 38.8°C at the time. She is now alert and back to her normal self. She has had no prior seizures.  
How is this seizure classified, and what is the appropriate emergency abortive therapy if a future seizure lasts more than 5 minutes?  
Show answer

**Answer: C.** Simple febrile convulsion; administer intranasal midazolam

**Why:** A simple febrile convulsion is generalised, lasts less than 15 minutes, and occurs once in a 24-hour period in an otherwise healthy child. A complex febrile convulsion has focal features, lasts >=15 minutes, or recurs within 24 hours. For any seizure lasting longer than 5 minutes, first-line abortive treatment is intranasal midazolam (0.2 mg/kg).

  * **A.** This is a simple febrile convulsion (generalised, <15 minutes, single episode in 24 hours), and intranasal midazolam is now preferred over rectal diazepam.
  * **B.** A single febrile convulsion does not define epilepsy, and daily anticonvulsants are not indicated.
  * **D.** The seizure resolved in 3 minutes, which is not status epilepticus (defined as >5 minutes of continuous seizure activity).  
Sources: RCH Melbourne Clinical Practice Guideline: Febrile Convulsions; eTG Complete
10. 9 / 10  
A 38-year-old man with advanced HIV (CD4 count 45 cells/uL) presents with a subacute headache, low-grade fever, and mild confusion. On examination, he has mild neck stiffness. A lumbar puncture is performed.  
Which of the following diagnostic tests is most rapid and highly sensitive to confirm the likely causative organism in this patient's CSF?  
Show answer

**Answer: A.** Cryptococcal antigen (CrAg) lateral flow assay

**Why:** Cryptococcal meningitis is a major opportunistic infection in patients with advanced HIV (CD4 < 100 cells/uL). The CSF cryptococcal antigen (CrAg) lateral flow assay is the preferred rapid diagnostic test due to its exceptional sensitivity (>98%). India ink staining is classic but less sensitive, and culture takes longer to yield results.

  * **B.** Bacterial culture will not identify fungal pathogens like Cryptococcus, which is the most likely cause of meningitis in this CD4 range.
  * **C.** While useful, India ink has lower sensitivity (60-80%) compared to the cryptococcal antigen assay.
  * **D.** Enterovirus causes viral meningitis, which is less likely to present with subacute cognitive decline in severe immunodeficiency.  
Sources: eTG complete, Infectious Diseases, Cryptococcosis; ASHM (Australasian Society for HIV Medicine) Guidelines
11. 10 / 10  
A 34-year-old warehouse manager has a first-ever unprovoked generalised tonic-clonic seizure. Her EEG and MRI brain are normal. She has a private driver's license and normal vitals.  
What is the mandatory non-driving period under Austroads guidelines for a private license holder?  
Show answer

**Answer: B.** She must not drive for at least 6 months post-seizure.

**Why:** Under Austroads guidelines, a first unprovoked seizure requires a minimum of 6 months free of seizures before private driving can resume. EEG and MRI findings are useful for prognosis but do not waive this period.

  * **A.** Twelve months is standard for commercial licenses, not private ones.
  * **C.** Starting medication does not bypass the mandatory 6-month suspension.
  * **D.** The clinical occurrence of a seizure itself triggers the suspension.  
Sources: Austroads Assessing Fitness to Drive Guidelines

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