Clinical High-Yield · 9 min read · April 24, 2026
Neurology feels intimidating because the conditions are complex and the consequences of missing them are severe. But here's the truth: the FNP boards test a very predictable set of neurological presentations, and once you know the patterns, these questions become some of the most straightforward on the exam.
The boards love headache differentiation. Know these cold:
Migraine: Unilateral, pulsating, moderate-to-severe, worse with activity, nausea/vomiting, photophobia/phonophobia. Aura in classic migraine. First-line: triptans (sumatriptan). Preventive: propranolol, topiramate, amitriptyline.
Tension-type: Bilateral, pressing/tightening, mild-to-moderate, not worsened by activity. First-line: NSAIDs, acetaminophen.
Cluster: Unilateral periorbital, severe, autonomic features (lacrimation, rhinorrhea, ptosis), occurs in clusters. More common in men. First-line acute: 100% oxygen, sumatriptan.
Red flag headaches — know these for the "worst headache of my life" question: subarachnoid hemorrhage (thunderclap onset), meningitis (fever + stiff neck + headache), temporal arteritis (age >50, jaw claudication, elevated ESR).
The boards test stroke recognition and the TIA vs. stroke distinction.
TIA: Transient (resolves within 24 hours, typically <1 hour). No infarction on imaging. ABCD2 score predicts 2-day stroke risk.
Ischemic stroke: Sudden focal neurological deficit. CT head first (to rule out hemorrhage). tPA within 4.5 hours if no contraindications.
Hemorrhagic stroke: Sudden severe headache, often with vomiting. No tPA. Neurosurgery consult.
Know the stroke syndromes: MCA (contralateral face/arm weakness, aphasia if dominant hemisphere), PCA (visual field defects), vertebrobasilar (vertigo, diplopia, ataxia, dysarthria).
First unprovoked seizure: Workup includes EEG, MRI brain, labs (glucose, electrolytes, CBC). Not all first seizures require treatment.
Status epilepticus: Seizure >5 minutes or two seizures without return to baseline. Emergency. Benzodiazepines first-line.
Medication: Levetiracetam (Keppra) is the most commonly tested first-line agent. Know that phenytoin requires cardiac monitoring and has many drug interactions.
Alzheimer's disease: Most common. Insidious onset, memory first, progressive. Cholinesterase inhibitors (donepezil, rivastigmine) for mild-moderate. Memantine for moderate-severe.
Vascular dementia: Stepwise progression, associated with cardiovascular risk factors.
Lewy body dementia: Fluctuating cognition, visual hallucinations, parkinsonism. Avoid antipsychotics — can cause severe reactions.
When you see a neurological question, ask yourself: Is this an emergency or not?
If it's an emergency (stroke, status epilepticus, meningitis, subarachnoid hemorrh...