Is neurology high yield on the PEBC exam?

Yes. Migraine and headache, epilepsy, and Parkinson's disease come up regularly, and migraine in particular is a common community-practice topic. The exact mix is randomized from one sitting to the next, but neurology is consistently worth solid preparation.

What neurology topics should I focus on for the PEBC?

Focus on migraine (both acute treatment and prevention), medication-overuse headache, seizure agent selection and interactions, and the basics of Parkinson's disease. Knowing the counselling points, especially driving and pregnancy, is a frequent question target.

Which guidelines should I use for neurology on the PEBC?

For migraine, the Canadian Headache Society guidance is the standard reference. For epilepsy and Parkinson's disease, use the condition-specific Canadian guidelines. The PEBC expects the Canadian approach to therapy selection.

How should I study neurology for the PEBC?

Separate acute treatment from prevention for headache, learn the seizure agents and their interactions, and know the key counselling points like driving and pregnancy.

PEBC Neurology Practice Questions

Neurology is a high-yield area on the PEBC exam, and a counselling-heavy one. Migraine and headache, seizures, and Parkinson's disease all show up, and most questions test agent selection, the difference between acute and preventive therapy, and the key safety counselling.

These free questions are drawn from across those areas. Answer one and the breakdown shows where all four options stand, including the detail that decided it.

Written and reviewed against current Canadian guidelines and references.

free questions here

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All 4

options explained

full clinical case

How to approach a PEBC neurology question

1For headache, separate acute treatment from prevention, and know when a headache is a red flag that needs referral rather than self-care.
2For migraine specifically, know the acute options (NSAIDs and triptans) and when to start prevention, and watch for medication-overuse headache from too-frequent acute use.
3For seizures, focus on agent selection, the major drug interactions, and the counselling on adherence, driving, and the pregnancy risks of valproate.
4For Parkinson's disease, know levodopa and why its timing matters, along with the common adverse effects.
5Anchor migraine care on the Canadian Headache Society guidance, and use the condition-specific Canadian guidelines for seizures and Parkinson's.

Practice questions

Tap an answer to see why each option is right or wrong.

Question 1Headache & Migraine

Which NSAID is classified as COX-2 selective?

Incorrect · Answer: C

PEBC Yield: Highintraclass-differentiationdrug-selectionadr-recognitionmonitoring

Tempting because ibuprofen is a familiar OTC NSAID, but it is classified as semiselective. Would be correct only if the question asked for a semiselective NSAID.

Tempting because diclofenac has stronger COX-2 affinity than ibuprofen, but it is still classified as semiselective. Would be correct for a semiselective option.

C) (Correct)

Correct -- celecoxib is the COX-2 selective NSAID. It sits at the low CV-risk / low GI-risk end.

Tempting because naproxen is widely used as an antiplatelet-friendly NSAID, but it is classified as nonselective. Would be correct for a nonselective NSAID.

Question 2Seizures

EJ is a 45 year old male with chronic focal epilepsy and type 2 diabetes on stable valproic acid 750 mg po bid and metformin 1000 mg po bid. He is admitted for a multidrug-resistant intra-abdominal infection and the infectious disease team is considering broader-spectrum antibiotic options. Which antibiotic class is documented to decrease valproic acid serum concentrations and risk uncontrolled seizures?

Incorrect · Answer: B

PEBC Yield: Highdrug-interactionmonitoringepilepsycarbapenemvalproic-acid

Tempting because macrolides such as clarithromycin are recognized CYP3A4 inhibitors. Wrong here because macrolides do not significantly reduce valproic acid levels; they typically raise levels of CYP3A4 substrates such as carbamazepine, not lower them. Would be correct only if the question asked which class can elevate carbamazepine levels.

B) (Correct)

Correct -- carbapenems such as meropenem, ertapenem, imipenem, and doripenem significantly decrease valproic acid serum concentrations and risk uncontrolled seizures. The combination should be avoided whenever an alternative antibiotic is appropriate.

Tempting because fluoroquinolones can lower the seizure threshold, which intuitively connects to breakthrough seizures. Wrong here because fluoroquinolones do not specifically decrease VPA serum levels through a documented PK interaction. Would be correct if the question asked which class lowers seizure threshold pharmacodynamically.

Tempting because aminoglycosides are used in serious gram-negative infection. Wrong here because aminoglycosides have no clinically significant pharmacokinetic interaction with valproic acid. Would be correct if asking which class requires renal dose adjustment in CKD.

Question 3Headache & Migraine

DW is a 47-year-old female reporting daily headaches for the past four months. She describes them as bilateral dull pressure, similar to tension-type headache. She takes sumatriptan about 12 days per month and acetaminophen most other days. Which of the following is the most likely contributing diagnosis?

Incorrect · Answer: B

PEBC Yield: Highdiagnosis-classificationADR-recognition

Secondary intracranial headache typically presents with red flags such as neurological deficits, thunderclap onset, or papilledema. Daily bilateral pressure with frequent analgesic use is classic for MOH.

B) (Correct)

Correct -- medication overuse headache is defined as headache occurring 15 or more days per month for 3 or more months. Triptans used 10 or more days per month (this patient uses 12) meet the threshold. MOH symptoms present as tension-type headache.

Migraine with brainstem aura involves specific neurologic symptoms and is rare. The daily bilateral dull pressure pattern with heavy analgesic use suggests medication overuse.

Cluster headaches present with severe unilateral piercing pain behind the eye, not bilateral dull pressure. The symptom profile is inconsistent with cluster headache.

Question 4Headache & Migraine

Which migraine antiemetic is best characterized by sedation, anticholinergic effects, and confusion?

Incorrect · Answer: C

PEBC Yield: Highadr-recognitiondrug-selectionmonitoringintraclass-differentiation

Tempting because metoclopramide can cause drowsiness, but its hallmark adverse effect set is extrapyramidal symptoms and tardive dyskinesia, not sedation/anticholinergic/confusion. Would be correct for an EPS-focused question.

Tempting because domperidone shares the prokinetic pharmacology, but its hallmark concern is QTc prolongation, not the sedation/anticholinergic/confusion triad. Would be correct for a QTc-focused question.

C) (Correct)

Correct -- dimenhydrinate is a first-generation antihistamine antinauseant whose hallmark adverse-effect set is sedation, anticholinergic effects, and confusion, especially in elderly patients.

Tempting because prochlorperazine has antiemetic and sedating properties, but its profile is more aligned with EPS, dystonia, and akathisia than the dimenhydrinate triad. Would be correct in a phenothiazine question.

Question 5Parkinson's Disease

A 58-year-old male was diagnosed with Parkinson's disease 3 years ago and is currently managed on levodopa/carbidopa 100/25 mg three times daily. Over the past 2 months, he has noticed his symptoms return approximately 1 hour before each scheduled dose. His neurologist decides to add entacapone to his regimen. Which of the following adjustments should be made when initiating entacapone?

Incorrect · Answer: B

PEBC Yield: Highdose-adjustmentdrug-interactionadverse-effect-prevention

Incorrect -- increasing levodopa when adding entacapone would compound dopaminergic exposure. Entacapone already enhances levodopa bioavailability by blocking peripheral COMT-mediated breakdown; raising the dose simultaneously would significantly increase the risk of peak-dose dyskinesia and psychosis.

B) (Correct)

Correct -- entacapone inhibits peripheral COMT, prolonging levodopa's half-life by 1-2.5 hours and increasing its central bioavailability. To offset this enhanced exposure and prevent dopaminergic adverse effects (dyskinesia, psychosis, diarrhea, abdominal pain), the levodopa dose should be reduced by 10-30% upon initiation. Entacapone is given with each dose of levodopa.

Incorrect -- entacapone has no antiparkinsonian effect when used without levodopa. Its mechanism depends entirely on inhibiting peripheral breakdown of levodopa; without levodopa substrate, there is nothing to potentiate. It must always be co-administered with levodopa.

Incorrect -- while domperidone is appropriate for levodopa-induced nausea, the primary concern when adding entacapone is dopaminergic excess from enhanced levodopa bioavailability. Maintaining the same dose without reduction risks dyskinesia and psychosis, which domperidone does not prevent.

Question 6Seizures

RT is a 30 year old female with focal seizures on phenytoin 300 mg po daily and hypertension on amlodipine 5 mg po daily. She is reviewing contraceptive options with the pharmacist. Which method is LIKELY to have reduced efficacy when used with an enzyme-inducing AED?

Incorrect · Answer: C

PEBC Yield: Highdrug-interactioncounsellingepilepsyphenytoinenzyme-induction

Tempting because IUDs are sometimes assumed to be vulnerable to drug interactions. Wrong here because copper IUDs are non-hormonal and are listed as not affected by enzyme-inducing AEDs. Would be correct if asking which method is least appropriate for a patient who explicitly wants to avoid hormones.

Tempting because depot progesterone is hormonal and could be assumed to be metabolized hepatically. Wrong here because depot progesterone is not affected by enzyme-inducing AEDs, partly because of its delivery profile. Would be correct only if depot were affected by enzyme inducers, which it does not.

C) (Correct)

Correct -- the combined oral contraceptive, along with the patch, ring, progestin implant, and progestin-only oral contraceptive, is listed as likely to be LESS effective in women on enzyme-inducing AEDs. Phenytoin is a strong CYP3A4 inducer that lowers contraceptive hormone exposure.

Tempting because barrier methods are sometimes assumed to be less reliable in general. Wrong here because barrier contraception is non-hormonal and is unaffected by enzyme inducers. Would be correct only if the question asked which method has the highest user-dependent failure rate.

Question 7Parkinson's Disease

Which product description best matches Duodopa?

Incorrect · Answer: D

PEBC Yield: Highintraclass-differentiationdrug-selectioncounsellingtherapeutic-substitution

Tempting because levodopa-carbidopa IR is a common formulation. It is wrong here because Duodopa is the intestinal gel. Would be correct if the question asked for a standard immediate-release tablet formulation.

Tempting because controlled-release levodopa-carbidopa is another formulation. It is wrong here because Duodopa is not the CR tablet. Would be correct if the question asked for a controlled-release tablet option.

Tempting because levodopa-benserazide is another levodopa plus decarboxylase inhibitor combination. It is wrong here because this pairing matches Prolopa, not Duodopa. Would be correct if the question asked for Prolopa.

D) (Correct)

Correct -- Duodopa is levodopa-carbidopa intestinal gel.

Question 8Headache & Migraine

Which agent is first-line for chronic prophylaxis of tension-type headache?

Incorrect · Answer: B

PEBC Yield: Highdrug-selectionprophylaxisintraclass-differentiationpatient-preference

Tempting because mirtazapine is used in TTH prophylaxis, but it is a second-line option, not first-line. Would be correct as a second-line agent.

B) (Correct)

Correct -- amitriptyline (and nortriptyline) are first-line agents for chronic TTH prophylaxis. Mirtazapine and venlafaxine are second-line options.

Tempting because venlafaxine is used in TTH prophylaxis, but it is a second-line option after the TCAs. Would be correct as a second-line agent.

Tempting because topiramate has prophylactic uses in migraine, but it is not the first-line TTH prophylactic. Would be correct for migraine prophylaxis in obesity.

Question 9Seizures

AS is a 28 year old female with focal seizures on carbamazepine 400 mg po bid for the past three years and asthma on fluticasone/salmeterol 250/50 mcg inhaled bid. She wants to switch from condoms to a more reliable method but the neurologist warned her about contraceptive interactions. Which contraceptive method is NOT likely to be affected by enzyme-inducing AEDs?

Incorrect · Answer: D

PEBC Yield: Highdrug-interactioncounsellingepilepsycarbamazepineenzyme-induction

Tempting because combined oral contraceptives are the most familiar method. Wrong here because COCs are listed as likely to be LESS effective in women taking enzyme-inducing AEDs. Would be correct if the patient were on a non-enzyme-inducing AED such as levetiracetam or lamotrigine.

Tempting because the patch is a non-oral hormonal method. Wrong here because the combined contraceptive patch is also listed as likely to be LESS effective with enzyme-inducing AEDs, as the same hepatic metabolism applies. Would be correct only if the AED were a non-inducer.

Tempting because the vaginal ring delivers hormones locally rather than orally. Wrong here because the vaginal ring is also on the LESS-effective list with enzyme-inducing AEDs. Would be correct only if the AED were a non-inducer.

D) (Correct)

Correct -- intrauterine devices (hormonal or non-hormonal) along with depot progesterone and barrier methods are not likely to be affected by enzyme-inducing AEDs. The IUD is the most appropriate switch target for this patient on chronic carbamazepine.

Question 10Seizures

MN is a 45 year old male with focal seizures and HIV on bictegravir/emtricitabine/tenofovir alafenamide 1 tab po daily. His neurologist needs an AED that will not affect hepatic metabolism of his antiretroviral regimen. Which of the following AEDs is NON-enzyme-inducing?

Incorrect · Answer: D

PEBC Yield: Highdrug-interactionintraclass-differentiationepilepsylevetiracetamenzyme-induction

Tempting because carbamazepine is first-line for focal seizures in many algorithms. Wrong here because carbamazepine is a strong CYP3A4 inducer and is on the enzyme-inducing list, which would compromise the integrase-inhibitor regimen. Would be correct only if asking which AED reduces COC efficacy via CYP3A4 induction.

Tempting because phenytoin is also first-line for focal seizures historically. Wrong here because phenytoin is a strong CYP3A4 inducer and would lower antiretroviral exposures. Would be correct only if asking which AED has saturation kinetics within the therapeutic range.

Tempting because primidone is sometimes overlooked when ranking inducers. Wrong here because primidone is metabolized to phenobarbital and induces multiple CYP enzymes, placing it on the enzyme-inducing list. Would be correct if asking which AED is metabolized to a barbiturate.

D) (Correct)

Correct -- levetiracetam has no CYP metabolism and is on the non-enzyme-inducing AED list, which also includes brivaracetam, ethosuximide, gabapentin, lacosamide, lamotrigine, valproic acid, and vigabatrin. It is the appropriate choice when antiretroviral exposures must be preserved.

Want the full bank?

These are a sample. The full bank adds full-length cases and timed mock exams.

Sample full case

One patient with several linked questions, the format the real exam uses for case clusters.

PL is a 45-year-old elementary school teacher with a 2-year history of gradually worsening right-hand tremor, slowness, and mild right-arm rigidity. She has recently had to move to part-time teaching (3 days/week from 5) because her handwriting has deteriorated markedly (students struggle to read board work) and she has had two falls in the last 6 months while walking between classrooms carrying supplies. She describes embarrassment in front of her class and growing social withdrawal. Cognitive screening (MoCA) is 28/30 and mood screening is negative for depression. Examination and workup:

Finding	Detail
Resting tremor	Right hand, 4–6 Hz, pill-rolling pattern
Rigidity	Right upper-extremity cogwheel
Bradykinesia	Decreased right-arm swing, slowed finger tapping
Postural stability	Mildly impaired pull test
Response to levodopa trial	Confirmed symptom improvement

PMH: None significant. Medications: None. Allergies: NKDA. Social: Non-smoker, occasional glass of wine. Her neurologist has diagnosed idiopathic Parkinson's disease (young-onset, early stage) and is discussing whether to begin pharmacotherapy. PL is asking whether she can 'wait and see' or whether she should start treatment now.

Question 1Parkinson's Disease

Which of the following best reflects the recommended approach to initiating pharmacotherapy in PL?

Incorrect · Answer: C

PEBC Yield: Hightreatment-initiation-thresholdfunctional-impact-criteriondisease-progression-vs-symptomatic-therapyyoung-onset-pd

Parkinson's disease treatment does NOT accelerate disease progression — this is a common misconception. Levodopa and dopamine agonists are symptomatic; they neither speed up nor slow underlying neurodegeneration. Delaying treatment despite functional impairment leaves the patient to suffer avoidable disability.

Cognitive symptoms in PD typically emerge later in the disease course. Waiting for cognitive decline to justify motor-symptom treatment is backwards clinical logic — PL's motor symptoms alone are already producing occupational disability and fall risk.

C) (Correct)

Correct. Pharmacotherapy in Parkinson's disease is mandatory once symptoms interfere with activities of daily living, employment, or quality of life. PL's work has been cut by 40%, her handwriting is no longer legible in her role as a teacher, and she has had two falls. These all meet the threshold for starting treatment. Patients with minimal symptoms that do not bother them do not need to start immediately — but PL is clearly past that threshold.

Exercise and allied-health interventions (PT, OT, SLP) are foundational in PD management and should be co-initiated with pharmacotherapy in a patient with functional impact — not used as a 6-month delaying tactic. Exercise is complementary, not a substitute for the pharmacotherapy threshold being crossed.

Question 2Parkinson's Disease

PL and her neurologist agree that pharmacotherapy should begin. She wants meaningful symptom relief for teaching but is worried about needing treatment for decades. Her cognition is intact, mood screen is negative, and tremor is accompanied by bradykinesia and rigidity that interfere with work. Which agent best balances symptom relief with delaying levodopa-related motor complications?

Incorrect · Answer: C

PEBC Yield: Highdopamine-agonist-first-lineyoung-onset-strategymotor-complication-delaypramipexole-vs-levodopa

Levodopa is the most effective symptomatic agent and is an acceptable first-line option. However, earlier exposure to levodopa in young patients is associated with earlier onset of motor complications (wearing-off, dyskinesias) because these complications are dose- and duration-dependent. For a 45-year-old with decades of disease ahead, starting a dopamine agonist first to delay levodopa exposure is the preferred strategy when delay of complications is the priority.

Selegiline (MAO-B inhibitor) is also a valid first-line monotherapy and has the mildest side-effect profile. However, its symptomatic effect is modest — often insufficient for a patient like PL whose QoL is clearly affected. It is best suited to very mild, minimally-functional-impact disease where the priority is keeping the patient off dopaminergic therapy for as long as possible.

C) (Correct)

Correct. Pramipexole (and other non-ergot dopamine agonists — ropinirole, rotigotine) are the preferred first-line monotherapy in young-onset PD with meaningful functional impact when the goal is to delay motor complications. They directly stimulate dopamine receptors without depending on the nigrostriatal pathway. Evidence shows that starting with a dopamine agonist (vs levodopa) delays the onset of wearing-off and dyskinesias by years — a meaningful benefit over a long disease course. Dopamine agonists carry specific risks (impulse-control disorders, somnolence, orthostatic hypotension) that must be discussed with the patient and family.

Trihexyphenidyl is an anticholinergic. The source note is clear that anticholinergics are no longer first-line in Parkinson's disease. They have a limited role in tremor-dominant early PD in young patients, but they cause cognitive/urinary/constipation side effects and have no effect on bradykinesia or rigidity — both of which PL has. Using trihexyphenidyl here would under-treat her illness.

Question 3Parkinson's Disease

Eight years later, PL is 53 and her Parkinson's disease has progressed. She is now maintained on levodopa/carbidopa IR 100/25 mg QID and levodopa/carbidopa CR 100/25 mg at bedtime (after an earlier trial of pramipexole). Over the past 3 months, her main complaint is troublesome peak-dose dyskinesia: involuntary writhing movements of her trunk and limbs about 60–90 minutes after each dose, lasting ~45 minutes and embarrassing her at work. She also notices mild end-of-dose wearing-off near the next scheduled IR tablet, but the neurologist wants first to reduce dyskinesia without shortening levodopa benefit. Which single adjunct is most appropriate?

Incorrect · Answer: C

PEBC Yield: Highamantadine-adjunctdyskinesia-with-wearing-offmotor-complication-managementnmda-antagonism

Switching entirely to CR formulation can smooth peaks but has erratic and delayed absorption, often creating unpredictable off-periods in a patient already experiencing wearing-off. Total switch IR → CR is not the preferred adjunct for concurrent dyskinesia + wearing-off.

Entacapone is the right choice for wearing-off alone — it prolongs levodopa's half-life at the synapse. However, adding entacapone to a patient who is ALREADY experiencing peak-dose dyskinesias would amplify the dyskinesia by raising peak dopamine exposure. The wearing-off component would improve but the dyskinesia would worsen — net harm.

C) (Correct)

Correct. Amantadine is the evidence-based adjunct of choice when both levodopa-induced dyskinesia AND wearing-off are present simultaneously. It reduces dyskinesia (via NMDA receptor antagonism and mild dopaminergic activity) without shortening the dose duration that drives the wearing-off. In effect, amantadine allows the clinician to maintain or increase the levodopa dose to address wearing-off without worsening the dyskinesia. Amantadine is renally cleared — monitor renal function and dose-adjust for CrCl <60 mL/min.

Reducing the levodopa dose would soften the peak and reduce dyskinesia, but would deepen the wearing-off troughs — exactly what PL does not need. A dose-reduction-only approach trades one problem for an amplified version of the other.

Full-length cases like this, across every PEBC domain, live in the question bank.

Frequently asked questions

Is neurology high yield on the PEBC exam?: Yes. Migraine and headache, epilepsy, and Parkinson's disease come up regularly, and migraine in particular is a common community-practice topic. The exact mix is randomized from one sitting to the next, but neurology is consistently worth solid preparation.
What neurology topics should I focus on for the PEBC?: Focus on migraine (both acute treatment and prevention), medication-overuse headache, seizure agent selection and interactions, and the basics of Parkinson's disease. Knowing the counselling points, especially driving and pregnancy, is a frequent question target.
Which guidelines should I use for neurology on the PEBC?: For migraine, the Canadian Headache Society guidance is the standard reference. For epilepsy and Parkinson's disease, use the condition-specific Canadian guidelines. The PEBC expects the Canadian approach to therapy selection.
How should I study neurology for the PEBC?: Separate acute treatment from prevention for headache, learn the seizure agents and their interactions, and know the key counselling points like driving and pregnancy.