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A comprehensive question and answer review for the neurology section of the pance exam. It covers a wide range of neurological disorders, including diseases of peripheral nerves, headaches, infectious disorders, movement disorders, vascular disorders, and other neurologic conditions. Each question is followed by a detailed answer, making it a valuable resource for physician assistant students preparing for their exams. The content is organized by topic, facilitating focused study and review. Key topics include huntington's disease, parkinson's disease, multiple sclerosis, and various types of headaches, providing a solid foundation in neurology for exam preparation. This study guide is designed to help students master essential concepts and improve their performance on the pance exam.
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Neurology PANCE Questions and Answers – Comprehensive Review for Physician Assistant Exam, Exams of Neurology Diseases of Peripheral Nerves
Sx: pill rolling tremor (resting) [activity will decrease tremor], bradykinesia, rigidity, face involvement, instability Myerson's sign → tapping bridge of nose causes sustained blink Tx: Levodopa/carbidopa (DOC), dopamine agonists (bromocriptine, pramipexole, ropinirole), anticholinergics, amatadine, MAOIs, COMT inhibitors What is Tourette syndrome? - ANSWERSx: motor tics, verbal tics, self- mutilating tics Tx: habit reversal therapy, dopamine blocking agents, alpha-adrenergics What is amyotrophic lateral sclerosis? - ANSWERNecrosis of UMN & LMN → progressive motor degeneration Sx: muscle weakness, loss of ability to initiate and control motor movements UMN: spasticity, stiffness, hyperreflexia LMN: muscle atrophy, hyporeflexia, weakness, fasciculations Bulbar: dysphagia, dysarthria, speech problems Tx: riluzole slows progression (fatal after 3-5 yrs of onset) What is cerebral palsy? - ANSWERPerinatal or prenatal period Sx: spasticity, motor deficits PE: hyperreflexia, limb-length discrepancies, congenital defects
Tx: baclofen, diazepam What is Guillain-Barré syndrome? - ANSWERDemyelinating polyradiculopathy of peripheral nerves (caused by campylobacter jejuni) Sx: ascending weakness & paresthesias, ↓DTR, autonomic dysfunction, breathing difficulty Dx: CSF (high protein with normal WBC) Tx: plasmapheresis, IVIG (Prednisone CI) What is Myasthenia gravis? - ANSWERAutoimmune peripheral nerve disorder (MC in young women) → antibodies against Ach postsynaptic receptors Sx: ocular weakness, diplopia, ptosis, generalized muscle weakness, bulbar weakness, respiratory weakness Dx: (+)Ach receptor antibodies, (+) MuSK Edrophonium (Tensilon) test (rapid response to short acting IV) Tx: Achesterase inhibitors (pyridostigmine/neostigmine), immunosuppression (plasmapheresis, IVIG), thymectomy
What is a migraine headache? - ANSWERCommon migraine (no aura) Classic migraine (aura) Sx: pulsing/throbbing headache, N/V, photophobia, phonophobia, worse with physical activity Aura: scotomas, photopsia, teichopsia Tx: triptans or ergotamines (vasoconstrict), dopamine blockers What is a cluster headache? - ANSWERSuicide headache or alarm-clock headache Sx: unilateral periorbital/temporal pain (sharp), worse at night, Horner's syndrome Tx: 100% O2 (1st line), anti-migraine meds (SQ sumatriptan) Prophylaxis = verapamil What are classic CSF findings for various syndromes? - ANSWERMultiple sclerosis = ↑IgG (oligioclonal bands) Guillan-Barré = ↑protein with normal WBC Bacterial meningitis = ↑protein with ↑WBC, ↓glucose
Viral meningitis = normal glucose, ↑WBC Fungal/TB meningitis = ↓glucose, ↑WBC Idiopathic ICN HTN = ↑CSF pressure SAH = xanthocromia, blood in CSF What is concussion syndrome? - ANSWERMild traumatic brain injury → altered mental status Sx: confusion, amnesia, headache Dx: CT scan (acute), MRI Tx: rest What is delirium? - ANSWERAcute, abrupt transient confused state due to an identifiable cause What is dementia? - ANSWERProgressive, chronic intellectual deterioration Memory loss Includes: Alzheimer's, vascular, frontotemporal, diffuse lewy body, Creutzfeldt-Jakob
What is diffuse lewy body disease? - ANSWERLewy bodies: abnormal neuronal protein deposits (diffuse compared to parkinson) Visual hallucinations, delusions later in disease What is a transient ischemic attack? - ANSWER"mini stroke" = without acute infarction Sx: amaurosis fugax, weakness in contralateral hand, brainstem/cerebellar symptoms Dx: CT scan (initial TOC), carotid doppler, CT angiography, echocardiogram Tx: aspirin +/- dipyridamole or clopidogrel Thrombolytics = CI What is acute bacterial meningitis? - ANSWERBacterial infection of meninges Sx: fever/chills. headache, stiff neck (+) kernig's sign (+) brudzinski sign Dx: Lumbar puncture, head CT scan WBC predominantly neutrophils Tx: ceftriaxone + vancomycin
What is viral meningitis? - ANSWEREnterovirus family (coxsackie, echovirus) Sx: headache, fever, mild confusion (+) kernig's sign (+) brudzinski sign Normal cerebellar function Dx: CSF analysis (normal glucose), MRI Tx: supportive care (self-limited) What is encephalitis? - ANSWERViral infection of brain parenchyma (HSV-1) Sx: headache, fever, profound lethargy, abnormal cerebellar function, seizures Dx: CSF analysis Tx: supportive care, valacyclovir
