PANCE Neurologic System 2 — Questions and Answers
Question 1: A 68-year-old man presents with sudden onset of left-sided weakness and slurred speech that resolved completely within 45 minutes. MRI shows no infarct. What is the most appropriate next step?
- Start aspirin and statin, arrange outpatient follow-up in 1 week
- Admit for urgent evaluation and stroke risk stratification (Correct answer)
- Order CT head without contrast only
- Discharge with carotid ultrasound scheduled in 2 weeks
Correct answer: Admit for urgent evaluation and stroke risk stratification
TIA carries high early stroke risk; urgent inpatient or rapid outpatient evaluation within 24 hours with ABCD2 scoring, imaging, and cardiac monitoring is indicated.
Question 2: Which dermatome corresponds to the umbilicus?
- T4
- T6
- T10 (Correct answer)
- L1
Correct answer: T10
T10 innervates the umbilicus, a landmark useful for assessing spinal cord injury level.
Question 3: A patient with Parkinson disease develops visual hallucinations after starting a new medication. Which drug is the most likely culprit?
- Carbidopa-levodopa
- Amantadine
- Trihexyphenidyl
- Pramipexole (Correct answer)
Correct answer: Pramipexole
Dopamine agonists such as pramipexole are the most common cause of hallucinations in Parkinson disease patients.
Question 4: A 35-year-old woman has episodes of sudden muscle weakness triggered by laughter. She also reports excessive daytime sleepiness. What is the most likely diagnosis?
- Epilepsy
- Narcolepsy with cataplexy (Correct answer)
- Hypokalemic periodic paralysis
- Multiple sclerosis
Correct answer: Narcolepsy with cataplexy
Narcolepsy with cataplexy presents with excessive daytime sleepiness and sudden loss of muscle tone triggered by strong emotions.
Question 5: On lumbar puncture in bacterial meningitis, which CSF finding best distinguishes it from viral meningitis?
- Elevated opening pressure
- Lymphocytic pleocytosis
- Glucose < 45 mg/dL with elevated protein (Correct answer)
- Xanthochromia
Correct answer: Glucose < 45 mg/dL with elevated protein
Bacterial meningitis characteristically shows low CSF glucose (< 45 mg/dL or CSF:serum ratio < 0.4) and markedly elevated protein, unlike viral meningitis.
Question 6: A 55-year-old man has a 3-month history of progressive distal lower extremity weakness, areflexia, and glove-and-stocking sensory loss. Nerve conduction studies show reduced amplitudes and slow velocities. What is the most likely diagnosis?
- Amyotrophic lateral sclerosis
- Multiple sclerosis
- Guillain-Barré syndrome
- Chronic inflammatory demyelinating polyneuropathy (CIDP) (Correct answer)
Correct answer: Chronic inflammatory demyelinating polyneuropathy (CIDP)
CIDP presents with progressive or relapsing symmetric limb weakness, areflexia, and demyelinating features on nerve conduction studies lasting > 8 weeks.
Question 7: Which of the following is the first-line treatment for absence seizures?
- Carbamazepine
- Phenytoin
- Ethosuximide (Correct answer)
- Valproic acid
Correct answer: Ethosuximide
Ethosuximide is first-line for pure absence seizures; it blocks T-type calcium channels in thalamic neurons.
PANCE Neurologic System 2
A 68-year-old man presents with sudden onset of left-sided weakness and slurred speech that resolved completely within 45 minutes.
MRI shows no infarct.
What is the most appropriate next step?