PANCE Neurologic System 4

Question 1

A 50-year-old man with a history of alcohol use disorder presents with confusion, ataxia, and ophthalmoplegia. What is the immediate treatment?

Accepted Answer

Thiamine before glucose

Answer

Wernicke encephalopathy requires immediate IV thiamine before glucose, as glucose administration can precipitate or worsen thiamine deficiency.

Question 2

A 25-year-old woman has recurrent episodes of unilateral throbbing headache with photophobia, phonophobia, and nausea lasting 12–24 hours. What is the acute treatment of choice?

Accepted Answer

Triptans (e.g., sumatriptan)

Answer

Triptans are serotonin 5-HT1B/1D receptor agonists and are first-line acute therapy for moderate-to-severe migraine.

Question 3

A 70-year-old woman develops diplopia and dysphagia after recovering from a respiratory infection 3 weeks ago. Tensilon (edrophonium) test is positive. What is the underlying mechanism?

Accepted Answer

Antibodies against acetylcholine receptors at the neuromuscular junction

Answer

Myasthenia gravis results from anti-AChR antibodies blocking neuromuscular transmission, and symptoms improve with edrophonium (acetylcholinesterase inhibitor).

Question 4

A patient with a seizure disorder is started on valproic acid. Which laboratory value must be monitored due to a serious adverse effect?

Accepted Answer

Liver function tests

Answer

Valproic acid can cause hepatotoxicity (particularly in children < 2 years) and pancreatitis; LFTs and amylase/lipase should be monitored.

Question 5

A right-handed patient has an infarct of the left middle cerebral artery territory. Which deficit is most expected?

Accepted Answer

Right hemiplegia with expressive aphasia

Answer

Left MCA stroke in a right-handed person causes contralateral (right) hemiplegia and Broca or global aphasia since language centers are in the left hemisphere.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Neurologic System 4