Practice Neurology Questions on the Physician Assistant Exam - dummies

Practice Neurology Questions on the Physician Assistant Exam

By Barry Schoenborn, Richard Snyder

These practice questions cover many important neurologic subject areas you see on the Physician Assistant Exams (PANCE/PANRE), including headaches, seizures, movement disorders, delirium, and the cerebrovascular accident (CVA).

Example PANCE Questions

  1. You’re evaluating a 50-year-old man who presents with a headache. He says that he notices that before his headaches, like now, he sees “funny squiggly things.” He asks if you can turn off the light as you come into the room, because the bright light is “driving him nuts.” Which one of the following would you give to help with his headache?

    (A) Oxygen

    (B) Cyclobenzaprine (Flexeril)

    (C) Lisinopril (Zestril)

    (D) Terazosin (Hytrin)

    (E) Ergotamine and caffeine (Cafergot)

  2. In which one of the following disorders would you see choreiform movements?

    (A) Parkinson’s disease

    (B) Rheumatic fever

    (C) Complex regional pain syndrome

    (D) Multiple sclerosis

    (E) Tourette’s syndrome

  3. Which one of the following signs is associated with meningitis?

    (A) Applebee’s sign

    (B) Kernig’s sign

    (C) Tinel’s sign

    (D) Trousseau’s sign

    (E) Homans’ sign

  4. You’re evaluating a 45-year-old woman with a history of a solid organ transplant. She’s on immunosuppression and presents with a fever and a change in mental status. She isn’t arousable and has become very lethargic. There’s a question as to whether she had a seizure at home. An MRI showed hemorrhagic changes and increased enhancement in the temporal lobe. Which one of the following does she need at this point?

    (A) Intravenous methylprednisolone (Medrol)

    (B) Plasmapheresis

    (C) Intravenous azithromycin (Zithromax)

    (D) Intravenous acyclovir (Zovirax)

    (E) Oral amoxicillin (Trimox)

  5. Which one of the following would be used in treating a peripheral neuropathy secondary to heavy metal toxicity?

    (A) Chelation

    (B) Dialysis

    (C) Electromyography

    (D) A good colonic

    (E) B12 supplementation

  6. Which of the following could be seen with the chronic use of phenytoin (Dilantin)?

    (A) Leukocytosis

    (B) Increased liver function levels

    (C) Hyponatremia

    (D) Hypovitaminosis D

    (E) Hypercalcemia

Example PANCE Answers and Explanations

Use this answer key to score the practice neurology questions. The answer explanations give you some insight into why the correct answer is better than the other choices.

1. E. This person has symptoms consistent with a migraine headache and the visual disturbances described are likely scotomas (and an aura). Choice (E), ergotamine and caffeine, is used in treating an acute migraine. Choice (A), oxygen, is one treatment for cluster headaches. Choice (B), cyclobenzaprine, is a muscle relaxer used for treating tension headaches. Choice (C), lisinopril, is used first-line to treat hypertension as well as proteinuria and albuminuria secondary to diabetes. Choice (D), terazosin, is used for hypertension as well as for benign prostatic hyperplasia.

2. B. With rheumatic fever, you may see subsequent Sydenham’s chorea. With Parkinson’s, Choice (A), you see bradykinesia, muscle rigidity, and a pill-rolling tremor. Choice (C), complex regional pain syndrome, is associated with pain, usually in an extremity with bone changes and usually after a significant trauma. Choice (D), multiple sclerosis, is an upper motor neuron lesion, so it’s associated with spasticity. Choice (E), Tourette’s, is associated with tic-like movements, especially facial and verbal tics.

3. B. Kernig’s sign (knee/leg extension) is a test for meningitis. Choice (A) isn’t really a clinical sign; it’s a sign that Rich is hungry and really wants to go out to eat. Choice (C), Tinel’s sign, is associated with carpal tunnel syndrome. Choice (D), Trousseau’s sign, is associated with two things: hypocalcemia and a migratory thrombophlebitis, usually associated with pancreatic cancer. Choice (E), Homans’ sign, is associated with a deep venous thrombosis.

4. D. This woman has encephalitis, namely herpes encephalitis, and you’re going to give intravenous acyclovir. Look at the question setup: The patient is immunosuppressed, presents with a fever, and has had a change in mental status. You see the characteristic finding in hemorrhage of the temporal lobe. Choice (A), methylprednisolone, is given for a multiple sclerosis exacerbation. Choice (B), plasmapheresis, is given to treat myasthenia gravis and Guillain-Barré syndrome. Choice (C), azithromycin, is one of the treatments for community-acquired pneumonia, and Choice (E), amoxicillin, is used for treating otitis media or bacterial sinusitis.

5. A. Heavy metal toxicity can present with a peripheral neuropathy. The treatment is chelation therapy, because these metals are in the tissues and can’t be removed by dialysis, Choice (B). Choice (C), electromyography (EMG), is used to evaluate and diagnose a peripheral neuropathy. Pretty much anyone can benefit from a good colonic, Choice (D), but the colonic won’t treat the problem at hand. Vitamin B12 supplementation, Choice (E), helps only with B12 deficiency.

6. D. Phenytoin (Dilantin) is associated with low vitamin D levels because the drug increases the metabolism of the liver and can deplete the vitamin D levels quickly. This can lead to osteoporosis. Choice (A), leukocytosis, is associated with lithium. You can see Choice (B), increased liver function levels, with valproic acid (Depakote). You can see Choice (C), hyponatremia, with carbamazepine (Tegretol). Concerning Choice (E), phenytoin isn’t associated with hypercalcemia.