Neuro PANCE Blueprint Topics & High-Yield Review

Anika, a 32-year-old woman, presents to the emergency department with progressive weakness that started in her feet and is now affecting her legs and arms. The physician suspects Guillain–Barré syndrome and orders a lumbar puncture. Based on this clinical scenario, which CSF profile fits the expected findings?

• Elevated protein with normal WBC

• Low protein with elevated WBC

• Elevated protein with neutrophilic predominance

• Normal protein with elevated WBC

Answer explanation

In Guillain–Barré syndrome, the CSF typically shows elevated protein levels with a normal white blood cell count (albuminocytologic dissociation). This aligns with the correct choice: elevated protein with normal WBC.

A 76-year-old retired accountant presents with 2 years of progressive memory problems, getting lost in familiar places, and difficulty with date and time. Which feature most specifically supports early Alzheimer’s disease rather than normal aging based on this case description?

• Occasional irritability with mild social withdrawal

• Forgetting recent conversations and repeating questions

• Misplacing items intermittently without functional impact

• Stable ability to manage finances and medications

Answer explanation

Forgetting recent conversations and repeating questions indicates a decline in memory function, which is more characteristic of early Alzheimer's disease than normal aging, where such severe memory issues are less common.

James visits his doctor for a routine check-up. According to his past medical history and the medications listed in his chart, which combination is correctly matched for James?

• Hypertension treated with hydrochlorothiazide; hyperlipidemia treated with atorvastatin

• Osteoarthritis treated with citalopram; hypertension treated with acetaminophen

• Hyperlipidemia treated with hydrochlorothiazide; depression treated with acetaminophen

• Hypertension treated with atorvastatin; osteoarthritis treated with hydrochlorothiazide

Answer explanation

The correct combination is hypertension treated with hydrochlorothiazide and hyperlipidemia treated with atorvastatin, as these medications are standard treatments for these conditions.

Anika is a 72-year-old woman whose social history notes she lives alone, is a non-smoker, and consumes a glass of wine occasionally. Considering risk and protective factors for dementia progression, which counseling point best fits her case?

• Advise complete alcohol abstinence because any intake accelerates Alzheimer’s progression

• Encourage continued social engagement with her daughter and reintroducing enjoyable activities

• Recommend stopping atorvastatin to reduce cognitive side effects

• Increase acetaminophen use daily to maintain routine and prevent confusion

Answer explanation

Encouraging social engagement and enjoyable activities is crucial for Anika's mental health and can help mitigate dementia progression, making it the best counseling point in her case.

A patient presents with short-term recall difficulties for 2 years, hesitancy in conversations due to losing her train of thought, occasional wrong turns while driving, and forgetting morning toothbrushing. Her neuro exam and vital signs are normal for age. What is the most appropriate next diagnostic step to further evaluate suspected Alzheimer’s dementia at this stage?

• Order Mini-Mental State Examination (MMSE) or similar cognitive screening and consider brain imaging

• Perform emergent lumbar puncture for CNS infection

• Initiate high-dose corticosteroids to reverse cognitive decline

• Schedule cardiac catheterization to rule out vascular causes

Answer explanation

The patient's symptoms suggest cognitive decline, warranting a cognitive screening like the MMSE. Brain imaging can help rule out other causes of dementia, making this the most appropriate next step.

A patient presents as alert, cooperative, and well-groomed, oriented to person but not to place or time. Neurologic exam shows intact cranial nerves, normal strength, normal sensation, normal reflexes, normal gait, and an MMSE score of 22/30 with poor recall after five minutes. Which finding most directly supports cognitive impairment rather than a primary motor or sensory deficit?

• Normal gait without ataxia

• Intact cranial nerves on examination

• Poor delayed recall of three objects

• Normal deep tendon reflexes

Answer explanation

Poor delayed recall of three objects indicates cognitive impairment, as it reflects memory dysfunction. The other findings, like normal gait and intact cranial nerves, suggest no primary motor or sensory deficits.

Benjamin, a 72-year-old man, is being evaluated for progressive memory loss. His laboratory studies reveal normal CBC, normal comprehensive metabolic panel, normal thyroid function tests, normal vitamin B12 and folate, and a head CT showing mild cortical atrophy with no acute intracranial pathology. Which conclusion best aligns with these results when evaluating his cognitive decline?

• Metabolic or endocrine causes are likely and warrant urgent correction

• Nutritional deficiency is the principal cause of symptoms

• Structural emergency is present and requires neurosurgical intervention

• Reversible systemic causes are less likely; findings are consistent with a degenerative process

Answer explanation

The normal lab results and mild cortical atrophy suggest a degenerative process rather than reversible systemic causes. This aligns with the conclusion that cognitive decline is likely due to a neurodegenerative condition.

Evelyn visits her doctor with concerns about her memory and mood. During the appointment, the doctor decides to use specific tools to assess both her cognitive function and screen for depression. Which combination of tools from the visit specifically targets cognition and mood screening to aid diagnosis?

• MMSE and lipid panel

• MOCA and PHQ-9

• CT head and MMSE

• EEG and PHQ-9

Answer explanation

The MOCA (Montreal Cognitive Assessment) specifically evaluates cognitive function, while the PHQ-9 (Patient Health Questionnaire-9) screens for depression. This combination effectively addresses Evelyn's concerns about memory and mood.

Anika, a 72-year-old patient, presents with MMSE 23/30 and MOCA 18/30, showing deficits in orientation, visuospatial and executive tasks, animal naming, delayed recall, and drawing. Which diagnosis is most likely, and what initial medication is recommended to start if tolerated?

• Vascular dementia; start memantine 20 mg immediately

• Frontotemporal dementia; start sertraline 50 mg daily

• Alzheimer’s dementia; start donepezil 5 mg daily and titrate to 23 mg over months

• Delirium; start haloperidol 10 mg nightly

Answer explanation

The patient's cognitive deficits and scores indicate Alzheimer's dementia. Donepezil is the recommended initial medication, starting at 5 mg daily and titrating up to 23 mg, which is standard for managing this condition.

Harper is administering the Montreal Cognitive Assessment (MOCA) to a patient. As part of the Visuospatial/Executive section, which task should Harper use to evaluate the patient's planning and visual construction skills?

• Repeat the phrase "No ifs, ands, or buts"

• Copy a cube and draw a clock indicating ten past eleven

• Name pictured animals such as a lion, rhinoceros, and camel

• Tap when hearing the letter A during a letter list

Answer explanation

The task to evaluate planning and visual construction skills in the MOCA is to copy a cube and draw a clock indicating ten past eleven. This assesses both visuospatial abilities and executive function, unlike the other options.