Physician Assistant National Certifying Examination (PANCE) Neurology and Behavioral Health Syllabus

Neurology and Behavioral Health syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Neurology and Behavioral Health in Physician Assistant National Certifying Examination (PANCE), not a summary of it.

1. 1

   Cerebrovascular Disease

   3 topics

   • Ischemic stroke
     • Thrombolysis and thrombectomy windows
     • Stroke syndromes by vascular territory
   • Transient ischemic attack
   • Hemorrhagic stroke and subarachnoid hemorrhage
2. 2

   Headache and Seizure Disorders

   3 topics

   • Primary headaches
     • Migraine, tension, cluster
   • Secondary headache red flags
   • Epilepsy and seizure classification
     • Status epilepticus management
3. 3

   Neurodegenerative and Movement Disorders

   4 topics

   • Parkinson disease
   • Alzheimer disease and other dementias
   • Multiple sclerosis
   • Essential tremor and Huntington disease
4. 4

   Peripheral Nerve and Neuromuscular Disorders

   4 topics

   • Peripheral neuropathy
   • Guillain-Barre syndrome
   • Myasthenia gravis
   • Bell palsy and cranial neuropathies
5. 5

   Psychiatric and Behavioral Disorders

   5 topics

   • Mood disorders
     • Major depression and bipolar disorder
   • Anxiety, OCD, and trauma-related disorders
   • Psychotic disorders and schizophrenia
   • Substance use disorders
   • Personality, somatic symptom, and neurodevelopmental disorders

Neurology and Behavioral Health flashcards for Physician Assistant National Certifying Examination (PANCE)

18 of 51 cards from the Neurology and Behavioral Health deck — real questions with worked answers.

1. What is the defining time threshold that distinguishes a transient ischemic attack (TIA) from an ischemic stroke?

   A TIA causes transient neurologic deficits from focal ischemia WITHOUT acute infarction on imaging (classically resolving within 24 hours, usually under 1 hour). An ischemic stroke shows infarction with persistent deficits.

2. What is the time window for IV tissue plasminogen activator (alteplase/tPA) in acute ischemic stroke?

   Within 3 hours of symptom onset (extended to 4.5 hours in selected eligible patients). Mechanical thrombectomy can be done up to 24 hours for large-vessel occlusion in selected patients.

3. Before giving IV thrombolytics for suspected acute stroke, what is the single most important imaging study to obtain first, and why?

   A non-contrast head CT — to exclude hemorrhagic stroke (an absolute contraindication to thrombolysis).

4. In ischemic stroke not eligible for thrombolysis, what is the recommended early blood pressure management?

   Permissive hypertension — do not lower BP unless it exceeds $\geq 220/120$ mmHg (or $\geq 185/110$ mmHg if thrombolysis is planned). Excessive lowering worsens penumbral perfusion.

5. A patient has acute monocular vision loss described as a 'curtain coming down' (amaurosis fugax). What is this a warning sign of?

   Transient ischemic attack from carotid artery atherosclerosis/embolism — it reflects retinal artery ischemia and signals high stroke risk.

6. What scoring tool estimates short-term stroke risk after a TIA, and name two of its components?

   The $ABCD^{2}$ score. Components: Age $\geq 60$, Blood pressure $\geq 140/90$, Clinical features (unilateral weakness, speech disturbance), Duration of symptoms, and Diabetes.

7. What is the classic clinical presentation of a subarachnoid hemorrhage (SAH)?

   Sudden, severe 'thunderclap' headache ('worst headache of my life'), often with nuchal rigidity, photophobia, and possible loss of consciousness. Most commonly from a ruptured saccular (berry) aneurysm.

8. In suspected SAH with a negative non-contrast CT, what is the next diagnostic step?

   Lumbar puncture looking for xanthochromia (yellow CSF from RBC breakdown) and/or persistently elevated RBCs across tubes.

9. Which medication is used to prevent cerebral vasospasm and improve outcomes after aneurysmal subarachnoid hemorrhage?

   Nimodipine (a calcium channel blocker), given for 21 days.

10. Compare the typical cause and location of hypertensive intracerebral hemorrhage versus lobar hemorrhage in the elderly.

    Hypertensive hemorrhage typically occurs in deep structures (basal ganglia/putamen, thalamus, pons, cerebellum) from chronic hypertension. Lobar hemorrhage in the elderly is often from cerebral amyloid angiopathy.

11. What are the diagnostic features distinguishing migraine from tension-type headache?

    Migraine: unilateral, pulsating, moderate-severe, worsened by activity, with nausea/photophobia/phonophobia, lasting 4-72 hours. Tension: bilateral, pressing/tightening (band-like), mild-moderate, NOT worsened by activity, no nausea.

12. What characterizes a cluster headache and its classic demographic?

    Severe unilateral periorbital/temporal pain lasting 15-180 minutes, occurring in clusters, with ipsilateral autonomic signs (lacrimation, rhinorrhea, ptosis, miosis, conjunctival injection). Classically affects middle-aged men; attacks often nocturnal.

13. What are the acute abortive and preventive treatments for cluster headache?

    Acute: 100% high-flow oxygen and subcutaneous sumatriptan. Preventive: verapamil (first-line).

14. List the classic 'red flag' features of a secondary headache (SNOOP mnemonic).

    Systemic symptoms/Secondary risk (fever, weight loss, cancer, HIV); Neurologic deficits; Onset sudden (thunderclap); Older age (>50, new headache); Pattern change/Progressive/Positional/Papilledema/Precipitated by Valsalva.

15. An older patient presents with new headache, jaw claudication, scalp tenderness, and elevated ESR. What is the diagnosis and immediate treatment?

    Giant cell (temporal) arteritis. Start high-dose corticosteroids IMMEDIATELY (before biopsy) to prevent irreversible vision loss; confirm with temporal artery biopsy.

16. What is the difference between a focal (partial) seizure and a generalized seizure?

    Focal seizures begin in one hemisphere/region (may be with or without impaired awareness) and can secondarily generalize. Generalized seizures involve both hemispheres from onset with impaired consciousness (e.g., tonic-clonic, absence, myoclonic, atonic).

17. How is status epilepticus defined, and what is the first-line abortive medication?

    Continuous seizure activity $\geq 5$ minutes, or recurrent seizures without recovery of consciousness between them. First-line abortive therapy: IV benzodiazepine (lorazepam), followed by a longer-acting agent (e.g., levetiracetam, fosphenytoin/phenytoin, or valproate).

18. Describe a typical childhood absence seizure and its EEG finding.

    Brief (5-10 sec) episodes of staring/behavioral arrest with impaired awareness, no postictal confusion, may be triggered by hyperventilation. EEG shows generalized 3-Hz spike-and-wave discharges. Treated with ethosuximide.

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