PANCE Blueprint Neurology (6%)

PANCE Blueprint Neurology (6%)

PANCE Blueprint Neurology (6%)

Follow along with the NCCPA™ PANCE and PANRE Neurology Content Blueprint

  • 35 PANCE and PANRE Neurology Content Blueprint Lessons (see below)
  • 84 Question Comprehensive Neurology Exam
  • Neurology Pearls Flashcards
  • Neurology Pearls high yield summary tables
  • ReelDX™ integrated video content (available to paid subscribers)

Lessons

  1. Neurology Flashcards (Members Only)

  2. Neurology Comprehensive Exam (Members Only)

  3. Diseases of Peripheral Nerves (PEARLS)

    1. Complex regional pain syndrome

      Non-dermatomal limb pain usually following a trauma or surgery. Upper or lower limbs pain, swelling, reduced range of motion, skin changes, and bone demineralization
      • Pain is disproportionate to the injury with continuing pain that is disproportionate to any inciting event
      • Sensory: hyperalgesia and/or allodynia
      • Vasomotor: skin, temperature, color asymmetry
      • Sudomotor/edema: edema, sweating changes, or sweating asymmetry
      • Motor/trophic: decreased range of motion or motor dysfunction and/or trophic changes (hair, nail, skin)
    2. Peripheral neuropathies

      Symmetric distal sensory loss along with burning pain or weakness
      • Slow onset in stocking glove (hands and feet) pattern think Diabetes mellitus, uremia
      • Fast onset think drugs
      • Ascending think Guillain-Barre Syndrome
  4. Headaches (PEARLS)

    1. Brian Wallace PA-C Podcast: Headaches

    2. Cluster headache

      Severe, unilateral, periorbital pain, lacrimation, and nasal congestion
      • More common in men (4:1). Treatment: 100% oxygen
    3. Migraine (ReelDx)

      Unilateral (70%), throbbing, disabling pain, nausea, vomiting, photophobia
      • Classic: Aura and Common: No aura (80% of migraines)
      • Abortive: Triptans (do not use in ischemic heart disease), ergotamine (do not use in pregnant women)
    4. Tension headache (ReelDx)

      Bilateral, non-throbbing, band-like or "vice like" pain
      • A tension-type headache is typically described as bilateral, mild to moderate, dull pain, whereas a migraine is typically pulsating; unilateral; and associated with nausea, vomiting, and photophobia or phonophobia.
      • Treatment: NSAIDs, Excedrin, muscle relaxer
  5. Infectious Neurologic Disorders (PEARLS)

    1. Encephalitis

      May present similar to meningitis but will see altered mental statusseizures, personality changes, exanthema. Encephalitis is clinically differentiated from meningitis by altered brain functioning.
      • Usually viral: Most common species: HSV or Immunocompromised: CMV
    2. Meningitis (ReelDx)

      Classic Triad: Fever, headache, stiff neck, petechiae (especially N. meningitidis)
      • Kernig's sign: knee flexion causes pain in neck (Remember K = Kernig's and K = Knee)
      • Brudzinski's sign: leg raise when bend neck
      • CSF Finding: 
        • Bacterial: ↑ Protein ↓ Glucose (bacteria love to eat glucose)
          • there is a markedly increased opening pressure
        • Viral:  normal pressure, increased WBC (lymphocytes)
  6. Movement Disorders (PEARLS)

    1. Essential tremor

      Bilateral intention tremor of the hands, forearm, and/or head without resting component
      • Family history in 50-70% of patients, autosomal dominant inheritance. Elderly patients
      • Worse on intention. Hands and head.
      • Better with alcohol
      • Less likely to be unilateral
    2. Huntington Disease

      Inherited autosomal dominant neurodegenerative disease characterized by progressive motor and psychiatric dysfunction, dementia, and chorea (nonrepeating, complex, involuntary rhythmic movements that may appear purposeful)
      • Genetic testing: 40+ CAG repeats
    3. Parkinson disease

      Resting/pill rolling tremor, masked facies,  cogwheel (catching and releasing), bradykinesia, and shuffling gait
      • Decreased dopamine in substantia nigra. Lewy bodies.
  7. Vascular Disorders (PEARLS)

    1. Cerebral aneurysm

    2. Intracranial hemorrhage (ReelDx)

      • Epidural Hematoma:  transient loss of consciousness from an injury, period of lucency, then neurologic deterioration. CT: lens-shaped, biconvex
      • Subdural Hematoma: elderly patient with a history of multiple falls who is now presenting with neurological symptom. May be chronic, taking days to weeks to develop symptoms. CT scan: Crescent shaped density in the brain
      • Subarachnoid hemorrhage: "explosive thunderclap" headache described as "the worst headache ever." Aneurysm or AVM rupture.
    3. Stroke (ReelDx)

    4. Transient ischemic attack

  8. Other Neurologic Disorders (PEARLS)

    1. Altered level of consciousness (ReelDx)

    2. Cerebral palsy (ReelDx)

    3. Concussion (ReelDx)

    4. Dementias

    5. Delirium

    6. Guillain-Barré syndrome

    7. Multiple sclerosis (ReelDx)

    8. Myasthenia gravis (ReelDx)

    9. Postconcussion syndrome

    10. Seizure disorders (ReelDx)

    11. Status epilepticus

    12. Syncope (ReelDx)

    13. Tourette disorder (ReelDx)

Teachers