PANCE, Medical exams, 7%

Neurologic System

Neurology questions test localization, time-critical stroke and seizure management, and chronic neurodegenerative and demyelinating disease. Expect vignettes where the physical examination localizes the lesion before imaging is offered.

Position: 6 of 15 content areas
Published weighting: 7% in the official framework
Topics covered: 7 topics in this guide

What is covered

Topics inside this content area.

These topics describe the scope students most often review for this part of PANCE. Treat them as a study checklist rather than an exhaustive list of what a single exam form can sample.

Cerebrovascular disease: Ischemic and hemorrhagic stroke syndromes, TIA risk stratification, and treatment windows.
Headache disorders: Migraine, tension, and cluster patterns plus the red flags that force urgent imaging.
Seizure disorders: Focal versus generalized classification, first-line agents, and status epilepticus response.
Movement disorders and dementia: Parkinson disease, essential tremor, and the differentiating features of the major dementias.
Demyelinating and neuromuscular disease: Multiple sclerosis, Guillain-Barré, myasthenia gravis, and their diagnostic studies.
CNS infections: Meningitis and encephalitis CSF patterns and empiric coverage by age group.
Peripheral neuropathies and cranial nerve disorders: Entrapment syndromes, Bell palsy, and the diabetic neuropathy spectrum.

Study tips

How to practice Neurologic.

Section-specific guidance that follows from how this material is usually tested.

Practice CSF-pattern interpretation as a table you can reproduce from memory.
Learn stroke syndromes by artery with one sentence of deficit each.
Use games or rapid-fire rounds for cranial-nerve findings; speed builds durable recognition.

Where this fits

Neurologic System is 6 of 15 content areas in the PANCE guide, and it carries a published weighting of 7% in the official framework. Use the full guide to balance it against everything else you have to review.

Back to the PANCE guide Official exam information

Sample Neurologic questions

Practice questions, not yet expert-reviewed

Original practice questions written to the published framework for this section. No expert has reviewed them, and they are not taken from any official exam. Try each one before you open the answer.

Question 1Foundational
Lumbar puncture returns cerebrospinal fluid with a neutrophil predominance, a glucose level well below the serum value, and elevated protein. Which diagnosis does this profile indicate?
1. AAcute bacterial meningitis
2. BViral meningitis
3. CGuillain-Barre syndrome
4. DSubarachnoid hemorrhage
Show answer
Answer: A. Acute bacterial meningitis
Bacteria consume cerebrospinal fluid glucose and provoke a brisk neutrophilic response, so a high neutrophil count with glucose well below the serum value and high protein is the classic bacterial profile. Viral meningitis is the tempting distractor because it also raises the cell count, but it produces a lymphocyte predominance with a normal glucose level.
Key insight: Low cerebrospinal fluid glucose is the finding that separates bacterial meningitis from viral meningitis.
Question 2Foundational
A 40-year-old develops acute unilateral facial droop that includes inability to wrinkle the forehead and close the eye on that side, with no weakness elsewhere. What is the most likely diagnosis?
1. AIschemic stroke of the middle cerebral artery
2. BBell palsy
3. CTrigeminal neuralgia
4. DMyasthenia gravis
Show answer
Answer: B. Bell palsy
Bell palsy is an idiopathic peripheral facial nerve palsy, and because the lower motor neuron lesion affects the entire hemiface the forehead is involved. A middle cerebral artery stroke is the tempting distractor, but a central lesion spares the forehead thanks to bilateral cortical innervation of the upper face and would usually cause limb findings as well.
Key insight: Forehead involved means peripheral facial nerve; forehead spared means look for a central cause.
Question 3Intermediate
Which primary headache disorder causes severe unilateral periorbital pain lasting 15 to 180 minutes with ipsilateral lacrimation, rhinorrhea, and ptosis, striking in daily bouts for weeks at a time?
1. AMigraine with aura
2. BTension-type headache
3. CCluster headache
4. DTrigeminal neuralgia
Show answer
Answer: C. Cluster headache
Cluster headache is defined by short, excruciating unilateral orbital attacks with ipsilateral cranial autonomic features and restlessness, occurring in clusters over weeks. Migraine is the tempting distractor but lasts 4 to 72 hours, drives people to lie still in a dark room, and does not produce lacrimation and rhinorrhea on one side.
Key insight: Short attacks with a red, tearing eye and a pacing patient means cluster, not migraine.
Question 4Intermediate
Which autoantibody is found in the majority of patients with generalized myasthenia gravis?
1. AAcetylcholine receptor antibody
2. BVoltage-gated calcium channel antibody
3. CAnti-ganglioside GQ1b antibody
4. DAnti-aquaporin-4 antibody
Show answer
Answer: A. Acetylcholine receptor antibody
Most people with generalized myasthenia gravis have antibodies against the postsynaptic acetylcholine receptor, which explains the fatigable weakness, ptosis, and diplopia that worsen with use. Voltage-gated calcium channel antibodies are the tempting distractor, but they define Lambert-Eaton myasthenic syndrome, a presynaptic disorder whose strength briefly improves with repeated effort.
Key insight: Postsynaptic receptor antibodies cause weakness that worsens with use; presynaptic calcium channel antibodies cause weakness that improves briefly with use.
Question 5Advanced
A 76-year-old has a broad-based magnetic gait, urinary incontinence, and progressive cognitive decline, and lumbar puncture shows a normal opening pressure with ventriculomegaly on imaging. What is the most likely diagnosis?
1. AAlzheimer disease
2. BParkinson disease
3. CNormal pressure hydrocephalus
4. DVascular dementia
Show answer
Answer: C. Normal pressure hydrocephalus
The triad of gait apraxia, urinary incontinence, and cognitive impairment with enlarged ventricles and a normal opening pressure defines normal pressure hydrocephalus, which is one of the few potentially reversible dementia syndromes. Alzheimer disease is the tempting distractor but begins with memory loss rather than gait disturbance and does not produce early incontinence with ventriculomegaly.
Key insight: When the gait fails before the memory does, think normal pressure hydrocephalus and a potentially treatable cause.

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Neurologic System