Neurology Exam Review: Diagnosis of Neurologic Disorders for Physician Assistants

Get ready for your physician assistant certification exam with this high-yield neurology review, based on A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants by Claire Babcock O'Connell and Thea Cogan-Drew. This guide covers essential neurologic disorders, clinical presentations, diagnostic strategies, and treatment approaches to ensure exam success and strong clinical skills.

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Neurologic Examination & Diagnostics

• History & Physical: Evaluate mental status, cranial nerves, motor and sensory function, reflexes, and cerebellar signs.
• Special Diagnostics: Brain and spinal imaging (CT, MRI), EMG, nerve conduction studies, lumbar puncture (LP).

Cerebrovascular Disorders

• Stroke (CVA): Ischemic or hemorrhagic; diagnosed with imaging. Risk factors include hypertension, diabetes, atrial fibrillation, age, and smoking. Thrombolytic therapy is used if eligible within 3–4.5 hours.
• Transient Ischemic Attacks (TIAs): Sudden deficits resolving within an hour. Managed with antiplatelets, anticoagulation, and possible carotid intervention.

Seizure Disorders

• Types: Generalized (loss of consciousness) and focal (localized onset). Status epilepticus = seizures >5 minutes.
• Management: Antiepileptic drugs (lamotrigine, carbamazepine, phenytoin), benzodiazepines for status, airway management.

Multiple Sclerosis (MS)

• Features: Autoimmune CNS demyelination causing sensory loss, weakness, vision/balance problems.
• Diagnosis: Clinical features, MRI lesions, CSF oligoclonal bands. Treated with corticosteroids, disease-modifying therapies.

Dementia & Cognitive Disorders

• Alzheimer’s Disease: Most common; managed with acetylcholinesterase inhibitors, memantine.
• Vascular Dementia: Related to stroke/TIA; manage risk factors.
• Other Types: Frontotemporal dementia, pseudodementia, psychiatric causes.

Headache & Movement Disorders

• Tension Headaches: Band-like pain; treated with analgesics.
• Migraines: Unilateral, pulsatile; treat with NSAIDs, triptans, preventives.
• Cluster Headaches: Severe, unilateral; managed with oxygen, sumatriptan.
• Parkinson’s Disease: Tremor, rigidity, bradykinesia; treated with levodopa, dopamine agonists.
• Huntington’s Disease, Tourette Syndrome: Managed symptomatically.

Peripheral Neuropathies & CNS Infections

• Guillain-Barré Syndrome (GBS): Ascending weakness; treat with IVIG, plasmapheresis.
• Myasthenia Gravis: Fluctuating weakness; treat with cholinesterase inhibitors, immunosuppressants.
• Meningitis & Encephalitis: Diagnose via LP; treat with antibiotics/antivirals.
• Brain/Spinal Cord Injuries: Stabilization, imaging, possible surgery.

Neoplasms & Sleep Disorders

• Brain Tumors: Managed with surgery, radiation, chemotherapy.
• Sleep Disorders: Insomnia, hypersomnia, parasomnias, sleep apnea—treat with sleep hygiene, CPAP if indicated.

Glossary of Key Terms

• Cerebrovascular Accident (CVA): Another term for stroke.
• Seizure: Abnormal brain electrical activity.
• Thrombolytic Therapy: Drugs used to dissolve blood clots.
• Oligoclonal Bands: CSF proteins indicating MS.
• Aura: Sensory warning before migraine or seizure.
• Dyskinesia: Involuntary movements.
• LP (Lumbar Puncture): Diagnostic spinal fluid collection.

Conclusion: Ace the Neurology Section

Success on your physician assistant neurology exam means recognizing clinical presentations, prioritizing diagnostics, and understanding evidence-based treatments. Mastering topics like stroke, seizures, MS, headaches, neuropathies, and movement disorders is essential for high performance on certification exams and delivering quality patient care.

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