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PANCE — Neurology, Psychiatry and Musculoskeletal flashcards

10 of 74 cards free to study here · 3 topics · the whole deck is built into Willys

Board-style vignettes on fractures, joints, spine and rheumatologic disease; stroke, headache, seizures, neuromuscular and movement disorders, meningitis and dementia; and mood, anxiety, psychotic and substance use disorders.

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Learn deck · part of PANCE (Physician Assistant boards) · written against: NCCPA PANCE content blueprint, effective January 2025 (organ systems); no dosing. Updated 2026-10-10.

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  1. After a fall on an outstretched hand, a patient has tenderness in the anatomic snuffbox but a normal wrist X-ray. What is the next step, and why?
    Immobilize in a thumb spica splint and repeat imaging in 1–2 weeks (or get an MRI). An occult scaphoid fracture is likely, and its retrograde blood supply puts the proximal pole at risk of avascular necrosis and nonunion.
    Musculoskeletal › Upper Extremity and Spine
  2. Which rotator cuff tendon is torn most often, and which exam test isolates it?
    The supraspinatus, tested with the empty can (Jobe) test. A positive drop-arm test suggests a full-thickness tear.
    Musculoskeletal › Upper Extremity and Spine
  3. After an anterior shoulder dislocation, a patient has numbness over the lateral shoulder and weak abduction. Which nerve is injured?
    The axillary nerve, which supplies the deltoid and the skin over it. Check it before and after reduction.

    Watch out: a posterior dislocation suggests a seizure or electric shock.
    Musculoskeletal › Upper Extremity and Spine
  4. A child falls on an outstretched arm and has a displaced supracondylar humerus fracture. Which structures are at risk?
    The brachial artery and the median nerve (especially its anterior interosseous branch). Missed vascular compromise can cause forearm compartment syndrome and a Volkmann ischemic contracture.
    Musculoskeletal › Upper Extremity and Spine
  5. A patient arrives with acute left-sided weakness. What is the first imaging study, and why?
    Noncontrast CT of the head, to rule out hemorrhage before giving thrombolytics. Early ischemic strokes often look normal on CT.
    Neurologic › Cerebrovascular Disease
  6. Which patients with acute ischemic stroke qualify for IV thrombolysis, and which qualify for mechanical thrombectomy?
    As of the 2026 AHA/ASA guideline, IV thrombolysis (alteplase or tenecteplase) is for eligible patients within 4.5 hours of last known well, or later in selected patients with salvageable tissue on advanced imaging. Mechanical thrombectomy is for large-vessel occlusion, up to 24 hours in selected patients on imaging.
    Neurologic › Cerebrovascular Disease
  7. A patient has contralateral leg weakness worse than arm weakness, with urinary incontinence. Which artery territory is involved?
    The anterior cerebral artery, which supplies the medial frontal and parietal lobes where the leg is represented.
    Neurologic › Cerebrovascular Disease
  8. Which criteria define a major depressive episode?
    Five or more of nine symptoms for at least 2 weeks, one of which must be depressed mood or anhedonia, causing distress or impairment. The nine are depressed mood plus SIG E CAPS: sleep, interest, guilt, energy, concentration, appetite, psychomotor change and suicidality.
    Psychiatry › Mood and Anxiety Disorders
  9. How long must symptoms last to diagnose a manic episode versus a hypomanic episode?
    Mania: at least 7 days (or any length if hospitalization is needed), with marked impairment. Hypomania: at least 4 days without marked impairment or psychosis. Mania defines bipolar I; hypomania plus major depression defines bipolar II.
    Psychiatry › Mood and Anxiety Disorders
  10. A patient with depression is started on an SSRI and within weeks has a decreased need for sleep, pressured speech and grandiosity. What should you suspect?
    Bipolar disorder unmasked by antidepressant-induced mania. In bipolar I disorder, an antidepressant is not given alone; a mood stabilizer or certain antipsychotics are used.
    Psychiatry › Mood and Anxiety Disorders

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About these cards

Review status: Second-reader reviewed, with corrections applied.

Checked against:

  • NCCPA PANCE content blueprint, effective January 2025 (topic outline only; no text copied)
  • Checked against standard internal-medicine references (reference only; no text copied)
  • Checked against the 2026 AHA/ASA acute ischemic stroke guideline, the 2020 ACR gout guideline, the 2019 EAN trigeminal neuralgia guideline, the 2018 CANMAT/ISBD bipolar disorder guidelines and DSM-5-TR criteria (reference only; no text copied)
  • Also checked against the 2021 ACR rheumatoid arthritis, 2021 ACR/VF giant cell arteritis and 2019 ACR/SAA/SPARTAN axial spondyloarthritis guidelines; the 2021 AAOS hip fracture guideline; the ACR Appropriateness Criteria for acute hand and wrist trauma; the IWGDF/IDSA 2023 diabetes-related foot infection guideline; the ESO 2021 carotid guideline; the EAN/PNS 2023 Guillain-Barré guideline; the MGFA international consensus guidance and the 2025 Israeli national guideline on myasthenia gravis; the 2018 UK consensus guideline on idiopathic intracranial hypertension; the 2021 AAN early Parkinson disease guideline; the 2004 IDSA bacterial meningitis guideline; the AAO-HNSF 2013 Bell's palsy guideline; the AAP 2019 ADHD guideline; NICE guidelines CG78, CG113, CG150, CG178, NG116, NG128, NG220 and NG240; and current FDA prescribing information on DailyMed (reference only; no text copied)

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