PANCE Type Neuro Questions

Question 1

A 58-year-old male presents complaining of weakness of his grip. Your examination reveals that the problem is bilateral. During the next few office visits, you note the development of hyperactivity of his DTRs, extensor plantar reflexes, and dysarthria. The patient’s sensory system remains normal and he denies any urinary symptomatology. Which of the following is the most likely diagnosis?

1. MS
2. Alzheimer’s Dz
3. Huntington’s chorea
4. ALS
5. Myasthenia gravis

Answer 1

ALS

Progressive bilateral muscle Dz

Lower motor neuron fasciculations
Hyperreflexia
Upper motor neuron (plantar reflexes)
Dysarthria

Sensation is normal as is bladder function.
~~MS may have dysarthria, but reflexes are normal, sensation is impaired and bladder function is frequently affected.
~~Alzheimer’s has normal neuro exam with cognitive disability.
~~Huntington’s causes a movement disorder with writhing choreiform movements of the body.
~~Myasthenia causes fatigue of the ocular muscles typically worsening at the end of the day