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Rank #55 in Medicine category

Education
Health & Fitness
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The Audio PANCE and PANRE Physician Assistant Board Review Podcast

Updated about 19 hours ago

Rank #55 in Medicine category

Education
Health & Fitness
Medicine
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Multiple Choice Physician Assistant Board Review and Rotation Exam Questions on the Go – Listen and Learn

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Multiple Choice Physician Assistant Board Review and Rotation Exam Questions on the Go – Listen and Learn

iTunes Ratings

128 Ratings
Average Ratings
99
17
7
2
3

Intro is death otherwise incredible

By Ggk2626 - Oct 18 2019
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This podcast is awesome! Sometimes I have to listen to the questions twice because I like to read thrones but honestly the questions are so great and the explanation is amazing. My teachers in pa school even steal his questions for exams

Indispensable

By Musicoholic4 - Jul 19 2019
Read more
After I got used to skipping the intro, the core content is consistently high quality. Ive listened multiple times thru!

iTunes Ratings

128 Ratings
Average Ratings
99
17
7
2
3

Intro is death otherwise incredible

By Ggk2626 - Oct 18 2019
Read more
This podcast is awesome! Sometimes I have to listen to the questions twice because I like to read thrones but honestly the questions are so great and the explanation is amazing. My teachers in pa school even steal his questions for exams

Indispensable

By Musicoholic4 - Jul 19 2019
Read more
After I got used to skipping the intro, the core content is consistently high quality. Ive listened multiple times thru!

Best weekly hand curated episodes for learning

Cover image of The Audio PANCE and PANRE Physician Assistant Board Review Podcast

The Audio PANCE and PANRE Physician Assistant Board Review Podcast

Latest release on Nov 09, 2020

Best weekly hand curated episodes for learning

The Best Episodes Ranked Using User Listens

Updated by OwlTail about 19 hours ago

Rank #1: Cardiology 1: The Audio PANCE and PANRE Board Review Podcast Episode 27

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Welcome to episode 27 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Over the next few episodes I will be covering topic specific PANCE and PANRE review from the Academy course content following the NCCPA content blueprint.

This week we will be covering 10 topic specific Cardiology board review questions.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full cardiology review includes over 147 cardiology specific questions and is available to all members of the PANCE and PANRE Academy.

  • You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
  • You can listen to the latest episode, take an interactive quiz and download your results below.

Listen Carefully Then Take The Quiz

If you can’t see the audio player click here to listen to the full episode.

Cardiology Questions 1-10

You can take the interactive exam by clicking here.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy.

I will be be releasing new episodes every two weeks. The Academy is currently discounted, so sign up now.

Resources and Show Notes:

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

The post Cardiology 1: The Audio PANCE and PANRE Board Review Podcast Episode 27 appeared first on The Audio PANCE and PANRE.

Sep 30 2015

13mins

Play

Rank #2: Pulmonology 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 29

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Welcome to episode 29 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Over the next few episodes I will be covering topic specific PANCE and PANRE review from the Academy course content following the NCCPA content blueprint.

This week we will be covering 10 topic specific Pulmonology board review questions.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full pulmonology review includes over 142 pulmonology specific questions and is available to all members of the PANCE and PANRE Academy.

  • You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
  • You can listen to the latest episode, take an interactive quiz and download your results below.

Listen Carefully Then Take The Quiz

If you can’t see the audio player click here to listen to the full episode.

Pulmonology PANCE and PANRE Podcast Quiz

You can take the interactive exam by clicking here.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy.

I will be releasing new episodes every few weeks. The Academy is currently discounted, so sign up now.

Resources and Show Notes:

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

The post Pulmonology 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 29 appeared first on The Audio PANCE and PANRE.

Nov 09 2015

15mins

Play

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Rank #3: Murmur Madness: The Audio PANCE and PANRE Episode 45

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Welcome to episode 45 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Today we are going to take a brief detour away from 10 daily questions and instead cover the murmurs you need to know for your PANCE and PANRE exam.

I have still included an 11 question exam at the end of this post so make sure you scroll down after you listen to the podcast.

There are a total of 17 cardiac conditions that may present on exam day in the form of a descriptive sound/murmur.

You will often be given supporting evidence such as the location of auscultation or radiation which you can use to narrow down your options.

There are total of 51 cardiac topics in the  NCCPA Cardiology PANCE and PANRE Content Blueprint which represents 16% of the PANCE and PANRE exam.

(click here to download the FREE NCCPA Content Blueprint cheat sheet)

These cardiac conditions and their associated murmurs cover a whopping 33% of the cardiology section of the PANCE and PANRE exam!

Take a listen to this week’s podcast episode

If you can’t see the audio player click here to listen to the full episode.

Let’s break this all down:

Each of the links below opens the corresponding lesson on SmartyPANCE and is available to members (you must be logged in or join now)

There are 9 valvular disorders associated with murmurs:

Valvular Disorders (PEARLS and Flashcards)

  1. Aortic stenosis (ReelDx)
  2. Aortic regurgitation (Diastolic Murmur)
  3. Mitral stenosis (Diastolic)
  4. Mitral regurgitation
  5. Mitral valve prolapse
  6. Tricuspid stenosis
  7. Tricuspid regurgitation
  8. Pulmonary stenosis
  9. Pulmonary regurgitation

Five congenital heart diseases that have corresponding murmurs

Congenital Heart Diseases (PEARLS)

  1. Atrial septal defect
  2. Coarctation of the aorta
  3. Patent ductus arteriosus
  4. Tetralogy of Fallot
  5. Ventricular septal defect

One murmur associated with cardiomyopathy

  1. Hypertrophic cardiomyopathy

And a pair of conditions nested under the label of “other forms of heart disease” that have associated murmurs/heart sounds worth mentioning

Other Forms of Heart Disease (PEARLS)

  1. Acute and subacute bacterial endocarditis
  2. Acute pericarditis

Making Sense of Murmurs

Let’s start with the valvular disorders:

You have 4 heart valves with two main conditions – half are diastolic murmurs and half are systolic murmurs. Here is a helpful mnemonic:

Recalling Common Systolic Heart Murmurs: MR PASS

  • itral
  • egurgitation
  • hysiologic (also known as functional, systolic flow murmur, a heart murmur heard in the absence of cardiac abnormality)
  • ortic
  • tenosis
  • ystolic – All the above murmurs are heard during systole.

MR PASS wins the Most Valuable Player award.

  • itral
  • alve
  • rolapse – Add MVP as another systolic murmur.

MR PASS often hangs around with MS ARD.

  • itral
  • tenosis
  • ortic
  • egurgitation
  • iastolic – All the above murmurs are heard during diastole.

Here are the nine valvular murmurs and their associated descriptions

Remember which are systolic and diastolic this can be very helpful at ruling out or ruling in a condition come exam day.

  1. Aortic Stenosis – Systolic harsh ejection crescendo decrescendo murmur at RUSB (aortic area) with radiation to the neck and apex
  2. Aortic Regurgitation – diastolic – soft high pitched blowing at LSB with patient sitting leaning forward and exhaling
  3. Mitral stenosis – diastolic – low pitched decrescendo rumbling with opening snap at the APEX (the mitral area) enhanced by expiration
  4. Mitral regurgitation – blowing holosystolic murmur loudest at the APEX (the mitral area) with a split S2 that radiates to the axilla and is increased by squatting, handgrip and expiration
  5. Tricuspid Stenosis – diastolic – mid diastolic rumbling at LLSB (tricuspid area) with opening snap
  6. Tricuspid regurgitation – High pitched holosystolic blowing murmur that radiates to the LSB (tricuspid area)
  7. Pulmonic stenosis – harsh midsystolic ejection crescendo-decrescendo murmur with widely split s2 at LSB that radiates to the left shoulder and neck
  8. Pulmonic regurgitation – diastolic –  high pitched, decrescendo murmur at LUSB increase with inspiration
  9. Mitral valve prolapse – Midsystolic ejection click head best at the APEX (the mitral area)

With these valvular murmurs you have 4 auscultation points which can be easily remembered using the mnemonic APT Ment watch this amazing video so you never forget!

Another helpful mnemonic: Aortic Pulmonic Tricuspid Mitral – ll P hysicians T ake M oney!

  1. Aortic area: right 2nd interspace (Right upper sternal border RUSB)
  2. Pulmonic area: 2nd left interspace (Left upper sternal border LUSB)
  3. Tricuspid area: Left lower sternal border LLSB
  4. Mitral area: APEX

You can use the auscultation point to successfully narrow down your murmur and use the designation of systolic or diastolic to narrow down even further.

Five congenital heart diseases that have corresponding murmurs

Congenital Heart Diseases (PEARLS)

  1. Atrial septal defect – Systolic ejection murmur at 2nd left intercostal space with an early to mid-systolic rumble and fixed splitting of the 2nd heart sound (s2) and CXR will show pulmonary vascular markings.
  2. Coarctation of the aorta – Late systolic ejection murmur-posterior or continuous murmur if collateral flow. Will have absent or weak femoral pulses with a delay of palpable femoral pulse and HTN in arms but low or normal blood pressure in the legs
  3. Patent ductus arteriosus – Continuous, rough, machinery-like murmur, heard best in the first interspaces of the LSB
  4. Tetralogy of Fallot – Harsh systolic ejection murmur heard best at the left sternal border. Associated with bluish skin, trouble gaining weight, and sudden loss of consciousness during crying or feeding
  5. Ventricular septal defect – Harsh high pitched holosystolic murmur heard best at the LSB with ride radiation and a fixed split S2

Several of these conditions have a “tell” that make it easy to identify the condition and they are usually always part of the root of the question.

  • PDA = machinery like murmur (remember that the physician assistant got a patent on his machine).
  • Tetralogy of Fallot usually presents with a young child having TET spells which are described as bluish skin, trouble gaining weight, and sudden loss of consciousness during crying or feeding. 
  • Coarctation will almost always present with absent or weak femoral pulses with a delay of palpable femoral pulse and HTN in arms but low or normal blood pressure in the legs. 
  • ASD is a bit tougher but they will usually give you a wide and fixed splitting of the S2 and patients will be easily fatigued. CXR will show pulmonary vascular markings.
  • VSD will have a high pitched holosystolic murmur and newborns may show dyspnea.

One murmur associated with cardiomyopathy

  1. Hypertrophic cardiomyopathy – Medium-pitched, mid-systolic murmur that decreases with squatting and increases with straining. S4 gallop and apical lift with thick, stiff left ventricle. HCM is the leading cause of sudden death in athletes and may cause angina.

And a pair of conditions nested under the label of “other forms of heart disease” that have associated murmurs/heart sounds worth mentioning

Other Forms of Heart Disease (PEARLS)

  1. Acute and subacute bacterial endocarditis  – A new mitral regurgitant murmur in a patient with a history of IVDA, fever (39.0º C),* and a blood culture that reveals 2 out of 2 positive growth
  2. Acute pericarditis – Although this is not a murmur, it is important to identify a pericardial friction rub heard best with patient upright and leaning forward. Chest pain is also relieved by sitting and/or leaning forward

You can listen to all these murmurs and see their associated waveforms at www.smartypance.com/courses/cardiology

Here is a wonderful video from the Khan Academy of how to approach murmurs video of murmurs

Murmur Flash Cards

Episode 45 PANCE and PANRE Murmur Quiz

You will see from these questions on the PANCE and PANRE things aren’t always so straightforward.

You can take the exam here: thepalife.com/murmur-madness

Looking for all the podcast episodes?

This FREE podcast series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy + SmartyPANCE

I will be releasing new episodes every few weeks. The Academy is discounted and now includes complimentary access to SmartyPANCE so sign up now.

Included is a full cardiology content blueprint board review exam with over 147 cardiology specific questions and 51 cardiology blueprint topics covered in detail. This is in addition to 1,000’s of additional board review questions and NCCPA content blueprint courses covering all 13 organ areas.

I am also happy to introduce ReelDX patient case based integration into many of the SmartyPANCE blueprint lessons. It’s like a virtual rotation from the comfort of your couch!

This podcast is available on iTunes and Stitcher Radio (among others)

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

The post Murmur Madness: The Audio PANCE and PANRE Episode 45 appeared first on The Audio PANCE and PANRE.

Jan 05 2017

14mins

Play

Rank #4: Gastroenterology 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 31

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Welcome to episode 31 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I continue to cover topic specific PANCE and PANRE review from the Academy course content following the NCCPA content blueprint.

This week we will be covering 10 topic specific Gastroenterology board review questions.

Gastroenterology and Nutrition accounts for 10% of your PANCE/PANRE board exam.  

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full Gastroenterology/Nutrition review includes over 149 GI/Nutrition specific questions and is available to all members of the PANCE and PANRE Academy.

  • You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
  • You can listen to the latest episode, take an interactive quiz and download your results below.

Listen Carefully Then Take The Quiz

If you can’t see the audio player click here to listen to the full episode.

Pulmonology PANCE and PANRE Podcast Quiz

You can take the interactive exam by clicking here.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy.

I will be releasing new episodes every few weeks. The Academy is currently discounted, so sign up now.

Resources and Show Notes:

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

The post Gastroenterology 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 31 appeared first on The Audio PANCE and PANRE.

Dec 21 2015

13mins

Play

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Rank #5: Episode 59: Emergency Medicine EOR – The Audio PANCE and PANRE Board Review Podcast

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The Audio PANCE/PANRE PA Board Review Podcast

Welcome to episode 59 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover ten Emergency Medicine End of Rotation Exam (EOR) review questions from the SMARTYPANCE course content following the NCCPA and PAEA content blueprint (download the FREE cheat sheet).

This week we will be covering ten emergency medicine end of rotation exam questions based on the NCCPA PANCE and PANRE Content Blueprint.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and SMARTYPANCE which are now bundled together into one very low price.

Listen Carefully Then Take The Practice Exam

If you can’t see the audio player click here to listen to the full episode.

Episode 59 – Emergency Medicine EOR Podcast Quiz

The following 10 questions are linked to NCCPA Content Blueprint lessons from the SMARTYPANCE and PANRE Board review website. If you are a member you will be able to log in and view this interactive video content.

1. During a baseball game, a 22-year-old college student is hit in the right eye by a baseball. He complains of blurry vision in that eye. On physical exam, the physician assistant notes proptosis of the right eye and limitation of movement in all directions. On CT scan, which of the following is most likely to be seen?

A. Fracture of the medial orbital wall
B. Prolapse of orbital soft tissue
C. Hematoma of the orbit
D. Orbital emphysema

Click here to see the answer

Answer: C. Hematoma of the orbit

Orbital hemorrhage into the space surrounding the globe following blunt trauma and rupture of the orbital vessels results in increased ocular pressure, proptosis, visual loss, and limitation of movement in all directions. CT reveals a hematoma.

A. Fracture of the medial orbital wall is associated with diplopia from medial rectus impingement, orbital emphysema, and epistaxis.
B. Prolapse of orbital soft tissue, including inferior rectus muscle, inferior oblique muscle, orbital fat, and connective tissue results in enophthalmos, ptosis, diplopia, anesthesia of the ipsilateral cheek and upper lip, and limitation of upward gaze and is seen with fractures of the orbital floor.
D. Orbital emphysema is seen with fractures of the medial orbital wall or floor of the orbit into the maxillary and ethmoid sinuses respectively. It will not lead to proptosis.

Blowout fractures are covered as part of the NCCPA EENT Content Blueprint which accounts for 9% of your exam.

2. A 29-year-old male presents with a complaint of substernal chest pain for 12 hours. The patient states that the pain radiates to his shoulders and is relieved with sitting forward. The patient admits to recent upper respiratory symptoms. On examination vital signs are BP 126/68, HR 86, RR 20, temp 100.3 degrees F. There is no JVD noted. Heart exam reveals regular rate and rhythm with no S3 or S4. There is a friction rub noted. Lungs are clear to auscultation. EKG shows diffuse ST-segment elevation. What is the treatment of choice for this patient?

A. Pericardiocentesis
B. Nitroglycerin
C. Percutaneous coronary intervention
D. Indomethacin (Indocin)

Click here to see the answer

Answer: D. Indomethacin

Indomethacin, a nonsteroidal anti-inflammatory medication, is the treatment of choice in a patient with acute pericarditis.

A. Pericardiocentesis is the treatment of choice in a patient with a pericardial effusion and cardiac tamponade, there is no evidence of either of these in this patient.
B. Nitroglycerin is indicated in the treatment of chest pain related to angina.
C. Percutaneous coronary intervention is the treatment of choice in a patient with an acute myocardial infarction.

Acute pericarditis is covered the NCCPA Cardiology Content Blueprint which accounts for 16% of your exam.

3. A 19-year-old female presents with a sore throat for nearly two weeks. She complains of fatigue and a low-grade fever. On physical examination, there is cervical, axillary, and inguinal lymphadenopathy, and mild splenomegaly. On review of the blood smear, which of the following would be expected?

A. Atypical lymphocytes
B. Hypersegmented neutrophils
C. Hypochromic red blood cells
D. Schistocytes

Click here to see the answer

Answer: A. Atypical lymphocytes

The hallmark of infectious mononucleosis is the presence of lymphocytosis with atypical large lymphocytes seen in the blood smear. These are larger than normal mature lymphocytes, stain more darkly, and frequently show vacuolated, foamy cytoplasm, and dark chromatin in the nucleus.

B. Hypersegmented neutrophils are seen in vitamin B12 deficiency.
C. Anemia, if seen in mononucleosis, is normocytic and normochromic.
D. Schistocytes are noted in hemolytic anemias.

Mononucleosis as part of the NCCPA Infectious Disease Content Blueprint which accounts for 3% of your exam.

4. A 30-year-old female complains of fatigue, weakness, diminished appetite, weight loss, and syncope. She denies fever, chest or abdominal pain, palpitations, changes in bowel patterns or sleep patterns. Physical examination reveals a thin female, BP 90/65 mmHg, and pulse 80 beats per minute. Pulmonary, cardiovascular, abdominal, and neurologic exam are without abnormalities. Areas of brown and bronze hyperpigmentation are noted on her elbows and the creases of her hands. Which of the following tests will be the most useful in making the diagnosis?

A. Drug screen
B. Urine dipstick
C. Complete blood count
D. Serum creatinine kinase

Click here to see the answer

Answer: D. Serum creatinine kinase

Serum creatinine kinase is the most sensitive test to detect rhabdomyolysis, a serious complication of seizures and hyperthermia related to drug abuse.

A. Although a drug screen may identify specific drugs, the results will not alter the care of this patient.
B. Urine dipstick is not sensitive for myoglobinuria.
C. This patient is at risk for myoglobinuria, and a complete blood count will not alter the treatment.

5. A 15-year-old male was seen last week with complaints of a sore throat, headache, and mild cough. A diagnosis of URI was made and supportive treatment was initiated. He returns today with complaints of worsening cough and increasing fatigue. At this time, chest x-ray reveals bilateral hilar infiltrates. A WBC count is normal and a cold hemagglutinin titer is elevated. The most likely diagnosis is

A. tuberculosis.
B. mycoplasma pneumonia.
C. pneumococcal pneumonia.
D. staphylococcal pneumonia.

Click here to see the answer

Answer: B. mycoplasma pneumonia.

The insidious onset of symptoms, the interstitial infiltrates on chest x-ray, and elevated cold hemagglutinin titer makes this diagnosis the most likely.

A. Most children with pulmonary tuberculosis are asymptomatic with few physical examination findings. The results of the diagnostic studies do not support tuberculosis as the most likely diagnosis.
C. The clinical presentation of bacterial pneumonia in children is variable, but usually involves fever of acute onset. The WBC count is also usually elevated, making this a less likely diagnosis.

Mycoplasma pneumonia is covered as part of the NCCPA Pulmonary Content Blueprint and accounts for 12% of the exam

6. Which of the following clinical manifestations is common in candidal vulvovaginitis?

A. Extreme vulvar irritation
B. Firm, painless ulcer
C. Tender lymphadenopathy
D. Purulent discharge

Click here to see the answer

Answer:  A. Extreme vulvar irritation 

Candida infection presents with pruritus, vulvovaginal erythema, and white, cheese-like (curd) discharge that may be malodorous.

B. A firm painless ulcer is seen in syphilis.
C. Tender lymphadenopathy is associated with bacterial infections and is not a feature of candidal vulvovaginitis.
D. Purulent discharge is noted in gonorrhea.

Vaginitis is covered as part of the NCCPA Reproductive System Content Blueprint and accounts for 8% of the exam

7. A 63-year-old female presents with a complaint of chest pressure for one hour noticed upon awakening. She admits to associated nausea, vomiting, and shortness of breath. 12 lead EKG reveals ST-segment elevation in leads II, III, and AVF. Which of the following is the most likely diagnosis?

A. Aortic dissection
B. Inferior wall myocardial infarction
C. Acute pericarditis
D. Pulmonary embolus

Click here to see the answer

Answer: B. Inferior wall myocardial infarction 

Myocardial infarction often presents with chest pressure and associated nausea and vomiting. ST-segment elevation in leads II, III, and AVF are classic findings seen in acute inferior wall myocardial infarction.

A. A patient with aortic dissection will complain of tearing, ripping pain. EKG is often normal but may reveal left ventricular strain pattern.
C. Acute pericarditis presents with atypical chest pain and diffuse ST-segment elevation.
D. Pulmonary embolism often presents with either no EKG changes or sinus tachycardia. Classically described, rarely seen findings include a large S wave in lead I, a Q wave with T wave inversion in lead III, ST-segment depression in lead II, T wave inversion in leads V1-V4 and a transient right bundle branch block.

Acute myocardial infarction is covered as part of the NCCPA Cardiology Content Blueprint and accounts for 16% of the exam

8. Small grayish vesicles and punched-out ulcers in the posterior pharynx in a child with pharyngitis is representative of which organism?

A. Epstein-Barr virus
B. Group C Streptococcus
C. Coxsackievirus
D. Gonorrhea

Click here to see the answer

Answer: C. Coxsackievirus

Coxsackievirus presents with small grayish vesicles and punched-out ulcers in the posterior pharynx.

A. Epstein-Barr virus presents with enlarged tonsils with exudates and petechiae of the palate.
B. Group C Streptococcus presents with a red pharynx and enlarged tonsils with a yellow, blood tinged exudates
D. Neisseria gonorrhea of the pharynx may be asymptomatic

Coxsackievirus is covered as part of the NCCPA Dermatology Content Blueprint which accounts for 5% of your exam.

9. Which of the following is the most appropriate management of acute psychosis in a patient with schizophrenia?

A. Amitriptyline (Elavil)
B. Risperidone (Risperdal)
C. Lithium (Eskalith)
D. Sertraline (Zoloft)

Click here to see the answer

Answer: B. Risperidone (Risperdal)

There are numerous options used in the management of acute psychosis including benzodiazepines and antipsychotics such as haloperidol (first generation – typical -antipsychotic), risperidone or aripiprazole (second Generation – atypical – antipsychotics). Antidepressants and lithium have no benefit in the treatment of acute psychosis.

Schizophrenia is covered as part of the NCCPA psychiatry Content Blueprint which accounts for 6% of your exam.

10. A 25-year-old presents with pain in the proximal ulna after falling directly on the forearm. X-ray shows a fracture of the proximal 1/3rd of the ulna. There is an associated anterior radial head dislocation. What is the proper name for this condition?

A. Galeazzi fracture
B. Monteggia fracture
C. Colles’ fracture
D. Smith fracture

Click here to see the answer

Answer: B. Monteggia fracture

A Monteggia fracture is a fracture of the proximal ulna with anterior dislocation of the radial head.

A. A Galeazzi fracture is a fracture along the length of the radius with an injury to the distal radioulnar joint.
C. A Colles’ fracture is a fracture of the distal radius with dorsal displacement of the radial head.
D. A Smith fracture is a fracture of the distal radius with a ventral displacement of the radial head.

Monteggia fracture is covered as part of the NCCPA Musculoskeletal Content Blueprint which accounts for 10% of your exam.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy + SMARTYPANCE

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Links From The Show

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

Download The Content Blueprint Checklist

Follow this link to download your FREE copy of the Content Blueprint Checklist

Print it up and start crossing out the topics you understand, marking the ones you don’t and making notes of key terms you should remember. The PDF version is interactive and linked directly to the individual lessons on SMARTY PANCE.

Download

The post Episode 59: Emergency Medicine EOR – The Audio PANCE and PANRE Board Review Podcast appeared first on The Audio PANCE and PANRE.

Apr 09 2018

18mins

Play

Rank #6: Episode 57: Endocrinology – The Audio PANCE/PANRE Board Review Podcast – Content Blueprint Review Endocrinology

Podcast cover
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The Audio PANCE/PANRE PA Board Review Podcast

Welcome to episode 57 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the SMARTYPANCE course content following the NCCPA content blueprint (download the FREE cheat sheet).

This week we will be covering ten endocrinology board review questions based on the NCCPA PANCE and PANRE Content Blueprint.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and SMARTYPANCE which are now bundled together into one very low price.

Listen Carefully Then Take The Practice Exam

If you can’t see the audio player click here to listen to the full episode.

Episode 57 – Endocrinology PANCE/PANRE Podcast Quiz

The following 10 questions are linked to NCCPA Content Blueprint lessons from the SMARTYPANCE and PANRE Board review website. If you are a member you will be able to log in and view this interactive video content.

1. A 53-year-old Hispanic woman comes to your clinic for her annual physical exam. She is obese, does not exercise, and regularly eats fried foods. A random blood glucose is 249 mg/dL. Her hemoglobin A1C is 9.5. Which of the following treatments would be weight neutral or cause weight loss in this patient?

A. Glargine
B. Glyburide
C. Actos
D. Metformin
E. Glipizide

Diabetes Mellitus Type 2 is covered as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: D. Metformin

The patient in this vignette most likely has type II diabetes. Of the given treatments, only metformin is weight neutral in the majority of cases (i.e. it does not cause significant weight gain/loss). Metformin is a first-line treatment for type II DM in most patients. Although the exact mechanism is unknown, it appears to decrease gluconeogenesis and increase insulin sensitivity. There is no risk of hypoglycemia or weight gain (though some patients even lose weight). The most high yield side effect involves lactic acidosis, particularly in patients with renal insufficiency. 

A. Glargine, a long-acting insulin, can cause weight gain.
B. Glyburide, a second-generation sulfonylurea, can cause weight gain.
C. Actos, a thiazolidinedione, can cause weight gain.
E. Glipizide, a second-generation sulfonylurea, can cause weight gain.

2. A solitary thyroid nodule is noted on physical examination. The TSH level is normal. The next step in the evaluation is:

A. measurement of T4 and free T3 levels.
B. a radionuclide thyroid scan.
C. a fine needle biopsy.
D. a surgical excision.

Solitary thyroid nodule is covered as part of thyroid neoplastic disease in the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: C. a fine needle biopsy

Fine needle aspiration (FNA) is the first step in the evaluation of a solitary nodule with a normal TSH level. FNA has a high level of accuracy in diagnosing benign versus malignant nodules in this setting.

A. Measurement of T4 and T3 levels would not be of benefit in the evaluation of a solitary thyroid nodule with a normal TSH level.
B. A thyroid scan would be the next step if there were a low TSH level.
D. Surgical excision would be the final step after determination of malignancy or suspicion of malignancy by FNA.

3. An 18-year-old male with a past medical history of type I diabetes presents to the emergency room with polyuria, polydipsia, and dehydration. Vital signs reveal tachycardia and hypotension. The physical exam is significant for dry mucous membranes and decreased skin turgor. In the waiting room, he begins vomiting and complains of intense abdominal pain. You observe him taking rapid, deep breaths, and over the course of his brief stay, getting more somnolent. Which of the following abnormalities would be expected in this patient?

A. Hypernatremia
B. Decreased total body potassium
C. Hypoglycemia
D. Absence of urinary beta-OH-butyrate
E. Non-anion-gap metabolic acidosis

Diabetic ketoacidosis is covered under Diabetes Mellitus Type 1 as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: B. Decreased total body potassium

This type I diabetic is presenting with signs and symptoms of diabetic ketoacidosis (DKA). In DKA, total body potassium stores are generally decreased due to osmotic diuresis. DKA is a life-threatening emergency that may occur in either type I or type II diabetics but is significantly more common in patients with type I. The pathogenesis is related to insulin deficiency resulting in hyperglycemia that leads to osmotic diuresis and hypovolemia. The inability of the body to use the available glucose for ATP production results in ketone formation and eventually an anion gap metabolic acidosis. Serum potassium levels may be low, normal, or elevated, but total body stores are generally low and require repletion. Common precipitating factors include infection, trauma, myocardial infarction, sepsis and, of course, inadequate insulin administration. Patients may present with nausea, vomiting, abdominal pain, Kussmaul respirations (rapid, deep breaths), dehydration, polydipsia, polyuria and may eventually progress to altered mental status.

A. Patients with DKA more often present with hyponatremia. Remember that serum sodium decreases 1.6 mEq/L for every 100 mg/dL increase in glucose.
C. DKA requires hyperglycemia by definition. Hypoglycemia can be a complication of treatment if glucose is not monitored closely.
D. Ketones, such as Beta-OH-Butyrate, are commonly found in patients with DKA since ketogenesis is a normal response to starvation caused by the inadequate transit of serum glucose into cells.
E. Patients with DKA present with an anion-gap metabolic acidosis secondary to ketoacids.

4. A 30-year-old female complains of fatigue, weakness, diminished appetite, weight loss, and syncope. She denies fever, chest or abdominal pain, palpitations, changes in bowel patterns or sleep patterns. Physical examination reveals a thin female, BP 90/65 mmHg, and pulse 80 beats per minute. Pulmonary, cardiovascular, abdominal, and neurologic exam are without abnormalities. Areas of brown and bronze hyperpigmentation are noted on her elbows and the creases of her hands. Which of the following is the most likely diagnosis?

A. Addison’s disease
B. Cushing’s disease
C. Anorexia nervosa
D. Porphyria

This condition is covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Click here to see the answer

Answer: A. Addison’s disease

Addison’s disease (adrenal insufficiency) would account for all her symptoms, the hypotension, and the hyperpigmentation of the skin.

B. Cushing’s disease, the presence of an ACTH-producing adenoma, is characterized by central obesity, hypertension, moon facies, purple striae, and glucose intolerance.
C. Anorexia nervosa may explain the weakness, weight loss, hypotension, and syncope, however, a normal pulse rate would be an unexpected finding along with the hyperpigmentation.
D. Porphyria presents acutely with anxiety, depression, disorientation, and insomnia.

5. A 39-year-old male presents to your clinic complaining of increasing constant headaches and progressive loss of peripheral vision. His medical and family history is unremarkable. Physical examination reveals bitemporal hemianopsia but is otherwise without any abnormalities. Which of the following is the most likely diagnosis?
Answers

A. An aneurysm involving the circle of Willis
B. A migraine headache
C. Multiple sclerosis
D. Pituitary tumor

This condition is covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Click here to see the answer

Answer: D. A pituitary tumor 

A pituitary tumor would account for the headaches and the loss of the peripheral vision in both visual fields. As the tumor grows, the optic chiasm will be compressed by the tumor.

A. An aneurysm involving the circle of Willis would result in CN III palsy. This would be a rare finding.
B. Although a migraine headache may produce visual field defects, these defects would remit upon resolution of the migraine. It would also be unusual to have the scotomas occur bilaterally.
C. Optic neuritis associated with multiple sclerosis presents with decreased visual acuity, dimness, or color desaturation in the central visual field. It would not affect the periphery.

6. Radioactive iodine is most successful in treating hyperthyroidism that results from

A. Grave’s disease.
B. subacute thyroiditis.
C. Hashimoto’s thyroiditis.
D. papillary thyroid carcinoma.

Watch this ReelDx Video of a 16-year-old with ADHD presents with chest pain and exophthalmos

Diseases of the thyroid gland are covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Click here to see the answer

Answer:  A. Grave’s disease.

Radioactive iodine is an excellent method to destroy overactive thyroid tissue of Grave’s disease.

B. Radioactive iodine is ineffective in subacute thyroiditis due to the thyroid’s low uptake of iodine.
C. Radioiodine uptake is low in Hashimoto’s thyroiditis and is often transient.
D. Papillary thyroid carcinoma is a common thyroid malignancy and must be treated by a thyroidectomy.

7. A newborn infant exhibits prolonged jaundice, feeding problems, hypotonia, and an enlarged tongue. Proper treatment in this infant would consist of which of the following?

A. IV antibiotics
B. Thyroid hormone replacement
C. Hepatitis B immunoglobulin
D. Vitamin B6 supplement

This condition is covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Click here to see the answer

Answer: B. Thyroid hormone replacement 

This scenario is consistent with congenital hypothyroidism. Measurement of TSH or T4 would confirm this and T4 should be given.

C. Hepatitis and sepsis may account for the presence of jaundice, feeding problems, and hypotonia, but would not result in an enlarged tongue.
D. A deficiency in vitamin B6 may lead to glossitis but would not account for or any of the other signs.

8. Which of the following glucose-lowering agents act by delaying glucose absorption?

A. Metformin (Glucophage)
B. Acarbose (Precose)
C. Glipizide (Glucotrol)
D. Pioglitazone (Actos)

Diabetes Mellitus Type 2 and associated medications are covered as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: B. Acarbose (Precose)

Alpha-glucosidase inhibitors, such as acarbose, reduce glucose by delaying glucose absorption.

A. Metformin, a biguanide, lowers glucose by decreasing hepatic glucose production and increased glucose utilization.
C. Glipizide and other sulfonylureas work by increasing insulin secretion.
D. Pioglitazone is a thiazolidinedione and decreases insulin resistance and increases glucose utilization.c

9. Which of the following conditions may result in hypokalemia?

A. Adrenal adenoma
B. Hypoparathyroidism
C. Hyperthyroidism
D. Adrenal insufficiency

Diseases of the Adrenal Glands are covered as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: A. Adrenal adenoma

Excessive secretion of aldosterone from an adrenal adenoma will lead to sodium retention and the secretion of potassium in the distal tubule of the kidney, eventually leading to hypokalemia.

B. Hypoparathyroidism and hyperthyroidism should not have any effect on potassium levels.
D. Adrenal insufficiency would lead to hyperkalemia.

10. A 7-year-old child with a history of type 1 diabetes mellitus for 3 years presents for routine follow-up. The mother states that the child has been having nightmares and night sweats. Additionally, his average morning glucose readings have risen from an average of 100 mg/dL to 145 mg/dL over the past week. This child is most likely experiencing

A. a growth spurt.
B. emotional problems.
C. the Somogyi effect.
D. the dawn phenomenon.

The Somogyi effect and the dawn phenomenon are covered under Diabetes Mellitus Type 1 as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: C. the Somogyi effect.

This refers to nocturnal hypoglycemia, which stimulates counter-regulatory hormone release resulting in rebound hyperglycemia.

A. Nightmares and night sweats are not associated with growth spurts.
B. With this limited history, it is impossible to label the child as emotionally unstable.
D. This refers to an early morning rise in plasma glucose due to reduced tissue sensitivity to insulin between 5 AM and 8 AM. It is not associated with nightmares and night sweats.

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The post Episode 57: Endocrinology – The Audio PANCE/PANRE Board Review Podcast – Content Blueprint Review Endocrinology appeared first on The Audio PANCE and PANRE.

Feb 20 2018

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Rank #7: Podcast Episode 75: Ten FREE PANCE and PANRE Audio Board Review Questions

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Welcome to episode 75 of the Audio PANCE and PANRE PA Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the SMARTYPANCE course content following the NCCPA content blueprint (download the FREE cheat sheet).

This week we will be covering ten general board review questions based on the NCCPA PANCE and PANRE Content Blueprints.

Below you will find an interactive exam to complement the podcast.

The Audio PANCE and PANRE Physician Assistant Board Review Podcast

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and Smarty PANCE.

Listen Carefully Then Take The Practice Exam

If you can’t see the audio player click here to listen to the full episode.

Podcast Episode 75: Ten Question PANCE and PANRE Podcast Quiz

The following questions are linked to NCCPA Content Blueprint lessons from the Smarty PANCE and PANRE Board Review Website. If you are a member you will be able to log in and view this interactive video lesson.

1. A 5-year-old girl is brought to the emergency department after drinking a bottle of drain cleaner. It is unknown how much the child drank. She has a past medical history of Down syndrome and obesity. The patient’s vitals are unremarkable. Physical exam is notable for a child in no acute distress. She is tolerating her oral secretions and is interactive. Inspection of the oropharynx is unremarkable. Which of the following is the appropriate management of this patient?

  1. Dilute hydrochloric acid
  2. Endoscopy
  3. Intubation
  4. Observation
  5. Polyethylene glycol
Click here to see the answer

Answer: B. Endoscopy 

Ingestion of caustic fluids (acid or alkali) such as drain cleaner may lead to esophageal damage and stricture. Any patient presenting after caustic ingestion should have an endoscopy performed between 12 and 24 hours of presentation. Injury due to ingestion of alkaline fluids such as drain/oven cleaner occurs rapidly in the first minutes to hours and is characterized by liquefactive necrosis of the esophageal tissue. Subsequently, esophageal strictures form due to scarring of the affected tissue. Patients should immediately be resuscitated following the ABC’s (airway, breathing, and circulation). Subsequent management involves endoscopy (typically within 12 to 24 hours of ingestion) to assess the extent of the damage and plan any further treatment that may be needed.

Incorrect Answers:

  • Answer 1: Dilute hydrochloric acid or administration of any agent to titrate the ingestion is always contraindicated as this will lead to more tissue damage.
  • Answer 3: Intubation would be indicated if the patient was failing to protect their airway or if they had impending airway loss. This well-appearing patient has no airway concerns.
  • Answer 4: Observation is certainly a part of this patient’s care; however, she must also receive endoscopy to assess for any esophageal/GI tract injury.
  • Answer 5: Polyethylene glycol or whole bowel irrigation has limited indications. It may be used to pass bags of drugs if ingested by a packer/stuffer but would not aid in the management of caustic ingestion.

Review NCCPA Blueprint Topic: Ingestion of toxic substances or foreign bodies

2. A 27-year-old man presents to the emergency department after a motor vehicle collision. The patient was a front seat unrestrained driver in a head-on collision. The patient’s echocardiogram (ECG) is notable only for sinus tachycardia. His temperature is 99.5°F (37.5°C), blood pressure is 107/58 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. The patient is given 2 liters of Ringer lactate solution and morphine. Initial workup demonstrates that the patient’s pulmonary capillary wedge pressure and troponins are elevated. The patient is currently complaining of chest pain. Physical exam is notable for an uncomfortable young man with bruising over his chest wall. Which of the following is the most likely diagnosis?

  1. Cardiac contusion
  2. Hemorrhage
  3. Myocardial infarction
  4. Pulmonary contusion
  5. Takotsubo cardiomyopathy
Click here to see the answer

Answer: A. Cardiac contusion

This patient is presenting after blunt chest trauma (which is common in motor vehicle accidents) with chest pain, elevated troponins, and an elevated pulmonary capillary wedge pressure suggesting a diagnosis of a cardiac contusion. A cardiac contusion is a blunt injury to the heart which can disrupt the mechanical and electrical function of the heart. There will typically be visible signs of chest trauma such as bruising and the patient will often complain of chest pain and dyspnea. The ECG can be unremarkable, demonstrate sinus tachycardia, or even demonstrate more severe dysrhythmias such as supraventricular tachycardia, atrial fibrillation, and a right bundle branch block. Initial cardiac troponins can be elevated. In the setting of any ECG abnormality or elevated troponins, patients with a suspected diagnosis of a cardiac contusion should be admitted to the hospital and observed until clinically stable with normalization of their troponins.

Incorrect Answers:

  • Answer 2: Hemorrhage would present with hypotension, tachycardia, and a decreased pulmonary capillary wedge pressure. Internal bleeding could be assessed with a FAST exam which assesses for pleural sliding, pericardial fluid and cardiac function, fluid in the hepatorenal and splenorenal recesses, and fluid surrounding the bladder.
  • Answer 3: Myocardial infarction presents with chest pain, shortness of breath, ST elevation on ECG and elevated cardiac troponins. This patient’s elevated troponins are likely secondary to blunt trauma to the heart as he has no risk factors for ischemic heart disease and is young.
  • Answer 4: Pulmonary contusion presents with chest pain, hypoxia, and patchy opacities on chest radiography which may not be initially apparent. Management for a pulmonary contusion is typically supportive in nature and to adequately control the patient’s pain.
  • Answer 5: Takotsubo cardiomyopathy presents with chest pain and dyspnea as well as ST elevation on ECG without reciprocal changes. Global hypokinesis of the heart can be seen on echocardiography and minor elevations in troponins can be present. The typical precipitating event for Takotsubo cardiomyopathy is an emotionally stressful life event and the patient is typically a woman in contrast to this male patient who has a mechanism of injury that supports a diagnosis of a cardiac contusion.

Review NCCPA Blueprint Topic: Chest/Rib Fractures and Trauma

3. A 33-year-old woman presents to her primary care PA for a wellness check-up. She states that recently she has been feeling well other than headaches that occur occasionally, which improve with ibuprofen and rest. She has a past medical history of hypertension and headaches and is currently taking hydrochlorothiazide. Her temperature is 99.2°F (37.3°C), blood pressure is 157/108 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam reveals a young woman who appears healthy. A normal S1 and S2 are auscultated on cardiac exam, and her lungs are clear with good air movement bilaterally. From her previous visit, it was determined that she has an elevated aldosterone and low renin level. Laboratory values are ordered as seen below.

Serum:
Na+: 139 mEq/L
Cl-: 100 mEq/L
K+: 3.7 mEq/L
HCO3-: 29 mEq/L
BUN: 20 mg/dL
Creatinine: 1.1 mg/dL

Which of the following is the most likely diagnosis?

  1. Benign essential hypertension
  2. Cushing syndrome
  3. Narrowing of the renal arteries
  4. Pheochromocytoma
  5. Primary hyperaldosteronism
Click here to see the answer

Answer: E. Primary hyperaldosteronism

This patient is presenting with hypertension refractory to a diuretic with a decreased potassium, a decreased renin level, and an increased aldosterone level suggesting a diagnosis of primary hyperaldosteronism.

Primary hyperaldosteronism occurs when the adrenal gland produces excess aldosterone. Aldosterone has the effect in the kidney of absorbing sodium (and thus water) and wasting potassium and hydrogen. Thus, hyperaldosteronism can lead to hypertension, hypokalemia, and a metabolic alkalosis. In primary hyperaldosteronism, the high blood pressure is detected by the kidney, and thus renin levels are decreased in the setting of an elevated aldosterone.

Incorrect Answers:

  • Answer 1: Benign essential hypertension typically occurs in overweight patients and has no clear underlying cause. It would not be associated with elevated aldosterone levels.
  • Answer 2: Cushing syndrome would be associated with weight gain, limb muscle atrophy, and striae on dermatological exam in the setting of a decreased renin and aldosterone.
  • Answer 3: Narrowing of the renal arteries (renal artery stenosis) would present with refractory hypertension in the setting of an elevated renin and aldosterone level.
  • Answer 4: Pheochromocytoma would present with severe episodic hypertension and headaches secondary to an adrenal mass that releases catecholamines.

Summary: Primary hyperaldosteronism presents with hypertension, a decreased renin and potassium level, a metabolic alkalosis, and an increased aldosterone level.

Review NCCPA Blueprint Topic: Secondary hypertension

4. A 24-year-old man is brought in to the emergency room after being retrieved by firefighters from a burning building. The patient is responding coherently to questions but reports pain secondary to a burn on his leg. He states he also has a headache and feels dizzy. His temperature is 98.5°F (36.9°C), blood pressure is 129/66 mmHg, pulse is 126/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for a confused young man with dry and flushed skin. The cardiopulmonary exam reveals a normal S1 and S2, as well as clear breath sounds bilaterally. The patient’s neurological exam is within normal limits. Towards the end of his exam, the patient begins vomiting. The dermatologic exam reveals a superficial burn covering 1% of the patient’s body over his right leg. Which of the following is the best next step in management for this patient?

  1. 100% oxygen
  2. CT scan of the head
  3. Hydroxocobalamin
  4. Normal saline
  5. Ondansetron
Click here to see the answer

Answer: A. 100% oxygen

This patient is presenting after being rescued from a fire with confusion, headache, nausea, vomiting, and flushed skin suggesting a diagnosis of carbon monoxide poisoning which should be treated with 100% oxygen.

Carbon monoxide exposure is common in fires and in patients who heat their house with an old-fashioned wood stove. Carbon monoxide binds to hemoglobin with a higher affinity than oxygen thus displacing it leading to symptoms. Carbon monoxide poisoning presents with confusion, headache, altered mental status, nausea, vomiting, and cherry-red skin. Pulse oximetry is often normal in these patients as the device detects hemoglobin bound to oxygen or carbon monoxide similarly. A carboxyhemoglobin level can be obtained to confirm the diagnosis in these patients; however, patients presenting with a clinical picture supportive of carbon monoxide poisoning should be treated with 100% (or hyperbaric) oxygen. Sequelae of carbon monoxide poisoning should be treated supportively, including dantrolene for increased muscle activity or benzodiazepines for seizure activity.

Incorrect Answers:

  • Answer 2: CT scan of the head would be indicated if a patient presented with head trauma followed by altered mental status, nausea, and vomiting. This patient’s neurological abnormalities, as well as his nausea and vomiting, can be explained by his carbon monoxide poisoning.
  • Answer 3: Hydroxocobalamin is the treatment of choice for cyanide poisoning which is also associated with exposure to fires. Patients will present with weakness, malaise, headache, dizziness, nausea, vomiting, and shortness of breath. Though this diagnosis is possible in this patient, a more likely diagnosis both epidemiologically and given his flushed skin is carbon monoxide poisoning. This patient will need empiric treatment for cyanide poisoning, however, a more dire intervention for the most likely diagnosis is putting the patient on oxygen to simultaneously and rapidly improve his respiratory status and treat his carbon monoxide poisoning.
  • Answer 4: Normal saline may be necessary to stabilize this patient’s blood pressure; however, his tachycardia is likely secondary to his pain and a more important initial intervention is stabilizing the patient’s respiratory status including administering oxygen for this patient’s carbon monoxide poisoning.
  • Answer 5: Ondansetron only treats this patient’s symptoms of nausea but does not address their respiratory status which should be treated promptly and prior to treating other concerns.

Summary: The treatment of carbon monoxide poisoning is 100% oxygen.

Review NCCPA Blueprint Topic: Burns (ReelDx)

5. A 42-year-old woman is brought to the emergency department after a motor vehicle accident. She complains of lower back pain and some minor abdominal pain. The patient has a past medical history of obesity and type II diabetes. Her current medications include atorvastatin, metformin, and glyburide. A FAST exam is performed in the trauma bay and does not reveal any signs of intra-abdominal bleeding. Her temperature is 98.2°F (36.8°C), blood pressure is 130/77 mmHg, pulse is 90/min, respirations are 16/min, and oxygen saturation is 99% on room air. Ultrasound findings are notable for multiple gallstones in the gallbladder. The patient is given naproxen. Which of the following is the best next step in management?

  1. CT scan of the abdomen
  2. NPO, IV fluids, and broad-spectrum antibiotics
  3. Perform a cholecystectomy this hospital visit
  4. Schedule an outpatient cholecystectomy
  5. Supportive therapy
Click here to see the answer

Answer: E. Supportive therapy

This patient is presenting with asymptomatic gallstones discovered incidentally. Asymptomatic gallstones do not need to be managed with a cholecystectomy. 

Acute cholecystitis classically presents with right upper quadrant abdominal pain that presents in a fat, fertile, female in her forties. Once the diagnosis is confirmed with ultrasound, “cooling off” of the gallbladder is necessary (keeping the patient NPO and IV fluids) followed by a cholecystectomy that hospital visit. However, if asymptomatic gallstones are discovered incidentally, there is no indication for cholecystectomy. These patients should be managed conservatively.

Incorrect Answers:

  • Answer 1: CT scan of the abdomen is unnecessary as there is no indication to perform a CT scan, in particular when the only finding in this assessment was asymptomatic gallstones on ultrasound. 
  • Answer 2: NPO, IV fluids, and broad spectrum antibiotics is the best initial management of ascending cholangitis. Patients with ascending cholangitis are acutely ill and present with a fever, jaundice, and right upper quadrant tenderness. They require immediate treatment as well as decompression (from interventional radiology), followed by ERCP/cholecystectomy. 
  • Answer 3: Performing a cholecystectomy this hospital visit is the appropriate management of acute cholecystitis. Acute cholecystitis would present with right upper quadrant abdominal pain in an overweight woman after eating a fatty meal. It is not indicated in the management of asymptomatic gallstones. 
  • Answer 4: Scheduling an outpatient cholecystectomy is not necessary as this patient is asymptomatic. Outpatient cholecystectomies are not typically performed in the management of acute cholecystitis as most patients do not comply with outpatient recommendations (avoiding triggers like fatty foods and alcohol) and end up returning to the hospital for another flare before their procedure. In certain compliant patients, it may be a viable option.

Review NCCPA Blueprint Topic: Cholelithiasis (ReelDx + Lecture)

6. A 60-year-old woman presents to the emergency department with dizziness. She states it started this morning when she woke up from bed and was severe causing her to vomit. The episode resolved in 1 minute. The patient has a past medical history of hypertension, diabetes, obesity, and atrial fibrillation treated with warfarin and metoprolol. She recently recovered from a cold a few days ago. Her temperature is 99.0°F (37.2°C), blood pressure is 174/99 mmHg, pulse is 115/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for a well-appearing woman. Her neurological exam including cranial nerves and gait is within normal limits. The patient is laid flat in the bed which causes an episode of dizziness with notable nystagmus and vomiting. She feels better after 1 minute. The patient’s ECG is within normal limits. Lab values are notable for an INR of 3.5. Which of the following is the most likely etiology of this patient’s symptoms?

  1. Canalithiasis
  2. Increased endolymph production
  3. Inflammation of the vestibular apparatus
  4. Inflammation of the vestibulocochlear apparatus
  5. Vertebrobasilar insufficiency
Click here to see the answer

Answer: A. Canalithiasis

This patient is presenting with intermittent, severe vertigo which is provoked by position changes which is most consistent with benign paroxysmal positional vertigo (BPPV). BPPV is commonly caused by canalithiasis.

Benign paroxysmal positional vertigo (BPPV) is a common form of peripheral vertigo that results from a dislodged piece of otolith (called otoconia when dislodged) causing disturbances in the semicircular canals. The presentation of BPPV involves sudden and episodic vertigo with head movements that lasts for seconds to minutes accompanied by nausea and vomiting. Physical exam will demonstrate a horizontal nystagmus with specific head postures (such as the Dix-Hallpike maneuver). Treatment involves repositioning exercises (such as the Epley maneuver) as well as meclizine or diphenhydramine for symptomatic control.

Incorrect Answers:

  • Answer 2: Increased endolymph production describes Meniere disease which presents with chronic symptoms including hearing loss and ear fullness and intermittent episodes of vertigo. Treatment involves diuretics and salt restriction.
  • Answers 3-4: Inflammation of the vestibular apparatus and the vestibulocochlear apparatus describes vestibular neuritis (sustained/persistent vertigo after a cold) and labyrinthitis (sustained/persistent vertigo and hearing loss after a cold), respectively. This condition will resolve on its own; however, symptoms can be treated with meclizine or diphenhydramine.
  • Answer 5: Vertebrobasilar insufficiency can present with syncope or if there is a hemorrhage/ischemia, may present in an elderly patient with multiple risk factors with sustained and severe vertigo that is sudden onset and associated with dysarthria and dystonia.

Summary: Benign paroxysmal positional vertigo is commonly caused by canalithiasis.

Review NCCPA Blueprint Topic: Vertigo (ReelDx + Lecture)

7. An 18-year-old male presents to his primary care provider with his parents for a sports physical. He was last seen in the clinic several months ago when he was diagnosed with attention deficit hyperactivity disorder (ADHD). He was started on methylphenidate at that time, and the patient now reports improvement in his ability to concentrate in school and at home. He hopes to play baseball in college and has begun lifting weights daily in preparation for baseball season. The patient reports that he eats a healthy diet to fuel his exercise regimen. His parents have no concerns and are pleased with the recent improvement in his grades. On physical exam, the patient has tall stature with average muscle mass for his age. He has no dysmorphic features. His chest has a normal appearance other than mild gynecomastia. The patient has sparse facial hair and a moderate amount of coarse pubic hair that extends across the pubis and spares the medial thighs. His testes are small and firm. Due to the latter, laboratory testing is performed and reveals the following:

  • Follicle-stimulating hormone (FSH): 42 mIU/mL (Reference range: 4-25 mIU/mL)
  • Luteinizing hormone (LH): 38 mIU/mL (Reference range: 6-23 mIU/mL)

Which of the following is the most likely etiology of this patient’s presentation?

  1. Anabolic steroid use
  2. CGG trinucleotide repeat disorder
  3. CTG trinucleotide repeat disorder
  4. Failure of neuronal migration
  5. Meiotic nondisjunction
Click here to see the answer

Answer: E. Meiotic nondisjunction

This patient presents with tall stature, gynecomastia, and small testes with elevated FSH and LH, which suggests a diagnosis of Klinefelter syndrome. Klinefelter syndrome is usually caused by meiotic nondisjunction that results in a 47,XXY genotype.

Klinefelter syndrome is the most common cause of primary hypogonadism. Patients with Klinefelter syndrome present with tall stature, neurocognitive difficulties (ADHD) and features of hypogonadism including gynecomastia, small testes, small phallus, hypospadias, underdeveloped secondary sex characteristics, and cryptorchidism. Patients without hypospadias or cryptorchidism are often not diagnosed until after puberty, when the symptoms of gynecomastia and small testes become more prominent. Because the hypogonadism in Klinefelter syndrome is caused by testicular fibrosis, laboratory results demonstrate a low testosterone and elevated FSH and LH.

Incorrect Answers:

  • Answer 1: Anabolic steroid use causes decreased levels of FSH and LH due to the suppression of GnRH release by the hypothalamus, which in turn suppresses FSH and LH release by the pituitary gland. Anabolic steroid use would not present with signs of hypogonadism.
  • Answer 2: The CGG trinucleotide repeat disorder characterizes Fragile X syndrome. Fragile X presents with macroorchidism rather than hypogonadism, and patients typically have dysmorphic features of a long, narrow face with large ears, prominent forehead, and prominent chin. Fragile X is the most common cause of inherited intellectual disability.
  • Answer 3: The CTG trinucleotide repeat disorder characterizes myotonic dystrophy. Although myotonic dystrophy presents with hypogonadism, patients would also present with symptoms of progressive weakness, such as facial weakness, dysphagia, or hand grip weakness.
  • Answer 4: Failure of neuronal migration characterizes Kallmann syndrome. Kallmann syndrome presents with the classic symptoms of loss of smell and hypogonadism, but patients with Kallmann syndrome have a low FSH and LH.

Summary: Klinefelter syndrome results in primary hypogonadism and presents with tall stature, gynecomastia, small testes, a small phallus, hypospadias, and cryptorchidism.

Review NCCPA Blueprint Topic: Hypogonadism

8. A 65-year-old man presents to the emergency department for sudden weakness. The patient states that he was at home enjoying his morning coffee when his symptoms began. He says that his left arm suddenly felt very odd and weak thus prompting him to come to the ED. The patient has a past medical history of diabetes, COPD, hypertension, anxiety, alcohol abuse, and PTSD. He recently fell off a horse while horseback riding but claims to not have experienced any significant injuries. He typically drinks 5-7 drinks per day and his last drink was yesterday afternoon. His current medications include insulin, metformin, atorvastatin, lisinopril, albuterol, and fluoxetine. His temperature is 99.5°F (37.5°C), blood pressure is 177/118 mmHg, pulse is 120/min, respirations are 18/min, and oxygen saturation is 93% on room air. On physical exam, you note an elderly man who is mildly confused. The cardiopulmonary exam demonstrates bilateral expiratory wheezes and a systolic murmur along the right upper sternal border that radiates to the carotids. Neurological exam reveals cranial nerves II-XII as grossly intact with finger-nose exam mildly abnormal on the left and heel-shin exam within normal limits. The patient has 5/5 strength in his right arm and 3/5 strength in his left arm. The patient struggles to manipulate objects such as a pen with his left hand. The patient is given a dose of diazepam and started on IV fluids. Which of the following is the most likely diagnosis in this patient?

  1. Berry aneurysm rupture
  2. Bridging vein tear
  3. Cerebellar bleeding
  4. Hypertensive encephalopathy
  5. Lacunar stroke
Click here to see the answer

Answer: E. Lacunar stroke

This patient is presenting with risk factors and symptoms suggestive of a diagnosis of a lacunar stroke. 

Lacunar strokes typically occur in patients with risk factors such as hypertension, diabetes, old age, and smoking. The basal ganglia, pons, and subcortical white matter are commonly affected. The pathophysiology occurs secondary to a small penetrating artery occlusion from hypertensive arteriolar sclerosis, lipohyalinosis, or microatheroma formation. Patients present with neurological deficits that can include pure motor hemiparesis, pure sensory stroke, ataxic hemiparesis, or dysarthria-clumsy hand syndrome.

Incorrect Answers:

  • Answer 1: Berry aneurysm rupture describes a subarachnoid hemorrhage that would present with a sudden onset, severe headache.
  • Answer 2: Bridging vein tear describes a subdural hematoma which could present with gradual neurological deficits and altered cognition in the setting of recent trauma in an elderly patient/alcoholic.
  • Answer 3: Cerebellar bleeding would present with ataxic gait and an abnormal finger-nose and heel-shin exam.
  • Answer 4: Hypertensive encephalopathy presents with general CNS dysfunction which can include headache, irritability, nausea/vomiting, disturbances of consciousness, and seizures.

Review NCCPA Blueprint Topic: Stroke (ReelDx + Lecture)

9. A 26-year-old woman presents to the emergency department with abdominal pain. She states that she was walking up the stairs at work when she felt sudden and severe abdominal pain followed by nausea and vomiting. Her past medical history is noncontributory and she is not currently taking any medications. Her temperature is 99.7°F (37.6°C), blood pressure is 122/78 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for an absence of abdominal tenderness, a left adnexal mass, and left adnexal tenderness. A transvaginal ultrasound demonstrates free fluid surrounding the ovary with edema and the presence of doppler flow. A urinary pregnancy test is negative. The patient’s symptoms persisted after ibuprofen and acetaminophen. Which of the following is the best next step in management?

  1. CT scan of the abdomen
  2. Laparoscopy
  3. Laparotomy
  4. MRI of the pelvis
  5. Observation and serial abdominal exams
Click here to see the answer

Answer: B. Laparoscopy

This patient is presenting with sudden onset abdominal pain, nausea, vomiting, and free fluid around the ovary with normal blood flow which is still concerning for ovarian torsion that should be managed with laparoscopy. Ovarian torsion occurs when the ovary twists around its blood supply causing ischemia and necrosis. Patients are typically young women who experience sudden/severe abdominal or vaginal pain, blood per vagina, a left adnexal mass with adnexal tenderness, and a negative urine pregnancy test. The best initial test is a transvaginal ultrasound with Doppler which can show blood flow to the ovary as well as ovarian enlargement and edema (signs of ischemia). Even in the setting of normal blood flow, torsion is possible as the ovary may twist and untwist. Patients presenting with symptoms concerning for ovarian torsion should be managed with laparoscopy to definitively treat and salvage the ovary.

Incorrect Answers:

  • Answer 1: CT scan of the abdomen would not be necessary as this patient has no abdominal tenderness and has physical exam and ultrasound findings concerning for ovarian torsion which should be managed surgically. 
  • Answer 3: Laparotomy is an open procedure that would be indicated if the patient suddenly decompensated and needed more aggressive management to stop acute bleeding. 
  • Answer 4: MRI of the pelvis would be a very accurate test for diagnosing pelvic pathology; however, it is not necessary in this patient who has a history and findings concerning for ovarian torsion. Performing an MRI would only delay treatment.
  • Answer 5: Observation and serial abdominal exams would be the appropriate management of a patient with abdominal pain with a clear etiology after a CT scan had ruled out any serious pathology. This patient’s likely ovarian torsion should not be observed.

Summary: Ovarian torsion should be treated with laparoscopy. 

Review NCCPA Blueprint Topic: Ovarian torsion

10. A 72-year-old man is brought into the emergency department by emergency medical services. He looks disheveled and states that he is homeless. He has bruising over his arms and legs and states that he does not have a regular source of nutrition. He denies prior medical conditions but states that he still smokes one pack of cigarettes per day. On exam, the patient’s vital signs are normal, but he appears extremely malnourished. His gums are swollen and bleeding and his tongue is unusually smooth. The hair on his arms is pinwheel-shaped. What is the most likely cause?

  1. Iron deficiency
  2. Vitamin B3 deficiency
  3. Vitamin C deficiency
  4. Vitamin B12 deficiency
  5. Vitamin K deficiency
Click here to see the answer

Answer: C. Vitamin C deficiency

An elderly, malnourished, cigarette-smoking male with swollen gums, bruising, and corkscrew hair is most likely suffering from vitamin C deficiency.

Though vitamin C deficiency, or scurvy, is uncommon in the developed world, cases in developing countries still exist. Typically, these cases occur in those who are very old or very young due to the inability to feed themselves properly. Since vitamin C, or ascorbic acid, is found in citrus fruits and green vegetables, deficiency in these foods or consumption of these foods with denatured vitamins (due to over-boiling) can result in deficiency. Those who smoke cigarettes have also been found to be more deficient in vitamin C.

Incorrect Answers:

  • Answer 1: Iron deficiency anemia would most commonly be asymptomatic, and if serious, would present with symptoms of fatigue and shortness of breath. It would not present with glossitis or corkscrew hair.
  • Answer 2: Vitamin B3, or niacin, can present with glossitis, but would typically also have the “3 D’s”: diarrhea, dermatitis, and dementia.
  • Answer 4: Vitamin B12 deficiency can also present with glossitis, but it would also have physical exam signs such as numbness and parasthesias of the extremities along with ataxia.
  • Answer 5: Vitamin K deficiency can present with bleeding and bruising, but it would not present with the other symptoms typically associated with scurvy.

Review NCCPA Blueprint Topic: Hypervitaminosis/hypovitaminosis

[spoiler title=”C

Looking for all the podcast episodes?

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This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE and PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher
  3. Google Play: The Audio PANCE and PANRE Podcast Google Play

Download The Content Blueprint Checklist

Follow this link to download your FREE copy of the Content Blueprint Checklist

Print it up and start crossing out the topics you understand, marking the ones you don’t and making notes of key terms you should remember. The PDF version is interactive and linked directly to the individual lessons on SMARTY PANCE.

Download for PANCE Download for PANRE

The post Podcast Episode 75: Ten FREE PANCE and PANRE Audio Board Review Questions appeared first on The Audio PANCE and PANRE.

Oct 03 2019

35mins

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Rank #8: Podcast Episode 67: Ten PANCE and PANRE Board Review Audio Questions

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Ten Mixed PA Board Review Questions

The Audio PANCE/PANRE – Ten PA Board Review Exam Questions

Welcome to episode 67 of the Audio PANCE and PANRE PA Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the SMARTYPANCE course content following the NCCPA content blueprint (download the FREE cheat sheet).

This week we will be covering ten general board review questions based on the NCCPA PANCE and PANRE Content Blueprint.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and SMARTYPANCE which are now bundled together into one very low price.

Listen Carefully Then Take The Practice Exam

If you can’t see the audio player click here to listen to the full episode.

Podcast Episode 67: 10 Question PANCE and PANRE Podcast Quiz

The following questions are linked to NCCPA Content Blueprint lessons from the SMARTYPANCE & PANRE Board Review Website. If you are a member you will be able to log in and view this interactive video lesson.

A 26-year-old female presents with several pruritic lesions on her dorsal forearms. The lesions are erythematous with vesicles, with a few beginning to weep. She works in a photography laboratory but denies any other possible exposures. Which of the following is the most useful diagnostic test?

A. VDRL serology
B. KOH prep
C. Patch testing
D. Gram’s stain

Click here to see the answer

C. Patch testing with a suspected agent is usually positive in cases of allergic contact dermatitis

A. VDRL serology is useful in the diagnosis of syphilis, not contact dermatitis
B. KOH prep is used for diagnosis of fungal infections, not contact dermatitis
D. Gram’s stain is useful in the diagnosis of bacterial infections, not contact dermatitis

2. An elderly female presents for evaluation of exertional syncope, dyspnea, and angina. She admits that previous to these symptoms she had insidious progression of fatigue that caused her to curtail her activities. Which of the following is the most likely diagnosis?

A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Mitral valve prolapse

Click here to see the answer

A. The major symptoms of aortic stenosis are exertional syncope, dyspnea, and angina. Symptoms do not become apparent for a number of years and usually are not present until the valve is narrowed to less than 0.5 cm to 2 cm of the valve surface area.

B. Patients with aortic regurgitation are likely to complain of an uncomfortable awareness of their heart, especially when lying down. These patients develop sinus tachycardia with exertion and complain of palpitations and head pounding with activity.
C. The symptoms related to mitral stenosis are related to increased pulmonary pressure after the left atrium can no longer overcome the outflow obstruction.
D. Patients with mitral valve prolapse are typically asymptomatic throughout their lives, although a wide range of
symptoms is possible. When symptoms do occur, palpitations from arrhythmias are most common along with lightheadedness. Syncope is not part of this disease process.

3. A 40-year-old female G5P5 complains of small quantities of urine leaking when she coughs, sneezes, or laughs. Her genitourinary examination is unremarkable and her urinalysis is normal. At this time, which of the following is the most appropriate management plan?

A. Refer for a cystoscopy
B. Recommend Kegel exercises
C. Refer for surgical correction
D. Recommend hormone replacement therapy

Click here to see the answer

B. Strengthening the pelvic muscles by Kegel exercises and emptying the bladder frequently may resolve the problem.

A. Conservative therapy for stress incontinence should be attempted prior to any evaluation, such as cystoscopy, that might indicate the need for surgical correction
D. There is no indication in the history for hormone replacement therapy and no vaginal atrophy was noted on pelvic examination

4. A 62-year-old male presents with complaints of vague epigastric abdominal pain associated with jaundice and generalized pruritus. Physical examination reveals jaundice and a palpable non-tender gallbladder but is otherwise unremarkable. Which of the following is the most likely diagnosis?

A. Viral hepatitis
B. Pancreatic cancer
C. Acute cholecystitis
D. Gilbert’s syndrome

Click here to see the answer

B. Pancreatic cancer is suggested by the vague epigastric pain with jaundice resulting from biliary obstruction due to cancer involving the pancreatic head. The presence of a palpable non-tender gallbladder (Courvoisier’s sign) also indicates obstruction due to the cancer

A. While viral hepatitis may cause jaundice, the liver is enlarged and tender
C. While acute cholecystitis may present with jaundice and an enlarged gallbladder, the pain is classically colicky and located in the right upper quadrant. On physical examination with deep inspiration and palpation of the right subcostal area increased pain and respiratory arrest (Murphy’s sign) is usually seen.
D. Gilbert’s syndrome is the most common of the hereditary hyperbilirubinemias. It is most often diagnosed near puberty or adult life based on results of a comprehensive metabolic panel.

5. Which of the following would you expect on physical examination in a patient with mitral valve stenosis?

A. Systolic blowing murmur
B. Opening snap
C. Mid-systolic click
D. Paradoxically split S2

Click here to see the answer

B. Mitral stenosis is characterized by a mid-diastolic opening snap

A. Mitral stenosis is a diastolic, not a systolic murmur
C. Mid-systolic clicks are noted in mitral valve prolapse, not mitral stenosis
D. Paradoxical splitting of S2 occurs in aortic stenosis, not mitral stenosis

Review PANCE and PANRE Valvular disorders pearls

6. A positive Wood’s light examination (fluorescence) demonstrates

A. viral infection with herpes zoster
B. bacterial infection with Treponema pallidum
C. parasitic infestation with Pediculus humanus
D. mycotic infection with Microsporum canis

Click here to see the answer

D. Microsporum causes tinea capitis and fluoresces blue-green under Wood’s light

A. Lesions of herpes, Treponema, and Pediculus infections do not fluoresce.

Review topic PANCE Dermatologic system dermatophyte infections

7. In which of the following patients would one most likely find acanthosis nigricans?

A. A 55-year-old obese female with hyperinsulinemia
B. A 55-year-old male with an enlarged spleen and pancytopenia
C. A 24-year-old female with increased Lyme titers
D. A 60-year-old male with increased triglycerides

Click here to see the answer

A. Acanthosis nigricans is associated with patients who have hyperinsulinemia

B. Hairy cell leukemia is associated with an enlarged spleen and pancytopenia. Acanthosis nigricans is not a cutaneous manifestation
C. Erythema chronicum migrans is the characteristic lesion associated with Lyme disease
D. Eruptive xanthelasma is associated with increased triglycerides

8. A 65-year-old male presents with back pain two days after he was shoveling snow. The patient complains of pain in his low back that radiates into his buttocks, posterior thigh and calf, and the bottom of his foot. There is associated numbness of the lateral and plantar surface of his foot. Which of the following disc herniations is most likely to be affected?

A. L3-L4
B. L4-L5
C. L5-S1
D. S1-S2

Click here to see the answer

C. The S1 nerve root impingement is most likely to occur from the herniation of the L5-S1 disc space. The S1 disc affects Achilles’ reflex, the gastrocnemius and soleus muscles, and the abductor hallucis and gluteus maximus muscles.

9. A 22-year-old female presents to the emergency department with a rapid heart rate. She appears quite thin and dehydrated. She denies that she is thin, stating “I am so fat that I can hardly stand myself! That is why I exercise every day.” She runs twelve to fifteen miles a day, and on weekends also bicycles forty to fifty miles. Her LMP was six months ago. On exam, she is 5′ 6″ tall and weighs 98 pounds. Temp 98 degrees F, pulse 100, respirations 18, BP 98/60. EKG shows sinus tachycardia. Laboratory findings include Na 138 mEq/L, K 2.8 mEq/L, Cl 91 mEq/L, BUN 35 mg/dL, Creatinine 1.1 mg/dL. Which of the following is the next most appropriate treatment?

A. Propylthiouracil (PTU) and individual psychotherapy
B. Hormone replacement and cognitive therapy
C. Weight restoration and family therapy
D. IV hydration and antidepressant therapy

Click here to see the answer

C. Anorexia nervosa requires a comprehensive, multidisciplinary approach to treatment that integrates medical management, individual psychotherapy, and family therapy. Currently, the best results have been shown with weight restoration accompanied by family therapy for patients with adolescent-onset anorexia nervosa and individual therapy for patients with onset after 18 years of age. Inpatient treatment is often required.

A. Propylthiouracil is used to treat hyperthyroidism, not anorexia nervosahttps://smartypance.com/lessons/ear-disorders/inner-ear-pearls/acoustic-neuroma/
B. Hormone replacement is not indicated for the amenorrhea of anorexia nervosa, but nutritional support may help.
D. Antidepressant therapy may be useful in bulimia nervosa

10. A 52-year-old female presents with complaints of intermittent episodes of dizziness, tinnitus, and hearing loss in the right ear for 6 months. She describes the dizziness as the “room spinning around her,” with the episodes typically lasting for 2 to 4 hours. Physical examination reveals horizontal nystagmus and right ear hearing loss, but the remainder of the examination is unremarkable. Which of the following is the most likely diagnosis?

A. Acute labyrinthitis
B. Positional vertigo
C. Acoustic neuroma
D. Ménière’s syndrome

Click here to see the answer

D. Ménière’s syndrome uhttps://smartypance.com/lessons/ear-disorders/inner-ear-pearls/vertigo-reeldx294/sually presents with episodes of vertigo that last from 1 to 8 hours, sensorineural hearing loss and tinnitus.

A. Acute labyrinthitis typically presents with an acute onset of continuous vertigo that lasts several days to a week and is associated with nausea and vomiting. It does not have any associated auditory or neurologic symptoms.
B. Positional vertigo occurs following changes in head positioning with very brief, less than 1 minute, episodes. Nystagmus occurs following the position change.
C. Acoustic neuroma typically presents with hearing loss and tinnitus. The neuroma grows slowly and central compensatory mechanisms can prevent or minimize the vertigo. Vertigo, when present, is continuous and not episodic.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy + SMARTYPANCE

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Links From The Show

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

Download The Content Blueprint Checklist

Follow this link to download your FREE copy of the Content Blueprint Checklist

Print it up and start crossing out the topics you understand, marking the ones you don’t and making notes of key terms you should remember. The PDF version is interactive and linked directly to the individual lessons on SMARTY PANCE.

Download

The post Podcast Episode 67: Ten PANCE and PANRE Board Review Audio Questions appeared first on The Audio PANCE and PANRE.

Dec 21 2018

18mins

Play

Rank #9: Podcast Episode 71: Ten PANCE and PANRE Audio Board Review Questions

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The Audio PANCE and PANRE Physician Assistant Board Review Podcast

Welcome to episode 71 of the Audio PANCE and PANRE PA Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the SMARTYPANCE course content following the NCCPA content blueprint (download the FREE cheat sheet).

This week we will be covering ten general board review questions based on the NCCPA PANCE and PANRE Content Blueprints.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and Smarty PANCE.

Listen Carefully Then Take The Practice Exam

If you can’t see the audio player click here to listen to the full episode.

Podcast Episode 71: Ten Question PANCE and PANRE Podcast Quiz

The following questions are linked to NCCPA Content Blueprint lessons from the Smarty PANCE and PANRE Board Review Website. If you are a member you will be able to log in and view this interactive video lesson.

1. A 52-year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the past few months. During his physical examination, you note a nontender, non-enlarged prostate with an isolated right posterior lobe nodule. Which of the following options is most appropriate?

  1. order a serum acid phosphatase level
  2. initiate prazosin and schedule a follow-up appointment in 6 weeks
  3. refer the patient for an ultrasound of the prostate and order a PSA level
  4. reassure the patient and schedule a follow-up appointment in six months
  5. initiate norfloxacin therapy for seven days and schedule follow-up in two weeks
Click here to see the answer

Answer: C. refer the patient for an ultrasound of the prostate and order a PSA level

This patient has an isolated nodule of the prostate gland — cancer until proven otherwise. You should order an ultrasound and a PSA. BPH will present as diffuse enlargement and not a discrete nodule.

Review NCCPA Blueprint Topic: Prostate disorders (PEARLS)

2. Which of the following is a major contraindication to curative surgical resection of a lung tumor?

A. Liver metastases
B. Vagus nerve involvement
C. Non-malignant pleural effusion
D. Chest wall invasion of the tumor

Click here to see the answer

Answer: A. Liver metastases

Distant metastases, except for solitary brain and adrenal metastases are an absolute contraindication for pulmonary resection. Other absolute contraindications include MI within the past 3 months, superior vena cava syndrome due to a metastatic tumor, bilateral endobronchial tumor, contralateral lymph node metastases, and malignant pleural effusion.

Review NCCPA Blueprint Topic: Pulmonary Neoplasms (PEARLS)

3. A 23-year-old female complains of fever and genital pain. Examination reveals the presence of lymphadenopathy in the groin and the presence of vulvar vesicles surrounded by erythematous skin. The diagnosis may be confirmed by

A. A culture of a vesicle using blood agar medium
B. The presence of similar lesions on the fingers and hands
C. A Gram stain of a scraping from the base of the lesion
D. The presence of giant multinucleated cells on Tzanck smear

Click here to see the answer

Answer: D. The presence of giant multinucleated cells on Tzanck smear – A Tzanck smear is the standard laboratory test to confirm the herpes virus as an etiologic agent of a vesicular lesion on an erythematous base.

A. Herpes virus will not grow on blood agar medium.
B. Herpes genitalis occurs in skin that comes into contact with the herpes virus. Usually, the infection is localized.
C. A Gram stain will not identify the herpes virus.

Review NCCPA Blueprint Topic: Herpes simplex (ReelDx)

4. A 28-year-old woman is complaining of heavy uterine bleeding and pelvic pressure that has progressively worsened over the past year. Evaluation reveals multiple moderate-sized uterine fibroids. The patient desires to have more children. The most appropriate definitive treatment is

A. Myomectomy
B. Hysterectomy
C. GnRH agonists
D. Oral progesterone

Click here to see the answer

Answer: A. Myomectomy –  Myomectomy is the definitive treatment of choice for moderate-sized uterine fibroids in young women who desire to maintain reproductive capability.

B. Hysterectomy is indicated as definitive treatment in a patient who does not desire to maintain reproductive capability.
C. GnRH agonists are used as an adjunct to surgery for treatment of uterine fibroids. Used alone, they would not be considered a definitive treatment.
D. Oral progesterone may be used to suppress menorrhagia preoperatively. Used alone, it would not be considered a definitive treatment.;

Review NCCPA Blueprint Topic:

5. A 59-year-old otherwise healthy female develops acute dyspnea and chest pain one week post total abdominal hysterectomy. Echocardiogram demonstrates normal heart size with normal right and left ventricular function. Lung scan demonstrates two segmental perfusion defects. Which of the following is the next step in the management of this patient?

A. Anticoagulation
B. Embolectomy
C. Thrombolysis
D. Inferior vena cava filter

Click here to see the answer

Answer: A. Anticoagulation – Anticoagulation is the treatment of choice in patients with pulmonary embolism with normal ventricular function and no absolute contraindications.

B. Embolectomy is not indicated as the initial treatment of a pulmonary embolism in patients with normal ventricular function.
C. Thrombolysis is contraindicated in patients within 10 days of having major surgery.
D. An inferior vena cava filter is considered in patients with contraindications to anticoagulation therapy or failed anticoagulation therapy.

Review NCCPA Blueprint Topic: Pulmonary embolism (ReelDx)

6. Long term use of which of the following drugs may cause a drug-induced lupus-type eruption?

A. prednisone
B. tetracycline
C. procainamide
D. oral contraceptives

Click here to see the answer

Answer: C. Procainamide – Procainamide, and hydralazine are the most common drugs that may cause a lupus-like eruption.

A. Prednisone is not implicated in drug-induced skin reactions.
B. Tetracycline and sulfonamides are known to cause a photosensitive rash on sun-exposed areas of the skin.
D. Oral contraceptives may induce erythema nodosum.

Review NCCPA Blueprint topic: Drug eruptions (ReelDx)

7. Which of the following clinical manifestations is most commonly seen in viral croup?

A. drooling
B. wheezing
C. sputum production
D. inspiratory stridor

Click here to see the answer

Answer: D. inspiratory stridor – Viral croup typically presents with a barking cough and stridor.

A. Drooling is common in epiglottitis, not viral croup.
B. Wheezing is noted in asthma.
C. Sputum production is noted in bacterial infections.

Review NCCPA Blueprint Topic: Croup (ReelDx)

8. Whispered voice test on a patient reveals decreased hearing in the left ear. Which of the following would be most consistent with conductive hearing loss in the left ear?

A. Sounds best heard in the left ear on Weber test.
B. Air conduction longer than bone conduction in the left ear on Rinne test.
C. Sound best heard in the right ear on Weber test.
D. Bone conduction longer than air conduction in the right ear.

Click here to see the answer

Answer: A. Sounds best heard in the left ear on Weber test – Sound best heard in the ear with a decreased hearing on Weber test (in this case, the left ear) is indicative of conductive hearing loss.

B. With conductive hearing loss, bone conduction should be heard as long as or longer than air conduction of sound in the affected ear. Air conduction lasting longer than bone conduction of sound would indicate a sensorineural hearing loss.
C. Sound best heard in the ear with an unaffected hearing on Weber test (in this case, the right ear) is indicative of sensorineural hearing loss.
D. With conductive hearing loss, bone conduction should be heard as long as or longer than air conduction of sound in the affected ear. The right ear showed normal hearing on physical exam.

Review NCCPA Blueprint Topic: Hearing impairment (Lecture)

9. A 65-year-old male presents with multiple lesions on his back. He denies any pruritis. Physical examination reveals the presence of multiple scattered brown plaques with a raised, warty surface that appears to be stuck onto the skin and feel greasy. Which of the following is the most likely diagnosis?

A. lentigines
B. actinic keratosis
C. keratoacanthomas
D. seborrheic keratosis

Click here to see the answer

Answer: D. seborrheic keratosis – Seborrheic keratosis is a common benign plaque in the elderly that characteristically has a velvety or warty surface associated with a stuck on appearance and greasy feel.

A. Lentigines most commonly are seen on the dorsum of the hand and appear as flat brown spots, often with sharp borders.
B. Actinic keratosis usually presents as small patches of flesh-colored, pink or yellow-brown lesions often with an erythematous component. The lesions are better felt than seen, having a rough, sandpaper feel and are often tender to palpation.
C. Keratoacanthomas usually occur as an isolated lesion on the face appearing as an erythematous, dome-shaped nodule with a central keratinaceous plug.

Review NCCPA Blueprint Topic: Keratotic disorders (PEARLS)

10. You are called to the nursery to see a male infant, born by uncomplicated vaginal delivery. He weighs 2,600 grams and has one deep crease on the anterior third of each foot. Respirations are 88 breaths/minute with expiratory grunting and intercostals retractions. He is cyanotic on room air and becomes pink when placed on 60% oxygen. Chest x-ray shows atelectasis with air bronchograms. Which of the following is the most likely diagnosis?

A. neonatal pneumonia
B. congenital heart disease
C. hyaline membrane disease
D. chronic lung disease of prematurity

Click here to see the answer

Answer: C. hyaline membrane disease – Hyaline membrane disease is the most common cause of respiratory distress in the premature infant. The infant typically presents with tachypnea, cyanosis, and expiratory grunting. A chest x-ray reveals hypoexpansion and air bronchograms.

A. While tachypnea, grunting, retractions, and cyanosis may be signs of neonatal pneumonia, they are primarily late findings of progressive respiratory distress and would not be seen immediately at the time of delivery. A chest x-ray in pneumonia would also most commonly reveal an infiltrate or effusion.
B. While congenital heart disease may present with cyanosis, the chest x-ray will reveal a cardiac abnormality, such as cardiomegaly.
D. Chronic lung disease of prematurity is a complication in about 20% of infants with hyaline membrane disease. It is defined as respiratory symptoms, oxygen requirement and chest x-ray abnormalities at 1 month of age so it cannot be diagnosed at this time in this newborn.;

Review NCCPA Blueprint Topic: The PANCE and PANRE Exam Academy + SMARTYPANCE

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Links From The Show

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

Download The Content Blueprint Checklist

Follow this link to download your FREE copy of the Content Blueprint Checklist

Print it up and start crossing out the topics you understand, marking the ones you don’t and making notes of key terms you should remember. The PDF version is interactive and linked directly to the individual lessons on SMARTY PANCE.

Download for PANCE Download for PANRE

The post Podcast Episode 71: Ten PANCE and PANRE Audio Board Review Questions appeared first on The Audio PANCE and PANRE.

May 09 2019

22mins

Play

Rank #10: EENT 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 33

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Welcome to episode 33 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I continue to cover topic specific PANCE and PANRE review from the Academy course content following the NCCPA content blueprint.

This week we will be covering 10 topic specific HEENT board review questions.

Eyes, Ears Nose and Throat accounts for 9% of your PANCE/PANRE board exam.  

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full Gastroenterology/Nutrition review includes over 111 EENT specific questions and is available to all members of the PANCE and PANRE Academy.

  • You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
  • You can listen to the latest episode, take an interactive quiz and download your results below.

Listen Carefully Then Take The Quiz

If you can’t see the audio player click here to listen to the full episode.

EENT PANCE and PANRE Podcast Quiz

You can take the interactive exam by clicking here.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy.

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Show Notes:

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

The post EENT 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 33 appeared first on The Audio PANCE and PANRE.

Feb 05 2016

18mins

Play

Rank #11: Musculoskeletal 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 37

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Welcome to episode 37 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I continue to cover topic specific PANCE and PANRE review from the Academy course content following the NCCPA content blueprint.

Click here to download my interactive content blueprint checklist

This week we will be covering 10 topic specific Musculoskeletal board review questions.

The Musculoskeletal System accounts for 10% of your PANCE/PANRE board exam.  

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full genitourinary board review includes over 72 GU specific questions and is available to all members of the PANCE and PANRE Academy.

  • You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
  • You can listen to the latest episode, take an interactive quiz and download your results below.

Listen Carefully Then Take The Quiz

If you can’t see the audio player click here to listen to the full episode.

Musculoskeletal PANCE and PANRE Podcast Quiz

You can take the interactive exam by clicking here.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy.

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Show Notes:

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

The post Musculoskeletal 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 37 appeared first on The Audio PANCE and PANRE.

Apr 25 2016

13mins

Play

Rank #12: Episode 53: General Surgery End of Rotation Exam – The Audio PANCE and PANRE Podcast

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Welcome to episode 53 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the Academy course content following the NCCPA content blueprint (download the FREE cheat sheet) and the PAEA End of Rotation Exams Blueprints & Topic Lists.

This week we will be covering ten General Surgery End of Rotation Exam Questions that are now part of the SMARTYPANCE website. 

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and SMARTYPANCE which are now bundled together into one very low price.

Listen Carefully Then Take The Quiz

If you can’t see the audio player click here to listen to the full episode.

Episode 51: General Surgery Endo of Rotation Exam Podcast Quiz

The following 10 questions are linked to NCCPA Content Blueprint lessons from the SMARTYPANCE and PANRE Board review website. If you are a member you will be able to log in and view this interactive video content.

1. An 18-year-old patient has a tibia/fibula fracture following a motorcycle crash. Twelve hours later the patient presents with increased pain despite adequate doses of analgesics and immobilization. Which of the following is the most likely diagnosis?

A. avascular necrosis
B. myositis ossificans
C. compartment syndrome
D. reflex sympathetic dystrophy

Click here to see the answer

Answer: C. Compartment syndrome

Compartment syndrome is characterized by a pathological increase of pressure within a closed space and results from edema or bleeding within the compartment. It may occur as an early local complication of fracture.

A. Avascular necrosis occurs primarily in muscles post-traumatically and may not arise for several months after an injury.

B. Myositis ossificans is a late complication of fracture resulting from disruption of the blood supply to the bone.

D. Reflex sympathetic dystrophy is characterized by painful wasting of the hand muscles that may be secondary to injury and could occur as a late complication.

2. A 25-year-old male presents to the ED with left calf pain and cramping, as well as nausea and vomiting. He admits to “partying with cocaine all night”. He describes his urine as a dark brown color. Serum creatinine kinase (CK) is 1325 IU/L (Normal Range 32-267 IU/L). Which of the following is the initial mainstay of therapy for this condition?

A. IV rehydration
B. Fasciotomy
C. Toradol (Ketorolac)
D. Hydrotherapy

Click here to see the answer

Answer: A. IV rehydration

IV rehydration with crystalloids for 24 to 72 hours is the mainstay of therapy for rhabdomyolysis.

B. Fasciotomy is indicated for compartment syndrome.

C. NSAIDs, such as Toradol (Ketorolac), should not be used due to the vasoconstrictive effects on the kidneys.

D. Hydrotherapy is not useful or indicated for Rhabdomyolysis

3. A 42-year-old male presents complaining of a sudden onset of a severe intermittent pain originating in the flank and radiating into the right testicle. He also complains of nausea and vomiting. On examination, the patient is afebrile but restless. Examination of the abdomen reveals tenderness to palpation along the right flank with no rebound or direct testicular tenderness. Urinalysis reveals a pH of 5.4 and microscopic hematuria but is otherwise unremarkable. Which of the following is the most likely diagnosis?

A. Bladder cancer
B. Nephrolithiasis
C. Acute appendicitis
D. Acute epididymitis

Click here to see the answer

Answer: B. Nephrolithiasis

A sudden onset of severe colicky flank pain associated with nausea and vomiting as well as the absence of rebound or direct testicular tenderness makes nephrolithiasis the most likely diagnosis. This is further supported by the presence of hematuria on the urinalysis.

A. While bladder cancer may have associated microscopic hematuria, it presents with painless hematuria or irritative voiding symptoms.

C. While an acute abdomen, such as acute appendicitis, is in the differential diagnosis, the absence of fever and peritoneal signs makes this diagnosis less likely

D. The absence of fever, as well as non-tenderness to palpation of the testes, suggests a renal rather than gonadal cause of the patient’s symptoms

4. What is the term for blue discoloration about the umbilicus?

A. Cullen’s sign
B. Murphy’s sign
C. Rovsing’s sign
D. Turner sign

Click here to see the answer

Answer: A. Cullen’s sign

Cullen’s sign is a blue discoloration about the umbilicus and can occur in hemorrhagic pancreatitis and results from hemoperitoneum.

B. Murphy’s sign is seen in liver and gallbladder disease by which the patient abruptly halts deep inspiration due to pain in the right upper quadrant while the examiner’s hand is keeping stable pressure to the area.

C. Rovsing’s sign is positive when the patient experiences right-sided abdominal pain with palpation to the left side. This is generally seen in those with appendicitis.

D. Turner sign is also seen in severe, acute pancreatitis but is represented by a green-brown discoloration of bilateral flanks

5. A 25-year-old female presents with right lower quadrant pain, right flank pain, nausea, and vomiting. Her temperature is 39.6 degrees C. There is right CVA tenderness and RLQ tenderness. The pelvic exam is unremarkable. Urinalysis reveals pH 7.0, trace protein, negative glucose, negative ketones, positive blood, and positive nitrates. Specific gravity is 1.022. Microscopy shows 102 RBCs/HPF, 50-75 WBCs/HPF, rare epithelial cells, and WBC casts. The most likely diagnosis is

A. acute salpingitis
B. nephrolithiasis
C. acute pyelonephritis
D. appendicitis

Click here to see the answer

Answer: C. acute pyelonephritis

Acute pyelonephritis presents with flank pain, fever, and generalized muscle tenderness. Urinalysis shows pyuria with leukocyte casts.

A. Acute salpingitis would be suggested if pelvic exam abnormalities were present.

B. Nephrolithiasis does not usually present with fever or casts. Urinalysis will have RBCs present.

D. This scenario is consistent with acute pyelonephritis, not acute appendicitis.

6. A 26-year-old gravida 0 sexually active female presents to the emergency room complaining of colicky pain in her lower abdomen for the past 12 hours. She passed out earlier in the day while trying to have a bowel movement. Her last menstrual period was 6 weeks ago. She has noted vaginal spotting over the last 24 hours. Vital signs show Temp 37 degrees C, BP 96/60mmHg, P 110, R 16, Oxygen Sat. 98%. Abdominal exam is positive for distension and tenderness. Bowel sounds are decreased. Pelvic exam shows cervical motion and adnexal tenderness. Which of the following is the most likely diagnosis?

A. Ectopic pregnancy 
B. Appendicitis 
C. Crohn’s disease 
D. Pelvic inflammatory disease

Click here to see the answer

Answer: A. Ectopic pregnancy 

High suspicion for ectopic pregnancy should be maintained when any possible pregnant woman presents with vaginal bleeding or abdominal pain.

B. Appendicitis presents with nausea, vomiting and periumbilical pain that moves to the right lower quadrant of the abdomen.

C. Crohn’s disease is more common in women and may present with an acute abdomen. However, the pelvic examination would be normal.

D. In pelvic inflammatory disease, the temperature is usually above 38 degrees C and pelvic pain usually follows onset of cessation of menses

7. A 12-year-old boy presents to the office with pain in his legs with activity gradually becoming worse over the past month. He is unable to ride a bicycle with his friends due to the pain in his legs. Examination of the heart reveals an ejection click and accentuation of the second heart sound. Femoral pulses are weak and delayed compared to the brachial pulses. Blood pressure obtained in both arms is elevated. Chest x-ray reveals rib notching. Which of the following is the most likely diagnosis?

A. abdominal aortic aneurysm
B. pheochromocytoma
C. coarctation of the aorta
D. thoracic outlet syndrome

Click here to see the answer

Answer: C. coarctation of the aorta

Coarctation is a discrete or long segment of narrowing adjacent to the left subclavian artery. As a result of the coarctation, systemic collaterals develop. X-ray findings occur from the dilated and pulsatile intercostal arteries and the “3” is due to the coarctation site with proximal and distal dilations.

A. Abdominal aortic aneurysm is usually asymptomatic until the patient has dissection or rupture. It is uncommon in a child.

B. Pheochromocytoma classically causes paroxysms of hypertension due to catecholamine release from the adrenal medulla but does not cause variations in blood pressure in the upper and lower extremities.

D. Thoracic outlet syndrome occurs when the brachial plexus, subclavian artery, or subclavian vein becomes compressed in the region of the thoracic outlet. It is the most common cause of acute arterial occlusion in the upper extremity of adults under 40 years old

8. A 28-year-old male presents with burns sustained from hot grease splashed on his left hand earlier this afternoon. The burn extends from his palm to the volar aspect of his wrist and has an erythematous base, covered by an intact blister. There are a few small scattered blisters over the dorsum of the left hand. Which of the following is the initial intervention of choice?

A. Tetanus prophylaxis 
B. Admission to a burn unit 
C. Intravenous fluid administration 
D. Debridement of blisters

Click here to see the answer

Answer: A. Tetanus prophylaxis

Tetanus prophylaxis should be initially considered in all burn patients

B. Admission to a burn unit is not indicated for adult patients with uncomplicated partial thickness burns covering less than 15 to 20% of total body surface area (TBSA).

C. IV fluids are indicated for severe partial thickness burns covering more than 10% TBSA or in burns with complications.

D. Debridement of blisters is controversial, however blisters on the palms and soles should remain intact.

9. Which of the following is the selected method for the prevention of venous thromboembolism in a 38-year-old male undergoing an inguinal hernia repair?

A. early ambulation
B. elastic stockings
C. intermittent pneumatic compression
D. low-molecular weight heparin

Click here to see the answer

Answer: A. early ambulation 

Early ambulation is recommended for prophylaxis of venous thromboembolism in low-risk, minor procedures when the patient is under 40 years of age and there are no clinical risk factors.

B. Elastic stockings are indicated for patients at moderate risk of venous thromboembolism in ages 40-60 with minor procedures with additional thrombosis risk factor, or major operations for patients under age 40 without additional clinical risk factors.

C. Intermittent pneumatic compression is indicated in patients undergoing a major operation plus an increased risk of bleeding.

D. Low molecular weight heparin is indicated in patients undergoing orthopedic surgery, neurosurgery, or trauma with an identifiable risk factor for thromboembolism.

10. A patient presents with abdominal pain in the right lower quadrant, examination reveals increased pain in the right lower quadrant on deep palpation of the left lower quadrant. This is commonly known as which of the following?

A. Psoas sign
B. Murphy’s sign
C. Rovsing’s sign
D. Obturator sign

Click here to see the answer

Answer: C. Rovsing’s sign 

A positive Rovsing’s sign can be elicited in a patient with appendicitis when increased pain occurs in the right lower quadrant upon palpation of the left lower quadrant. 

A. Psoas sign is right lower quadrant pain with right leg extension seen in acute appendicitis

B. Murphy’s sign is seen in liver and gallbladder disease in which the patient abruptly halts deep inspiration due to discomfort as the examiner’s hand applies pressure to the right upper quadrant.

D. Obturator sign is right lower quadrant pain with internal rotation of the hip seen in acute appendicitis

Appendicitis: RLQ pain, + Obturator and Psoas sign

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy + SMARTYPANCE

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Links From The Show

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

Download The Content Blueprint Checklist

Follow this link to download your FREE copy of the Content Blueprint Checklist

Print it up and start crossing out the topics you understand, marking the ones you don’t and making notes of key terms you should remember. The PDF version is interactive and linked directly to the individual lessons on SMARTY PANCE.

FREE Download

The post Episode 53: General Surgery End of Rotation Exam – The Audio PANCE and PANRE Podcast appeared first on The Audio PANCE and PANRE.

Oct 05 2017

19mins

Play

Rank #13: Episode 51: The Audio PANCE and PANRE Board Review Podcast – Comprehensive Audio Quiz

Podcast cover
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Welcome to episode 51 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the Academy course content following the NCCPA content blueprint (download the FREE cheat sheet).

This week we will be covering ten general board review questions based on the NCCPA PANCE and PANRE Content Blueprint.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and SmartyPANCE which are now bundled together into one very low price.

Listen Carefully Then Take The Quiz

If you can’t see the audio player click here to listen to the full episode.

Episode 51 PANCE and PANRE Podcast Quiz

The following 10 questions are linked to NCCPA Content Blueprint lessons from the SMARTYPANCE and PANRE Board review website. If you are a member you will be able to log in and view this interactive video content.

1. A 42-year-old male with a history of constipation presents with complaints of severe pain with defecation described as feeling like he is “tearing apart.” He has also noted occasional small amounts of blood on toilet paper. External examination of the rectum is unremarkable and an internal rectal exam cannot be performed due to severe pain when attempted. Which of the following is the most likely diagnosis?

A. Proctitis
B. Anal fissure
C. Rectal prolapse
D. Internal hemorrhoids

Anal fissures are covered as part of the NCCPA Content Blueprint GI and Nutrition which accounts for 10% of the exam

View this ReelDx patient video case of a 51-year-old with rectal bleeding and abdominal pain (proctitis)

Click here to see the answer

Answer: B. Anal fissures

Anal fissures are easily diagnosed from history alone with the classic finding of severe pain upon defecation. Constipation is also a common cause of the trauma that leads to the development of a fissure.

A. Proctitis is usually caused by anorectal infections that produce symptoms of anorectal discomfort, tenesmus, constipation, and discharge from the rectum.
C. Rectal prolapse is commonly seen in elderly females with complaints that include an anal mass, rectal bleeding and a change in bowel habits.
D. While internal hemorrhoids may cause rectal bleeding, tearing pain is an uncommon complaint unless there is evidence of thrombosis of irreducible tissue.

2. What type of chest pain is most commonly associated with a dissecting aortic aneurysm?

A. Squeezing
B. Dull, aching
C. Ripping, tearing
D. Burning

Dissecting aortic aneurysm is covered as part of the NCCPA Cardiology Content Blueprint and accounts for 16% of the exam

Click here to see the answer

Answer: C. A dissecting aortic aneurysm often presents with a very severe ripping, tearing like pain.

A dissecting aortic aneurysm often presents with a very severe ripping, tearing like pain.

A. Squeezing pain is more characteristic of angina or esophageal pain.
B. Dull, aching pain is more characteristic of chest wall pain, possibly angina, or anxiety.
D. Burning pain is more characteristic of esophageal reflux, esophagitis, or tracheobronchitis.

3. A 15-year-old softball player presents after jamming the distal tip of her finger into severe flexion. She is unable to extend the distal phalanx and she has pain on palpation of the distal interphalangeal joint. X-ray of the hand fails to reveal any associated avulsion fracture. Which of the following is the treatment of choice?

A. Open reduction and internal fixation
B. Continuous extension of the DIP with splinting
C. Continuous flexion of the PIP with splinting
D. Application of short arm cast

Soft tissue injuries of the forearm, wrist, and hand are covered as part of the NCCPA Musculoskeletal Content Blueprint and accounts for 10% of the exam

Click here to see the answer

Answer: B. Continuous extension of the DIP with splinting

The treatment of choice for a tear in the extensor tendon of the finger is continuous extension of the DIP via splinting for 6 to 8 weeks.

D. Short arm casting is indicated in wrist and metacarpal injuries but not in DIP extensor injuries.

4. A patient presents with loss of pigmentation on the back of hands, face, and body folds due to the absence of epidermal melanocytes. There has been improvement with PUVA treatment. Which of the following is the most likely diagnosis?

A. Pityriasis alba
B. Tinea versicolor
C. Vitiligo
D. Melasma

View this ReelDx patient video case of a 7-year-old female with localized, depigmented skin patches; rash

Click here to see the answer

Answer: C. Vitiligo

 Vitiligo is the acquired loss of pigmentation due to the absence of epidermal melanocytes presenting on the back of hands, face, or body folds.

A. Pityriasis alba is caused by dermal inflammation that becomes scaly and hypopigmented.
B. Tinea versicolor is a fungal infection of the skin presenting as oval or circular lesions
D. Melasma is an acquired brown hyperpigmentation involving the face and neck in women during their second or third trimester of pregnancy.

5. Which of the following medications used in the management of anxiety has a delayed onset of action?

A. Buspirone (BuSpar)
B. Diphenhydramine (Benadryl)
C. Lorazepam (Ativan)
D. Butalbital (Fiorinal)

Anxiety disorders are covered as part of the NCCPA Content Psychiatry Blueprint which accounts for 6% of your exam

Click here to see the answer

Answer: A. buspirone (BuSpar)

Buspirone takes several days to weeks for it to have clinical activity.

B. Diphenhydramine works as a histamine blocker and will cause sedation immediately because of its anticholinergic effects.
C. Lorazepam is an anxiolytic medication that has an immediate onset of activity.
D. Butalbital is a short to intermediate-acting barbiturate that has immediate activity.

6. A 57-year-old male was working on his farm when some manure was slung hitting his left eye. He presents several days after with a red, tearing, painful eye. Fluorescein stain reveals uptake over the cornea looking like a shallow crater. Which of the following interventions would be harmful?

A. Ophthalmic antibiotics
B. Pressure patch
C. Examination for visual acuity
D. Copious irrigation

Corneal abrasion is covered as part of the NCCPA EENT Content Blueprint and accounts for 9% of the exam

Click here to see the answer

Answer: B. Pressure patch

Patching of the eye after a corneal abrasion associated with organic material contamination is contraindicated due to increased risk of fungal infection.

A. Ophthalmic antibiotics and copious irrigation are indicated when treating a patient with a suspected corneal ulcer due to an infectious cause.
C. Examination for assessment of visual acuity should be performed.

7. A 75-year-old female falls on her outstretched arm. She sustains a humeral mid-shaft fracture. Nerve impingement occurs due to the fracture. What is the most likely physical examination abnormality that will be encountered?

A. Inability to extend the wrist against resistance
B. Numbness over the deltoid muscle in the shoulder
C. Winging of the scapula
D. Weakness of the rotator cuff

Fractures and dislocations of the forearm, wrist, and hand are covered as part of the NCCPA Musculoskeletal Content Blueprint and accounts for 10% of the exam

Click here to see the answer

Answer: D. Inability to extend the wrist against resistance

The radial nerve is most likely entrapped by this fracture. Radial nerve damage will cause an inability to extend the wrist against resistance.

B. Axillary nerve injury results in numbness over the deltoid muscle; this nerve is more commonly injured in proximal humeral fractures and anterior shoulder dislocations.
C. Injury to the long thoracic nerve causes winging of the scapula due to its innervation of the serratus anterior muscle.
D. Injury to the subscapular nerve results in weakness and pain of the infraspinatus muscle; this injury is commonly seen in volleyball players from repetitive stress.

8. A 16-year-old male involved in a fight sustained a laceration to his right upper eyelid. He is unable to open his eye, and a possible laceration of the globe is suspected. Which of the following is the next step?

A. Use a slit lamp to determine the extent of the injury.
B. Use fluorescein strips to determine the extent of the injury.
C. Apply a metal eye shield and refer to an ophthalmologist.
D. Apply antibiotic ointment to the lid and recheck in 24 hours.

Disorders of they eye are covered as part of the NCCPA EENT Content Blueprint and accounts for 9% of the exam

66-year-old female with acute onset of periorbital deformitySmartyPANCE ReelDx + members can view this real-world case!

Click here to see the answer

Answer: C. Apply a metal eye shield and refer to an ophthalmologist.

Protect the eye from any pressure with a rigid metal eye shield and refer for immediate ophthalmologic consultation. Avoid unnecessary actions that would delay treatment or cause further injury.

9. Which of the following typical findings would be revealed during a sigmoidoscopy on a patient with Crohn’s disease of the intestine?

A. Rectal pseudopolyps
B. Diffuse ulceration and bleeding
C. Sheets of WBCs with inflamed mucosa
D. Intermittent longitudinal mucosal ulcers and fissures

Inflammatory bowel disease is covered as part of the NCCPA Content Blueprint GI and Nutrition which accounts for 10% of the exam

Click here to see the answer

Answer: D. Intermittent longitudinal mucosal ulcers and fissures

Ulcerations tend to be linear with transverse fissures in Crohn’s disease. These skip lesions are common with Crohn’s disease.

A. Rectal pseudopolyps are associated with ulcerative colitis rather than Crohn’s.
B. Diffuse ulcerations and bleeding are more characteristic of ulcerative colitis than Crohn’s disease.
C. Sheets of WBCs or “pseudomembranes” can be detected in patients with pseudomembranous colitis.

10. A 72-year-old patient with a history of hypertension and atrial fibrillation presents with episodes of weakness, numbness, and paresthesia’s in the right arm. At the same time, she notes speech difficulty and loss of vision in her left eye. These symptoms come on abruptly and clear within minutes. Physical examination is normal except for the previously known arrhythmia. Which of the following is the most likely diagnosis?

A. Focal seizure
B. Migraine headache
C. Hypoglycemic episodes
D. Transient ischemic attack

Atrial fibrillation is covered as part of the NCCPA Cardiology Content Blueprint which is 16% of your exam

SmartyPANCE + ReelDx members can view this ReelDx patient case video of an 83-year-old with fast heart rate, palpitations

Click here to see the answer

Answer: D. Transient ischemic attack

This patient’s symptoms are consistent with transient ischemia in the carotid territory. Atrial fibrillation is a risk factor for cerebral emboli.

A. Focal seizures usually cause abnormal motor movement rather than weakness or loss of feeling.
B. Patients with migraines commonly have a history of episodes since adolescence.
C. Hypoglycemic episodes do not present with focal neurological findings.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy + SMARTYPANCE

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Links From The Show

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

Download The Content Blueprint Checklist

Follow this link to download your FREE copy of the Content Blueprint Checklist

Print it up and start crossing out the topics you understand, marking the ones you don’t and making notes of key terms you should remember. The PDF version is interactive and linked directly to the individual lessons on SMARTY PANCE.

FREE Download

The post Episode 51: The Audio PANCE and PANRE Board Review Podcast – Comprehensive Audio Quiz appeared first on The Audio PANCE and PANRE.

Jul 11 2017

17mins

Play

Rank #14: Episode 61: The Audio PANCE and PANRE – Ten Mixed NCCPA™ Content Blueprint Multiple Choice Questions

Podcast cover
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Ten Mixed NCCPA Content Blueprint Multiple Choice Questions

Welcome to episode 61 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the SMARTYPANCE course content following the NCCPA content blueprint (download the FREE cheat sheet).

This week we will be covering ten general board review questions based on the NCCPA PANCE and PANRE Content Blueprint.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and SMARTYPANCE which are now bundled together into one very low price.

Listen Carefully Then Take The Practice Exam

If you can’t see the audio player click here to listen to the full episode.

Episode 5 – General PANCE/PANRE Podcast Quiz

The following 10 questions are linked to NCCPA Content Blueprint lessons from the SMARTYPANCE and PANRE Board review website. If you are a member you will be able to log in and view this interactive video content.

1. An 18-year-old male presents with pain in his wrist after he fell off of a moving motorcycle. Physical examination reveals tenderness in the anatomic snuffbox. No fracture is noted on plain radiography of the wrist. Which of the following is the recommended treatment for this patient?

A. An ace wrap of the wrist
B. Closed reduction of the fracture site
C. Thumb spica cast application
D. Open reduction of the fracture site

Click here to see the answer

Answer: C. Thumb spica cast application

Even with normal initial radiographs, patients with a consistent history and tenderness in the anatomical snuffbox are treated as a stable fracture with immobilization in a thumb spica cast. Casting is recommended for all presumed nondisplaced scaphoid fractures.

Scaphoid fractures covered in fractures and dislocation of the forearm, wrist, and hand and are part of the NCCPA Endocrinology Musculoskeletal Blueprint (10%)

2. A solitary pulmonary nodule is found on a pre-employment screening chest x-ray in a 34-year-old non-smoking male. There are no old chest x-rays to compare. Which of the following is the most appropriate next step in the evaluation?

A. CT scan of the chest
B. Needle biopsy of the lesion
C. Positron emission tomography of the chest
D. Fiberoptic bronchoscopy

Solitary pulmonary nodules are covered as part of the NCCPA PANCE Blueprint Pulmonary (12%) Content Blueprint (12%)

Click here to see the answer

Answer: A. CT scan of the chest

In the absence of old x-rays in a nonsmoking individual less than 35 years old, CT scan of the chest is the next step in the evaluation of a solitary pulmonary nodule.

B. A needle biopsy would be indicated for a person greater than 35 years old and/or with a history of smoking to evaluate a solitary pulmonary nodule.
C. Positron emission tomography (PET scan) would be indicated if the CT scan was nonconclusive.
D. Fiberoptic bronchoscopy would be indicated only in the presence of a history of tobacco use or if the lesion was suggestive of malignancy.

3. Early clues to impending delirium tremens include

A. agitation and decreased cognition.
B. visual hallucinations and diaphoresis.
C. autonomic hyperactivity and dehydration.
D. mental confusion and sensory hyperacuity.

Delirium tremens is covered as part of the NCCPA Psychiatry content blueprint (6%) under the topic of withdrawal

Click here to see the answer

Answer: A. agitation and decreased cognition.

Anxiety, decreased cognition, tremulousness, increasing irritability, and hyperactivity are common early clues to impending delirium tremens.

Mental confusion, tremor, sensory hyperacuity, visual hallucinations, autonomic hyperactivity, diaphoresis, dehydration, electrolyte disturbances, seizures, and cardiovascular abnormalities are common signs and/or symptoms of full-blown delirium tremens.

4. Dental caries are caused by which of the following organisms?

A. Streptococcus mutans
B. Streptococcus pyogenes
C. Staphylococcus epidermidis
D. Staphylococcus aureus

Dental caries are covered as part of the NCCPA EENT Content Blueprint (9%) under diseases of the teeth and gums

Click here to see the answer

Answer: A. Streptococcus mutans

Streptococcus mutans is the principal organism that helps to demineralize the enamel.

5. The most definitive treatment for primary enuresis is

A. oxybutynin chloride (Ditropan).
B. imipramine (Tofranil).
C. trimethoprim-sulfamethoxazole (Bactrim).
D. desmopressin (DDAVP)

Primary enuresis is covered under incontinence as part of the NCCPA Genitourinary Content Blueprint (6%)

Click here to see the answer

Answer: D. desmopressin (DDAVP)

Intranasal desmopressin is effective in 50% of patients treated and is the treatment of choice.

A. Oxybutynin chloride is used for bladder spasms. It cannot be used for children under 5 years of age and is not indicated in primary enuresis.
B. Imipramine is an older form of treatment that is moderately effective, but many patients relapse when therapy is stopped. This is no longer considered the treatment of choice.
C. TMP-SMX is indicated for urinary tract infections that may cause secondary enuresis, but it is not used in primary enuresis.

6. A 47-year-old female presents to the clinic with complaints of prolonged, heavy menses that have been getting progressively worse for 3 years. She denies any pain. On physical examination, enlargement of the uterus with multiple smooth, spherical, firm masses is noted. A CBC is consistent with a mild anemia. Which of the following is the most likely diagnosis?

A. Leiomyoma
B. Adenomyosis
C. Endometriosis
D. Endometrial polyps

Click here to see the answer

Leiomyoma is covered as part of the NCCPA Reproductive Content Blueprint (8%)

Answer:  A. Leiomyoma

Abnormal uterine bleeding and irregular enlargement of the uterus are most consistent with leiomyoma. Pain is rarely present unless vascular compromise occurs.

B. While adenomyosis may present with hypermenorrhea, dysmenorrhea is often also present. Physical examination would reveal the presence of diffuse globular uterine enlargement, not the irregular enlargement as noted in the case presented.
C. Endometriosis presents with dyspareunia, dysmenorrhea, and infertility. If the pelvic exam were abnormal, uterine findings would include tender nodules in the cul de sac, not the uterus.
D. While endometrial polyps are compatible with the history of abnormal uterine bleeding, the uterus would be normal size without the irregular enlargement noted in the case presented.

7. Which of the following is the laboratory test that marks recovery from Hepatitis B infection and non-infectivity?

A. Hepatitis B surface antibody(anti-HBs)
B. Hepatitis B surface antigen (HBsAg)
C. Hepatitis B core antigen (HBcAg)
D. Hepatitis A antibody (anti-HAV)

Hepatitis B serology is covered as part of acute and chronic hepatitis and is part of the NCCPA GI and Nutrition Content Blueprint (10%)

Click here to see the answer

Answer: A. Hepatitis B surface antibody(anti-HBs)

Specific antibody to HBsAg appears in most individuals after clearance of HBsAg which indicates recovery from hepatitis B infection, non-infectivity, and immunity.

B. This test establishes infection with HBV and implies infectivity.
C. Presence of the hepatitis B core antigen reflects active infection.
D. Patients who have immunity to hepatitis A do not have immunity to hepatitis B.

8. A 36-year-old woman admits that her husband has abused her for over ten years. You should inform the woman that she is at most risk for injury or death

A. just before a holiday.
B. just after leaving an abusive spouse.
C. when an abusive spouse arrives home after work.
D. when an abusive spouse has been drinking heavily.

Domestic violence is covered as part of the NCCPA Psychiatry Content Blueprint (6%)

Click here to see the answer

Answer: B. just after leaving an abusive spouse.

Women are more likely to be assaulted or murdered when attempting to report the abuse or leave the abusive relationship; up to 75% of domestic assaults occur after separation.

9. A patient presents with an acutely painful and cold left leg. Distal pulses are absent. Leg is cyanotic. There are no signs of gangrene or other open lesions. Symptoms occurred one hour ago. Which of the following treatments is most appropriate?

A. Vena cava filter
B. Embolectomy
C. Amputation
D. Aspirin

Arterial embolism/thrombosis is covered as part of the NCCPA Cardiology Content Blueprint (16%)

Click here to see the answer

Answer: B. Embolectomy

Embolectomy within 4 to 6 hours is the treatment of choice.

A. Vena cava filters are used in the management of venous thromboembolic disease when anticoagulation cannot be done.
C. Amputation is done only when no viable tissue is present. Cutting off a viable limb is never a good idea.
D. Aspirin is used in the prevention and treatment of coronary disease and has no role in the treatment of peripheral arterial embolism.

10. A 53-year-old male is seen in the emergency department following a motor vehicle collision in which his knee impacted against the dashboard. The patient has a posterior knee dislocation that is promptly reduced in the emergency department. The patient currently has a palpable pulse in the dorsalis pedis and posterior tibial areas. Which of the following studies is mandatory?

A. Anterior plain film of knee
B. Sunrise view of the knee
C. Measurement of compartment pressures
D. Angiography

Fractures and dislocations of the knee are covered as part of the NCCPA Musculoskeletal Content Blueprint (10%)

Click here to see the answer

Answer: D. Angiography

The popliteal artery is at risk for injury whenever a patient sustains a posterior dislocation of the knee and should be evaluated with an arteriogram despite the presence of pedal pulses.

C. Compartment pressures are performed in cases of suspected compartment syndrome, not to determine the patency of the popliteal artery.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy + SMARTYPANCE

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Links From The Show

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

Download The Content Blueprint Checklist

Follow this link to download your FREE copy of the Content Blueprint Checklist

Print it up and start crossing out the topics you understand, marking the ones you don’t and making notes of key terms you should remember. The PDF version is interactive and linked directly to the individual lessons on SMARTY PANCE.

Download

The post Episode 61: The Audio PANCE and PANRE – Ten Mixed NCCPA™ Content Blueprint Multiple Choice Questions appeared first on The Audio PANCE and PANRE.

May 14 2018

14mins

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Rank #15: Genitourinary 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 35

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Welcome to episode 35 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I continue to cover topic specific PANCE and PANRE review from the Academy course content following the NCCPA content blueprint.

This week we will be covering 10 topic specific Genitourinary board review questions.

GU accounts for 6% of your PANCE/PANRE board exam.  

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full genitourniary board review includes over 72 GU specific questions and is available to all members of the PANCE and PANRE Academy.

  • You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
  • You can listen to the latest episode, take an interactive quiz and download your results below.

Listen Carefully Then Take The Quiz

If you can’t see the audio player click here to listen to the full episode.

Genitourinary PANCE and PANRE Podcast Quiz

You can take the interactive exam by clicking here.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy.

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Show Notes:

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

The post Genitourinary 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 35 appeared first on The Audio PANCE and PANRE.

Mar 14 2016

17mins

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Rank #16: The Audio PANCE and PANRE Board Review Podcast Episode 25

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Welcome to episode 25 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

The Audio PANCE and PANRE is an audio board review series that includes 10 Multiple Choice PANCE and PANRE Board Review Questions in each episode.

I hope you enjoy this free audio component to the examination portion of this site. The full series is available to all members of the PANCE and PANRE Academy.

  • You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
  • You can listen to the latest episode, download the transcript and take an interactive quiz of the questions below.

Download the FREE PDF transcript for FREE here or on Scribd.

Listen Carefully Then Take The Quiz

If you can’t see the audio player click here to listen to the full episode.

Questions 1-10

The Audio PANCE and PANRE Episode 25

1. Which of the following conditions will produce a transudative pleural effusion?

A. Kaposi’s sarcoma
B. Pneumonia
C. Cirrhosis
D. Mesothelioma

Click here to see the answer

Answer: C. Cirrhosis

Transudative pleural effusions result from alteration in the formation of pleural fluid, the absorption of pleural fluid, or both, by systemic factors. Local factors affecting pleural fluid absorption and/or formation produce exudative pleural effusions.

2. Which of the following pathophysiological processes is believed to initiate acute appendicitis?

A. Obstruction
B. Perforation
C. Hemorrhage
D. Vascular compromise

Click here to see the answer

Answer: A. Obstruction

Obstruction of the appendiceal lumen by lymphoid hyperplasia, a fecalith or foreign body initiates most cases of appendicitis.

3. A 23 year-old female with a history of palpitations presents for evaluation. She admits to acute onset of rapid heart beating lasting seconds to minutes with associated shortness of breath and chest pain. The patient states she can relieve her symptoms with Valsalva. Which of the following is the most appropriate diagnostic study to establish a definitive diagnosis in this patient?

A. Cardiac catheterization
B. Cardiac MRI
C. Chest CT scan
D. Electrophysiology study

Click here to see the answer

Answer: D. Electrophysiology study

Electrophysiology study is useful in establishing the diagnosis and pathway of complex arrhythmias such as supraventricular tachycardia.

4. A known alcoholic presents to the emergency department with altered level of consciousness and a blood glucose level of 35 mg/dL. Which of the following best explains this glucose result?

A. Excess pancreatic insulin release
B. Rapid carbohydrate discharge into the small bowel
C. Agonist insulin receptor antibody formation
D. Hepatic glycogen depletion and impaired gluconeogenesis

Click here to see the answer

Answer: D. Hepatic glycogen depletion and impaired gluconeogenesis

Alcohol-related hypoglycemia results from hepatic glycogen depletion and impaired gluconeogenesis and not due to antibody formation, excessive insulin release from the pancreas, or rapid release of carbohydrate into the small bowel.

5. Which of the following is the chief adverse effect of thiazide diuretics?

A. Hypokalemia
B. Hypernatremia
C. Hypocalcemia
D. Hypermagnesemia

Click here to see the answer

Answer: A. Hypokalemia

Thiazide diuretics can induce electrolyte changes. Principle among those is hypokalemia.

6. The most distinctive sign of pertussis is

A. stridor without cough.
B. productive cough with basilar rales.
C. loose cough with coarse rhonchi.
D. paroxysmal cough with crowing inspiration.

Click here to see the answer

Answer: D. paroxysmal cough with crowing inspiration.

A paroxysmal cough with a loud inspiration (the whoop) is noted in pertussis.

7. The finding of egophony is most consistent with

A. emphysema.
B. atelectasis.
C. pneumothorax.
D. lobar pneumonia

Click here to see the answer

Answer D. Lobar pneumonia

Egophony occurs with consolidation caused by lobar pneumonia.

8. A patient presents with edema, which is most noticeable in the hands and face. Laboratory findings include proteinuria, hypoalbuminemia, and hyperlipidemia. The most likely diagnosis is

A. congestive heart failure.
B. end-stage liver disease.
C. nephrotic syndrome.
D. malnutrition.

Click here to see the answer

Answer: C. nephrotic syndrome.

Proteinuria, hyperlipidemia, and hypoalbuminemia are consistent with nephrotic syndrome.

9. The best course of action for a patient with a bothersome inflamed pinguecula (pingueculitis) is

A. antibiotic drops.
B. excision.
C. Visine drops.
D. no treatment.

Click here to see the answer

Answer: D. no treatment.

With pingueculitis, no treatment is necessary; a short course of NSAID drops or steroids may help.

10. An immunocompromised patient presents with signs and symptoms consistent with Legionella pneumophila who has not responded to initial antibiotic therapy with a macrolide. Which of the following should be added?

A. Clarithromycin (Biaxin)
B. Rifampin (Rifadin)
C. Levofloxacin (Levaquin)
D. Amoxicillin-clavulanate (Augmentin)

Click here to see the answer

Answer B. Rifampin

Rifampin should be used as an adjunct in patients with either a macrolide or quinolone antibiotic, who have failed therapy, are immunocompromised or have severe illness.

Looking for all the episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy.

I will be be releasing new episodes every two weeks. The Academy is currently discounted, so sign up now.

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

While you are over there, download and subscribe to Brian Wallaces’ excellent Physician Assistant Exam Review Podcast. Follow along with Brian who covers new topics twice monthly and really does an amazing job!

Cheers,

Stephen Pasquini PA-C

The post The Audio PANCE and PANRE Board Review Podcast Episode 25 appeared first on The Audio PANCE and PANRE.

Aug 31 2015

8mins

Play

Rank #17: Episode 63: The Audio PANCE and PANRE – Ten Mixed NCCPA™ Content Blueprint Multiple Choice Questions

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Ten Mixed NCCPA PANCE Content Blueprint Multiple Choice Questions

Welcome to episode 63 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the SMARTYPANCE course content following the NCCPA content blueprint (download the FREE cheat sheet).

This week we will be covering ten general board review questions based on the NCCPA PANCE and PANRE Content Blueprint.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and SMARTYPANCE which are now bundled together into one very low price.

Listen Carefully Then Take The Practice Exam

If you can’t see the audio player click here to listen to the full episode.

Episode 63 – General PANCE/PANRE Podcast Quiz

The following 10 questions are linked to NCCPA Content Blueprint lessons from the SMARTYPANCE and PANRE Board review website. If you are a member you will be able to log in and view this interactive video content.

1. A 24-year-old male presents complaining of a 9-month history of increasing shortness of breath, dyspnea on exertion, and a cough productive of white sputum, mostly in the mornings. He denies orthopnea, PND, peripheral edema, fever, chills, night sweats, recent changes in weight, palpitations, chest pain, food intolerances, or other complaints. Patient has a history of recurrent lung infections. He states that his father had chronic pulmonary problems and died at age 42 from unknown lung disease. The patient denies smoking, alcohol or illicit drug use. On physical examination, the respiratory rate is 22 breaths per minute, a pulse of 98 bpm, a temperature of 98.7 degrees. Pulmonary exam reveals end-expiratory wheezes bilaterally and hyperresonance to percussion. His cardiac exam is normal. Chest X-ray shows decreased lung markings. ECG is normal. Pulmonary function tests show an FEV1 63% of expected and residual capacity is 123% of expected. Which of the following is the most likely diagnosis?

A. Emphysema
B. Pulmonary fibrosis
C. Ventricular septal defect
D. Congestive heart failure

Click here to see the answer

Answer: A. Emphysema

This person has an obstructive lung disease based on PFTs. Emphysema is the most likely diagnosis and may be related to alpha-1 antitrypsin deficiency based on family history and lack of smoking history and young age.

Emphysema is covered as part of the NCCPA Pulmonary Blueprint (12%)

B. The PFTs from a person with pulmonary fibrosis would be consistent with a restrictive pattern. This patient has an obstructive pattern of lung disease.
C. Ventricular septal defect will have a systolic murmur associated with it.
D. Congestive heart failure might explain some of the symptoms of this patient (increasing shortness of breath and DOE), he denies other common symptoms, such as orthopnea and peripheral edema. CHF should not result in changes in the PFTs.

2. A male patient complains of chronic dysuria, frequency, and urgency with associated perineal pain. The most likely diagnosis is

A. cystitis
B. gonococcal urethritis
C. epididymitis
D. prostatitis

Click here to see the answer

Answer: D. prostatitis

Some patients are asymptomatic, but low back or perineal pain, fever, chills, and irritative urinary symptoms are common in prostatitis.

Prostatitis is covered as part of the NCCPA PANCE Genitourinary Blueprint

A. Cystitis is characterized by dysuria without urethral discharge.
B. Initially, there is burning on urination and serous or milky discharge in gonococcal urethritis.
C. Epididymitis is characterized by dysuria, unilateral scrotal pain, and swelling.

3. Which of the following preventive strategies against osteoporosis-associated vertebral fractures has a known side effect of increasing the incidence of hot flashes when used in a perimenopausal female?

A. Calcitonin (Miacalcin) nasal spray
B. Alendronate (Fosamax)
C. Estrogen/progesterone (Prempro)replacement
D. Raloxifene (Evista)

Osteoporosis is covered as part of the PANCE Musculoskeletal Blueprint

Click here to see the answer

Answer: D. Raloxifene (Evista)

Raloxifene has effects on bone turnover and bone mass and has been shown to decrease vertebral fractures. It has anti-estrogen effects on the non-skeletal portions of the body and increases hot flashes in perimenopausal females.

A. Calcitonin does not have any estrogen effects on the body and serves as an analgesic when used in the management of vertebral fractures.
B. Alendronate is a bisphosphonate that does not have any hormonal effects on the body.
C. Estrogen/progesterone replacement has the benefit of maintaining bone and decreasing vertebral fractures but it would improve perimenopausal hot flashes.

4. A 70-year-old presents with a headache and neck stiffness. On physical exam, the patient is febrile, Kernig’s sign is present, and no rash is noted. A spinal tap reveals a white count of 250/cm3 with 100% neutrophils, total protein 250mg/dL, and glucose 35 mg/dL. Which of the following is the most appropriate treatment?

A. Acyclovir (Zovirax)
B. Fluconazole (Diflucan)
C. Ampicillin and ceftriaxone (Rocephin)
D. Penicillin and chloramphenicol (Chloromycetin)

Bacterial meningitis is covered as part of the PANCE Neurology Blueprint

Click here to see the answer

Answer: C. Ampicillin and ceftriaxone (Rocephin)

Ampicillin and ceftriaxone are used to treat bacterial meningitis, secondary to Listeria monocytogenes, which is common in the elderly. Ceftriaxone will cover other common etiologic agents such as Streptococcal pneumonia

A. Acyclovir is used to treat meningitis secondary to herpes. Viral meningitis presents with an increased number of lymphocytes and elevated glucose in the CSF.
B. Fluconazole is used to treat fungal meningitis. Fungal meningitis, typically noted in immunocompromised hosts, presents with an increased number of lymphocytes in the CSF.
D. Penicillin and chloramphenicol is used to treat bacterial meningitis, secondary to Neisseria meningitidis. Bacterial meningitis due to N

5. A 45-year-old patient with type 1 diabetes mellitus is being screened for diabetic nephropathy. Which of the following urinalysis findings is most consistent with early diabetic nephropathy?

A. Microalbuminuria
B. Red cell casts
C. White cell casts
D. Renal epithelial cells

Diabetic neuropathy is covered as part of the PANCE Endocrinology Blueprint

Click here to see the answer

Answer: A. Microalbuminuria

Microalbuminuria is most consistent with early diabetic neuropathy.

B. Red cell casts are more indicative of acute glomerular nephritis.
C. White cell casts are more consistent with acute pyelonephritis.
D. A few renal epithelial cells normally may be found in the urine.

6. A 74-year-old female is being treated for mild hypertension. She is found at home with right hemiparesis and brought to the emergency department. Her daughter states that the patient fell in her kitchen 2 days ago, but had no complaints at that time. She did state that her mother sounded a little confused this morning. The patient’s left pupil is dilated. Which of the following diagnostic studies should be ordered first?

A. MRI of the brain
B. CT scan of the brain
C. Skull x-ray
D. Lumbar puncture

Click here to see the answer

Answer:  B. CT scan of the brain

This patient presents with a history of minor trauma and progressive neurological abnormalities consistent with subdural hematoma. Diagnosis would be confirmed by CT scan, which is less expensive and more sensitive for blood than an MRI.

Intracranial Hemorrhage is covered as part of the PANCE Neurology Blueprint

C. Skull x-rays would not be helpful because they evaluate bony, not soft tissue, injury.
D. A lumbar puncture is contraindicated because of the potential for brain herniation.

7. A post-op patient has signs and symptoms highly suggestive of a pulmonary embolism. The results of the CT scan of the lung is nondiagnostic. What is the most appropriate next step in the evaluation?

A. Ventilation-perfusion (V/Q) scan
B. Ultrasound of the legs
C. Echocardiography
D. D-dimer

Pulmonary embolism and is part of the PANCE Pulmonary Blueprint

Click here to see the answer

Answer: B. Ultrasound of the legs

In a patient with a high likelihood of pulmonary embolism or an inpatient, as in this case, ultrasound of the legs would be the next diagnostic step after a nondiagnostic CT.

A. Ventilation-perfusion scans are performed prior to the CT scan of the chest and would not likely add additional information to this clinical scenario.
C. Although echocardiography may show right ventricular free wall hypokinesis with normal motion of the apex suggestive of pulmonary embolism, more than 50% of patients with a pulmonary embolism will have normal echocardiography. Echocardiography is not used in the diagnosis of inpatients.
D. In a post-op patient, a d-dimer will be positive regardless of the presence or absence of a pulmonary embolism.

8. Seizures that first manifest in early to middle adult life should be considered suspicious of which of the following causes?

A. Cerebrovascular disease
B. Encephalitis
C. Tumor
D. Idiopathic epilepsy

Seizure disorders are covered as part of the PANCE Neurology Blueprint

Click here to see the answer

Answer: C. Tumor

Seizures that develop during adolescence and adult life are predominantly due to tumor, trauma, drug use, or alcohol withdrawal.

9. Which of the following medications used in the treatment of supraventricular tachycardia is able to cause sinus arrest and asystole for a few seconds while it breaks the paroxysmal supraventricular tachycardia?

A. Digoxin (Lanoxin)
B. Adenosine (Adenocard)
C. Verapamil (Calan)
D. Quinidine (Quinaglute)

Paroxysmal supraventricular tachycardia is covered as part of the PANCE Cardiology Blueprint

Click here to see the answer

Answer: B. Adenosine (Adenocard)

Adenosine is an endogenous nucleoside that results in profound (although transient) slowing of the AV conduction and sinus node discharge rate. This agent has a very short half-life of 6 seconds.

A. Digoxin is not used for the acute termination of supraventricular tachycardia.
C. Although verapamil may be used for the termination of acute supraventricular tachycardia, it does not lead to sinus arrest in therapeutic doses.
D. Quinidine is rarely used today and is not indicated for the termination of supraventricular tachycardia.

10. A 32-year-old presents with a 3-day history of diarrhea. The patient denies blood, mucus, or night awakening with diarrhea. He recently returned from a business trip to Canada. On physical examination, the patient is afebrile and vital signs reveal BP 115/80, the pulse is 76, and respirations are 14. The abdominal examination reveals hyperactive bowel sounds but is otherwise unremarkable. Which of the following is the most appropriate initial intervention?

A. Stool for culture, ova, and parasites
B. Proctosigmoidoscopy
C. Metronidazole (Flagyl)
D. Supportive treatment

Infectious and Noninfectious Diarrhea are covered as part of the NCCPA PANCE GI and Nutrition Blueprint

Click here to see the answer

Answer: D. Supportive treatment

Symptomatic treatment, including dietary management and over-the-counter antidiarrheals, is indicated for afebrile patients with watery diarrhea of less than 5 days duration.

A. Stool culture and examination for ova and parasites are indicated when diarrhea has persisted longer than 3 weeks or is associated with abdominal pain, fever, and/or bloody stools.
B. Proctosigmoidoscopy is indicated when inflammatory bowel disease is suspected on the basis of fever, bloody diarrhea, or abdominal pain.
C. Metronidazole is indicated with a confirmed diagnosis of Giardia lamblia or amebic disease.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy + SMARTYPANCE

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Links From The Show

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

Download The Content Blueprint Checklist

Follow this link to download your FREE copy of the Content Blueprint Checklist

Print it up and start crossing out the topics you understand, marking the ones you don’t and making notes of key terms you should remember. The PDF version is interactive and linked directly to the individual lessons on SMARTY PANCE.

Download

The post Episode 63: The Audio PANCE and PANRE – Ten Mixed NCCPA™ Content Blueprint Multiple Choice Questions appeared first on The Audio PANCE and PANRE.

Aug 09 2018

17mins

Play

Rank #18: Episode 55: The Audio PANCE and PANRE Board Review Podcast – Mixed Content Blueprint Review

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Welcome to episode 55 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the SMARTYPANCE course content following the NCCPA content blueprint (download the FREE cheat sheet).

This week we will be covering ten general board review questions based on the NCCPA PANCE and PANRE Content Blueprint.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and SMARTYPANCE which are now bundled together into one very low price.

Listen Carefully Then Take The Quiz

If you can’t see the audio player click here to listen to the full episode.

Episode 55 PANCE and PANRE Podcast Quiz

The following 10 questions are linked to NCCPA Content Blueprint lessons from the SMARTYPANCE and PANRE Board review website. If you are a member you will be able to log in and view this interactive video content.

1. Which of the following physical examination findings would be consistent with a pleural effusion?

A. Hyperresonance to percussion
B. Increased tactile fremitus
C. Unilateral lag on chest expansion
D. Egophony

Pleural effusions are covered as part of the NCCPA Content Blueprint Pulmonology section which accounts for 10% of the exam

View this ReelDx patient video case of a 68-year-old female complaining of bilateral chest pain and difficulty breathing. Included in this lesson is the Picmonic explaning Light’s Criteria.

Click here to see the answer

Answer: C. Unilateral lag on chest expansion

A lag on chest expansion may be seen in the presence of a pleural effusion.

A. Hyperresonance to percussion would be suggestive of emphysema or pneumothorax.
B. Increased tactile fremitus would be consistent with a consolidation.
D. The presence of egophony would be consistent with a consolidation.

2. A 55 year-old female presents with complaints of stiffness, aching, and pain in the muscles of her neck, shoulders, lower back, hips, and thighs. There is no associated weakness associated with the stiffness and achiness. Laboratory evaluation shows an elevated C reactive protein and erythrocyte sedimentation rate. Which of the following medications is used to treat this condition immediately and will also serve to prevent a known complication from this disorder?

A. Glucocorticoids
B. Cyclophosphamide (Cytoxan)
C. Methotrexate (Rheumatrex)
D. Azathioprine (Imuran)

This condition is covered as part of the NCCPA Musculoskeletal Content Blueprint and accounts for 10% of the exam

Click here to see the answer

Answer: A. Glucocorticoids

This patient has polymyalgia rheumatica and treatment with glucocorticoids can relieve discomfort and prevent the associated ischemic temporal arteritis, which threatens vision.

B. Cyclophosphamide is an immunosuppressant used in the treatment of acute leukemia.
C. Methotrexate is a folate inhibitor used to treat rheumatoid arthritis, not polymyalgia rheumatica.
D. Azathioprine is an immunosuppressant that is used to treat rheumatic disease and inflammatory bowel disease, not polymyalgia rheumatica.

3. A 35 year-old pregnant patient presents with fever, chills, and left-sided flank pain. On physical examination left-sided CVA tenderness is noted. Urinalysis reveals numerous white blood cells and white blood cell casts. Which of the following is the most appropriate treatment?

A. Oral ciprofloxacin (Cipro)
B. Oral trimethoprim-sulfamethoxazole (Bactrim)
C. IV gentamicin (Garamycin)
D. IV ceftriaxone (Rocephin)

This condition is covered as part of the NCCPA Genitourinary Content Blueprint and accounts for 6% of the exam

Click here to see the answer

Answer: D. IV ceftriaxone (Rocephin)

IV cephalosporins are first line treatment of pyelonephritis in a pregnant patient, followed by oral step-down therapy.

A. See B for explanation.
B. The fluoroquinolones and trimethoprim-sulfamethoxazole are contraindicated in pregnancy.
C. Gentamicin is not indicated as first line therapy in the treatment of pyelonephritis in a pregnant patient.

4. A 26 year-old female arrives in the emergency department with friends who say she was standing in front of her church, dressed in a white bathrobe, claiming to be the Virgin Mary and handing out $100 bills to all passers-by. Her friends noted that she had been depressed lately, but now seems completely euphoric. She had a similar episode two years ago. Which of the following is the most appropriate treatment?

A. Inpatient olanzapine (Zyprexa) therapy
B. Inpatient electroconvulsive therapy
C. Outpatient paroxetine (Paxil) therapy
D. Outpatient psychotherapy

This condition is covered as part of the NCCPA Psychiatry Content Blueprint and accounts for 6% of the exam

Click here to see the answer

Answer: A. Inpatient olanzapine (Zyprexa) therapy

Treatment of the manic phase is usually done in the hospital to protect patients from behaviors associated with grandiosity (spending inordinate amounts of money, making embarrassing speeches, etc.). Lithium, valproate, and olanzapine are considered effective in the manic stage; the depressive stage is treated with
antidepressants.

5. A 19 year-old patient was involved in a motor vehicle crash and brought to the emergency department fully immobilized. The patient sustained multiple blunt injuries to the chest and abdomen. During the trauma assessment, there was no blood at the urethral meatus and a Foley catheter was placed. The urine was positive for blood on the dipstick. Which of the following is the most appropriate diagnostic test

A. Retrograde urethrography
B. CT scan of abdomen and pelvis
C. Serum haptoglobin
D. Urine myoglobin

Click here to see the answer

Answer: B. CT scan of abdomen and pelvis

CT scan of the abdomen and pelvis is indicated in blunt trauma including those resulting in hematuria or when renal injury is suspected.

A. A retrograde urethrogram should be performed when blood is found at the external urinary meatus prior to insertion of a catheter.
C. A decreased serum haptoglobin is seen in hemolysis and does not provide information on renal status.
D. A positive test for blood in the absence of red blood cells on urine examination suggests myoglobinuria, and should be confirmed by electrophoresis.

6. A 48 year-old male presents with complaints of heartburn that occurs approximately 45 minutes after eating about three times a week that is relieved by antacids. He claims to have followed advice about elevating the head of the bed, avoiding spicy foods, and losing weight, but continues to have heartburn. Which of the following is the most appropriate next step?

A. Ranitidine (Zantac)
B. Sucralfate (Carafate)
C. Metoclopramide (Reglan)
D. Misoprostol (Cytotec)

GERD (Gastroesophageal reflux disease) is covered as part of the NCCPA GI and Nutrition Content Blueprint and accounts for 10% of the exam

Click here to see the answer

Answer: A. Ranitidine (Zantac)

Ranitidine, an H2 receptor blocker, is indicated for the treatment of mild, intermittent symptoms of gastroesophageal reflux disease.

B. Sucralfate is used in the treatment of duodenal ulcers.
C. Metoclopramide is indicated for the treatment of gastroparesis as a first-line agent and as a second-line agent in the treatment of refractory gastroesophageal reflux.
D. Misoprostol is indicated for the prevention of NSAID-induced gastritis.

7. Radioactive iodine (I131) is most successful in treating hyperthyroidism that results from

A. Grave’s disease.
B. subacute thyroiditis.
C. Hashimoto’s thyroiditis.
D. papillary thyroid carcinoma.

Watch this ReelDx Video of a 16-year-old with ADHD presents with chest pain and exophthalmos

Diseases of the thyroid gland are covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Click here to see the answer

Answer: A. Grave’s disease.

Radioactive iodine (I131) is an excellent method to destroy overactive thyroid tissue of Grave’s disease.

B. Radioactive iodine is ineffective in subacute thyroiditis due to the thyroid’s low uptake of iodine.
C. Radioiodine uptake is low in Hashimoto’s thyroiditis making radioactive therapy ineffective.
D. Papillary thyroid carcinoma is a common thyroid malignancy and should be treated by a thyroidectomy.

8. An 8 year-old boy is brought to a health care provider complaining of dyspnea and fatigue. On physical examination, a continuous machinery murmur is heard best in the second left intercostal space and is widely transmitted over the precordium. The most likely diagnosis is

A. ventricular septal defect
B. atrial septal defect
C. congenital aortic stenosis
D. patent ductus arteriosus

This disorder is covered as part of the NCCPA Cardiology Content Blueprint and accounts for 9% of the exam

Click here to see the answer

Answer: D. patent ductus arteriosus.

Patent ductus arteriosus is classically described in children as a continuous machinery-type murmur that is widely transmitted across the precordium.

A. Ventricular septal defect causes a holosystolic murmur rather than a continuous machinery-like murmur.
B. Atrial septal defect causes a fixed split S2 rather than a continuous systolic heart murmur.
C. Congenital aortic stenosis causes a crescendo-decrescendo systolic murmur heard best in the second intercostal space.

9. A 63 year-old male with history of hypertension and tobacco abuse presents complaining of dyspnea on exertion for two weeks. The patient admits to one episode of chest discomfort while shoveling snow which was relieved after five minutes of rest. Vital signs are BP 130/70, HR 68, RR 14. Heart exam reveals regular rate and rhythm, normal S1 and S2, no murmur, gallop, or rub. Lungs are clear to auscultation bilaterally. There is no edema noted. Which of the following is the most appropriate initial diagnostic study for this patient?

A. Helical CT scan
B. Chest x-ray
C. Nuclear stress test
D. Cardiac catheterization

Angina is covered as part of the NCCPA Cardiology Content Blueprint which accounts for 10% of the exam

Click here to see the answer

Answer: C. Nuclear stress test

In patients with classic symptoms of angina, nuclear stress testing is the most widely used test for diagnosis of ischemic heart disease.

A. Helical CT scan aids in the diagnosis of pulmonary embolism, not in the evaluation of angina.
B. Chest x-ray is not used as a diagnostic study to evaluate symptoms of angina or coronary heart disease.
D. Coronary angiography is indicated in patients with classic stable angina who are severely symptomatic despite medical therapy and are being considered for percutaneous intervention (PCI), patients with troublesome symptoms that are difficult to diagnose, angina symptoms in a patient who has survived sudden cardiac death event, patients with ischemia on noninvasive testings.

10. A 52 year-old male with history of hypertension and hyperlipidemia presents with an acute myocardial infarction. Urgent cardiac catheterization is performed and shows a 90% occlusion of the left anterior descending artery. The other arteries have minimal disease. Ejection fraction is 45%. Which of the following is the treatment of choice in this patient?

A. Coronary artery bypass grafting (CABG)
B. Streptokinase
C. Percutaneous coronary intervention (PCI)
D. Warfarin (Coumadin)

Acute myocardial infarction [Non-ST-segment elevation (NSTEMI)] and [ST-segment elevation myocardial infarction (STEMI)] are covered as part of the NCCPA Cardiology Content Blueprint which represents 16% of your exam

Click here to see the answer

Answer: C. Percutaneous coronary intervention (PCI)

Immediate coronary angiography and primary percutaneous coronary intervention have been shown to be superior to thrombolysis.

A. Percutaneous coronary intervention is a better, less invasive alternative to CABG for single vessel coronary artery disease.
B. Streptokinase is not commonly used for the treatment of acute myocardial infarction because it is ineffective at opening the occluded artery and reducing mortality. Streptokinase would be harmful because it would increase the risk of bleeding.
D. Warfarin is used to prevent thrombosis and not for acute treatment.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy + SMARTYPANCE

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Links From The Show

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

Download The Content Blueprint Checklist

Follow this link to download your FREE copy of the Content Blueprint Checklist

Print it up and start crossing out the topics you understand, marking the ones you don’t and making notes of key terms you should remember. The PDF version is interactive and linked directly to the individual lessons on SMARTY PANCE.

Download

The post Episode 55: The Audio PANCE and PANRE Board Review Podcast – Mixed Content Blueprint Review appeared first on The Audio PANCE and PANRE.

Nov 30 2017

19mins

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Rank #19: Episode 49: The Audio PANCE and PANRE Board Review Podcast – Comprehensive Audio Quiz

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Welcome to episode 49 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover ten PANCE and PANRE board review questions from the Academy course content following the NCCPA content blueprint (download the FREE cheat sheet).

This week we will be covering 10 general board review questions based on the NCCPA PANCE and PANRE Content Blueprint. 

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and SmartyPANCE.

  • You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
  • You can listen to the latest episode, take an interactive quiz and download your results below.

Listen Carefully Then Take The Quiz

If you can’t see the audio player click here to listen to the full episode.

Episode 49 PANCE and PANRE Podcast Quiz

The following 10 questions are linked to NCCPA Content Blueprint lessons from the SmartyPANCE PANCE and PANRE board review website. If you are a member and login you will be able to view this content.

1. Which of the following clinical findings would be seen in a patient with food poisoning caused by Staphylococcus aureus?

A. Ingestion of mayonnaise-based salads 48 hours earlier
B. Bloody diarrhea with mucus for one week
C. Abdominal cramps and vomiting for 48 hours
D. High fever for 1 week

Staphylococcus aureus food poisoning is part of the NCCPA Content Blueprint GI and Nutrition which accounts for 10% of the exam

Click here to see the answer

Answer: C. Abdominal cramps and vomiting for 48 hours

Abdominal cramps, nausea, vomiting, and watery diarrhea typically last 1-2 days with staphylococcal food poisoning.

A. A preformed toxin causes staphylococcal food poisoning; it has a short incubation period of 1-8 hours.
B. Because Staphylococcus aureus does not invade the mucus, blood and mucus are not seen with this noninflammatory cause of food poisoning.
D. Staphylococcal food poisoning may be associated with low-grade fever or subnormal temperature.

2. Which of the following diagnostic tests should be ordered initially to evaluate for suspected deep venous thrombosis

A. Venogram
B. Arteriogram
C. Duplex ultrasound
D. Impedance plethysmography

Venous thrombosis is part of the NCCPA Cardiology Content Blueprint and represents 16% of the exam

Click here to see the answer

Answer: C. Duplex ultrasound

Ultrasound is the technique of choice to detect deep venous thrombosis in the leg.

A. Venogram has been replaced by noninvasive tests due to discomfort, cost, technical difficulties, and complications, such as phlebitis.
B. Thrombophlebitis is a venous problem, not an arterial one. Any unnecessary invasive procedure is potentially harmful.
D. Impedance plethysmography is equivalent to ultrasound in detecting thrombi of the femoral and popliteal veins, but it may miss early, nonocclusive thrombi.

3. A patient presents with signs and symptoms of Cushing’s syndrome. Extensive diagnostic evaluation reveals an ACTH-secreting pituitary adenoma. First-line therapy should consist of

A. pituitary radiation
B. medical adrenalectomy
C. transsphenoidal resection of the tumor
D. amiloride (Midamor)

Cushings disease is part of the NCCPA Content Blueprint Endocrinology which represents 6% of your exam

Click here to see the answer

Answer: C. transsphenoidal resection of the tumor

Transsphenoidal resection of the tumor cures about 80% of patients. The remainder can be given a combination of pituitary radiation and medical adrenalectomy with one or more drugs. If these procedures fail, the last option is bilateral adrenalectomy.

4. A 26-year-old man is stung by a bee, and shortly thereafter, a wheal develops at the site of the sting. He soon feels flushed and develops hives, rhinorrhea, and tightness in the chest. He is seen in the urgent care center. Immediate therapy should be to

A. transfer him to a local hospital emergency department
B. apply a cold compress to site of the sting
C. administer subcutaneous epinephrine
D. administer oral albuterol

Click here to see the answer

Answer: C. administer subcutaneous epinephrine

Epinephrine hydrochloride 1:1000, 0.2 to 0.5 mL subcutaneously is indicated for the initial treatment of this systemic reaction. Additional injections may be given every 20 to 30 minutes if needed.

A. Systemic (anaphylactic) reactions can rapidly become life-threatening. Delay in treatment may cause death.
B. This is only supportive local therapy and does not address the need to treat the systemic reaction present.
D. Albuterol is indicated in the presence of bronchospasm (suggested by the presence of chest tightness) but would be delivered by an aerosol, not an oral, route.

5. An 18-year-old sexually active female was seen in the student health clinic 1 week ago for a sore throat. A streptococcal antigen test was positive, and she was given a prescription for oral penicillin. After 3 days, she stopped her medication because she felt better. She now presents with a severe sore throat. On physical examination, she has a temperature of 102.6° F (39.2° C), marked pharyngeal erythema, medial deviation of the soft palate on the left, tender left anterior cervical adenopathy, and a “hot potato” voice. The rest of her history and physical examination are unremarkable. Which of the following is the most likely diagnosis?

A. Recurrent streptococcal pharyngitis
B. Infectious mononucleosis
C. Gonococcal pharyngitis
D. Peritonsillar abscess

Peritonsillar abscess is covered as part of the NCCPA Content Blueprint EENT which accounts for 6% of your exam

View this ReelDx patient video case ~4d pain back of throat; swelling; difficulty swallowing

SmartyPANCE ReelDx + members can view this real-world case!

Click here to see the answer

Answer: D. Peritonsillar abscess

The soft palate deviation and a muffled voice are classic signs of peritonsillar abscess.

A. This presentation suggests a complication of an incompletely treated streptococcal pharyngitis rather than recurrent disease
B. Infectious mononucleosis may present with a severe sore throat and cervical adenopathy in this age group, but would not cause deviation of the soft palate or the muffled voice
C. Gonococcal pharyngitis usually follows a more indolent course than this patient’s presentation

6. Which of the following would provide the most specific information regarding the functional cardiac status in a patient with chronic heart failure?

A. Electrocardiogram
B. Chest x-ray
C. Serum electrolytes
D. Echocardiogram

Heart Failure is covered as part of the NCCPA Content Blueprint Cardiology and accounts for 16% of the exam

View this SMARTYPANCE ReelDx patient video case: 45-year-old female with difficulty breathing; edema; 8/10 chest pain and whole-body pain

SmartyPANCE ReelDx + members can view this real-world case!

Click here to see the answer

Answer: D. Echocardiogram

An echocardiogram will estimate ejection fraction, which is an indicator of left ventricular function.

A. Electrocardiogram offers no specific information of functional status but may provide clues about the cause.
B. A chest x-ray may show findings of chronic heart failure, such as cardiomegaly or pulmonary congestion, but does not reflect cardiac functional status.
C. Serum electrolytes may be abnormal, either as a result of heart failure, or as a contributing factor, but they do not indicate functional status.

7.  A 33-year-old female presents for follow-up of her Pap smear that showed a low-grade squamous intraepithelial lesion. Reflex HPV testing is positive. Which of the following is the most appropriate diagnostic procedure?

A. Cone biopsy
B. Aspiration needle biopsy
C. Dilation and curettage
D. Colposcopy-directed biopsy

Cervical dysplasia and cervical cancer are covered as part of the NCCPA Content Blueprint Reproductive system and accounts for 8% of your exam

Click here to see the answer

Answer: D. Colposcopy-directed biopsy

A colposcopy-directed biopsy is the first diagnostic evaluation indicated for cervical dysplasia.

A. A cervical cone biopsy may be indicated in further evaluation of this patient, but it is dependent on the results of the colposcopy.
B. An aspiration needle biopsy has no role in the evaluation of cervical dysplasia.
C. Dilatation and curettage has no role in either the diagnosis or treatment of isolated cervical dysplasia.

8. A decrease in the fetal heart rate (FHR) occurring late during contractions is noted. The FHR returns to the baseline slowly after the uterine contraction. The physician assistant should be alerted to the possibility of

A. pelvic dystocia
B. precipitous labor
C. fetal head compression
D. placental insufficiency

Fetal distress is covered as part of the NCCPA Content Blueprint Reproductive system and accounts for 8% of your exam

SmartyPANCE ReelDx + members can view this real-world case!

Click here to see the answer

Answer: D. placental insufficiency

Placental insufficiency is the probable cause of fetal distress resulting in late decelerations.

A. Pelvic dystocia, particularly that due to small bony architecture, is the most common cause of passage abnormalities and is not directly associated with FHR decelerations.
B. This refers to the length of labor, not decelerations in FHR.
C. The drop in FHR is caused by an interference with uterine blood flow to the intervillous space causing an early, not late, deceleration.

9. A 36-year-old patient with cardiomyopathy secondary to viral myocarditis develops fatigue, increasing dyspnea, and lower extremity edema over the past 3 days. He denies fever. A chest x-ray shows no significant increase in heart size but reveals prominence of the superior pulmonary vessels. Based on these clinical findings, which of the following is the most likely diagnosis?

A. Heart failure
B. Subacute bacterial endocarditis
C. Pulmonary embolus
D. Pneumonia

Heart Failure is covered as part of the NCCPA Content Blueprint Cardiology and accounts for 16% of the exam

Click here to see the answer

Answer: A. Heart failure

Given the presence of cardiomyopathy, the patient’s heart has decreased functional reserve. The symptoms and chest x-ray findings are typical of congestive heart failure.

B. Endocarditis occurs as a result of an infection that primarily occurs in the blood stream. Endocarditis would present with signs of infection or seeding rather than signs of heart failure.
C. Pulmonary embolus usually presents with an acute onset of chest pain, severe dyspnea, and anxiety.
D. Pneumonia is less likely since there is no fever and edema is not usually associated with pneumonia.

10. Which of the following is the first-line treatment for symptomatic bradyarrhythmias due to sick sinus syndrome (SSS)?

A. Permanent pacemaker
B. Radiofrequency ablation
C. Antiarrhythmics
D. Anticoagulation therapy

Sick sinus syndrome is covered as part of the NCCPA Cardiology Content Blueprint which is 16% of your exam

Click here to see the answer

Answer: A. Permanent pacemaker

Permanent pacemakers are the therapy of choice in patients with symptomatic bradyarrhythmias in sick sinus syndrome.

B. Radiofrequency ablation is used for the treatment of accessory pathways in the heart.

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy + SMARTYPANCE

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Links From The Show

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

Download The Content Blueprint Checklist

Follow this link to download your FREE copy of the Content Blueprint Checklist

Print it up and start crossing out the topics you understand, marking the ones you don’t and making notes of key terms you should remember. The PDF version is interactive and linked directly to the individual lessons on SMARTY PANCE.

FREE Download

The post Episode 49: The Audio PANCE and PANRE Board Review Podcast – Comprehensive Audio Quiz appeared first on The Audio PANCE and PANRE.

May 16 2017

18mins

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Rank #20: Podcast Episode 69: Ten PANCE and PANRE Board Review Audio Questions

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The Audio PANCE/PANRE Board Review Exam Questions

Welcome to episode 69 of the Audio PANCE and PANRE PA Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the SMARTYPANCE course content following the NCCPA content blueprint (download the FREE cheat sheet).

This week we will be covering ten general board review questions based on the NCCPA PANCE and PANRE Content Blueprints.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full board review includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and Smarty PANCE.

Listen Carefully Then Take The Practice Exam

If you can’t see the audio player click here to listen to the full episode.

Podcast Episode 69: 10 Question PANCE and PANRE Podcast Quiz

The following questions are linked to NCCPA Content Blueprint lessons from the Smarty PANCE and PANRE Board Review Website. If you are a member you will be able to log in and view this interactive video lesson.

1. Which of the following is the most common cause of acute myocardial infarction?

A. Occlusion caused by coronary microemboli
B. Thrombus development at a site of vascular injury
C. Congenital abnormalities
D. Severe coronary artery spasm

Click here to see the answer

B. Thrombus development at a site of vascular injury – Acute myocardial infarction occurs when a coronary artery thrombus develops rapidly at a site of vascular injury. In most cases, infarction occurs when an atherosclerotic plaque fissures, ruptures, or ulcerates and when conditions favor thrombogenesis so that a mural thrombus forms at the site of rupture and leads to coronary artery occlusion.

A. Coronary microemboli occlusion is a rare cause of acute myocardial infarction.
C. Congenital abnormalities are rare causes of acute MI.
D. Severe coronary artery spasm is more likely to result in Prinzmetal’s angina rather than true infarction.

Review NCCPA Blueprint Topic: Acute myocardial infarction (PEARLS) (Lesson)

2. Endotracheal intubation should be performed with caution in patients with which of the following underlying conditions due to the propensity to cause subluxation of C1 on C2?

A. Rheumatoid arthritis
B. Osteoarthritis
C. Gout
D. Pseudogout

Click here to see the answer

A. Rheumatoid arthritis – Patients with advanced rheumatoid arthritis will have synovitis of the atlantoaxial joint (C1-C2) which may damage the transverse ligament of the atlas, producing a forward displacement of the atlas on the axis (atlantoaxial subluxation).

B. Although patients with osteoarthritis may have neck pain and stiffness, there is no predilection for the atlantoaxial joints.
C. Patients with gout are likely to have involvement of peripheral joints rather than spinal joints.
D. Patients with pseudogout are more likely to have involvement of the knees, wrist, shoulder, ankle, elbow, and hands rather than the cervical spine.

Review NCCPA Blueprint Topic: Rheumatoid arthritis (Lecture) (Lesson)

3. Which of the following interventions is the treatment of choice for an actinic keratosis?

A. Mohs surgery
B. Cryotherapy
C. Acid peels
D. Radiation therapy

Click here to see the answer

B. Cryotherapy – Cryotherapy is the treatment of choice for isolated superficial actinic keratosis.

A. Mohs surgery and radiation therapy are not indicated in the treatment for actinic keratosis.
C. Acid peels can be used to treat actinic keratosis but are not the treatment of choice.

Review NCCPA Blueprint Topic: Actinic keratosis

4. A 55-year-old secretary presents with ongoing pain and numbness in her hand. These symptoms are worse at night and she must shake her hand to regain feeling in it. Which of the following physical examination signs will be
present?

A. Hypothenar atrophy
B. Weakness of finger abduction
C. Inability to maintain wrist extension against resistance
D. Weakness of thumb abduction

Click here to see the answer

D. A weakness of thumb abduction – Median nerve injury causes weakness of thumb abduction (measured by thumb opposition strength) along with thenar atrophy. Tinel’s and Phalen’s signs will also be positive with carpal tunnel syndrome.

A. Hypothenar atrophy may occur with aging and disuse but it is not part of the median nerve involvement that occurs with carpal tunnel syndrome.
B. Finger abduction weakness is associated with ulnar nerve injury, which does not occur with carpal tunnel syndrome.
C. Radial nerve injury causes weakness of wrist extension and this is not part of carpal tunnel syndrome.

Review NCCPA Blueprint Topic: Carpal Tunnel Syndrome (Lesson)

5. A 78-year-old male with history of coronary artery disease status post-CABG and ischemic cardiomyopathy presents with a complaint of progressive dyspnea and orthopnea. He also complains of lower extremity edema. The patient denies fever, chest pain, or cough. On physical examination, vital signs are BP 120/68, HR 75 and regular, RR 22, afebrile. You note the patient to have an S3 heart sound, jugular venous distention, and 2+ lower extremity edema. The patient is admitted and treated. Upon discharge from the hospital, the patient should be educated to monitor which of the following at home?

A. Daily weights
B. Daily spirometry
C. Daily blood glucose
D. Daily fat intake

Click here to see the answer

A. Daily weights – Home monitoring of daily weights can alert the health care provider to the early recognition of worsening heart failure.

B. Spirometry monitoring is important in a patient with asthma, not heart failure.
C. Daily blood glucose monitoring is important in a patient with diabetes, not heart failure.
D. Daily fat intake is important, but will not improve his heart failure management.

Review NCCPA Blueprint Topic: Heart Failure (ReelDx) (Lesson)

6. Which of the following rotator cuff tendons is most likely to sustain injury because of its repeated impingement (carpal tunnel syndrome) between the humeral head and the undersurface of the anterior third of the acromion and coracoacromial ligament?

A. Supraspinatus
B. Infraspinatus
C. Teres minor
D. Subscapularis

Click here to see the answer

A. Supraspinatus – A critical zone exists for the supraspinatus tendon due to its superior insertion site. It is susceptible for injury because it has a reduction in its blood supply that occurs with abduction of the arm. Impingement of the shoulder is most commonly seen with the supraspinatus tendon, the long head of the biceps tendon and/or the subacromial bursa.

Review NCCPA Blueprint topic: Soft tissue injuries of the forearm, wrist, and hand (ReelDx) (Lesson)

7. Which of the following diagnostic findings in the urinary sediment is specific for a diagnosis of chronic renal failure?

A. Hematuria
B. Proteinuria
C. Broad waxy casts
D. Hyaline casts

Click here to see the answer

C. Broad waxy casts – Broad waxy casts in urinary sediment are a specific finding in chronic renal failure.

A. Hematuria and proteinuria are frequent, but nonspecific, findings in chronic renal failure.
D. Hyaline casts may be found in normal urine or in states of dehydration.

Review NCCPA Blueprint Topic: Chronic kidney disease (Lesson)

8. In addition to tobacco products, which of the following is also considered a major risk factor in the development of oral cancer?

A. Sun exposure
B. Alcohol abuse
C. Occupational exposure
D. History of oral candidiasis

Click here to see the answer

B. Alcohol abuse – Major risk factors for the development of oral cancer are the use of tobacco products and alcohol abuse.

A. Sun exposure is a risk factor for cancer of the lip but is not considered a major risk factor for oral cancer.
C. While occupational exposures and the presence of premalignant lesions, such as leukoplakia, are risk factors for the development of oral cancer, they are not considered major risk factors.
D. History of oral candidiasis has no correlation to the development of oral cancer.

Review NCCPA Blueprint Topic: EENT Benign and Malignant Neoplasms (Lesson)

9. A 13-year-old boy with leukemia presents with epistaxis for 2 hours. The bleeding site appears to be from Kiesselbach’s area. The most appropriate intervention is

A. electrocautery of the bleeding site
B. silver nitrate application
C. posterior nasal packing
D. intranasal petrolatum gauze

Click here to see the answer

D. intranasal petrolatum gauze – Petrolatum gauze will provide pressure to the bleeding point while the cause of bleeding is corrected.

A. Cautery is not used because the edges of the cauterized area may begin to bleed.
B. Silver nitrate is not used in children because it increases the risk of nasal septal perforation.
C. Posterior nasal packing is indicated for posterior bleeds in the inferior meatus.

Review NCCPA Blueprint Topic: Epistaxis (ReelDx + Lecture) (Lesson)

10. A 2-year-old female presents with purulent nasal discharge bilaterally with fever and cough for several days. Her mom had taken her out of daycare for a similar occurrence 2 months ago, that was treated with Amoxicillin. Exam further reveals halitosis and periorbital edema. Treatment should be initiated with which of the following?

A. Antihistamines
B. Ribavirin (Rebetol)
C. Intranasal corticosteroids
D. Amoxicillin-clavulanate (Augmentin)

Click here to see the answer

D. Amoxicillin-clavulanate (Augmentin) – High dose amoxicillin-clavulanate is the treatment of choice for resistant bacterial sinusitis, especially in children presenting with risk factors (daycare attendance, previous antibiotic treatment 1-3 months prior, age younger than 2 years).

A. Antihistamines and intranasal corticosteroids have not been adequately studied in children to prove they make a difference in treating recurrent sinusitis.
B. Ribavirin is approved for the treatment of RSV infection.

Review NCCPA Blueprint Topic: Acute and chronic sinusitis (ReelDx + Lecture) (Lesson)

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The post Podcast Episode 69: Ten PANCE and PANRE Board Review Audio Questions appeared first on The Audio PANCE and PANRE.

Mar 28 2019

18mins

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