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.

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

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

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.

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

A. cystitis

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.

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

Osteoporosis is covered as part of the PANCE Musculoskeletal Blueprint

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.

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)

Bacterial meningitis is covered as part of the PANCE Neurology Blueprint

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.

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

Diabetic neuropathy is covered as part of the PANCE Endocrinology Blueprint

Answer: A. Microalbuminuria

Microalbuminuria is most consistent with early diabetic neuropathy.

B. Red cell casts are more indicative of acute glomerular nephritis.

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

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.

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

Pulmonary embolism and is part of the PANCE Pulmonary Blueprint

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.

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

A. Cerebrovascular disease

Seizure disorders are covered as part of the PANCE Neurology Blueprint

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)

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

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.

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

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

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.

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

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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.

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