Welcome to episode 89 of the Audio PANCE and PANRE PA Board Review Podcast.

Join me as I cover ten PANCE, PANRE and EOR review questions from the Smarty PANCE Instagram/Facebook page and the smartypance.com board review website.

Special from today’s episode:

Below you will find an interactive exam to complement today’s podcast.

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

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1. The definition of amblyopia is . . .

A. Congenital cataracts noted at birth

B. Retinal detachment seen in premature children

C. Irregular pupillary size

D. Increased distance between the medial and lateral canthus

E. Subnormal visual acuity in one or both eyes despite correction of refractive error

Answer: E. Subnormal visual acuity in one or both eyes despite correction of refractive error

Amblyopia, also called lazy eye, is a disorder of sight in which the brain fails to process inputs from one eye and over time favors the other eye. It results in decreased vision in an eye that otherwise typically appears normal

DX: Screening to detect amblyopia in all children younger than five years of age

TX: Treatment includes correction of refraction error as well as forced use of the amblyopic eye by patching the better eye

View lesson: Amblyopia

A 45-year old woman being managed for ulcerative colitis, developed abdominal pain, vomiting, diarrhea, the passage of blood and mucus per rectum, and fever. On examination, she was pale, febrile (temp: 102.2 C), moderately dehydrated, heart rate: 124bpm. There was abdominal distention and tenderness, bowel sounds were hypoactive. Lab results showed Hb: 9g/dl, WBC: 14 x 109/L, elevated CRP. Stool was negative for C. difficile. HIV status was negative. Abdominal radiograph showed dilated transverse colon of about 11 cm. What is the most likely diagnosis of this patient?

A. Hirschsprung’s disease

B. Cytomegalovirus colitis

C. Toxic megacolon

D. Kaposi’s sarcoma

Answer: C. Toxic megacolon

The hallmarks of toxic megacolon (toxic colitis) are nonobstructive colonic dilatation (>6 cm) and signs of systemic toxicity. It occurs following complications from causes of colitis e.g. ulcerative colitis as is the case in the index patient.

Incorrect Answers:

View lesson: Toxic megacolon

3. Which of the following is not transmitted by blood?

A. Hepatitis A

B. Hepatitis B

C. Hepatitis C

D. Hepatitis D

Answer: A. Hepatitis A

Hepatitis A is transmitted via the fecal-oral route

Incorrect Answers:

View lesson: Acute and Chronic Hepatitis

4. When is PKU testing performed?

A. 24 weeks gestation

B. 24 to 48 h after birth

C. 48 to 72 h after birth

D. at the first well-child visit

Answer: B. 24 to 48 h after birth

In the US and many developed countries, all neonates are screened for PKU 24 to 48 h after birth. Tandem mass spectrometry is the method of choice. It has a low false-positive rate, and excellent accuracy and precision.

View lesson: Phenylketonuria

5. A 20-year-old female with a history of type 1 diabetes presents to the clinic complaining of weight loss, increased flatulence, foul-smelling stools, and a pruritic rash. You notice multiple papules and vesicles on the extensor surfaces of the elbows. Which of the following is most likely to be positive?

A. Anti-cyclic citrullinated peptide antibody

B. Anti-dsDNA antibody

C. Anti-tissue transglutaminase antibody

D. Anti-topoisomerase antibody

E. Anti-beta 2 glycoprotein 1antibody

Answer: C. Anti-tissue transglutaminase antibody

The patient has Celiac disease, which is an immune disorder characterized by sensitivity to gluten. It is more common in patients with Type 1 diabetes, autoimmune thyroiditis, Trisomy 21, and Turner syndrome.

Clinical features include diarrhea with bulky, foul-smelling floating stool, flatulence, and weight loss. Patients may have dermatitis herpetiformis, which is a rash located on the elbows, forearms, and knees.

Laboratory studies to order include anti-tissue transglutaminase antibodies and IgA anti-endomysial antibodies. The best diagnostic test is an upper endoscopy with a small bowel biopsy. Patients must avoid food with gluten, which includes barley, rye, oats, and wheat.

Incorrect Answers:

View lesson: Celiac disease

6. Which of the following is the most common cause of postpartum hemorrhage?

A. Severe vaginal laceration

B. Uterine atony

C. Hematoma

D. Retained products of conception

E. Placental abruption

Answer: B. Uterine atony

Postpartum hemorrhage is an obstetric emergency. It is defined as an estimated blood loss ≥ 500 mL during vaginal delivery or ≥ 1000 in a cesarean section. The most common cause is uterine atony.

Uterine atony presents as a soft, boggy uterus after delivery and should initially be managed with fundal massage and IV oxytocin.

In general, the main focus of managing postpartum hemorrhage should be (1) resuscitation and management of hypovolemic shock and (2) identifying and treating the underlying cause.

View lesson: Postpartum hemorrhage

7. A 37-year-old female with no past medical history is brought in by EMS. She is hypotensive. On physical exam, you notice muffled heart sounds and jugular vein distention. What is the most appropriate initial treatment for this condition?

A. Emergent needle decompression

B. IV beta-blockers

C. Pericardiocentesis

D. Thrombolytics

E. None of the above

Answer: C. Pericardiocentesis

The patient is experiencing cardiac tamponade, which is defined as fluid accumulation in the pericardial sac. The most common cause of cardiac tamponade is trauma. Other causes include malignancy, uremia, infection, and iatrogenic.

Patients may have Beck’s Triad – hypotension, muffled heart sounds, and jugular vein distention. They may also have pulsus paradoxus (large decrease in systolic blood pressure on inspiration).

The best diagnostic test is an echocardiogram. The treatment of cardiac tamponade is pericardiocentesis. An open surgical approach (i.e., thoracotomy) is typically needed for traumatic cases though.

Incorrect Answers:

View lesson: Cardiac Tamponade

8. Which of the following should be avoided in patients who have an acute kidney injury?

A. NSAIDs

B. Aminoglycosides

C. Macrolides

D. Acetaminophen

E. Both A and B

Answer: E. Both A and B

Acute kidney injury (AKI) is defined by an acute decline in renal function. You will see an increase in serum creatinine with possible oliguria or anuria.

AKI can be broken up into 3 main etiologies: pre-renal, intrinsic, and post-renal. The most common cause of acute kidney injury overall is reduced perfusion. Prolonged pre-renal AKI can lead to ischemic acute tubular necrosis.

Nephrotoxic agents, such as NSAIDs, vancomycin, aminoglycosides, and ACEI/ARBs, should be avoided. Treatment is managing the underlying cause, plus correcting acid-base & electrolyte issues.

View lesson: Acute Renal Failure

9. A 38-year-old male presents to the ER with acute onset of dyspnea, dizziness, chest pain, and diaphoresis, He has had 4 episodes similar in the past. Vital signs are remarkable for mild tachycardia (103 bpm). Lab and imaging studies are insignificant. Which of the following is the best long-term medical treatment for the likely diagnosis?

A. Benzodiazepines

B. Selective serotonin reuptake inhibitors

C. Atypical antipsychotics

D. Calcium channel blockers

E. Melatonin

Answer: B. Selective serotonin reuptake inhibitors

The patient most likely has panic disorder. The DSM V criteria for panic disorder include the following:

Symptoms of a panic attack include diaphoresis, chest pain, lightheadedness, shortness of breath, palpitations, sense of doom, or fear of dying. The treatment of panic disorder is selective serotonin reuptake inhibitors. Patients may benefit from taking hydroxyzine or benzodiazepines on a short-term, as-needed basis.

View lesson: Panic Disorder

10. Which of the following best represents values you would expect in a patient with SIADH?

A. High serum sodium, high serum osmolality, low urine osmolality

B. High serum sodium, high serum osmolality, high urine osmolality

C. Low serum sodium, low serum osmolality, low urine osmolality

D. Low serum sodium, low serum osmolality, high urine osmolality

E. None of the above

Answer: D. Low serum sodium, low serum osmolality, high urine osmolality

SIADH or syndrome of inappropriate antidiuretic hormone secretion is characterized by the excessive release of ADH. ADH increases the permeability of the distal convoluted tubule and collecting ducts, increasing the reabsorption of water. This decreases plasma osmolality, increases urine osmolality, and leads to hyponatremia.

Causes include intrathoracic diseases (pneumonia, TB, acute respiratory failure, lung cancer), neurological issues (stroke, hemorrhage, tumors), and drugs (NSAIDs, opioids, ecstasy, and SSRIs). The goal is to determine and manage the underlying cause. Fluid restriction is often used as well.

View lesson: Syndrome of inappropriate antidiuretic hormone secretion

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