Welcome to episode 73 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.

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

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 45-year obese female (BMI=36.7 ) presents to your clinic with a random serum glucose level of 242.  You diagnose the patient with type II diabetes and place her on metformin 500 mg twice daily and ask that she check her glucose first thing in the morning and again late at night. The patient states that her glucose first thing in the morning is 424 and by the evening it is 96.  Which of the following tests would you like to order to confirm your diagnosis?

Answer: D. Dexamethasone suppression test

This patient is presenting with elevated glucose levels in the morning and normal levels at night. This is due to the dawn phenomenon or secreting too much cortisol first thing in the morning which is very common in patients with Cushing syndrome. The diagnostic test of choice for Cushing syndrome is a dexamethasone suppression test. While it is true that the cortisol levels will be elevated this does not diagnose Cushing’s syndrome.

Review NCCPA Blueprint Topic: Cushing’s syndrome

2. A 49-year-old male is admitted to the hospital with a diagnosis of pneumonia. He has had a cough and fever up to 101.2 °F for five days.  The patient states that his cough is productive and he is also complaining of sharp right-sided chest pain. On physical exam, you note diminished breath sounds on the right as well as dullness to percussion.  The chest x-ray demonstrates a right lower lobe infiltrate. Which of the following bacteria would be the most likely cause of this patient’s pneumonia?

Answer: B. Pneumococcal

Pneumococcal pneumonia is the most common form of pneumonia in an adult that is greater than 40. It usually presents as lobar pneumonia with dullness to percussion and diminished breath sounds. There is also a vaccination available. Mycoplasma is the most common form of pneumonia in young adults and those less than 40.

Review NCCPA Blueprint Topic: Bacterial pneumonia (ReelDx)

3. A 21-year-old male is brought into the emergency room by his fraternity brothers. He appears confused and is agitated. He has a temperature of 100.5 F, horizontal nystagmus, muscular rigidity and at times becomes incredibly combative. His laboratory evaluation shows a CPK level of 8000 and his blood alcohol level is 0. Which of the following drugs most likely explains this patient’s symptoms?

Answer: C. PCP

PCP can cause extreme agitation as well as fever, muscular rigidity, horizontal nystagmus, and rhabdomyolysis.  The best treatment for these patients is IV fluids and sedation with medications like Geodon, Haldol, Thorazine, and Ativan. You can also add Benadryl to this cocktail.

Review NCCPA Blueprint Topic: Substance-related and addictive disorders

4. A 51-year-old male presents to the ED complaining of substernal burning discomfort. He reports a history of mild hypertension and Raynaud’s phenomenon. On physical exam, you notice he has shortened fingers. When further questioned the patients states that he was once told that he may have a type of autoimmune disease but is unaware of the name. Which of the following medications would be most helpful for the patient’s chronic heartburn??

Answer: E. Amlodipine

The patient’s symptoms of heartburn, hypertension, Raynaud’s phenomenon, and short fingers are consistent with scleroderma. The best treatment for the reflux esophagitis that can occur with scleroderma is a calcium channel blocker. Calcium channel blockers serve as a smooth muscle relaxant which will relax his tight esophagus resulting in increased mobility and fewer chances for heartburn.

Review NCCPA Blueprint Topic: Systemic sclerosis – Scleroderma

5. You are called to see a patient who is currently on multiple psychiatric medications including Lithium, Lorazepam, Abilify, Trazodone, and Sertraline. He also takes Lasix.  He is in an assisted living facility and is brought to you by his care team for an acute psychotic episode. Which of the following medications is most likely responsible for the patient’s acute psychosis?

Answer: B. Lasix

Loop diuretics can be very problematic in patients taking psychiatric medications. Loop diuretic result in a loss of water in the vascular volume, henceforth levels of different psychiatric medications will become higher. For example, if a patient is on lithium and they are currently on Lasix lithium level becomes higher and they can become with lithium toxic.

Review NCCPA Blueprint Topic: Schizophrenia spectrum and other psychotic disorders

6. A young healthy female patient with a recent diagnosis of depression complains of a 4-month history of amenorrhea and decreased sex drive. She has no significant past medical history and usually has normal menstrual cycles. Which of the following medications is most likely the cause of this patient’s symptoms?

Answer: E. Risperidone

Older (second-generation) atypical antipsychotic agents can cause elevations in plasma prolactin concentrations while the newer atypical antipsychotics have minimal effect. Risperidone (an older second-generation antipsychotic agent) can cause amenorrhea, sexual dysfunction, and infertility.

Review NCCPA Blueprint Topic: Depressive disorders (Pearls)

7. A 64-year-old male presents with a chief complaint of lower extremity pain while walking his dog every afternoon. What is the most important risk factor for developing peripheral vascular disease?

Answer: A. Smoking

Smoking is the strongest risk factor for PVD. As a class of drugs view nicotine as a very potent vasoconstrictor causing vasoconstriction everywhere. For example vasoconstriction of the vessels in the heart=CAD which can lead to MI. Constricted blood vessels in the brain=CVA and constricted blood vessels in the periphery=PVD.

Review NCCPA Blueprint Topic: Peripheral artery disease (Lesson)

8. A 35-year-old male patient presents concerned about his cardiac risk factors. He has a low HDL level, hypertension, type II DM, and an elevated LDL and triglyceride levels. His brother had CAD at the age of 47. Which of the following risk factor has the highest value when determining this patients risk of developing CAD?

Answer: C. Diabetes

Diabetes is the strongest risk factor for CAD. All the other choices are risk factors however they do not have the same predictive value as diabetes when it comes to the severity of CAD.

Review NCCPA Blueprint Topic: Coronary Heart Disease (PEARLS)

9. Which of the following is considered to be a 1st line medication used in endocarditis prophylaxis for high-risk patients undergoing invasive procedures such as an esophageal stricture dilation?

Answer: C. Amoxicillin

Amoxicillin is the prophylactic agent of choice against endocarditis, as it is able to cover both gram-negative and gram-positive organisms. If the patient is PCN allergic then Clindamycin is the next best choice.

Review NCCPA Blueprint Topic: Acute and subacute bacterial endocarditis

10. In a patient with a VSD murmur which of the following will be seen during the physical exam?

Answer: D. Holosystolic murmur

In VSD the patient will have a holosystolic murmur moving from left to right during systole causing more blood to move into the right ventricle and pulmonary artery. End game is pulmonary hypertension.

Review NCCPA Blueprint Topic: Ventricular septal defect

[spoiler title=”C

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.

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