January 01, 2015

The Audio PANCE and PANRE Board Review Podcast Episode 11

8 minutes

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.

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Questions 1-10

The Audio PANCE and PANRE Episode 11

1. What is the initial treatment of choice for hyperthyroidism in a 10-week pregnant patient?

A. No treatment is necessary.

B. Propylthiouracil (PTU)

C. Radioiodine treatment

D. Subtotal thyroidectomy

Click here to see the answerB. Propylthiouracil (PTU) – This is the initial treatment of choice.

2. A patient presents with eye pain and blurred vision. Snellen testing reveals vision of 20/200 in the affected eye and 20/20 in the unaffected eye. Fluorescein staining reveals the presence of a dendritic ulcer. Which of the following is the most likely diagnosis?

A. Viral keratitis

B. Fungal corneal ulcer

C. Acanthamoeba keratitis

D. Bacterial corneal ulcer

Click here to see the answerA. Viral keratitis – Herpes Simplex virus is a common cause of dendritic ulceration noted on fluorescein staining.

And in case you were wondering:

B. Fungal corneal ulcers have an indolent course with intraocular infection being common but fluorescein staining is negative for a dendritic pattern.

C. Acanthamoeba keratitis has a waxing and waning course over several months and has no fluorescein staining in a dendritic pattern.

D. Bacterial corneal ulcers can progress aggressively resulting in corneal perforation. Fluorescein staining does not occur in a dendritic pattern.

3. A 63 year-old female with history of diabetes mellitus presents for blood pressure follow-up. At her last two visits her blood pressure was 150/92 and 152/96. Today in the office her blood pressure is 146/92. Recent blood work shows a Sodium 140 mEq/L, Potassium 4.2 mEq/L, BUN of 23 mg/dL, and Creatinine of 1.1 mg/dL. Which of the following is the most appropriate initial medication in this patient?

A. Terazosin (Hytrin)

B. Atenolol (Tenormin)

C. Lisinopril (Zestril)

D. Hydrochlorothiazide (HCTZ)

Click here to see the answerC. Lisinopril (Zestril) – For the boards ACE inhibitors should be part of the initial treatment of hypertension in diabetics because of beneficial effects in diabetic nephropathy and is the most appropriate initial medication. In real practice, despite what we have been led to believe, it actually makes little difference which antihypertensive is used in diabetic patients just as long as we reach our blood pressure goals.

4. What is the EKG manifestation of cardiac end-organ damage due to hypertension?

A. Right bundle branch block

B. Left ventricular hypertrophy

C. Right ventricular hypertrophy

D. ST segment elevation in lateral precordial leads

Click here to see the answerB. Left ventricular hypertrophy – Long-standing hypertension can lead to left ventricular hypertrophy with characteristic changes noted on EKG.

5. Annual blood pressure determinations should be obtained beginning at the age of

A. 3 years.

B. 5 years.

C. 12 years.

D. 18 years.

Click here to see the answerA. 3 years – Periodic measurements of blood pressure should be part of routine preventive health assessments beginning at the age of 3 years.

6. In adults and intravenous drug abusers, which of the following bones is most commonly affected with acute osteomyelitis?

A. Femur

B. Humerus

C. Vertebral spine

D. Tibia

Click here to see the answerC. Vertebral spine – The bones of the vertebral spine are most commonly affected in a patient with osteomyelitis. Organisms reach the well-perfused vertebral body of adults via spinal arteries and quickly spread from the end plate into the disk space and then to the adjacent vertebral body. The infection may originate in the urinary tract and intravenous drug use carries an increased risk of spinal infection.

7. Treatment of the patient with Pediculosis pubis consists of which of the following?

A. Permethrin (Nix) cream

B. Clotrimazole (Gyne-Lotrimin)

C. Podofilox (Condylox) solution

D. Selenium sulfide (Selsun) suspension

Click here to see the answerA. Permethrin 1% cream/shampoo is used to kill the louse and remove the eggs from the hair shafts.

8. A 43 year-old asymptomatic diabetic female is found to have an elevated total calcium level of 12.4 mg/dL. Which of the following tests must be assessed in order to evaluate this laboratory abnormality?

A. Intact parathyroid hormone

B. Serum albumin

C. 24 hour urine calcium level

D. Complete blood count

Click here to see the answerB. Serum albumin – Since approximately 50% of calcium is protein bound, total calcium levels should be interpreted relative to albumin levels.

9. Which of the following conditions would cause a positive Kussmaul’s sign on physical examination?

A. Left ventricular failure

B. Pulmonary edema

C. Coarctation of the aorta

D. Constrictive pericarditis

Click here to see the answerD. Constrictive pericarditis – Kussmaul’s sign is an increase rather than the normal decrease in the CVP during inspiration. It is most often caused by severe right-sided heart failure; it is a frequent finding in patients with constrictive pericarditis or right ventricular infarction.

10. Treatment of Bell’s palsy includes which of the following?

A. Acyclovir

B. Reassurance of the patient’s recovery

C. Referral to a neurosurgeon

D. Electromyography

Click here to see the answerB. Reassurance of the patient’s recovery – Although I usually always treat with Acyclovir, Bell’s palsy is a peripheral neuropathy of cranial nerve VII. Although it has been suggested it may be related to an activation of herpes simplex virus, there is little empiric evidence for this. Approximately 60% of cases of Bell’s palsy recover without treatment and patient reassurance of this is advised. Electromyography may provide aid in the prognosis, but not as a treatment option. A neurosurgeon has no role in the management of Bell’s palsy.

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By Smarty PANCE | The PA Life

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