Welcome to episode 19 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.

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The Audio PANCE and PANRE Episode 17

1. A 12 month-old child with tetralogy of Fallot is most likely to have which of the following clinical features?

A. Chest pain

Answer: B. Cyanosis

Cyanosis is very common in tetralogy of Fallot.

2. Intraarticular injection of hyaluronic acid has been approved for treatment of patients with which of the following conditions?

A. Rheumatoid arthritis of the knee

Answer: B. Osteoarthritis of the knee

Intraarticular injection of hyaluronic acid has been approved recently for treatment of patients with osteoarthritis of the knee that have failed other therapies. Although the onset of action of this medication is slower than injected glucocorticoids, it has a sustained length of activity outlasting the injected glucocorticoids.

3. A 28 year-old female, who has experienced occasional painful migratory arthralgias, complains now of a tender, swollen, and hot left ankle. The joint was aspirated and the synovial fluid showed 55,000 WBCs, 75% polymorphonuclear lymphocytes, low glucose level, and no crystals. Which of the following would be the most likely diagnosis?

A. Rheumatoid arthritis

Answer:  B. Septic arthritis

Septic arthritis presents with a large number of WBCs, predominantly polymorphonuclear, and with glucose levels much lower than serum levels.

4. A 25 year-old presents with pain in the proximal ulna after falling directly on the forearm. X-ray shows 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

Answer: B. Monteggia fracture

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

5. A 20 year-old male presents with a mass in the groin. On examination with the patient standing, a mass is noted that extends into the scrotum. The patient denies any trauma. The most likely diagnosis is

A. an indirect inguinal hernia.

Answer: A. an indirect inguinal hernia.

An indirect inguinal hernia is caused by a patent processus vaginalis and the hernial contents may be felt in the ipsilateral scrotum.

6. A patient with type 2 diabetes mellitus presents for a yearly eye exam. Ophthalmoscopic exam reveals neovascularization. Which of the following is the most likely complication related to this finding?

A. Glaucoma

Answer: C. Vitreous hemorrhage

Proliferative retinopathy, as evidenced by neovascularization, is associated with an increased risk of vitreous hemorrhage.

7. Which of the following oral hypoglycemic agents when used as monotherapy is most likely to cause hypoglycemia?

A. Glipizide (Glucotrol)

Answer: A. Glipizide

Sulfonylureas increase insulin levels and predispose patients to hypoglycemia.

8. A 75 year-old female presents with medial knee pain that worsens with stair climbing. Physical examination reveals swelling and point tenderness inferior and medial to the patella and tenderness overlying the medial tibial plateau. Which of the following is the most likely diagnosis?

A. Pes anserine bursitis

Answer: A. Pes anserine bursitis

The pes anserine bursa underlies the semimembranosus tendon and may become inflamed or painful owing to trauma, overuse, or inflammation. It is a common cause of knee pain and it is often misdiagnosed in adults.

9. A 23 year-old male presents with syncope. On physical examination you note a medium-pitched, mid-systolic murmur that decreases with squatting and increases with straining. Which of the following is the most likely diagnosis?

A. Hypertrophic cardiomyopathy

Answer: A. Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is characterized by a medium- pitched, mid-systolic murmur that decreases with squatting and increases with straining.

10. Which of the following can be a very serious consequence of using antidiarrheals in a patient with inflammatory bowel disease?

A. Lymphoma

Answer: B. Toxic megagolon.

Antidiarrheals may cause the development of toxic megacolon when used by patients with active severe inflammatory bowel disease.

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