The Audio PANCE and PANRE Physician Assistant Board Review Podcast

Welcome to episode 77 of the Audio PANCE and PANRE PA Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the Smarty PANCE course content following the NCCPA™ content blueprint (download the FREE cheat sheet).

Special from today’s episode:

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 10-month-old girl was admitted to the hospital for cardiac catheterization. Her history included cyanosis noted at about 6 weeks of age, increasing over the last 7 months and becoming more severe with crying or physical activity. The chest x-ray demonstrates a “boot-shaped heart.” A presumptive diagnosis of tetralogy of Fallot (TOF) was made on admission. TOF has 4 components, which of the following below is NOT PART of the diagnosis?

A. Pulmonary valve stenosis
B. VSD
C. Overriding aorta
D. Right ventricular hypertrophy
E. ASD

Answer: E, ASD

In 1888, Fallot described a congenital heart defect composed of four characteristics (a) large ventricular septal defect (VSD) (b) right ventricular outflow obstruction (pulmonary valve stenosis) (c) overriding aorta (d) right ventricular hypertrophy. The main characteristic of TOF is cyanosis. Hypercyanotic spells or “tet spells” are paroxysmal episodes in which the cyanosis acutely worsens. Crying, feeding, or defecating can bring on these episodes.

Review NCCPA Blueprint Topic: Tetralogy of Fallot

2. A 65-year-old man presents with pain in his right knee. He says he fell and “banged it up fairly bad” approximately 6 months ago but that it had since recovered spontaneously and provided no further trouble until now. On examination, his temperature is 37.5 °C and his blood pressure is 125/70 mm Hg. He has an inflamed, tender, swollen right knee. No other joints are affected. No other abnormalities are found on physical examination. A plain radiographic examination of the right knee reveals streaking of the surrounding soft tissue with calcium deposits (chondrocalcinosis). What is the definitive diagnostic test of choice for this patient’s disease

A. A plasma level
B. A random urine test
C. A 24-hour urine
D. A synovial fluid analysis
E. Gram stain plus culture and sensitivity

The answer is D: A synovial fluid analysis

A definitive diagnosis of gout is made by demonstrating negatively birefringent, needle-shaped monosodium urate crystals under a polarizing microscope. Although an elevated serum uric acid concentration is often seen in acute gout, it is neither as sensitive nor as specific a test as the demonstration of uric acid crystals in the synovial fluid under a microscope.

Serum uric acid levels can be normal in patients with acute gouty arthritis. The diagnosis of septic arthritis can be ruled out by appropriate Gram stain and culture of the same specimen of synovial fluid obtained for examination with the polarizing microscope.

Review NCCPA Blueprint Topic: Gout and pseudogout (Lecture)

3. What is (are) the major difference(s) between polymyalgia rheumatica (PMR) and polymyositis?

A. Marked proximal muscle weakness in polymyositis
B. Marked proximal muscle tenderness in polymyositis
C. Elevated muscle enzymes such as creatine kinase (CK) in polymyositis
D. a, b, and c

The answer is D: a, b, and c

The differences between Polymyalgia Rheumatica (PMR) and polymyositis on clinical examination are as follows:

Polymyositis Pearls

Polymyositis is an autoimmune-mediated inflammatory destruction of muscles leading to muscle weakness

Diagnosis

Treatment

Review NCCPA Blueprint Topic: Polymyositis (ReelDx + Lecture)

4. Clinical features of botulism include all of the following except

A. Paresthesia
B. Dysphagia
C. Diplopia
D. Fixed/dilated pupils

The answer is A: Paresthesia

Paresthesia is not a feature of botulism while dysphagia, diplopia, and fixed dilated pupils are.

Botulism Pearls

Diagnosis

Treatment

Review NCCPA Blueprint Topic: Botulism

5. A 59-year-old male complains of “flashing lights behind my eye” followed by a sudden loss of vision, stating that it was “like a curtain across my eye.” He denies trauma. He takes Glucophage for his diabetes mellitus and atenolol for his hypertension. He has no other complaints. On the fundoscopic exam, the retina appears to be out of focus. Which of the following is the most likely diagnosis?

A. Central retinal vein occlusion
B. Retinal artery occlusion
C. Retinal detachment
D. Hyphema

The answer is C: Retinal Detachment

Patients with retinal detachment frequently complain of flashes of light or floaters that occur during traction on the retina as it detaches. This is followed by loss of vision. In small detachments, the retina may appear out of focus, but with larger detachments, a retinal fold may be identified.

Retinal Detachment Pearls

Diagnosis

Treatment

Review NCCPA Blueprint Topic: Retinal detachment (Lecture)

6. The first dose of the combined vaccine of measles, mumps, and rubella (MMR) is usually given at age

A. 12 months
B. 6 weeks
C. Birth
D. 9 months

The answer is A: The first dose of MMR is given at age 12 – 15 months and a second dose at age 4-6 years

Mumps Pearls

Mumps is a viral disease that is part of the paramyxovirus family. It presents with parotitis (painful parotid gland swelling), orchitis, or aseptic meningitis. It is transmitted through respiratory droplets and has an incubation period of 12-14 days

Diagnosis

Treatment

Review NCCPA Blueprint Topic: Mumps

7. A 28-year old sub-fertile woman presents to you on account of dysmenorrhea, deep dyspareunia, dyschezia, and pelvic pain of a few months’ duration. Physical examination revealed nodularity of the uterosacral ligaments, tenderness in the pouch of Douglas, and a fixed retroverted uterus with positive cervical excitation tenderness. What is the most likely diagnosis?

A. Endometriosis
B. Pelvic inflammatory disease
C. Adenomyosis
D. Uterine leiomyoma

The diagnosis is generally made by

A. Detection of increased estrogen levels
B. Endometrial biopsy
C. Pelvic ultrasound
D. Laparoscopy
E. CT of the pelvis

Answer: A, endometriosis, and D Laparoscopy

Incorrect Answers:

Review NCCPA Blueprint Topic: Endometriosis (Lecture)

8. A 45-year-old obese Caucasian gentleman arrives at your clinic for a routine check-up after having some blood work done during a workplace health screening. He is found to have an LDL cholesterol level of 550 mg/dL. He states that his father and brother had high cholesterol and both died at a young age from a heart attack. He has a follow-up appointment with his cardiologist because of some occasional chest pain and abnormalities seen on his EKG. Additionally, you notice that he has well-demarcated yellow deposits around his eyes. He is started on high dose statin and his LDL at 12 weeks is 350 mg/dL. What is the next best step in this patient’s management?

A. Continue high dose statin, the patient’s LDL is at goal
B. Add niacin 100 mg three times daily
C. Add ezetimibe (Zetia) 10 mg daily
D. Add a PCSK9 inhibitor
E. Refer to a lipid specialist

The answer is C: add ezetimibe 10 mg

If LDL-C is not at goal after 6-12 weeks the next best step for the treatment of familial hypercholesterolemia is to add ezetimibe 10 mg daily and check again in 6-12 weeks. If at that time the patient’s LDL is still not at goal (ideally < 150) refer to lipid specialist to consider adding a PCSK9 inhibitor.

Pearls

Diagnosis

Treatment

Review NCCPA Blueprint Topic: Hypercholesterolemia

9. What best describes the time that preeclampsia is commonly seen?

A. Before 18 weeks of pregnancy
B. After 18 weeks of pregnancy
C. After 16 weeks of pregnancy
D. After 20 weeks of pregnancy
E. Before 12 weeks of pregnancy

The answer is D, after 20 weeks of pregnancy

Preeclampsia is a systemic disease characterized by hypertension that is accompanied by proteinuria. Preeclampsia usually begins after the 20th week of gestation; however, it can appear at any time during pregnancy. It occurs most frequently in the final trimester.

Pearls

Diagnosis

Treatment

Review NCCPA Blueprint Topic: PANCE Blueprint Reproductive System (7%) ⇒ Hypertension disorders in pregnancy

10. A 36-year-old male who is hospitalized because of severe injuries from a motor vehicle accident develops a rapid onset of profound dyspnea. The initial chest x-ray shows a normal heart size with diffuse bilateral infiltrates. A follow-up chest x-ray shows confluent bilateral infiltrates that spare the costophrenic angles. Which of the following is the best clinical intervention for this patient?

A. Tracheal intubation
B. Bilateral chest tube insertion
C. Type-specific packed cells
D. Colloid solutions
E. Provide supplemental oxygen

The answer is A – Tracheal intubation

Tracheal intubation with the lowest level of PEEP is required to maintain the PaO2 above 60 mmHg or SaO2 above 90% in a patient with ARDS

Pearls

Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by fluid collecting in the lungs depriving organs of oxygen

Three clinical settings account for 75% of ARDS cases:

People with ARDS have severe shortness of breath and often are unable to breathe on their own without support from a ventilator

Diagnosis

Chest radiograph shows air bronchograms and bilaterally fluffy infiltrate

Treatment

Review NCCPA Blueprint Topic: PANCE Blueprint Pulmonary (10%) ⇒ Acute respiratory distress syndrome (Lecture)

[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

Welcome to episode 75 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 5-year-old girl is brought to the emergency department after drinking a bottle of drain cleaner. It is unknown how much the child drank. She has a past medical history of Down syndrome and obesity. The patient’s vitals are unremarkable. Physical exam is notable for a child in no acute distress. She is tolerating her oral secretions and is interactive. Inspection of the oropharynx is unremarkable. Which of the following is the appropriate management of this patient?

Answer: B. Endoscopy 

Ingestion of caustic fluids (acid or alkali) such as drain cleaner may lead to esophageal damage and stricture. Any patient presenting after caustic ingestion should have an endoscopy performed between 12 and 24 hours of presentation. Injury due to ingestion of alkaline fluids such as drain/oven cleaner occurs rapidly in the first minutes to hours and is characterized by liquefactive necrosis of the esophageal tissue. Subsequently, esophageal strictures form due to scarring of the affected tissue. Patients should immediately be resuscitated following the ABC’s (airway, breathing, and circulation). Subsequent management involves endoscopy (typically within 12 to 24 hours of ingestion) to assess the extent of the damage and plan any further treatment that may be needed.

Incorrect Answers:

Review NCCPA Blueprint Topic: Ingestion of toxic substances or foreign bodies

2. A 27-year-old man presents to the emergency department after a motor vehicle collision. The patient was a front seat unrestrained driver in a head-on collision. The patient’s echocardiogram (ECG) is notable only for sinus tachycardia. His temperature is 99.5°F (37.5°C), blood pressure is 107/58 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. The patient is given 2 liters of Ringer lactate solution and morphine. Initial workup demonstrates that the patient’s pulmonary capillary wedge pressure and troponins are elevated. The patient is currently complaining of chest pain. Physical exam is notable for an uncomfortable young man with bruising over his chest wall. Which of the following is the most likely diagnosis?

Answer: A. Cardiac contusion

This patient is presenting after blunt chest trauma (which is common in motor vehicle accidents) with chest pain, elevated troponins, and an elevated pulmonary capillary wedge pressure suggesting a diagnosis of a cardiac contusion. A cardiac contusion is a blunt injury to the heart which can disrupt the mechanical and electrical function of the heart. There will typically be visible signs of chest trauma such as bruising and the patient will often complain of chest pain and dyspnea. The ECG can be unremarkable, demonstrate sinus tachycardia, or even demonstrate more severe dysrhythmias such as supraventricular tachycardia, atrial fibrillation, and a right bundle branch block. Initial cardiac troponins can be elevated. In the setting of any ECG abnormality or elevated troponins, patients with a suspected diagnosis of a cardiac contusion should be admitted to the hospital and observed until clinically stable with normalization of their troponins.

Incorrect Answers:

Review NCCPA Blueprint Topic: Chest/Rib Fractures and Trauma

3. A 33-year-old woman presents to her primary care PA for a wellness check-up. She states that recently she has been feeling well other than headaches that occur occasionally, which improve with ibuprofen and rest. She has a past medical history of hypertension and headaches and is currently taking hydrochlorothiazide. Her temperature is 99.2°F (37.3°C), blood pressure is 157/108 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam reveals a young woman who appears healthy. A normal S1 and S2 are auscultated on cardiac exam, and her lungs are clear with good air movement bilaterally. From her previous visit, it was determined that she has an elevated aldosterone and low renin level. Laboratory values are ordered as seen below.

Serum:
Na+: 139 mEq/L
Cl-: 100 mEq/L
K+: 3.7 mEq/L
HCO3-: 29 mEq/L
BUN: 20 mg/dL
Creatinine: 1.1 mg/dL

Which of the following is the most likely diagnosis?

Answer: E. Primary hyperaldosteronism

This patient is presenting with hypertension refractory to a diuretic with a decreased potassium, a decreased renin level, and an increased aldosterone level suggesting a diagnosis of primary hyperaldosteronism.

Primary hyperaldosteronism occurs when the adrenal gland produces excess aldosterone. Aldosterone has the effect in the kidney of absorbing sodium (and thus water) and wasting potassium and hydrogen. Thus, hyperaldosteronism can lead to hypertension, hypokalemia, and a metabolic alkalosis. In primary hyperaldosteronism, the high blood pressure is detected by the kidney, and thus renin levels are decreased in the setting of an elevated aldosterone.

Incorrect Answers:

Summary: Primary hyperaldosteronism presents with hypertension, a decreased renin and potassium level, a metabolic alkalosis, and an increased aldosterone level.

Review NCCPA Blueprint Topic: Secondary hypertension

4. A 24-year-old man is brought in to the emergency room after being retrieved by firefighters from a burning building. The patient is responding coherently to questions but reports pain secondary to a burn on his leg. He states he also has a headache and feels dizzy. His temperature is 98.5°F (36.9°C), blood pressure is 129/66 mmHg, pulse is 126/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for a confused young man with dry and flushed skin. The cardiopulmonary exam reveals a normal S1 and S2, as well as clear breath sounds bilaterally. The patient’s neurological exam is within normal limits. Towards the end of his exam, the patient begins vomiting. The dermatologic exam reveals a superficial burn covering 1% of the patient’s body over his right leg. Which of the following is the best next step in management for this patient?

Answer: A. 100% oxygen

This patient is presenting after being rescued from a fire with confusion, headache, nausea, vomiting, and flushed skin suggesting a diagnosis of carbon monoxide poisoning which should be treated with 100% oxygen.

Carbon monoxide exposure is common in fires and in patients who heat their house with an old-fashioned wood stove. Carbon monoxide binds to hemoglobin with a higher affinity than oxygen thus displacing it leading to symptoms. Carbon monoxide poisoning presents with confusion, headache, altered mental status, nausea, vomiting, and cherry-red skin. Pulse oximetry is often normal in these patients as the device detects hemoglobin bound to oxygen or carbon monoxide similarly. A carboxyhemoglobin level can be obtained to confirm the diagnosis in these patients; however, patients presenting with a clinical picture supportive of carbon monoxide poisoning should be treated with 100% (or hyperbaric) oxygen. Sequelae of carbon monoxide poisoning should be treated supportively, including dantrolene for increased muscle activity or benzodiazepines for seizure activity.

Incorrect Answers:

Summary: The treatment of carbon monoxide poisoning is 100% oxygen.

Review NCCPA Blueprint Topic: Burns (ReelDx)

5. A 42-year-old woman is brought to the emergency department after a motor vehicle accident. She complains of lower back pain and some minor abdominal pain. The patient has a past medical history of obesity and type II diabetes. Her current medications include atorvastatin, metformin, and glyburide. A FAST exam is performed in the trauma bay and does not reveal any signs of intra-abdominal bleeding. Her temperature is 98.2°F (36.8°C), blood pressure is 130/77 mmHg, pulse is 90/min, respirations are 16/min, and oxygen saturation is 99% on room air. Ultrasound findings are notable for multiple gallstones in the gallbladder. The patient is given naproxen. Which of the following is the best next step in management?

Answer: E. Supportive therapy

This patient is presenting with asymptomatic gallstones discovered incidentally. Asymptomatic gallstones do not need to be managed with a cholecystectomy. 

Acute cholecystitis classically presents with right upper quadrant abdominal pain that presents in a fat, fertile, female in her forties. Once the diagnosis is confirmed with ultrasound, “cooling off” of the gallbladder is necessary (keeping the patient NPO and IV fluids) followed by a cholecystectomy that hospital visit. However, if asymptomatic gallstones are discovered incidentally, there is no indication for cholecystectomy. These patients should be managed conservatively.

Incorrect Answers:

Review NCCPA Blueprint Topic: Cholelithiasis (ReelDx + Lecture)

6. A 60-year-old woman presents to the emergency department with dizziness. She states it started this morning when she woke up from bed and was severe causing her to vomit. The episode resolved in 1 minute. The patient has a past medical history of hypertension, diabetes, obesity, and atrial fibrillation treated with warfarin and metoprolol. She recently recovered from a cold a few days ago. Her temperature is 99.0°F (37.2°C), blood pressure is 174/99 mmHg, pulse is 115/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for a well-appearing woman. Her neurological exam including cranial nerves and gait is within normal limits. The patient is laid flat in the bed which causes an episode of dizziness with notable nystagmus and vomiting. She feels better after 1 minute. The patient’s ECG is within normal limits. Lab values are notable for an INR of 3.5. Which of the following is the most likely etiology of this patient’s symptoms?

Answer: A. Canalithiasis

This patient is presenting with intermittent, severe vertigo which is provoked by position changes which is most consistent with benign paroxysmal positional vertigo (BPPV). BPPV is commonly caused by canalithiasis.

Benign paroxysmal positional vertigo (BPPV) is a common form of peripheral vertigo that results from a dislodged piece of otolith (called otoconia when dislodged) causing disturbances in the semicircular canals. The presentation of BPPV involves sudden and episodic vertigo with head movements that lasts for seconds to minutes accompanied by nausea and vomiting. Physical exam will demonstrate a horizontal nystagmus with specific head postures (such as the Dix-Hallpike maneuver). Treatment involves repositioning exercises (such as the Epley maneuver) as well as meclizine or diphenhydramine for symptomatic control.

Incorrect Answers:

Summary: Benign paroxysmal positional vertigo is commonly caused by canalithiasis.

Review NCCPA Blueprint Topic: Vertigo (ReelDx + Lecture)

7. An 18-year-old male presents to his primary care provider with his parents for a sports physical. He was last seen in the clinic several months ago when he was diagnosed with attention deficit hyperactivity disorder (ADHD). He was started on methylphenidate at that time, and the patient now reports improvement in his ability to concentrate in school and at home. He hopes to play baseball in college and has begun lifting weights daily in preparation for baseball season. The patient reports that he eats a healthy diet to fuel his exercise regimen. His parents have no concerns and are pleased with the recent improvement in his grades. On physical exam, the patient has tall stature with average muscle mass for his age. He has no dysmorphic features. His chest has a normal appearance other than mild gynecomastia. The patient has sparse facial hair and a moderate amount of coarse pubic hair that extends across the pubis and spares the medial thighs. His testes are small and firm. Due to the latter, laboratory testing is performed and reveals the following:

Which of the following is the most likely etiology of this patient’s presentation?

Answer: E. Meiotic nondisjunction

This patient presents with tall stature, gynecomastia, and small testes with elevated FSH and LH, which suggests a diagnosis of Klinefelter syndrome. Klinefelter syndrome is usually caused by meiotic nondisjunction that results in a 47,XXY genotype.

Klinefelter syndrome is the most common cause of primary hypogonadism. Patients with Klinefelter syndrome present with tall stature, neurocognitive difficulties (ADHD) and features of hypogonadism including gynecomastia, small testes, small phallus, hypospadias, underdeveloped secondary sex characteristics, and cryptorchidism. Patients without hypospadias or cryptorchidism are often not diagnosed until after puberty, when the symptoms of gynecomastia and small testes become more prominent. Because the hypogonadism in Klinefelter syndrome is caused by testicular fibrosis, laboratory results demonstrate a low testosterone and elevated FSH and LH.

Incorrect Answers:

Summary: Klinefelter syndrome results in primary hypogonadism and presents with tall stature, gynecomastia, small testes, a small phallus, hypospadias, and cryptorchidism.

Review NCCPA Blueprint Topic: Hypogonadism

8. A 65-year-old man presents to the emergency department for sudden weakness. The patient states that he was at home enjoying his morning coffee when his symptoms began. He says that his left arm suddenly felt very odd and weak thus prompting him to come to the ED. The patient has a past medical history of diabetes, COPD, hypertension, anxiety, alcohol abuse, and PTSD. He recently fell off a horse while horseback riding but claims to not have experienced any significant injuries. He typically drinks 5-7 drinks per day and his last drink was yesterday afternoon. His current medications include insulin, metformin, atorvastatin, lisinopril, albuterol, and fluoxetine. His temperature is 99.5°F (37.5°C), blood pressure is 177/118 mmHg, pulse is 120/min, respirations are 18/min, and oxygen saturation is 93% on room air. On physical exam, you note an elderly man who is mildly confused. The cardiopulmonary exam demonstrates bilateral expiratory wheezes and a systolic murmur along the right upper sternal border that radiates to the carotids. Neurological exam reveals cranial nerves II-XII as grossly intact with finger-nose exam mildly abnormal on the left and heel-shin exam within normal limits. The patient has 5/5 strength in his right arm and 3/5 strength in his left arm. The patient struggles to manipulate objects such as a pen with his left hand. The patient is given a dose of diazepam and started on IV fluids. Which of the following is the most likely diagnosis in this patient?

Answer: E. Lacunar stroke

This patient is presenting with risk factors and symptoms suggestive of a diagnosis of a lacunar stroke. 

Lacunar strokes typically occur in patients with risk factors such as hypertension, diabetes, old age, and smoking. The basal ganglia, pons, and subcortical white matter are commonly affected. The pathophysiology occurs secondary to a small penetrating artery occlusion from hypertensive arteriolar sclerosis, lipohyalinosis, or microatheroma formation. Patients present with neurological deficits that can include pure motor hemiparesis, pure sensory stroke, ataxic hemiparesis, or dysarthria-clumsy hand syndrome.

Incorrect Answers:

Review NCCPA Blueprint Topic: Stroke (ReelDx + Lecture)

9. A 26-year-old woman presents to the emergency department with abdominal pain. She states that she was walking up the stairs at work when she felt sudden and severe abdominal pain followed by nausea and vomiting. Her past medical history is noncontributory and she is not currently taking any medications. Her temperature is 99.7°F (37.6°C), blood pressure is 122/78 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for an absence of abdominal tenderness, a left adnexal mass, and left adnexal tenderness. A transvaginal ultrasound demonstrates free fluid surrounding the ovary with edema and the presence of doppler flow. A urinary pregnancy test is negative. The patient’s symptoms persisted after ibuprofen and acetaminophen. Which of the following is the best next step in management?

Answer: B. Laparoscopy

This patient is presenting with sudden onset abdominal pain, nausea, vomiting, and free fluid around the ovary with normal blood flow which is still concerning for ovarian torsion that should be managed with laparoscopy. Ovarian torsion occurs when the ovary twists around its blood supply causing ischemia and necrosis. Patients are typically young women who experience sudden/severe abdominal or vaginal pain, blood per vagina, a left adnexal mass with adnexal tenderness, and a negative urine pregnancy test. The best initial test is a transvaginal ultrasound with Doppler which can show blood flow to the ovary as well as ovarian enlargement and edema (signs of ischemia). Even in the setting of normal blood flow, torsion is possible as the ovary may twist and untwist. Patients presenting with symptoms concerning for ovarian torsion should be managed with laparoscopy to definitively treat and salvage the ovary.

Incorrect Answers:

Summary: Ovarian torsion should be treated with laparoscopy. 

Review NCCPA Blueprint Topic: Ovarian torsion

10. A 72-year-old man is brought into the emergency department by emergency medical services. He looks disheveled and states that he is homeless. He has bruising over his arms and legs and states that he does not have a regular source of nutrition. He denies prior medical conditions but states that he still smokes one pack of cigarettes per day. On exam, the patient’s vital signs are normal, but he appears extremely malnourished. His gums are swollen and bleeding and his tongue is unusually smooth. The hair on his arms is pinwheel-shaped. What is the most likely cause?

Answer: C. Vitamin C deficiency

An elderly, malnourished, cigarette-smoking male with swollen gums, bruising, and corkscrew hair is most likely suffering from vitamin C deficiency.

Though vitamin C deficiency, or scurvy, is uncommon in the developed world, cases in developing countries still exist. Typically, these cases occur in those who are very old or very young due to the inability to feed themselves properly. Since vitamin C, or ascorbic acid, is found in citrus fruits and green vegetables, deficiency in these foods or consumption of these foods with denatured vitamins (due to over-boiling) can result in deficiency. Those who smoke cigarettes have also been found to be more deficient in vitamin C.

Incorrect Answers:

Review NCCPA Blueprint Topic: Hypervitaminosis/hypovitaminosis

[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

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

Welcome to episode 71 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 52-year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the past few months. During his physical examination, you note a nontender, non-enlarged prostate with an isolated right posterior lobe nodule. Which of the following options is most appropriate?

Answer: C. refer the patient for an ultrasound of the prostate and order a PSA level

This patient has an isolated nodule of the prostate gland — cancer until proven otherwise. You should order an ultrasound and a PSA. BPH will present as diffuse enlargement and not a discrete nodule.

Review NCCPA Blueprint Topic: Prostate disorders (PEARLS)

2. Which of the following is a major contraindication to curative surgical resection of a lung tumor?

A. Liver metastases
B. Vagus nerve involvement
C. Non-malignant pleural effusion
D. Chest wall invasion of the tumor

Answer: A. Liver metastases

Distant metastases, except for solitary brain and adrenal metastases are an absolute contraindication for pulmonary resection. Other absolute contraindications include MI within the past 3 months, superior vena cava syndrome due to a metastatic tumor, bilateral endobronchial tumor, contralateral lymph node metastases, and malignant pleural effusion.

Review NCCPA Blueprint Topic: Pulmonary Neoplasms (PEARLS)

3. A 23-year-old female complains of fever and genital pain. Examination reveals the presence of lymphadenopathy in the groin and the presence of vulvar vesicles surrounded by erythematous skin. The diagnosis may be confirmed by

A. A culture of a vesicle using blood agar medium
B. The presence of similar lesions on the fingers and hands
C. A Gram stain of a scraping from the base of the lesion
D. The presence of giant multinucleated cells on Tzanck smear

Answer: D. The presence of giant multinucleated cells on Tzanck smear – A Tzanck smear is the standard laboratory test to confirm the herpes virus as an etiologic agent of a vesicular lesion on an erythematous base.

A. Herpes virus will not grow on blood agar medium.

Review NCCPA Blueprint Topic: Herpes simplex (ReelDx)

4. A 28-year-old woman is complaining of heavy uterine bleeding and pelvic pressure that has progressively worsened over the past year. Evaluation reveals multiple moderate-sized uterine fibroids. The patient desires to have more children. The most appropriate definitive treatment is

A. Myomectomy
B. Hysterectomy
C. GnRH agonists
D. Oral progesterone

Answer: A. Myomectomy –  Myomectomy is the definitive treatment of choice for moderate-sized uterine fibroids in young women who desire to maintain reproductive capability.

B. Hysterectomy is indicated as definitive treatment in a patient who does not desire to maintain reproductive capability.

Review NCCPA Blueprint Topic:

5. A 59-year-old otherwise healthy female develops acute dyspnea and chest pain one week post total abdominal hysterectomy. Echocardiogram demonstrates normal heart size with normal right and left ventricular function. Lung scan demonstrates two segmental perfusion defects. Which of the following is the next step in the management of this patient?

A. Anticoagulation
B. Embolectomy
C. Thrombolysis
D. Inferior vena cava filter

Answer: A. Anticoagulation – Anticoagulation is the treatment of choice in patients with pulmonary embolism with normal ventricular function and no absolute contraindications.

B. Embolectomy is not indicated as the initial treatment of a pulmonary embolism in patients with normal ventricular function.

Review NCCPA Blueprint Topic: Pulmonary embolism (ReelDx)

6. Long term use of which of the following drugs may cause a drug-induced lupus-type eruption?

A. prednisone
B. tetracycline
C. procainamide
D. oral contraceptives

Answer: C. Procainamide – Procainamide, and hydralazine are the most common drugs that may cause a lupus-like eruption.

A. Prednisone is not implicated in drug-induced skin reactions.

Review NCCPA Blueprint topic: Drug eruptions (ReelDx)

7. Which of the following clinical manifestations is most commonly seen in viral croup?

A. drooling
B. wheezing
C. sputum production
D. inspiratory stridor

Answer: D. inspiratory stridor – Viral croup typically presents with a barking cough and stridor.

A. Drooling is common in epiglottitis, not viral croup.

Review NCCPA Blueprint Topic: Croup (ReelDx)

8. Whispered voice test on a patient reveals decreased hearing in the left ear. Which of the following would be most consistent with conductive hearing loss in the left ear?

A. Sounds best heard in the left ear on Weber test.
B. Air conduction longer than bone conduction in the left ear on Rinne test.
C. Sound best heard in the right ear on Weber test.
D. Bone conduction longer than air conduction in the right ear.

Answer: A. Sounds best heard in the left ear on Weber test – Sound best heard in the ear with a decreased hearing on Weber test (in this case, the left ear) is indicative of conductive hearing loss.

B. With conductive hearing loss, bone conduction should be heard as long as or longer than air conduction of sound in the affected ear. Air conduction lasting longer than bone conduction of sound would indicate a sensorineural hearing loss.

Review NCCPA Blueprint Topic: Hearing impairment (Lecture)

9. A 65-year-old male presents with multiple lesions on his back. He denies any pruritis. Physical examination reveals the presence of multiple scattered brown plaques with a raised, warty surface that appears to be stuck onto the skin and feel greasy. Which of the following is the most likely diagnosis?

A. lentigines
B. actinic keratosis
C. keratoacanthomas
D. seborrheic keratosis

Answer: D. seborrheic keratosis – Seborrheic keratosis is a common benign plaque in the elderly that characteristically has a velvety or warty surface associated with a stuck on appearance and greasy feel.

A. Lentigines most commonly are seen on the dorsum of the hand and appear as flat brown spots, often with sharp borders.

Review NCCPA Blueprint Topic: Keratotic disorders (PEARLS)

10. You are called to the nursery to see a male infant, born by uncomplicated vaginal delivery. He weighs 2,600 grams and has one deep crease on the anterior third of each foot. Respirations are 88 breaths/minute with expiratory grunting and intercostals retractions. He is cyanotic on room air and becomes pink when placed on 60% oxygen. Chest x-ray shows atelectasis with air bronchograms. Which of the following is the most likely diagnosis?

A. neonatal pneumonia
B. congenital heart disease
C. hyaline membrane disease
D. chronic lung disease of prematurity

Answer: C. hyaline membrane disease – Hyaline membrane disease is the most common cause of respiratory distress in the premature infant. The infant typically presents with tachypnea, cyanosis, and expiratory grunting. A chest x-ray reveals hypoexpansion and air bronchograms.

A. While tachypnea, grunting, retractions, and cyanosis may be signs of neonatal pneumonia, they are primarily late findings of progressive respiratory distress and would not be seen immediately at the time of delivery. A chest x-ray in pneumonia would also most commonly reveal an infiltrate or effusion.

Review NCCPA Blueprint Topic:

Looking for all the podcast episodes?

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

Welcome to episode 69 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. Which of the following is the most common cause of acute myocardial infarction?

A. Occlusion caused by coronary microemboli
B. Thrombus development at a site of vascular injury
C. Congenital abnormalities
D. Severe coronary artery spasm

B. Thrombus development at a site of vascular injury – Acute myocardial infarction occurs when a coronary artery thrombus develops rapidly at a site of vascular injury. In most cases, infarction occurs when an atherosclerotic plaque fissures, ruptures, or ulcerates and when conditions favor thrombogenesis so that a mural thrombus forms at the site of rupture and leads to coronary artery occlusion.

A. Coronary microemboli occlusion is a rare cause of acute myocardial infarction.

Review NCCPA Blueprint Topic: Acute myocardial infarction (PEARLS) (Lesson)

2. Endotracheal intubation should be performed with caution in patients with which of the following underlying conditions due to the propensity to cause subluxation of C1 on C2?

A. Rheumatoid arthritis
B. Osteoarthritis
C. Gout
D. Pseudogout

A. Rheumatoid arthritis – Patients with advanced rheumatoid arthritis will have synovitis of the atlantoaxial joint (C1-C2) which may damage the transverse ligament of the atlas, producing a forward displacement of the atlas on the axis (atlantoaxial subluxation).

B. Although patients with osteoarthritis may have neck pain and stiffness, there is no predilection for the atlantoaxial joints.

Review NCCPA Blueprint Topic: Rheumatoid arthritis (Lecture) (Lesson)

3. Which of the following interventions is the treatment of choice for an actinic keratosis?

A. Mohs surgery
B. Cryotherapy
C. Acid peels
D. Radiation therapy

B. Cryotherapy – Cryotherapy is the treatment of choice for isolated superficial actinic keratosis.

A. Mohs surgery and radiation therapy are not indicated in the treatment for actinic keratosis.

Review NCCPA Blueprint Topic: Actinic keratosis

4. A 55-year-old secretary presents with ongoing pain and numbness in her hand. These symptoms are worse at night and she must shake her hand to regain feeling in it. Which of the following physical examination signs will be
present?

A. Hypothenar atrophy
B. Weakness of finger abduction
C. Inability to maintain wrist extension against resistance
D. Weakness of thumb abduction

D. A weakness of thumb abduction – Median nerve injury causes weakness of thumb abduction (measured by thumb opposition strength) along with thenar atrophy. Tinel’s and Phalen’s signs will also be positive with carpal tunnel syndrome.

A. Hypothenar atrophy may occur with aging and disuse but it is not part of the median nerve involvement that occurs with carpal tunnel syndrome.

Review NCCPA Blueprint Topic: Carpal Tunnel Syndrome (Lesson)

5. A 78-year-old male with history of coronary artery disease status post-CABG and ischemic cardiomyopathy presents with a complaint of progressive dyspnea and orthopnea. He also complains of lower extremity edema. The patient denies fever, chest pain, or cough. On physical examination, vital signs are BP 120/68, HR 75 and regular, RR 22, afebrile. You note the patient to have an S3 heart sound, jugular venous distention, and 2+ lower extremity edema. The patient is admitted and treated. Upon discharge from the hospital, the patient should be educated to monitor which of the following at home?

A. Daily weights
B. Daily spirometry
C. Daily blood glucose
D. Daily fat intake

A. Daily weights – Home monitoring of daily weights can alert the health care provider to the early recognition of worsening heart failure.

B. Spirometry monitoring is important in a patient with asthma, not heart failure.

Review NCCPA Blueprint Topic: Heart Failure (ReelDx) (Lesson)

6. Which of the following rotator cuff tendons is most likely to sustain injury because of its repeated impingement (carpal tunnel syndrome) between the humeral head and the undersurface of the anterior third of the acromion and coracoacromial ligament?

A. Supraspinatus
B. Infraspinatus
C. Teres minor
D. Subscapularis

A. Supraspinatus – A critical zone exists for the supraspinatus tendon due to its superior insertion site. It is susceptible for injury because it has a reduction in its blood supply that occurs with abduction of the arm. Impingement of the shoulder is most commonly seen with the supraspinatus tendon, the long head of the biceps tendon and/or the subacromial bursa.

Review NCCPA Blueprint topic: Soft tissue injuries of the forearm, wrist, and hand (ReelDx) (Lesson)

7. Which of the following diagnostic findings in the urinary sediment is specific for a diagnosis of chronic renal failure?

A. Hematuria
B. Proteinuria
C. Broad waxy casts
D. Hyaline casts

C. Broad waxy casts – Broad waxy casts in urinary sediment are a specific finding in chronic renal failure.

A. Hematuria and proteinuria are frequent, but nonspecific, findings in chronic renal failure.

Review NCCPA Blueprint Topic: Chronic kidney disease (Lesson)

8. In addition to tobacco products, which of the following is also considered a major risk factor in the development of oral cancer?

A. Sun exposure
B. Alcohol abuse
C. Occupational exposure
D. History of oral candidiasis

B. Alcohol abuse – Major risk factors for the development of oral cancer are the use of tobacco products and alcohol abuse.

A. Sun exposure is a risk factor for cancer of the lip but is not considered a major risk factor for oral cancer.

Review NCCPA Blueprint Topic: EENT Benign and Malignant Neoplasms (Lesson)

9. A 13-year-old boy with leukemia presents with epistaxis for 2 hours. The bleeding site appears to be from Kiesselbach’s area. The most appropriate intervention is

A. electrocautery of the bleeding site
B. silver nitrate application
C. posterior nasal packing
D. intranasal petrolatum gauze

D. intranasal petrolatum gauze – Petrolatum gauze will provide pressure to the bleeding point while the cause of bleeding is corrected.

A. Cautery is not used because the edges of the cauterized area may begin to bleed.

Review NCCPA Blueprint Topic: Epistaxis (ReelDx + Lecture) (Lesson)

10. A 2-year-old female presents with purulent nasal discharge bilaterally with fever and cough for several days. Her mom had taken her out of daycare for a similar occurrence 2 months ago, that was treated with Amoxicillin. Exam further reveals halitosis and periorbital edema. Treatment should be initiated with which of the following?

A. Antihistamines
B. Ribavirin (Rebetol)
C. Intranasal corticosteroids
D. Amoxicillin-clavulanate (Augmentin)

D. Amoxicillin-clavulanate (Augmentin) – High dose amoxicillin-clavulanate is the treatment of choice for resistant bacterial sinusitis, especially in children presenting with risk factors (daycare attendance, previous antibiotic treatment 1-3 months prior, age younger than 2 years).

A. Antihistamines and intranasal corticosteroids have not been adequately studied in children to prove they make a difference in treating recurrent sinusitis.

Review NCCPA Blueprint Topic: Acute and chronic sinusitis (ReelDx + Lecture) (Lesson)

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

Welcome to episode 67 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 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 questions are linked to NCCPA Content Blueprint lessons from the SMARTYPANCE & PANRE Board Review Website. If you are a member you will be able to log in and view this interactive video lesson.

A 26-year-old female presents with several pruritic lesions on her dorsal forearms. The lesions are erythematous with vesicles, with a few beginning to weep. She works in a photography laboratory but denies any other possible exposures. Which of the following is the most useful diagnostic test?

A. VDRL serology
B. KOH prep
C. Patch testing
D. Gram’s stain

C. Patch testing with a suspected agent is usually positive in cases of allergic contact dermatitis

A. VDRL serology is useful in the diagnosis of syphilis, not contact dermatitis

2. An elderly female presents for evaluation of exertional syncope, dyspnea, and angina. She admits that previous to these symptoms she had insidious progression of fatigue that caused her to curtail her activities. Which of the following is the most likely diagnosis?

A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Mitral valve prolapse

A. The major symptoms of aortic stenosis are exertional syncope, dyspnea, and angina. Symptoms do not become apparent for a number of years and usually are not present until the valve is narrowed to less than 0.5 cm to 2 cm of the valve surface area.

B. Patients with aortic regurgitation are likely to complain of an uncomfortable awareness of their heart, especially when lying down. These patients develop sinus tachycardia with exertion and complain of palpitations and head pounding with activity.

3. A 40-year-old female G5P5 complains of small quantities of urine leaking when she coughs, sneezes, or laughs. Her genitourinary examination is unremarkable and her urinalysis is normal. At this time, which of the following is the most appropriate management plan?

A. Refer for a cystoscopy
B. Recommend Kegel exercises
C. Refer for surgical correction
D. Recommend hormone replacement therapy

B. Strengthening the pelvic muscles by Kegel exercises and emptying the bladder frequently may resolve the problem.

A. Conservative therapy for stress incontinence should be attempted prior to any evaluation, such as cystoscopy, that might indicate the need for surgical correction

4. A 62-year-old male presents with complaints of vague epigastric abdominal pain associated with jaundice and generalized pruritus. Physical examination reveals jaundice and a palpable non-tender gallbladder but is otherwise unremarkable. Which of the following is the most likely diagnosis?

A. Viral hepatitis
B. Pancreatic cancer
C. Acute cholecystitis
D. Gilbert’s syndrome

B. Pancreatic cancer is suggested by the vague epigastric pain with jaundice resulting from biliary obstruction due to cancer involving the pancreatic head. The presence of a palpable non-tender gallbladder (Courvoisier’s sign) also indicates obstruction due to the cancer

A. While viral hepatitis may cause jaundice, the liver is enlarged and tender

5. Which of the following would you expect on physical examination in a patient with mitral valve stenosis?

A. Systolic blowing murmur
B. Opening snap
C. Mid-systolic click
D. Paradoxically split S2

B. Mitral stenosis is characterized by a mid-diastolic opening snap

A. Mitral stenosis is a diastolic, not a systolic murmur

Review PANCE and PANRE Valvular disorders pearls

6. A positive Wood’s light examination (fluorescence) demonstrates

A. viral infection with herpes zoster
B. bacterial infection with Treponema pallidum
C. parasitic infestation with Pediculus humanus
D. mycotic infection with Microsporum canis

D. Microsporum causes tinea capitis and fluoresces blue-green under Wood’s light

A. Lesions of herpes, Treponema, and Pediculus infections do not fluoresce.

Review topic PANCE Dermatologic system dermatophyte infections

7. In which of the following patients would one most likely find acanthosis nigricans?

A. A 55-year-old obese female with hyperinsulinemia
B. A 55-year-old male with an enlarged spleen and pancytopenia
C. A 24-year-old female with increased Lyme titers
D. A 60-year-old male with increased triglycerides

A. Acanthosis nigricans is associated with patients who have hyperinsulinemia

B. Hairy cell leukemia is associated with an enlarged spleen and pancytopenia. Acanthosis nigricans is not a cutaneous manifestation

8. A 65-year-old male presents with back pain two days after he was shoveling snow. The patient complains of pain in his low back that radiates into his buttocks, posterior thigh and calf, and the bottom of his foot. There is associated numbness of the lateral and plantar surface of his foot. Which of the following disc herniations is most likely to be affected?

A. L3-L4
B. L4-L5
C. L5-S1
D. S1-S2

C. The S1 nerve root impingement is most likely to occur from the herniation of the L5-S1 disc space. The S1 disc affects Achilles’ reflex, the gastrocnemius and soleus muscles, and the abductor hallucis and gluteus maximus muscles.

9. A 22-year-old female presents to the emergency department with a rapid heart rate. She appears quite thin and dehydrated. She denies that she is thin, stating “I am so fat that I can hardly stand myself! That is why I exercise every day.” She runs twelve to fifteen miles a day, and on weekends also bicycles forty to fifty miles. Her LMP was six months ago. On exam, she is 5′ 6″ tall and weighs 98 pounds. Temp 98 degrees F, pulse 100, respirations 18, BP 98/60. EKG shows sinus tachycardia. Laboratory findings include Na 138 mEq/L, K 2.8 mEq/L, Cl 91 mEq/L, BUN 35 mg/dL, Creatinine 1.1 mg/dL. Which of the following is the next most appropriate treatment?

A. Propylthiouracil (PTU) and individual psychotherapy
B. Hormone replacement and cognitive therapy
C. Weight restoration and family therapy
D. IV hydration and antidepressant therapy

C. Anorexia nervosa requires a comprehensive, multidisciplinary approach to treatment that integrates medical management, individual psychotherapy, and family therapy. Currently, the best results have been shown with weight restoration accompanied by family therapy for patients with adolescent-onset anorexia nervosa and individual therapy for patients with onset after 18 years of age. Inpatient treatment is often required.

A. Propylthiouracil is used to treat hyperthyroidism, not anorexia nervosahttps://smartypance.com/lessons/ear-disorders/inner-ear-pearls/acoustic-neuroma/

10. A 52-year-old female presents with complaints of intermittent episodes of dizziness, tinnitus, and hearing loss in the right ear for 6 months. She describes the dizziness as the “room spinning around her,” with the episodes typically lasting for 2 to 4 hours. Physical examination reveals horizontal nystagmus and right ear hearing loss, but the remainder of the examination is unremarkable. Which of the following is the most likely diagnosis?

A. Acute labyrinthitis
B. Positional vertigo
C. Acoustic neuroma
D. Ménière’s syndrome

D. Ménière’s syndrome uhttps://smartypance.com/lessons/ear-disorders/inner-ear-pearls/vertigo-reeldx294/sually presents with episodes of vertigo that last from 1 to 8 hours, sensorineural hearing loss and tinnitus.

A. Acute labyrinthitis typically presents with an acute onset of continuous vertigo that lasts several days to a week and is associated with nausea and vomiting. It does not have any associated auditory or neurologic symptoms.

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

Welcome to episode 65 of the Audio PANCE and PANRE PA Board Review Podcast.

In today’s episode, I welcome my friend, exclusive smartypance lecturer, and PA board review extraordinaire Joe Gilboy PA-C who will be breaking down Hepatitis B as you’ve never seen it before.

This is a recorded lecture featured on my smartypance.com board review website covering Hepatitis A, B, and C testing with twelve follow up questions at the end.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of the site. The full board review covers the entire NCCPA Content Blueprint, all indexed, searchable, and now available with Joe’s Gilboy’s priceless lectures.

To top it off you can sign up today for the free 60-day board review email series which includes Joe’s audio explanations.

If you enjoyed this podcast episode:

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 SMARTYPANCE & PANRE Board Review Website. If you are a member you will be able to log in and view this interactive video lesson.

1. A patient presents wanting to be tested to see if they presently have Hepatitis A which labs would you order?

a. Anti-HAV (IgG)

c. Anti-HAV (IgM)

2. Which lab result would a PA and an IV drug abuser both have that are positive?

a. Anti-HBs

a. Anti-HBs

3. Which positive lab tells you a person is currently actively infected with hepatitis B?

a. HBsAg

d. HBeAg

4. Which of the following lab result would a chronic hepatitis B patient have that is positive?

a. HBsAg

a. HBsAg

5. Immunoglobulin is given within two weeks for family members and close contacts when they are exposed to hepatitis A. Which immunoglobulin is given?

a. IgM

b. IgG

6. Hepatitis D needs what part of hepatitis B to exist?

a. HBsAg

a. HBsAg

7. Hepatitis E is transmitted by which vector?

a. IV drug abuse

c. Fecal-oral

8. What is the 1st evidence of infection with hepatitis B?

a. HBcAg

c. Anti-HBs

9. What is the lab test to indicate a diagnosis of acute hepatitis B?

a. Anti-HBs

c. Anti-HBc

10. What is the lab test that indicates viral replication and infectious Hepatitis B?

a. HBcAg

b. HBeAg

11. Which of the following is the first sign of a patient with an elevated conjugated bilirubin (direct)?

a. Icteric sclera

d. Tea-colored urine

12. A 52-yo male with upper abdominal pain and an elevated aminotransferase(AST) >10,000 u/l is consistent with which problem?

a. Gallstones

d. Viral Hepatitis

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

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

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

Welcome to episode 61 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. An 18-year-old male presents with pain in his wrist after he fell off of a moving motorcycle. Physical examination reveals tenderness in the anatomic snuffbox. No fracture is noted on plain radiography of the wrist. Which of the following is the recommended treatment for this patient?

A. An ace wrap of the wrist

Answer: C. Thumb spica cast application

Even with normal initial radiographs, patients with a consistent history and tenderness in the anatomical snuffbox are treated as a stable fracture with immobilization in a thumb spica cast. Casting is recommended for all presumed nondisplaced scaphoid fractures.

Scaphoid fractures covered in fractures and dislocation of the forearm, wrist, and hand and are part of the NCCPA Endocrinology Musculoskeletal Blueprint (10%)

2. A solitary pulmonary nodule is found on a pre-employment screening chest x-ray in a 34-year-old non-smoking male. There are no old chest x-rays to compare. Which of the following is the most appropriate next step in the evaluation?

A. CT scan of the chest

Solitary pulmonary nodules are covered as part of the NCCPA PANCE Blueprint Pulmonary (12%) Content Blueprint (12%)

Answer: A. CT scan of the chest

In the absence of old x-rays in a nonsmoking individual less than 35 years old, CT scan of the chest is the next step in the evaluation of a solitary pulmonary nodule.

B. A needle biopsy would be indicated for a person greater than 35 years old and/or with a history of smoking to evaluate a solitary pulmonary nodule.

3. Early clues to impending delirium tremens include

A. agitation and decreased cognition.

Delirium tremens is covered as part of the NCCPA Psychiatry content blueprint (6%) under the topic of withdrawal

Answer: A. agitation and decreased cognition.

Anxiety, decreased cognition, tremulousness, increasing irritability, and hyperactivity are common early clues to impending delirium tremens.

Mental confusion, tremor, sensory hyperacuity, visual hallucinations, autonomic hyperactivity, diaphoresis, dehydration, electrolyte disturbances, seizures, and cardiovascular abnormalities are common signs and/or symptoms of full-blown delirium tremens.

4. Dental caries are caused by which of the following organisms?

A. Streptococcus mutans

Dental caries are covered as part of the NCCPA EENT Content Blueprint (9%) under diseases of the teeth and gums

Answer: A. Streptococcus mutans

Streptococcus mutans is the principal organism that helps to demineralize the enamel.

5. The most definitive treatment for primary enuresis is

A. oxybutynin chloride (Ditropan).

Primary enuresis is covered under incontinence as part of the NCCPA Genitourinary Content Blueprint (6%)

Answer: D. desmopressin (DDAVP)

Intranasal desmopressin is effective in 50% of patients treated and is the treatment of choice.

A. Oxybutynin chloride is used for bladder spasms. It cannot be used for children under 5 years of age and is not indicated in primary enuresis.

6. A 47-year-old female presents to the clinic with complaints of prolonged, heavy menses that have been getting progressively worse for 3 years. She denies any pain. On physical examination, enlargement of the uterus with multiple smooth, spherical, firm masses is noted. A CBC is consistent with a mild anemia. Which of the following is the most likely diagnosis?

A. Leiomyoma

Leiomyoma is covered as part of the NCCPA Reproductive Content Blueprint (8%)

Answer:  A. Leiomyoma

Abnormal uterine bleeding and irregular enlargement of the uterus are most consistent with leiomyoma. Pain is rarely present unless vascular compromise occurs.

B. While adenomyosis may present with hypermenorrhea, dysmenorrhea is often also present. Physical examination would reveal the presence of diffuse globular uterine enlargement, not the irregular enlargement as noted in the case presented.

7. Which of the following is the laboratory test that marks recovery from Hepatitis B infection and non-infectivity?

A. Hepatitis B surface antibody(anti-HBs)

Hepatitis B serology is covered as part of acute and chronic hepatitis and is part of the NCCPA GI and Nutrition Content Blueprint (10%)

Answer: A. Hepatitis B surface antibody(anti-HBs)

Specific antibody to HBsAg appears in most individuals after clearance of HBsAg which indicates recovery from hepatitis B infection, non-infectivity, and immunity.

B. This test establishes infection with HBV and implies infectivity.

8. A 36-year-old woman admits that her husband has abused her for over ten years. You should inform the woman that she is at most risk for injury or death

A. just before a holiday.

Domestic violence is covered as part of the NCCPA Psychiatry Content Blueprint (6%)

Answer: B. just after leaving an abusive spouse.

Women are more likely to be assaulted or murdered when attempting to report the abuse or leave the abusive relationship; up to 75% of domestic assaults occur after separation.

9. A patient presents with an acutely painful and cold left leg. Distal pulses are absent. Leg is cyanotic. There are no signs of gangrene or other open lesions. Symptoms occurred one hour ago. Which of the following treatments is most appropriate?

A. Vena cava filter

Arterial embolism/thrombosis is covered as part of the NCCPA Cardiology Content Blueprint (16%)

Answer: B. Embolectomy

Embolectomy within 4 to 6 hours is the treatment of choice.

A. Vena cava filters are used in the management of venous thromboembolic disease when anticoagulation cannot be done.

10. A 53-year-old male is seen in the emergency department following a motor vehicle collision in which his knee impacted against the dashboard. The patient has a posterior knee dislocation that is promptly reduced in the emergency department. The patient currently has a palpable pulse in the dorsalis pedis and posterior tibial areas. Which of the following studies is mandatory?

A. Anterior plain film of knee

Fractures and dislocations of the knee are covered as part of the NCCPA Musculoskeletal Content Blueprint (10%)

Answer: D. Angiography

The popliteal artery is at risk for injury whenever a patient sustains a posterior dislocation of the knee and should be evaluated with an arteriogram despite the presence of pedal pulses.

C. Compartment pressures are performed in cases of suspected compartment syndrome, not to determine the patency of the popliteal artery.

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

Welcome to episode 59 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover ten Emergency Medicine End of Rotation Exam (EOR) review questions from the SMARTYPANCE course content following the NCCPA™ and PAEA content blueprint (download the FREE cheat sheet).

This week we will be covering ten emergency medicine end of rotation exam 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. During a baseball game, a 22-year-old college student is hit in the right eye by a baseball. He complains of blurry vision in that eye. On physical exam, the physician assistant notes proptosis of the right eye and limitation of movement in all directions. On CT scan, which of the following is most likely to be seen?

A. Fracture of the medial orbital wall

Answer: C. Hematoma of the orbit

Orbital hemorrhage into the space surrounding the globe following blunt trauma and rupture of the orbital vessels results in increased ocular pressure, proptosis, visual loss, and limitation of movement in all directions. CT reveals a hematoma.

A. Fracture of the medial orbital wall is associated with diplopia from medial rectus impingement, orbital emphysema, and epistaxis.

Blowout fractures are covered as part of the NCCPA EENT Content Blueprint which accounts for 9% of your exam.

2. A 29-year-old male presents with a complaint of substernal chest pain for 12 hours. The patient states that the pain radiates to his shoulders and is relieved with sitting forward. The patient admits to recent upper respiratory symptoms. On examination vital signs are BP 126/68, HR 86, RR 20, temp 100.3 degrees F. There is no JVD noted. Heart exam reveals regular rate and rhythm with no S3 or S4. There is a friction rub noted. Lungs are clear to auscultation. EKG shows diffuse ST-segment elevation. What is the treatment of choice for this patient?

A. Pericardiocentesis

Answer: D. Indomethacin

Indomethacin, a nonsteroidal anti-inflammatory medication, is the treatment of choice in a patient with acute pericarditis.

A. Pericardiocentesis is the treatment of choice in a patient with a pericardial effusion and cardiac tamponade, there is no evidence of either of these in this patient.

Acute pericarditis is covered the NCCPA Cardiology Content Blueprint which accounts for 16% of your exam.

3. A 19-year-old female presents with a sore throat for nearly two weeks. She complains of fatigue and a low-grade fever. On physical examination, there is cervical, axillary, and inguinal lymphadenopathy, and mild splenomegaly. On review of the blood smear, which of the following would be expected?

A. Atypical lymphocytes

Answer: A. Atypical lymphocytes

The hallmark of infectious mononucleosis is the presence of lymphocytosis with atypical large lymphocytes seen in the blood smear. These are larger than normal mature lymphocytes, stain more darkly, and frequently show vacuolated, foamy cytoplasm, and dark chromatin in the nucleus.

B. Hypersegmented neutrophils are seen in vitamin B12 deficiency.

Mononucleosis as part of the NCCPA Infectious Disease Content Blueprint which accounts for 3% of your exam.

4. A 30-year-old female complains of fatigue, weakness, diminished appetite, weight loss, and syncope. She denies fever, chest or abdominal pain, palpitations, changes in bowel patterns or sleep patterns. Physical examination reveals a thin female, BP 90/65 mmHg, and pulse 80 beats per minute. Pulmonary, cardiovascular, abdominal, and neurologic exam are without abnormalities. Areas of brown and bronze hyperpigmentation are noted on her elbows and the creases of her hands. Which of the following tests will be the most useful in making the diagnosis?

A. Drug screen

Answer: D. Serum creatinine kinase

Serum creatinine kinase is the most sensitive test to detect rhabdomyolysis, a serious complication of seizures and hyperthermia related to drug abuse.

A. Although a drug screen may identify specific drugs, the results will not alter the care of this patient.

5. A 15-year-old male was seen last week with complaints of a sore throat, headache, and mild cough. A diagnosis of URI was made and supportive treatment was initiated. He returns today with complaints of worsening cough and increasing fatigue. At this time, chest x-ray reveals bilateral hilar infiltrates. A WBC count is normal and a cold hemagglutinin titer is elevated. The most likely diagnosis is

A. tuberculosis.

Answer: B. mycoplasma pneumonia.

The insidious onset of symptoms, the interstitial infiltrates on chest x-ray, and elevated cold hemagglutinin titer makes this diagnosis the most likely.

A. Most children with pulmonary tuberculosis are asymptomatic with few physical examination findings. The results of the diagnostic studies do not support tuberculosis as the most likely diagnosis.

Mycoplasma pneumonia is covered as part of the NCCPA Pulmonary Content Blueprint and accounts for 12% of the exam

6. Which of the following clinical manifestations is common in candidal vulvovaginitis?

A. Extreme vulvar irritation

Answer:  A. Extreme vulvar irritation 

Candida infection presents with pruritus, vulvovaginal erythema, and white, cheese-like (curd) discharge that may be malodorous.

B. A firm painless ulcer is seen in syphilis.

Vaginitis is covered as part of the NCCPA Reproductive System Content Blueprint and accounts for 8% of the exam

7. A 63-year-old female presents with a complaint of chest pressure for one hour noticed upon awakening. She admits to associated nausea, vomiting, and shortness of breath. 12 lead EKG reveals ST-segment elevation in leads II, III, and AVF. Which of the following is the most likely diagnosis?

A. Aortic dissection

Answer: B. Inferior wall myocardial infarction 

Myocardial infarction often presents with chest pressure and associated nausea and vomiting. ST-segment elevation in leads II, III, and AVF are classic findings seen in acute inferior wall myocardial infarction.

A. A patient with aortic dissection will complain of tearing, ripping pain. EKG is often normal but may reveal left ventricular strain pattern.

Acute myocardial infarction is covered as part of the NCCPA Cardiology Content Blueprint and accounts for 16% of the exam

8. Small grayish vesicles and punched-out ulcers in the posterior pharynx in a child with pharyngitis is representative of which organism?

A. Epstein-Barr virus

Answer: C. Coxsackievirus

Coxsackievirus presents with small grayish vesicles and punched-out ulcers in the posterior pharynx.

A. Epstein-Barr virus presents with enlarged tonsils with exudates and petechiae of the palate.

Coxsackievirus is covered as part of the NCCPA Dermatology Content Blueprint which accounts for 5% of your exam.

9. Which of the following is the most appropriate management of acute psychosis in a patient with schizophrenia?

A. Amitriptyline (Elavil)

Answer: B. Risperidone (Risperdal)

There are numerous options used in the management of acute psychosis including benzodiazepines and antipsychotics such as haloperidol (first generation – typical -antipsychotic), risperidone or aripiprazole (second Generation – atypical – antipsychotics). Antidepressants and lithium have no benefit in the treatment of acute psychosis.

Schizophrenia is covered as part of the NCCPA psychiatry Content Blueprint which accounts for 6% of your exam.

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

A. A Galeazzi fracture is a fracture along the length of the radius with an injury to the distal radioulnar joint.

Monteggia fracture is covered as part of the NCCPA Musculoskeletal Content Blueprint which accounts for 10% of your exam.

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