The Audio PANCE and PANRE Physician Assistant Board Review Podcast

Welcome to episode 57 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 endocrinology 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 53-year-old Hispanic woman comes to your clinic for her annual physical exam. She is obese, does not exercise, and regularly eats fried foods. A random blood glucose is 249 mg/dL. Her hemoglobin A1C is 9.5. Which of the following treatments would be weight neutral or cause weight loss in this patient?

A. Glargine

Diabetes Mellitus Type 2 is covered as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Answer: D. Metformin

The patient in this vignette most likely has type II diabetes. Of the given treatments, only metformin is weight neutral in the majority of cases (i.e. it does not cause significant weight gain/loss). Metformin is a first-line treatment for type II DM in most patients. Although the exact mechanism is unknown, it appears to decrease gluconeogenesis and increase insulin sensitivity. There is no risk of hypoglycemia or weight gain (though some patients even lose weight). The most high yield side effect involves lactic acidosis, particularly in patients with renal insufficiency. 

A. Glargine, a long-acting insulin, can cause weight gain.

2. A solitary thyroid nodule is noted on physical examination. The TSH level is normal. The next step in the evaluation is:

A. measurement of T4 and free T3 levels.

Solitary thyroid nodule is covered as part of thyroid neoplastic disease in the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Answer: C. a fine needle biopsy

Fine needle aspiration (FNA) is the first step in the evaluation of a solitary nodule with a normal TSH level. FNA has a high level of accuracy in diagnosing benign versus malignant nodules in this setting.

A. Measurement of T4 and T3 levels would not be of benefit in the evaluation of a solitary thyroid nodule with a normal TSH level.

3. An 18-year-old male with a past medical history of type I diabetes presents to the emergency room with polyuria, polydipsia, and dehydration. Vital signs reveal tachycardia and hypotension. The physical exam is significant for dry mucous membranes and decreased skin turgor. In the waiting room, he begins vomiting and complains of intense abdominal pain. You observe him taking rapid, deep breaths, and over the course of his brief stay, getting more somnolent. Which of the following abnormalities would be expected in this patient?

A. Hypernatremia

Diabetic ketoacidosis is covered under Diabetes Mellitus Type 1 as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Answer: B. Decreased total body potassium

This type I diabetic is presenting with signs and symptoms of diabetic ketoacidosis (DKA). In DKA, total body potassium stores are generally decreased due to osmotic diuresis. DKA is a life-threatening emergency that may occur in either type I or type II diabetics but is significantly more common in patients with type I. The pathogenesis is related to insulin deficiency resulting in hyperglycemia that leads to osmotic diuresis and hypovolemia. The inability of the body to use the available glucose for ATP production results in ketone formation and eventually an anion gap metabolic acidosis. Serum potassium levels may be low, normal, or elevated, but total body stores are generally low and require repletion. Common precipitating factors include infection, trauma, myocardial infarction, sepsis and, of course, inadequate insulin administration. Patients may present with nausea, vomiting, abdominal pain, Kussmaul respirations (rapid, deep breaths), dehydration, polydipsia, polyuria and may eventually progress to altered mental status.

A. Patients with DKA more often present with hyponatremia. Remember that serum sodium decreases 1.6 mEq/L for every 100 mg/dL increase in glucose.

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 is the most likely diagnosis?

A. Addison’s disease

This condition is covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Answer: A. Addison’s disease

Addison’s disease (adrenal insufficiency) would account for all her symptoms, the hypotension, and the hyperpigmentation of the skin.

B. Cushing’s disease, the presence of an ACTH-producing adenoma, is characterized by central obesity, hypertension, moon facies, purple striae, and glucose intolerance.

5. A 39-year-old male presents to your clinic complaining of increasing constant headaches and progressive loss of peripheral vision. His medical and family history is unremarkable. Physical examination reveals bitemporal hemianopsia but is otherwise without any abnormalities. Which of the following is the most likely diagnosis?

A. An aneurysm involving the circle of Willis

This condition is covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Answer: D. A pituitary tumor 

A pituitary tumor would account for the headaches and the loss of the peripheral vision in both visual fields. As the tumor grows, the optic chiasm will be compressed by the tumor.

A. An aneurysm involving the circle of Willis would result in CN III palsy. This would be a rare finding.

6. Radioactive iodine is most successful in treating hyperthyroidism that results from

A. Grave’s disease.

Watch this ReelDx Video of a 16-year-old with ADHD presents with chest pain and exophthalmos

Diseases of the thyroid gland are covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Answer:  A. Grave’s disease.

Radioactive iodine is an excellent method to destroy overactive thyroid tissue of Grave’s disease.

B. Radioactive iodine is ineffective in subacute thyroiditis due to the thyroid’s low uptake of iodine.

7. A newborn infant exhibits prolonged jaundice, feeding problems, hypotonia, and an enlarged tongue. Proper treatment in this infant would consist of which of the following?

A. IV antibiotics

This condition is covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Answer: B. Thyroid hormone replacement 

This scenario is consistent with congenital hypothyroidism. Measurement of TSH or T4 would confirm this and T4 should be given.

C. Hepatitis and sepsis may account for the presence of jaundice, feeding problems, and hypotonia, but would not result in an enlarged tongue.

8. Which of the following glucose-lowering agents act by delaying glucose absorption?

A. Metformin (Glucophage)

Diabetes Mellitus Type 2 and associated medications are covered as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Answer: B. Acarbose (Precose)

Alpha-glucosidase inhibitors, such as acarbose, reduce glucose by delaying glucose absorption.

A. Metformin, a biguanide, lowers glucose by decreasing hepatic glucose production and increased glucose utilization.

9. Which of the following conditions may result in hypokalemia?

A. Adrenal adenoma

Diseases of the Adrenal Glands are covered as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Answer: A. Adrenal adenoma

Excessive secretion of aldosterone from an adrenal adenoma will lead to sodium retention and the secretion of potassium in the distal tubule of the kidney, eventually leading to hypokalemia.

B. Hypoparathyroidism and hyperthyroidism should not have any effect on potassium levels.

10. A 7-year-old child with a history of type 1 diabetes mellitus for 3 years presents for routine follow-up. The mother states that the child has been having nightmares and night sweats. Additionally, his average morning glucose readings have risen from an average of 100 mg/dL to 145 mg/dL over the past week. This child is most likely experiencing

A. a growth spurt.

The Somogyi effect and the dawn phenomenon are covered under Diabetes Mellitus Type 1 as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Answer: C. the Somogyi effect.

This refers to nocturnal hypoglycemia, which stimulates counter-regulatory hormone release resulting in rebound hyperglycemia.

A. Nightmares and night sweats are not associated with growth spurts.

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 55 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. Which of the following physical examination findings would be consistent with a pleural effusion?

A. Hyperresonance to percussion

Pleural effusions are covered as part of the NCCPA Content Blueprint Pulmonology section which accounts for 10% of the exam

View this ReelDx patient video case of a 68-year-old female complaining of bilateral chest pain and difficulty breathing. Included in this lesson is the Picmonic explaning Light’s Criteria.

Answer: C. Unilateral lag on chest expansion

A lag on chest expansion may be seen in the presence of a pleural effusion.

A. Hyperresonance to percussion would be suggestive of emphysema or pneumothorax.

2. A 55 year-old female presents with complaints of stiffness, aching, and pain in the muscles of her neck, shoulders, lower back, hips, and thighs. There is no associated weakness associated with the stiffness and achiness. Laboratory evaluation shows an elevated C reactive protein and erythrocyte sedimentation rate. Which of the following medications is used to treat this condition immediately and will also serve to prevent a known complication from this disorder?

A. Glucocorticoids

This condition is covered as part of the NCCPA Musculoskeletal Content Blueprint and accounts for 10% of the exam

Answer: A. Glucocorticoids

This patient has polymyalgia rheumatica and treatment with glucocorticoids can relieve discomfort and prevent the associated ischemic temporal arteritis, which threatens vision.

B. Cyclophosphamide is an immunosuppressant used in the treatment of acute leukemia.

3. A 35 year-old pregnant patient presents with fever, chills, and left-sided flank pain. On physical examination left-sided CVA tenderness is noted. Urinalysis reveals numerous white blood cells and white blood cell casts. Which of the following is the most appropriate treatment?

A. Oral ciprofloxacin (Cipro)

This condition is covered as part of the NCCPA Genitourinary Content Blueprint and accounts for 6% of the exam

Answer: D. IV ceftriaxone (Rocephin)

IV cephalosporins are first line treatment of pyelonephritis in a pregnant patient, followed by oral step-down therapy.

A. See B for explanation.

4. A 26 year-old female arrives in the emergency department with friends who say she was standing in front of her church, dressed in a white bathrobe, claiming to be the Virgin Mary and handing out $100 bills to all passers-by. Her friends noted that she had been depressed lately, but now seems completely euphoric. She had a similar episode two years ago. Which of the following is the most appropriate treatment?

A. Inpatient olanzapine (Zyprexa) therapy

This condition is covered as part of the NCCPA Psychiatry Content Blueprint and accounts for 6% of the exam

Answer: A. Inpatient olanzapine (Zyprexa) therapy

Treatment of the manic phase is usually done in the hospital to protect patients from behaviors associated with grandiosity (spending inordinate amounts of money, making embarrassing speeches, etc.). Lithium, valproate, and olanzapine are considered effective in the manic stage; the depressive stage is treated with

5. A 19 year-old patient was involved in a motor vehicle crash and brought to the emergency department fully immobilized. The patient sustained multiple blunt injuries to the chest and abdomen. During the trauma assessment, there was no blood at the urethral meatus and a Foley catheter was placed. The urine was positive for blood on the dipstick. Which of the following is the most appropriate diagnostic test

A. Retrograde urethrography

Answer: B. CT scan of abdomen and pelvis

CT scan of the abdomen and pelvis is indicated in blunt trauma including those resulting in hematuria or when renal injury is suspected.

A. A retrograde urethrogram should be performed when blood is found at the external urinary meatus prior to insertion of a catheter.

6. A 48 year-old male presents with complaints of heartburn that occurs approximately 45 minutes after eating about three times a week that is relieved by antacids. He claims to have followed advice about elevating the head of the bed, avoiding spicy foods, and losing weight, but continues to have heartburn. Which of the following is the most appropriate next step?

A. Ranitidine (Zantac)

GERD (Gastroesophageal reflux disease) is covered as part of the NCCPA GI and Nutrition Content Blueprint and accounts for 10% of the exam

Answer: A. Ranitidine (Zantac)

Ranitidine, an H2 receptor blocker, is indicated for the treatment of mild, intermittent symptoms of gastroesophageal reflux disease.

B. Sucralfate is used in the treatment of duodenal ulcers.

7. Radioactive iodine (I131) is most successful in treating hyperthyroidism that results from

A. Grave’s disease.

Watch this ReelDx Video of a 16-year-old with ADHD presents with chest pain and exophthalmos

Diseases of the thyroid gland are covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Answer: A. Grave’s disease.

Radioactive iodine (I131) is an excellent method to destroy overactive thyroid tissue of Grave’s disease.

B. Radioactive iodine is ineffective in subacute thyroiditis due to the thyroid’s low uptake of iodine.

8. An 8 year-old boy is brought to a health care provider complaining of dyspnea and fatigue. On physical examination, a continuous machinery murmur is heard best in the second left intercostal space and is widely transmitted over the precordium. The most likely diagnosis is

A. ventricular septal defect

This disorder is covered as part of the NCCPA Cardiology Content Blueprint and accounts for 9% of the exam

Answer: D. patent ductus arteriosus.

Patent ductus arteriosus is classically described in children as a continuous machinery-type murmur that is widely transmitted across the precordium.

A. Ventricular septal defect causes a holosystolic murmur rather than a continuous machinery-like murmur.

9. A 63 year-old male with history of hypertension and tobacco abuse presents complaining of dyspnea on exertion for two weeks. The patient admits to one episode of chest discomfort while shoveling snow which was relieved after five minutes of rest. Vital signs are BP 130/70, HR 68, RR 14. Heart exam reveals regular rate and rhythm, normal S1 and S2, no murmur, gallop, or rub. Lungs are clear to auscultation bilaterally. There is no edema noted. Which of the following is the most appropriate initial diagnostic study for this patient?

A. Helical CT scan

Angina is covered as part of the NCCPA Cardiology Content Blueprint which accounts for 10% of the exam

Answer: C. Nuclear stress test

In patients with classic symptoms of angina, nuclear stress testing is the most widely used test for diagnosis of ischemic heart disease.

A. Helical CT scan aids in the diagnosis of pulmonary embolism, not in the evaluation of angina.

10. A 52 year-old male with history of hypertension and hyperlipidemia presents with an acute myocardial infarction. Urgent cardiac catheterization is performed and shows a 90% occlusion of the left anterior descending artery. The other arteries have minimal disease. Ejection fraction is 45%. Which of the following is the treatment of choice in this patient?

A. Coronary artery bypass grafting (CABG)

Acute myocardial infarction [Non-ST-segment elevation (NSTEMI)] and [ST-segment elevation myocardial infarction (STEMI)] are covered as part of the NCCPA Cardiology Content Blueprint which represents 16% of your exam

Answer: C. Percutaneous coronary intervention (PCI)

Immediate coronary angiography and primary percutaneous coronary intervention have been shown to be superior to thrombolysis.

A. Percutaneous coronary intervention is a better, less invasive alternative to CABG for single vessel coronary artery disease.

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 53 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 Academy course content following the NCCPA™ content blueprint (download the FREE cheat sheet) and the PAEA End of Rotation™ Exams Blueprints & Topic Lists.

This week we will be covering ten General Surgery End of Rotation Exam Questions that are now part of the SMARTYPANCE website. 

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 patient has a tibia/fibula fracture following a motorcycle crash. Twelve hours later the patient presents with increased pain despite adequate doses of analgesics and immobilization. Which of the following is the most likely diagnosis?

A. avascular necrosis

Answer: C. Compartment syndrome

Compartment syndrome is characterized by a pathological increase of pressure within a closed space and results from edema or bleeding within the compartment. It may occur as an early local complication of fracture.

A. Avascular necrosis occurs primarily in muscles post-traumatically and may not arise for several months after an injury.

B. Myositis ossificans is a late complication of fracture resulting from disruption of the blood supply to the bone.

D. Reflex sympathetic dystrophy is characterized by painful wasting of the hand muscles that may be secondary to injury and could occur as a late complication.

2. A 25-year-old male presents to the ED with left calf pain and cramping, as well as nausea and vomiting. He admits to “partying with cocaine all night”. He describes his urine as a dark brown color. Serum creatinine kinase (CK) is 1325 IU/L (Normal Range 32-267 IU/L). Which of the following is the initial mainstay of therapy for this condition?

A. IV rehydration

Answer: A. IV rehydration

IV rehydration with crystalloids for 24 to 72 hours is the mainstay of therapy for rhabdomyolysis.

B. Fasciotomy is indicated for compartment syndrome.

C. NSAIDs, such as Toradol (Ketorolac), should not be used due to the vasoconstrictive effects on the kidneys.

D. Hydrotherapy is not useful or indicated for Rhabdomyolysis

3. A 42-year-old male presents complaining of a sudden onset of a severe intermittent pain originating in the flank and radiating into the right testicle. He also complains of nausea and vomiting. On examination, the patient is afebrile but restless. Examination of the abdomen reveals tenderness to palpation along the right flank with no rebound or direct testicular tenderness. Urinalysis reveals a pH of 5.4 and microscopic hematuria but is otherwise unremarkable. Which of the following is the most likely diagnosis?

A. Bladder cancer

Answer: B. Nephrolithiasis

A sudden onset of severe colicky flank pain associated with nausea and vomiting as well as the absence of rebound or direct testicular tenderness makes nephrolithiasis the most likely diagnosis. This is further supported by the presence of hematuria on the urinalysis.

A. While bladder cancer may have associated microscopic hematuria, it presents with painless hematuria or irritative voiding symptoms.

C. While an acute abdomen, such as acute appendicitis, is in the differential diagnosis, the absence of fever and peritoneal signs makes this diagnosis less likely

D. The absence of fever, as well as non-tenderness to palpation of the testes, suggests a renal rather than gonadal cause of the patient’s symptoms

4. What is the term for blue discoloration about the umbilicus?

A. Cullen’s sign

Answer: A. Cullen’s sign

Cullen’s sign is a blue discoloration about the umbilicus and can occur in hemorrhagic pancreatitis and results from hemoperitoneum.

B. Murphy’s sign is seen in liver and gallbladder disease by which the patient abruptly halts deep inspiration due to pain in the right upper quadrant while the examiner’s hand is keeping stable pressure to the area.

C. Rovsing’s sign is positive when the patient experiences right-sided abdominal pain with palpation to the left side. This is generally seen in those with appendicitis.

D. Turner sign is also seen in severe, acute pancreatitis but is represented by a green-brown discoloration of bilateral flanks

5. A 25-year-old female presents with right lower quadrant pain, right flank pain, nausea, and vomiting. Her temperature is 39.6 degrees C. There is right CVA tenderness and RLQ tenderness. The pelvic exam is unremarkable. Urinalysis reveals pH 7.0, trace protein, negative glucose, negative ketones, positive blood, and positive nitrates. Specific gravity is 1.022. Microscopy shows 102 RBCs/HPF, 50-75 WBCs/HPF, rare epithelial cells, and WBC casts. The most likely diagnosis is

A. acute salpingitis

Answer: C. acute pyelonephritis

Acute pyelonephritis presents with flank pain, fever, and generalized muscle tenderness. Urinalysis shows pyuria with leukocyte casts.

A. Acute salpingitis would be suggested if pelvic exam abnormalities were present.

B. Nephrolithiasis does not usually present with fever or casts. Urinalysis will have RBCs present.

D. This scenario is consistent with acute pyelonephritis, not acute appendicitis.

6. A 26-year-old gravida 0 sexually active female presents to the emergency room complaining of colicky pain in her lower abdomen for the past 12 hours. She passed out earlier in the day while trying to have a bowel movement. Her last menstrual period was 6 weeks ago. She has noted vaginal spotting over the last 24 hours. Vital signs show Temp 37 degrees C, BP 96/60mmHg, P 110, R 16, Oxygen Sat. 98%. Abdominal exam is positive for distension and tenderness. Bowel sounds are decreased. Pelvic exam shows cervical motion and adnexal tenderness. Which of the following is the most likely diagnosis?

A. Ectopic pregnancy 

Answer: A. Ectopic pregnancy 

High suspicion for ectopic pregnancy should be maintained when any possible pregnant woman presents with vaginal bleeding or abdominal pain.

B. Appendicitis presents with nausea, vomiting and periumbilical pain that moves to the right lower quadrant of the abdomen.

C. Crohn’s disease is more common in women and may present with an acute abdomen. However, the pelvic examination would be normal.

D. In pelvic inflammatory disease, the temperature is usually above 38 degrees C and pelvic pain usually follows onset of cessation of menses

7. A 12-year-old boy presents to the office with pain in his legs with activity gradually becoming worse over the past month. He is unable to ride a bicycle with his friends due to the pain in his legs. Examination of the heart reveals an ejection click and accentuation of the second heart sound. Femoral pulses are weak and delayed compared to the brachial pulses. Blood pressure obtained in both arms is elevated. Chest x-ray reveals rib notching. Which of the following is the most likely diagnosis?

A. abdominal aortic aneurysm

Answer: C. coarctation of the aorta

Coarctation is a discrete or long segment of narrowing adjacent to the left subclavian artery. As a result of the coarctation, systemic collaterals develop. X-ray findings occur from the dilated and pulsatile intercostal arteries and the “3” is due to the coarctation site with proximal and distal dilations.

A. Abdominal aortic aneurysm is usually asymptomatic until the patient has dissection or rupture. It is uncommon in a child.

B. Pheochromocytoma classically causes paroxysms of hypertension due to catecholamine release from the adrenal medulla but does not cause variations in blood pressure in the upper and lower extremities.

D. Thoracic outlet syndrome occurs when the brachial plexus, subclavian artery, or subclavian vein becomes compressed in the region of the thoracic outlet. It is the most common cause of acute arterial occlusion in the upper extremity of adults under 40 years old

8. A 28-year-old male presents with burns sustained from hot grease splashed on his left hand earlier this afternoon. The burn extends from his palm to the volar aspect of his wrist and has an erythematous base, covered by an intact blister. There are a few small scattered blisters over the dorsum of the left hand. Which of the following is the initial intervention of choice?

A. Tetanus prophylaxis 

Answer: A. Tetanus prophylaxis

Tetanus prophylaxis should be initially considered in all burn patients. 

B. Admission to a burn unit is not indicated for adult patients with uncomplicated partial thickness burns covering less than 15 to 20% of total body surface area (TBSA).

C. IV fluids are indicated for severe partial thickness burns covering more than 10% TBSA or in burns with complications.

D. Debridement of blisters is controversial, however blisters on the palms and soles should remain intact.

9. Which of the following is the selected method for the prevention of venous thromboembolism in a 38-year-old male undergoing an inguinal hernia repair?

A. early ambulation

Answer: A. early ambulation 

Early ambulation is recommended for prophylaxis of venous thromboembolism in low-risk, minor procedures when the patient is under 40 years of age and there are no clinical risk factors.

B. Elastic stockings are indicated for patients at moderate risk of venous thromboembolism in ages 40-60 with minor procedures with additional thrombosis risk factor, or major operations for patients under age 40 without additional clinical risk factors.

C. Intermittent pneumatic compression is indicated in patients undergoing a major operation plus an increased risk of bleeding.

D. Low molecular weight heparin is indicated in patients undergoing orthopedic surgery, neurosurgery, or trauma with an identifiable risk factor for thromboembolism.

10. A patient presents with abdominal pain in the right lower quadrant, examination reveals increased pain in the right lower quadrant on deep palpation of the left lower quadrant. This is commonly known as which of the following?

A. Psoas sign

Answer: C. Rovsing’s sign 

A positive Rovsing’s sign can be elicited in a patient with appendicitis when increased pain occurs in the right lower quadrant upon palpation of the left lower quadrant. 

A. Psoas sign is right lower quadrant pain with right leg extension seen in acute appendicitis

B. Murphy’s sign is seen in liver and gallbladder disease in which the patient abruptly halts deep inspiration due to discomfort as the examiner’s hand applies pressure to the right upper quadrant.

D. Obturator sign is right lower quadrant pain with internal rotation of the hip seen in acute appendicitis

Appendicitis: RLQ pain, + Obturator and Psoas sign

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.

FREE Download

Welcome to episode 51 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 Academy 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 42-year-old male with a history of constipation presents with complaints of severe pain with defecation described as feeling like he is “tearing apart.” He has also noted occasional small amounts of blood on toilet paper. External examination of the rectum is unremarkable and an internal rectal exam cannot be performed due to severe pain when attempted. Which of the following is the most likely diagnosis?

A. Proctitis

Anal fissures are covered as part of the NCCPA Content Blueprint GI and Nutrition which accounts for 10% of the exam

View this ReelDx patient video case of a 51-year-old with rectal bleeding and abdominal pain (proctitis)

Answer: B. Anal fissures

Anal fissures are easily diagnosed from history alone with the classic finding of severe pain upon defecation. Constipation is also a common cause of the trauma that leads to the development of a fissure.

A. Proctitis is usually caused by anorectal infections that produce symptoms of anorectal discomfort, tenesmus, constipation, and discharge from the rectum.

2. What type of chest pain is most commonly associated with a dissecting aortic aneurysm?

A. Squeezing

Dissecting aortic aneurysm is covered as part of the NCCPA Cardiology Content Blueprint and accounts for 16% of the exam

Answer: C. A dissecting aortic aneurysm often presents with a very severe ripping, tearing like pain.

A dissecting aortic aneurysm often presents with a very severe ripping, tearing like pain.

A. Squeezing pain is more characteristic of angina or esophageal pain.

3. A 15-year-old softball player presents after jamming the distal tip of her finger into severe flexion. She is unable to extend the distal phalanx and she has pain on palpation of the distal interphalangeal joint. X-ray of the hand fails to reveal any associated avulsion fracture. Which of the following is the treatment of choice?

A. Open reduction and internal fixation

Soft tissue injuries of the forearm, wrist, and hand are covered as part of the NCCPA Musculoskeletal Content Blueprint and accounts for 10% of the exam

Answer: B. Continuous extension of the DIP with splinting

The treatment of choice for a tear in the extensor tendon of the finger is continuous extension of the DIP via splinting for 6 to 8 weeks.

D. Short arm casting is indicated in wrist and metacarpal injuries but not in DIP extensor injuries.

4. A patient presents with loss of pigmentation on the back of hands, face, and body folds due to the absence of epidermal melanocytes. There has been improvement with PUVA treatment. Which of the following is the most likely diagnosis?

A. Pityriasis alba

View this ReelDx patient video case of a 7-year-old female with localized, depigmented skin patches; rash

Answer: C. Vitiligo

 Vitiligo is the acquired loss of pigmentation due to the absence of epidermal melanocytes presenting on the back of hands, face, or body folds.

A. Pityriasis alba is caused by dermal inflammation that becomes scaly and hypopigmented.

5. Which of the following medications used in the management of anxiety has a delayed onset of action?

A. Buspirone (BuSpar)

Anxiety disorders are covered as part of the NCCPA Content Psychiatry Blueprint which accounts for 6% of your exam

Answer: A. buspirone (BuSpar)

Buspirone takes several days to weeks for it to have clinical activity.

B. Diphenhydramine works as a histamine blocker and will cause sedation immediately because of its anticholinergic effects.

6. A 57-year-old male was working on his farm when some manure was slung hitting his left eye. He presents several days after with a red, tearing, painful eye. Fluorescein stain reveals uptake over the cornea looking like a shallow crater. Which of the following interventions would be harmful?

A. Ophthalmic antibiotics

Corneal abrasion is covered as part of the NCCPA EENT Content Blueprint and accounts for 9% of the exam

Answer: B. Pressure patch

Patching of the eye after a corneal abrasion associated with organic material contamination is contraindicated due to increased risk of fungal infection.

A. Ophthalmic antibiotics and copious irrigation are indicated when treating a patient with a suspected corneal ulcer due to an infectious cause.

7. A 75-year-old female falls on her outstretched arm. She sustains a humeral mid-shaft fracture. Nerve impingement occurs due to the fracture. What is the most likely physical examination abnormality that will be encountered?

A. Inability to extend the wrist against resistance

Fractures and dislocations of the forearm, wrist, and hand are covered as part of the NCCPA Musculoskeletal Content Blueprint and accounts for 10% of the exam

Answer: D. Inability to extend the wrist against resistance

The radial nerve is most likely entrapped by this fracture. Radial nerve damage will cause an inability to extend the wrist against resistance.

B. Axillary nerve injury results in numbness over the deltoid muscle; this nerve is more commonly injured in proximal humeral fractures and anterior shoulder dislocations.

8. A 16-year-old male involved in a fight sustained a laceration to his right upper eyelid. He is unable to open his eye, and a possible laceration of the globe is suspected. Which of the following is the next step?

A. Use a slit lamp to determine the extent of the injury.

Disorders of they eye are covered as part of the NCCPA EENT Content Blueprint and accounts for 9% of the exam

66-year-old female with acute onset of periorbital deformity. SmartyPANCE ReelDx + members can view this real-world case!

Answer: C. Apply a metal eye shield and refer to an ophthalmologist.

Protect the eye from any pressure with a rigid metal eye shield and refer for immediate ophthalmologic consultation. Avoid unnecessary actions that would delay treatment or cause further injury.

9. Which of the following typical findings would be revealed during a sigmoidoscopy on a patient with Crohn’s disease of the intestine?

A. Rectal pseudopolyps

Inflammatory bowel disease is covered as part of the NCCPA Content Blueprint GI and Nutrition which accounts for 10% of the exam

Answer: D. Intermittent longitudinal mucosal ulcers and fissures

Ulcerations tend to be linear with transverse fissures in Crohn’s disease. These skip lesions are common with Crohn’s disease.

A. Rectal pseudopolyps are associated with ulcerative colitis rather than Crohn’s.

10. A 72-year-old patient with a history of hypertension and atrial fibrillation presents with episodes of weakness, numbness, and paresthesia’s in the right arm. At the same time, she notes speech difficulty and loss of vision in her left eye. These symptoms come on abruptly and clear within minutes. Physical examination is normal except for the previously known arrhythmia. Which of the following is the most likely diagnosis?

A. Focal seizure

Atrial fibrillation is covered as part of the NCCPA Cardiology Content Blueprint which is 16% of your exam

SmartyPANCE + ReelDx members can view this ReelDx patient case video of an 83-year-old with fast heart rate, palpitations

Answer: D. Transient ischemic attack

This patient’s symptoms are consistent with transient ischemia in the carotid territory. Atrial fibrillation is a risk factor for cerebral emboli.

A. Focal seizures usually cause abnormal motor movement rather than weakness or loss of feeling.

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.

FREE Download

Welcome to episode 49 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 Academy course content following the NCCPA™ content blueprint (download the FREE cheat sheet).

This week we will be covering 10 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.

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 PANCE and PANRE board review website. If you are a member and login you will be able to view this content.

1. Which of the following clinical findings would be seen in a patient with food poisoning caused by Staphylococcus aureus?

A. Ingestion of mayonnaise-based salads 48 hours earlier

Staphylococcus aureus food poisoning is part of the NCCPA Content Blueprint GI and Nutrition which accounts for 10% of the exam

Answer: C. Abdominal cramps and vomiting for 48 hours

Abdominal cramps, nausea, vomiting, and watery diarrhea typically last 1-2 days with staphylococcal food poisoning.

A. A preformed toxin causes staphylococcal food poisoning; it has a short incubation period of 1-8 hours.

2. Which of the following diagnostic tests should be ordered initially to evaluate for suspected deep venous thrombosis

A. Venogram

Venous thrombosis is part of the NCCPA Cardiology Content Blueprint and represents 16% of the exam

Answer: C. Duplex ultrasound

Ultrasound is the technique of choice to detect deep venous thrombosis in the leg.

A. Venogram has been replaced by noninvasive tests due to discomfort, cost, technical difficulties, and complications, such as phlebitis.

3. A patient presents with signs and symptoms of Cushing’s syndrome. Extensive diagnostic evaluation reveals an ACTH-secreting pituitary adenoma. First-line therapy should consist of

A. pituitary radiation

Cushings disease is part of the NCCPA Content Blueprint Endocrinology which represents 6% of your exam

Answer: C. transsphenoidal resection of the tumor

Transsphenoidal resection of the tumor cures about 80% of patients. The remainder can be given a combination of pituitary radiation and medical adrenalectomy with one or more drugs. If these procedures fail, the last option is bilateral adrenalectomy.

4. A 26-year-old man is stung by a bee, and shortly thereafter, a wheal develops at the site of the sting. He soon feels flushed and develops hives, rhinorrhea, and tightness in the chest. He is seen in the urgent care center. Immediate therapy should be to

A. transfer him to a local hospital emergency department

Answer: C. administer subcutaneous epinephrine

Epinephrine hydrochloride 1:1000, 0.2 to 0.5 mL subcutaneously is indicated for the initial treatment of this systemic reaction. Additional injections may be given every 20 to 30 minutes if needed.

A. Systemic (anaphylactic) reactions can rapidly become life-threatening. Delay in treatment may cause death.

5. An 18-year-old sexually active female was seen in the student health clinic 1 week ago for a sore throat. A streptococcal antigen test was positive, and she was given a prescription for oral penicillin. After 3 days, she stopped her medication because she felt better. She now presents with a severe sore throat. On physical examination, she has a temperature of 102.6° F (39.2° C), marked pharyngeal erythema, medial deviation of the soft palate on the left, tender left anterior cervical adenopathy, and a “hot potato” voice. The rest of her history and physical examination are unremarkable. Which of the following is the most likely diagnosis?

A. Recurrent streptococcal pharyngitis

Peritonsillar abscess is covered as part of the NCCPA Content Blueprint EENT which accounts for 6% of your exam

View this ReelDx patient video case ~4d pain back of throat; swelling; difficulty swallowing

SmartyPANCE ReelDx + members can view this real-world case!

Answer: D. Peritonsillar abscess

The soft palate deviation and a muffled voice are classic signs of peritonsillar abscess.

A. This presentation suggests a complication of an incompletely treated streptococcal pharyngitis rather than recurrent disease

6. Which of the following would provide the most specific information regarding the functional cardiac status in a patient with chronic heart failure?

A. Electrocardiogram

Heart Failure is covered as part of the NCCPA Content Blueprint Cardiology and accounts for 16% of the exam

View this SMARTYPANCE ReelDx patient video case: 45-year-old female with difficulty breathing; edema; 8/10 chest pain and whole-body pain

SmartyPANCE ReelDx + members can view this real-world case!

Answer: D. Echocardiogram

An echocardiogram will estimate ejection fraction, which is an indicator of left ventricular function.

A. Electrocardiogram offers no specific information of functional status but may provide clues about the cause.

7.  A 33-year-old female presents for follow-up of her Pap smear that showed a low-grade squamous intraepithelial lesion. Reflex HPV testing is positive. Which of the following is the most appropriate diagnostic procedure?

A. Cone biopsy

Cervical dysplasia and cervical cancer are covered as part of the NCCPA Content Blueprint Reproductive system and accounts for 8% of your exam

Answer: D. Colposcopy-directed biopsy

A colposcopy-directed biopsy is the first diagnostic evaluation indicated for cervical dysplasia.

A. A cervical cone biopsy may be indicated in further evaluation of this patient, but it is dependent on the results of the colposcopy.

8. A decrease in the fetal heart rate (FHR) occurring late during contractions is noted. The FHR returns to the baseline slowly after the uterine contraction. The physician assistant should be alerted to the possibility of

A. pelvic dystocia

Fetal distress is covered as part of the NCCPA Content Blueprint Reproductive system and accounts for 8% of your exam

SmartyPANCE ReelDx + members can view this real-world case!

Answer: D. placental insufficiency

Placental insufficiency is the probable cause of fetal distress resulting in late decelerations.

A. Pelvic dystocia, particularly that due to small bony architecture, is the most common cause of passage abnormalities and is not directly associated with FHR decelerations.

9. A 36-year-old patient with cardiomyopathy secondary to viral myocarditis develops fatigue, increasing dyspnea, and lower extremity edema over the past 3 days. He denies fever. A chest x-ray shows no significant increase in heart size but reveals prominence of the superior pulmonary vessels. Based on these clinical findings, which of the following is the most likely diagnosis?

A. Heart failure

Heart Failure is covered as part of the NCCPA Content Blueprint Cardiology and accounts for 16% of the exam

Answer: A. Heart failure

Given the presence of cardiomyopathy, the patient’s heart has decreased functional reserve. The symptoms and chest x-ray findings are typical of congestive heart failure.

B. Endocarditis occurs as a result of an infection that primarily occurs in the blood stream. Endocarditis would present with signs of infection or seeding rather than signs of heart failure.

10. Which of the following is the first-line treatment for symptomatic bradyarrhythmias due to sick sinus syndrome (SSS)?

A. Permanent pacemaker

Sick sinus syndrome is covered as part of the NCCPA Cardiology Content Blueprint which is 16% of your exam

Answer: A. Permanent pacemaker

Permanent pacemakers are the therapy of choice in patients with symptomatic bradyarrhythmias in sick sinus syndrome.

B. Radiofrequency ablation is used for the treatment of accessory pathways in the heart.

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.

FREE Download

Welcome to episode 47 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover 10 PANCE and PANRE board review questions from the Academy course content following the NCCPA™ content blueprint (download the FREE cheat sheet).

This week we will be covering 10 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 genitourinary board review includes over 72 GU specific questions and is available to all members of the PANCE and PANRE Academy and SmartyPANCE

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 PANCE and PANRE board review website. If you are a member and login you will be able to view this content.

1. To relieve dependent edema in a pregnant patient, which of the following should be instituted as treatment?

Uncomplicated pregnancy is part of the NCCPA Content Blueprint Reproductive System which is 8% of the exam

Answer: B. Elevate the legs.

Dependent edema is a common and rarely serious complication of pregnancy due to impedance of venous return. Leg elevation improves circulation

A. Limitation of fluid is not indicated and may be harmful.

2. To further assess ascites in a patient, the physician assistant instructs the patient to turn onto one side while performing percussion. Which of the following is the reason for this maneuver?

Ascites is a common complication of liver disease. Disorders of the liver is part of the NCCPA GI and Nutrition Content Blueprint and represents 10% of the exam

Answer:  A. Testing for shifting of dullness on percussion.

In ascites, dullness shifts to the more dependent side as the fluid relocates into dependent space, while tympany shifts to the top as the gas-filled organs float to the top of the ascitic fluid

C. Pain with movement is associated with peritonitis and not ascites.

3.  A 7-year-old child with a history of type 1 diabetes mellitus for 3 years presents for routine follow-up. The mother states that the child has been having nightmares and night sweats. Additionally, his average morning glucose readings have risen from an average of 100 mg/dL to 145 mg/dL over the past week. This child is most likely experiencing

Diabetes mellitus type 1 is part of the NCCPA Content Blueprint Endocrinology which represents 6% of your exam

Answer: C. the Somogyi effect.

This refers to nocturnal hypoglycemia, which stimulates counterregulatory hormone release resulting in rebound hyperglycemia

A. Nightmares and night sweats are not associated with growth spurts.

4. A patient complains of loss of sensation at the level of the umbilicus. Which of the following dermatomes is affected?

Radicular pain is a common symptom of a herniated nucleus pulposus covered as part of the NCCPA Content Blueprint Musculoskeletal System which is 10% of your exam

Answer: C. T10.

The dermatome T10 is at the level of the umbilicus.

5. A 25-year-old female graduate student presents to the student health center for the eighth time in three weeks to be sure she does not have meningitis. She read that there was a student on campus who had meningitis last month, and now she has headaches and is requesting to be tested to make sure she does not have meningitis. She has been evaluated at each visit, and physical examination has been completely normal each time. Which of the following is the most likely diagnosis?

Somatoform disorders are covered as part of the NCCPA Content Blueprint Psychiatry which is 6% of your exam

Answer: B. Hypochondriasis.

Hypochondriasis is the chronic preoccupation with the idea of having a serious disease, which is usually not amenable to reassurance

A. Conversion disorder is characterized by onset of symptoms or deficits mimicking neurologic or medical illness, but the etiology is psychological.

6. What is the mechanism for the relapsing fevers associated with malaria?

Malaria is covered as part of the NCCPA Content Blueprint Infectious Disease and is 3% of the exam

Answer: A. Release of malarial merozoites into the bloodstream.

Fever, chills, and sweats coincide with the release of merozoites from red blood cells that have been infected with Plasmodium species. Each merozoite may infect a new red blood cell, leading to a cycle of invasion growth, and release.

7. A 29-year-old patient with idiopathic thrombocytopenia purpura (ITP) is treated with prednisone therapy. Despite therapy, platelet counts remain consistently below 20,000/microliter over the course of 6 weeks. Which of the following is the most appropriate intervention for this patient?

Idiopathic thrombocytopenic purpura is covered as part of the NCCPA Content Blueprint Hematology and is 3% of your exam

Answer: D. Splenectomy

Persistently low platelet counts (< 20,000) require effective long-term treatment, and splenectomy is the treatment of choice.

A. Aspirin inhibits platelet function and could lead to significant bleeding and death of this patient.

8. A 27 year-old female presents to your office for evaluation of weakness, visual loss, and sensory loss over the right great toe. These symptoms have occurred during three episodes approximately three months apart with each episode lasting about three days. Which of the following tests would be most useful in further evaluating this patient?

This condition is covered as part of the NCCPA Content Blueprint Neurology which is 6% of your exam

SmartyPANCE ReelDx + members can view this real-world case!

Answer: A. MRI of the brain.

Multiple sclerosis typically presents with relapsing weakness of the limbs, sensory loss, paresthesias, and visual changes. Diagnosis is based on history and either abnormal brain or spinal cord MRI, or visual, auditory, or somatosensory evoked electrical response.

C. Glucose tolerance test is used in the evaluation of diabetes mellitus.

9. A patient taking bleomycin (Blenoxane) should be monitored for which of the following side effects?

This condition is is covered as part of the NCCPA Pulmonary Content Blueprint which represents 12% of your exam

Answer: D. Pulmonary fibrosis.

Pulmonary fibrosis and pulmonary infiltrates are known side effects of bleomycin

A. Optic neuritis is a potential side effect of ethambutol, used in the treatment of tuberculosis.

10. A patient presents for a follow-up visit for chronic hypertension. Which of the following findings may be noted on the fundoscopic examination of this patient?

This condition is a common complications of chronic hypertension covered as part of the NCCPA Cardiology Content Blueprint which is 16% of your exam

Answer: D. arteriovenous nicking

Arteriovenous nicking is common in chronic hypertension

A. Cherry-red fovea and boxcar segmentation of the retinal veins are findings seen in central retinal artery occlusion.

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 + SmaryPANCE

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.

FREE Download

Welcome to episode 45 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Today we are going to take a brief detour away from 10 daily questions and instead cover the murmurs you need to know for your PANCE and PANRE exam.

I have still included an 11 question exam at the end of this post so make sure you scroll down after you listen to the podcast.

There are a total of 17 cardiac conditions that may present on exam day in the form of a descriptive sound/murmur.

You will often be given supporting evidence such as the location of auscultation or radiation which you can use to narrow down your options.

There are total of 51 cardiac topics in the  NCCPA™ Cardiology PANCE and PANRE Content Blueprint which represents 16% of the PANCE and PANRE exam.

(click here to download the FREE NCCPA Content Blueprint cheat sheet)

These cardiac conditions and their associated murmurs cover a whopping 33% of the cardiology section of the PANCE and PANRE exam!

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

Each of the links below opens the corresponding lesson on SmartyPANCE and is available to members (you must be logged in or join now)

There are 9 valvular disorders associated with murmurs:

Valvular Disorders (PEARLS and Flashcards)

Five congenital heart diseases that have corresponding murmurs

Congenital Heart Diseases (PEARLS)

One murmur associated with cardiomyopathy

And a pair of conditions nested under the label of “other forms of heart disease” that have associated murmurs/heart sounds worth mentioning

Other Forms of Heart Disease (PEARLS)

Let’s start with the valvular disorders:

You have 4 heart valves with two main conditions – half are diastolic murmurs and half are systolic murmurs. Here is a helpful mnemonic:

Recalling Common Systolic Heart Murmurs: MR PASS

MR PASS wins the Most Valuable Player award.

MR PASS often hangs around with MS ARD.

Remember which are systolic and diastolic this can be very helpful at ruling out or ruling in a condition come exam day.

With these valvular murmurs you have 4 auscultation points which can be easily remembered using the mnemonic APT Ment watch this amazing video so you never forget!

Another helpful mnemonic: Aortic Pulmonic Tricuspid Mitral – A ll P hysicians T ake M oney!

You can use the auscultation point to successfully narrow down your murmur and use the designation of systolic or diastolic to narrow down even further.

Congenital Heart Diseases (PEARLS)

Several of these conditions have a “tell” that make it easy to identify the condition and they are usually always part of the root of the question.

And a pair of conditions nested under the label of “other forms of heart disease” that have associated murmurs/heart sounds worth mentioning

Other Forms of Heart Disease (PEARLS)

You can listen to all these murmurs and see their associated waveforms at www.smartypance.com/courses/cardiology

Here is a wonderful video from the Khan Academy of how to approach murmurs video of murmurs

You will see from these questions on the PANCE and PANRE things aren’t always so straightforward.

You can take the exam here: thepalife.com/murmur-madness

This FREE podcast 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 and now includes complimentary access to SmartyPANCE so sign up now.

Included is a full cardiology content blueprint board review exam with over 147 cardiology specific questions and 51 cardiology blueprint topics covered in detail. This is in addition to 1,000’s of additional board review questions and NCCPA content blueprint courses covering all 13 organ areas.

I am also happy to introduce ReelDX™ patient case based integration into many of the SmartyPANCE blueprint lessons. It’s like a virtual rotation from the comfort of your couch!

Welcome to episode 43 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover 10 PANCE and PANRE board review questions from the Academy course content following the NCCPA™ content blueprint (download the FREE cheat sheet).

This week we will continue to take a break from topic specific board review and covering 10 general board review questions.

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 genitourinary board review includes over 72 GU specific questions and is available to all members of the PANCE and PANRE Academy.

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

1. A mother brings in her five-year-old boy for his school physical. She voices some concerns about his readiness for school, saying he seems to be socially immature. She has noticed he does not interact with other children well, and that when he plays with them, he has a tendency to “place them” and then run around them as if they were statues. He rarely cries when he is hurt, and he shrugs off any attempt to hug him. He has good attention to details, and will sit and draw the same geometric shapes over and over again, but does not seem interested in learning the alphabet. He avoids eye contact with anyone. Which of the following is the most likely diagnosis?

Answer: C. Autism

Children with autism do not tend to make eye contact, and even avoid it. They do not accept comfort when hurt and stiffen up when hugged. They do not tend to play with others, and do not tend to imitate grown-ups in play.

2. A 3-week-old male infant presents with recurrent regurgitation after feeding that has progressed to projectile vomiting in the last few days. The mother states that the child appears hungry all of the time. She denies any diarrhea in the child. Which of the following clinical findings is most likely?

Answer: C. Olive-sized mass in the right upper abdomen

An olive-sized mass may be palpated in the right upper abdomen in pyloric stenosis and if found, is pathognomonic for pyloric stenosis.

3. A 65 year-old with COPD receiving their first pneumococcal polysaccharide PPSV23 vaccination should be revaccinated in

Answer: D. Never

People who are first vaccinated with PPSV23 at age 65 years or older should receive only 1 dose, regardless of their underlying medical condition.

ACIP recommendations for revaccination remain unchanged from the 1997 recommendations. For most persons for whom PPSV23 is indicated, ACIP does not recommend routine revaccination. A second dose of PPSV23 is recommended 5 years after the first dose for persons aged 19–64 years with functional or anatomic asplenia and for persons with immunocompromising conditions . ACIP does not recommend multiple revaccinations because of insufficient data regarding clinical benefit, particularly the degree and duration of protection, and safety.

All adults age 65 years and older should also receive one dose of PCV13.

Click here to review the CDC guidelines

4. Which of the following therapies is recommended for a 13 month-old child with sickle cell disease?

Answer: A. Folic acid and penicillin V

Patients with sickle cell disease should receive prophylactic penicillin V starting at 2 months of age and folic acid starting at 1 year of age. Ferrous sulfate is not globally recommended for patients with sickle cell disease.

5. A patient with severe COPD presents to the Emergency Department with a 3 day history of increasing shortness of breath with exertion and cough productive of purulent sputum. An arterial blood gas reveals a pH of 7.25, PaCO2 of 70 mmHg and PaO2 of 50 mmHg. He is started on albuterol nebulizer, nasal oxygen at 2 liters per minute, and an IV is started. After one hour of treatment, his arterial blood gas now reveals a pH of 7.15, PaCO2 100 mmHg and PaO2 of 70 mmHg. Which of the following is the most appropriate next step in his treatment?

A. Decrease the oxygen flow rate.

This person has increasing respiratory failure as indicated by the raising PaCO2 levels. Intubation is required at this time.

6. A patient should be tested for tuberculosis prior to being treated with

A. etanercept (Enbrel).

Answer: A. etanercept (Enbrel)

Etanercept is an anti-cytokine agent used in the treatment of rheumatoid arthritis and has as a side effect the potential for serious infections. One of these side effects includes reactivation of dormant tuberculosis.

B. Cyclosporine, methotrexate, and prednisone do not have the requirement to check for tuberculosis prior to initiating treatment.

7. Which of the following side effects is associated with long-term administration of phenytoin (Dilantin)?

A. Ataxia

Answer: C. Osteomalacia

Osteomalacia, or demineralization of bone, is a side effect of phenytoin that may occur after chronic administration.

8. Hairy leukoplakia has the greatest prevalence of distribution on the

A. palate.

Answer: C. lateral tongue.

The lateral border of the tongue is where hairy leukoplakia is commonly seen.

9. 75 year-old male presents for a routine physical. Vitals are normal with no orthostatic changes. On physical examination, a fine cortical movement with repetitive rubbing of the tip of the thumb along the tips of the fingers is noted at rest. Which of the following is the most likely diagnosis?

A. Seizure disorder

Parkinson’s disease presents with tremor at rest (pill-rolling), bradykinesia, rigidity, and postural instability.

10. A 45 year-old female presents to the emergency department with generalized, hot, erythema of the skin. Physical exam reveals an oral temperature of 102 degrees Fahrenheit, purulent conjunctivitis, and mucosal erosions. Her skin is painful and separates from the dermis with touch. Which of the following is the most likely cause for this condition?

A. Penicillin

Answer: A. Penicillin

Medications are most frequently implicated in toxic epidermal necrolysis. These usually include, analgesics (NSAIDs), antibiotics – sulfonamides (sulfamethoxazole, sulfadiazine, sulfapyridine,

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.

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Welcome to episode 41 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover 10 PANCE and PANRE board review questions from the Academy course content following the NCCPA™ content blueprint.

This week we will be taking a break from topic specific board review and covering 10 general board review questions.

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 genitourinary board review includes over 72 GU specific questions and is available to all members of the PANCE and PANRE Academy.

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

1. A mother brings her 6-year-old boy for evaluation of school behavior problems. She says the teacher told her that the boy does not pay attention in class, that he gets up and runs around the room when the rest of the children are listening to a story, and that he seems to be easily distracted by events outside or in the hall. He refuses to remain in his seat during class, and occasionally sits under his desk or crawls around under a table. The teacher told the mother this behavior is interfering with the child’s ability to function in the classroom and to learn. The mother states that she has noticed some of these behaviors at home, including his inability to watch his favorite cartoon program all the way through. Which of the following is the most likely diagnosis?

Answer: D. Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder is characterized by inattention, including increased distractibility and difficulty sustaining attention; poor impulse control and decreased self-inhibitory capacity; and motor over activity and motor restlessness, which are pervasive and interfere with the individual’s ability to function under normal circumstances.

2. Which of the following is the treatment of choice for a torus (buckle) fracture involving the distal radius?

A. Open reduction and internal fixation

Answer: B. Ace wrap or anterior splinting

A torus or buckle fracture occurs after a minor fall on the hand. These fractures are very stable and are not as painful as unstable fractures. They heal uneventfully in 3-4 weeks.

3. Which of the following can be used to treat chronic bacterial prostatitis?

A. Penicillin

Chronic bacterial prostatitis (Type II prostatitis) can be difficult to treat and requires the use of fluoroquinolones or trimethoprim-sulfamethoxazole, both of which penetrate the prostate.

4. A 25 year-old male with history of syncope presents for evaluation. The patient admits to intermittent episodes of rapid heart beating that resolve spontaneously. 12 Lead EKG shows delta waves and a short PR interval. Which of the following is the treatment of choice in this patient?

A. Radiofrequency catheter ablation

Answer: A. Radiofrequency catheter ablation

Radiofrequency catheter ablation is the treatment of choice on patients with accessory pathways, such as Wolff-Parkinson-White Syndrome.

5. Which of the following pathophysiological processes is associated with chronic bronchitis?

A. Destruction of the lung parenchyma

Chronic bronchitis results from the enlargement of mucous glands and goblet cell hypertrophy in the large airways.

6. Which of the following dietary substances interact with monoamine oxidase-inhibitor antidepressant drugs?

A. Lysine

Answer: C. Tyramine

Monoamine oxidase inhibitors are associated with serious food/drug and drug/drug interactions. Patient must restrict intake of foods having a high tyramine content to avoid serious reactions. Tyramine is a precursor to norepinephrine.

Lysine, glycine, and phenylalanine are not known to interact with MAO inhibitors.

7. Gallstones usually result in biliary symptoms by causing inflammation or obstruction following migration into the common bile duct or

A. cystic duct

Answer: A. cystic duct

Obstruction of the cystic duct by gallstones causes the typical symptom of biliary colic. Once obstructed the gallbladder distends and becomes edematous and inflamed. Gallstones can also migrate into the common bile duct through the cystic duct leading to a condition known as choledocholithiasis.

8. An elderly patient with poorly-controlled Type 2 diabetes and renal disease develops a fever of 102°F orally, productive cough, and dyspnea. Physical examination demonstrates a respiratory rate of 32/min, labored breathing, and rales at the left base. Pulse oximetry is 90%. Which of the following is the next appropriate step in the management of this patient?

A. Administer nebulized corticosteroids

Answer: B. Admit to the hospital

Community acquired pneumonia is the most deadly infectious disease in the U.S. Important risk factors for increased morbidity and mortality include advanced age, alcoholism, comorbid medical conditions, altered mental status, respiratory rate greater than 30 breaths/min, hypotension, and a BUN greater than 30.

9. A 53 year-old female who is well known to the practice presents to the office complaining of increasing fatigue, constipation, and a weight gain of 10 lb (4.5 kg) over the past year. She also states others have noticed a recent hoarseness to her voice, and she is bothered by “charley horses” in her legs that wake her up at night. Her past medical history is unremarkable except for a history of hyperthyroidism treated by radioactive iodine 5 years ago. She is currently taking no medications and has no known drug allergies. Which of the following is the most likely cause of the patient’s symptoms?

A. Hypothyroidism

The current symptoms, along with the past treatment of hyperthyroidism with radioactive iodine, would indicate hypothyroidism.

10. Which of the following is most frequently associated with bladder cancer?

A. Hematuria

Significant persistent hematuria >3 RBC/HPF on three urinalyses, a single urinalysis with >100 RBC, or gross hematuria, identifies significant renal or urologic lesions. Bladder cancer usually presents with painless hematuria.

Dysuria, urgency, and frequency are associated with irritative voiding symptoms associated with cystitis.

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Resources From The Show

Welcome to episode 39 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I continue to cover topic specific PANCE and PANRE review from the Academy course content following the NCCPA™ content blueprint.

Click here to download my interactive content blueprint checklist

This week we will be covering 10 topic specific OBGYN/reproductive board review questions.

The reproductive system accounts for 8% of your PANCE/PANRE board exam.  

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 reproductive review includes over 107 reproductive system content blueprint specific questions and is available to all members of the PANCE and PANRE Academy or my new site SMARTY PANCE!!

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

You can take the interactive quiz by clicking here

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.

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Show Notes: