The Audio PANCE and PANRE Physician Assistant Board Review Podcast

Welcome to episode 21 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

The Audio PANCE and PANRE is an audio board review series that includes 10 Multiple Choice PANCE and PANRE Board Review Questions in each episode.

I hope you enjoy this free audio component to the examination portion of this site. The full series is available to all members of the PANCE and PANRE Academy.

Download the FREE PDF transcript for FREE here or on  Scribd.

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The Audio PANCE and PANRE Episode 21

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

A. Rheumatoid arthritis

Answer: B. Cyanosis

Cyanosis is very common in tetralogy of Fallot.

2. When the diagnosis of gonococcal urethritis is confirmed, which of the following is the treatment of choice?

A. Ceftriaxone (Rocephin)

Answer: C. Ceftriaxone 250 mg IM in a single dose PLUS Azithromycin 1g orally in a single dose.

Because of resistance, the CDC now recommends dual therapy with Ceftriaxone 250 mg IM in a single dose PLUS Azithromycin 1g orally in a single dose Alertnative regimens if ceftriaxone is not available include Cefixime 400 mg orally in a single dose PLUS Azithromycin 1 g orally in a single dose

3. Erythema nodosum is characterized by

A. subcutaneous red tender nodules.

Answer: A, subcutaneous red tender nodules.

Erythema nodosum produces erythematous red tender nodules, especially on the shins.

4. Use of systemic corticosteroids can cause which of the following adverse effects in the eye?

A. Cortical blindness

Answer: C. Glaucoma

Glaucoma can be caused by the long-term use of steroids.

5. It is determined that a woman has a nonexistent rubella titer level during her first trimester of pregnancy. When should she receive the rubella vaccine?

A. During the first trimester of pregnancy

Answer: D. After delivery of the infant

The patient should not receive the rubella vaccine during the course of her pregnancy as the possibility of transmission of the rubella virus does exist. During the time that the patient is without protective titer she should avoid anyone with active rubella infection. The proper time to receive the vaccine is after delivery of the infant.

6. A patient with which of the following is at highest risk for coronary artery disease?

A. Congenital heart disease

Answer: D. Diabetes mellitus

Patients with diabetes mellitus are in the same risk category for coronary artery disease as those patients with established atherosclerotic disease.

7. A 44-year-old female presents with ongoing arthralgias and myalgias with intermittent flares of arthritis. She is found to have a malar rash that worsens with sun exposure. She is known to have progressive renal damage and has recurrent infections that are slow to respond to therapy. She takes ibuprofen (Motrin) as needed for her joint pain and takes no other medication. Which of the following tests would be the initial test recommended to screen for this diagnosis?

A. Rheumatoid factor

Answer: A. Glipizide

Sulfonylureas increase insulin levels and predispose patients to hypoglycemia.

8. Upon stroking of the lateral aspect of the sole from the heel to the ball of the foot, the great toe dorsiflexes and the other toes fan. This is a positive

A. Kernig’s sign.

Answer: C. A Babinski test is performed by stroking the lateral aspect of the sole from the heel to the ball of the foot, the great toe dorsiflexes and the other toes fan in a positive test.

For your knowledge:

Kernig’s sign is positive when pain is noted on straightening the knee after flexing both the hip and knee.

Brudzinski’s sign occurs with neck flexion resulting in resultant flexion of the hips. It is a sign of meningeal irritation.

A positive Gower’s sign is noted in certain types of muscular dystrophy and is described as children rising to stand by rolling over prone and pushing off the floor with arms while the legs remain extended.

9. Which of the following strategies promotes improved carbohydrate metabolism and is recommended for all Type 2 diabetic patients?

A. Low-carbohydrate, high-protein diet

Answer: B. Routine aerobic exercise

Routine exercise improves carbohydrate metabolism and insulin sensitivity.

10. Acute rebound hypertensive episodes have been reported to occur with the sudden withdrawal of

A. verapamil (Calan).

Answer: C, Clonodine

Clonidine (Catapres) is a central alpha agonist and abrupt withdrawal may produce a rebound hypertensive crisis.

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Cheers,

Stephen Pasquini PA-C

Welcome to episode 19 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

The Audio PANCE and PANRE is an audio board review series that includes 10 Multiple Choice PANCE and PANRE Board Review Questions in each episode.

I hope you enjoy this free audio component to the examination portion of this site. The full series is available to all members of the PANCE and PANRE Academy.

Use one of the social links below to unlock and download the FREE PDF Transcript of this podcast:

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The Audio PANCE and PANRE Episode 17

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

A. Chest pain

Answer: B. Cyanosis

Cyanosis is very common in tetralogy of Fallot.

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

A. Rheumatoid arthritis of the knee

Answer: B. Osteoarthritis of the knee

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

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

A. Rheumatoid arthritis

Answer:  B. Septic arthritis

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

4. A 25 year-old presents with pain in the proximal ulna after falling directly on the forearm. X-ray shows fracture of the proximal 1/3rd of the ulna. There is an associated anterior radial head dislocation. What is the proper name for this condition?

A. Galeazzi fracture

Answer: B. Monteggia fracture

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

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

A. an indirect inguinal hernia.

Answer: A. an indirect inguinal hernia.

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

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

A. Glaucoma

Answer: C. Vitreous hemorrhage

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

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

A. Glipizide (Glucotrol)

Answer: A. Glipizide

Sulfonylureas increase insulin levels and predispose patients to hypoglycemia.

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

A. Pes anserine bursitis

Answer: A. Pes anserine bursitis

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

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

A. Hypertrophic cardiomyopathy

Answer: A. Hypertrophic cardiomyopathy

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

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

A. Lymphoma

Answer: B. Toxic megagolon.

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

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 be releasing new episodes every two weeks. The Academy is currently discounted, so sign up now.

Welcome to episode 17 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

The Audio PANCE and PANRE is an audio board review series that includes 10 Multiple Choice PANCE and PANRE Board Review Questions in each episode.

I hope you enjoy this free audio component to the examination portion of this site. The full series is available to all members of the PANCE and PANRE Academy.

The Audio PANCE and PANRE Episode 17

1. A 64 year-old male presents complaining of new onset of fatigue, weight gain, constipation, erectile dysfunction, and loss of body hair. Laboratory investigation demonstrates: TSH less than 0.5 microunits/mL (normal range 0.5-5.0 microU/mL); Thyroxine (T4) 2 mcg/dL (normal range 5-12 mcg/dL); Prolactin 10 nanograms/ml (normal 2 – 18 ng/mL.) What is the most likely diagnosis?

A. Primary hypothyroidism

2. A 15 year-old male was seen last week with complaints of 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.

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

A. Extreme vulvar irritation

4. 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

5. An 18 year-old woman presents to the clinic complaining of fatigue. She reports a past history of lifelong frequent nosebleeds and bleeding gums. She also has menorrhagia. Her mother and maternal grandfather have a similar bleeding history. Initial lab results are as follows: WBC 9,500/mm3, Hgb 10.9 g/dL, HCT 33%, MCV 69 fL, MCHC 26 pg and platelets 284,000/mm3. Which of the following tests should be ordered to evaluate this patient’s diagnosis?

A. Hemoglobin electrophoresis

6. A 35 year-old patient has recurrent seasonal rhinitis and a history of mild asthma. Which of the following should be included for first-line management?

A. Immunotherapy

7. A 35-year-old female presents with multiple ulcerative lesions on her labia and perineum. A Tzanck preparation of one of the lesions reveals multinucleated giant cells. Which of the following is the most likely diagnosis?

A. Herpes Simplex Virus (HSV)

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

9. A 53 year-old female has a diagnosis of migraine headaches. She had been using sumatriptan (Imitrex) to abort her headaches, but she is now having one or two headaches per week. The most appropriate preventive therapy is

A. zolmitriptan (Zomig).

10. Which of the following primitive reflexes should begin to disappear at about 2 months of age in a normal infant?

A. Moro

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 be releasing new episodes every two weeks. The Academy is currently discounted, so sign up now.

Welcome to episode 15 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

The Audio PANCE and PANRE is an audio board review series that includes 10 Multiple Choice PANCE and PANRE Board Review Questions in each episode.

I hope you enjoy this free audio component to the examination portion of this site. The full series is available to all members of the PANCE and PANRE Academy.

The Audio PANCE and PANRE Episode 15

1. A patient with prostate cancer has a nonpalpable, focal lesion, and the patient is reluctant to have surgery at this time. Which of the following would best monitor disease progression?

A. Periodic rectal exams

2. If a woman has a normal 28-day menstrual cycle what tissue and hormonal phase occurs during the last 14 days

A. Proliferative follicular phase under the influence of estrogen.

3. A 24 year-old male presents for routine physical examination. On physical examination, you find that the patient’s upper extremity blood pressure is higher than the blood pressure in the lower extremity. Heart exam reveals a late systolic murmur heard best posteriorly. What is the most likely diagnosis in this patient?

A. Hypertrophic obstructive cardiomyopathy

4. A mother brings a 3 month-old infant to the office because she is concerned about a red, vascular, nodular growth on the child’s back. It appears to be enlarging slightly and the vessels are slightly dilated. It seems to cause the child no discomfort. The most likely diagnosis is

A. a hemangioma.

5. A 45 year-old male with Type 1 diabetes presents with the following lipid panel: Total cholesterol 321 mg/dL; Triglycerides 225 mg/dL; HDL 30 mg/dL; LDL 155 mg/dL. The treatment of choice for this patient is

A. Nicotinic acid (Niacin).

6. A 45 year-old male presents with abdominal pain and one episode of mild hematemesis, which happened days ago. On physical examination, vital signs are stable and he is in no acute distress. Hemoglobin and hematocrit are unremarkable; endoscopy reveals non-bleeding small superficial ulceration of the duodenal bulb. Rapid urease test is positive. Which of the following is the most appropriate treatment at this time?

A. Schedule for a selective vagotomy and antrectomy

7. 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

8. Which of the following increases the risk of developing testicular cancer?

A. Low socioeconomic status

9. A 17 year-old patient presents to the emergency department with agitation and hallucinations, and has one seizure. He admits to using “some drugs” but does not know what they were. On physical examination, temperature is 103 degrees F, BP 140/90, pulse 120, respirations 20. Remainder of the examination is unremarkable. Which of the following diagnostic studies will be of most help in managing this patient?

A. Drug screen

10. Which of the following medications is the treatment of choice for patients with chronic gout to prevent recurrence of symptoms during its quiescent phase?

A. Probenecid (Benemid)

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 be releasing new episodes every two weeks. The Academy is currently discounted, so sign up now.

The Audio PANCE and PANRE is an audio board review series that includes 10 Multiple Choice PANCE and PANRE Board Review Questions in each episode.

I hope you enjoy this free audio component to the examination portion of this site. The full series is available to all members of the PANCE and PANRE Academy.

The Audio PANCE and PANRE Episode 13

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

2. Which of the following physical findings is suggestive of atrial septal defect?

A. Fixed split S2

3. Which of the following is essential to make a diagnosis of cystic fibrosis?

A. Positive family history

4. In infants, the eyes should move in parallel without deviation by the age of

A. 2 weeks.

5. Which of the following physical exam findings is consistent with moderate emphysema?

A. Increased tactile fremitus

6. Which of the following is the most common indication for operative intervention in patients with chronic pancreatitis?

A. Weight loss

7. A 22 year old male presents to the ED with pain that 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 in this patient?

A. Pericardiocentesis

8. As a general rule, sutures in the face should be removed in

A. 3 days.

9. Patient education for a 23 year-old using oral contraceptives should include which of the following?

A. Rifampin may decrease the effectiveness of the oral contraceptives.

10. When performing a rectal examination, prostatic massage is contraindicated in

A. acute bacterial prostatitis.