Podcast Episode 67: Ten PANCE and PANRE Board Review Audio Questions

The Audio PANCE and PANRE Physician Assistant Board Review Podcast Episode 67 — The Audio PANCE and PANRE Episode 67

The Audio PANCE/PANRE - Ten PA Board Review Exam Questions

Welcome to episode 67 of the Audio PANCE and PANRE PA Board Review Podcast.

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

This week we will be covering ten general board review questions based on the NCCPA PANCE and PANRE Content Blueprint.

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

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Podcast Episode 67: 10 Question PANCE and PANRE Podcast Quiz

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

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

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

Click here to see the answer

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

A. VDRL serology is useful in the diagnosis of syphilis, not contact dermatitis
B. KOH prep is used for diagnosis of fungal infections, not contact dermatitis
D. Gram’s stain is useful in the diagnosis of bacterial infections, not contact dermatitis

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

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

Click here to see the answer

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

B. Patients with aortic regurgitation are likely to complain of an uncomfortable awareness of their heart, especially when lying down. These patients develop sinus tachycardia with exertion and complain of palpitations and head pounding with activity.
C. The symptoms related to mitral stenosis are related to increased pulmonary pressure after the left atrium can no longer overcome the outflow obstruction.
D. Patients with mitral valve prolapse are typically asymptomatic throughout their lives, although a wide range of
symptoms is possible. When symptoms do occur, palpitations from arrhythmias are most common along with lightheadedness. Syncope is not part of this disease process.

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

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

Click here to see the answer

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

A. Conservative therapy for stress incontinence should be attempted prior to any evaluation, such as cystoscopy, that might indicate the need for surgical correction
D. There is no indication in the history for hormone replacement therapy and no vaginal atrophy was noted on pelvic examination

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

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

Click here to see the answer

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

A. While viral hepatitis may cause jaundice, the liver is enlarged and tender
C. While acute cholecystitis may present with jaundice and an enlarged gallbladder, the pain is classically colicky and located in the right upper quadrant. On physical examination with deep inspiration and palpation of the right subcostal area increased pain and respiratory arrest (Murphy’s sign) is usually seen.
D. Gilbert’s syndrome is the most common of the hereditary hyperbilirubinemias. It is most often diagnosed near puberty or adult life based on results of a comprehensive metabolic panel.

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

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

Click here to see the answer

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

A. Mitral stenosis is a diastolic, not a systolic murmur
C. Mid-systolic clicks are noted in mitral valve prolapse, not mitral stenosis
D. Paradoxical splitting of S2 occurs in aortic stenosis, not mitral stenosis

Review PANCE and PANRE Valvular disorders pearls

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

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

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

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

Review topic PANCE Dermatologic system dermatophyte infections

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

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

Click here to see the answer

A. Acanthosis nigricans is associated with patients who have hyperinsulinemia

B. Hairy cell leukemia is associated with an enlarged spleen and pancytopenia. Acanthosis nigricans is not a cutaneous manifestation
C. Erythema chronicum migrans is the characteristic lesion associated with Lyme disease
D. Eruptive xanthelasma is associated with increased triglycerides

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

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

Click here to see the answer

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

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

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

Click here to see the answer

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

A. Propylthiouracil is used to treat hyperthyroidism, not anorexia nervosahttps://smartypance.com/lessons/ear-disorders/inner-ear-pearls/acoustic-neuroma/
B. Hormone replacement is not indicated for the amenorrhea of anorexia nervosa, but nutritional support may help.
D. Antidepressant therapy may be useful in bulimia nervosa

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

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

Click here to see the answer

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

A. Acute labyrinthitis typically presents with an acute onset of continuous vertigo that lasts several days to a week and is associated with nausea and vomiting. It does not have any associated auditory or neurologic symptoms.
B. Positional vertigo occurs following changes in head positioning with very brief, less than 1 minute, episodes. Nystagmus occurs following the position change.
C. Acoustic neuroma typically presents with hearing loss and tinnitus. The neuroma grows slowly and central compensatory mechanisms can prevent or minimize the vertigo. Vertigo, when present, is continuous and not episodic.

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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.