Podcast Episode 105: Ten PANCE, PANRE, and Rotation Review Questions

The Audio PANCE and PANRE Physician Assistant Board Review Podcast

Listen to Podcast Episode 105: Ten PANCE, PANRE, and Rotation Review Questions

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Welcome to episode 105 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.

Join me today as we cover ten board review questions for your PANCE, PANRE, EOR, and EOC exams.

Links from today’s episode:

• Sign up for the Entire Blueprint Email Series
• Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram
• Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook
• Review systemic lupus erythematosus (SLE)
• Review the diabetes diagnostic guidelines
• Review gestational diabetes screening guidelines
• Review basal cell carcinoma and our comparison tables of the Blueprint dermatologic neoplasms
• Join the Smarty PANCE Member’s Community, then sign up for a study group to get updates about upcoming webinars.

I hope you enjoy this free audio component of the examination portion of this site. Smarty PANCE includes over 2,000 interactive board review questions, along with flashcards, ReelDx cases, integrated Picmonics, and lessons covering every blueprint topic available to all Smarty PANCE members.

• You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and all podcasting apps
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Interactive exam to complement today’s podcast

1. A 68-year-old male farmer presents with a flesh-colored papule with a rolled border located on the right side of his forehead. As you examine the lesion closely, you notice something else about the lesion. Which of the following physical exam findings would make you more suspicious of malignancy?

A. Telangiectasia
B. Nikolsky sign
C. Hypopigmentation
D. Tenderness to palpation
E. Central umbilication

Answer and topic summary

The answer is A. Telangiectasia

The patient has basal cell carcinoma, which is a skin cancer with low metastatic potential. It commonly occurs on the face (70% of the time). There are different types of BCC (nodular vs. superficial vs. infiltrative). However, nodular is the most common (80%) and typical characteristics you may see include a papule with a rolled border, pearly-like look, flesh-colored, and telangiectasia. Risk factors for BCC include UV radiation, certain genes, inherited disorders, etc.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Dermatology ⇒ Dermatologic Neoplasms ⇒ Basal cell carcinoma

Also covered as part of the General Surgery EOR and Family Medicine EOR topic list

2. Which of the following is the most common type of elder abuse?

A. Neglect
B. Emotional abuse
C. Physical abuse
D. Sexual abuse
E. Financial exploitation

Answer and topic summary

The answer is A. Neglect

The most common type of elder abuse is neglect, which refers to the failure of a trusted person to protect an older person from harm or provide for their needs. Self-neglect is also common, which is when an older person can’t proide their own care. Some warning signs include bruising, lacerations, skin tears, spiral fractures, malnutrition, pressure ulcers, and dehydration. If you even suspect an older adult is being neglected, you should report this immediately to adult protective services (or similar agencies) and treat the medical complications immediately.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Psychiatry ⇒ Abuse and Neglect ⇒ Child/elder abuse

3. Which of the following is the most common bacterial cause of a hordeolum?

A. Streptococcus pyogenes
B. Staphylococcus aureus
C. Clostridium perfringens
D. Propionibacterium species
E. Enterobacter aerogenes

Answer and topic summary

The answer is B. Staphylococcus aureus

A hordeolum (stye) is an abscess of the eyelid that is acute. It will usually present with pain and swelling of the eyelid. The most common pathogen indicated is Staphylococcus aureus. Risk factors include dirty eye makeup, rosacea, and seborrheic dermatitis. A way to differentiate hordeolums from chalazions is that Hordeolums are Hot (aka warm/tender).

Treatment may include warm compresses (10 min up to 5 times daily) plus massaging the eyelid to aid in drainage.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint EENT ⇒ Disorders of the Eye ⇒ Lid disorders ⇒ Hordeolum

Also covered as part of the Family Medicine EOR topic list

4. A 19-year-old female presents to the clinic with fatigue, weight loss, arthralgia, and an erythematous rash in a malar distribution over the cheeks and nose (that spares the nasolabial folds). Which of the following is the most common cardiac manifestation of the patient’s likely diagnosis?

A. Third-degree AV block
B. Mitral regurgitation
C. Myocarditis
D. Pericarditis
E. Bradydysrhythmias

Answer and topic summary

The answer is D. Pericarditis

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can impact almost any organ. It’s important to be aware of how SLE clinically presents in order to get to a diagnosis and treatment.

The most common clinical features overall are fatigue (80-100%), arthralgia/arthritis (>90%), fever (>50%), and Raynaud phenomenon (~50%). You may also see the classic malar rash that spares nasolabial folds.

Cardiac complications are common (50%) in SLE, and they lead to morbidity and mortality. The most common cardiac manifestation is pericarditis. Other cardiac issues these patients may have include pericardial effusion, myocarditis (rare), and valvular dysfunction.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Rheumatologic Disorders ⇒ Systemic lupus erythematosus

Also covered as part of the Internal Medicine EOR and Family Medicine EOR topic list

5. Which of the following is the most common and important risk factor for aortic dissection?

A. Bicuspid aortic valve
B. Connective tissue disorder
C. Turner’s syndrome
D. Systemic hypertension
E. Aortic surgery

Answer and topic summary

The answer is D. Systemic hypertension

Aortic dissection is a life-threatening emergency and is defined by a tear of the inner layer of the aorta. On an exam, you may be asked about the classifications:

– Standford Classification: Stanford A is ascending aorta and Standford B is descending aorta

– DeBakey Classifications: type I is Both (ascending + descending aorta), type II is Ascending aorta, and III is Descending aorta. (Hint: It spells out BAD.)

The most important & common risk factor is systemic hypertension. Known causes of acute, severe increases in blood pressure include weight lifting, energy drinks, and cocaine. The classic presentation is “tearing and ripping chest pain with pulse deficits.” Treatment is lowering the BP via IV beta-blockers for both Type A and B and then surgery (for Type A).

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Vascular Disease ⇒ Aortic aneurysm/dissection

6. Which of the following is characterized by a rash that has a “slapped cheek” appearance at first and then progresses into a maculopapular rash on the arms and trunk in a reticular pattern?

A. Roseola infantum
B. Rubella
C. Measles
D. Erythema infectiosum
E. Kawasaki disease

Answer and topic summary

The answer is D. Erythema infectiosum

Erythema infectiosum is a condition characterized by a fever with a rash. It is caused by parvovirus B19 infection. The classic presentation is a “slapped cheek” rash on the face and an erythematous, lacy reticular rash on the trunk and extremities. Some call it the “fifth disease.” It is a common childhood viral exanthem. Diagnosis is usually clinical (serology can be done though). The disease is self-limiting and no specific therapy is warranted (most of the time).

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Infectious Disease ⇒ Viral Infectious Disease ⇒ Erythema infectiosum

Also covered as part of the Pediatric Rotation EOR topic list

7. Which of the following is the most common cause of generalized musculoskeletal pain in young adult females?

A. Multiple sclerosis
B. Rheumatoid arthritis
C. Polymyalgia rheumatica
D. Menstruation
E. Fibromyalgia

Answer and topic summary

The answer is E. Fibromyalgia

Fibromyalgia is the most common cause of generalized muscle/bone pain in young adult females. Patients with fibromyalgia also usually have fatigue, cognitive fog, sleep disturbances, morning stiffness, headaches, paresthesias, and depression. On a physical exam, you will see tenderness to palpation at multiple sites. Initial treatment includes patient education, aerobic exercise, management of concurrent issues (e.g., sleep and psychiatric), & tricyclic antidepressants (e.g., amitriptyline 10 mg).

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Rheumatologic Disorders ⇒ Fibromyalgia

Also covered as part of the Internal Medicine EOR and Family Medicine EOR topic list

8. Which of the following is the best first-line treatment for a post-menopausal woman with osteoporosis and no pathological fractures?

A. Bisphosphonates
B. Parathyroid hormone analogs
C. RANKL inhibitors
D. Selective estrogen receptor modulators
E.Calcitonin

Answer and topic summary

The answer is A. Bisphosphonates

Osteoporosis is characterized by low bone mass and skeletal fragility leading to decreased bone strength. There are no clinical symptoms of osteoporosis until a patient has an actual fracture. Vertebral fractures in particular, are the MOST common clinical manifestation of osteoporosis.

Diagnosis is made by a DEXA scan (T-score < -2.5 standard deviations) or a fragility fracture.

Lifestyle changes that can be made include exercise and cessation of smoking. The first-line pharmacological agent is oral bisphosphonates (e.g., alendronate or risedronate).

Remember bisphosphonates should be administered first thing in the AM and >30 min before the first food. Patients should stay upright for >30 minutes.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Rheumatologic Disorders ⇒ Osteoporosis

Also covered as part of the Family Medicine EOR topic list

9. A 72-year-old female with sick sinus syndrome (s/p pacemaker) presents to your clinic with fever and chills. On a physical exam, you appreciate a new murmur located at the left 5th intercostal space at the midclavicular line. You also notice petechiae on the patient’s conjunctivae. Which of the following is the most likely diagnosis?

A. Bacterial pneumonia
B. Pericarditis
C. Rheumatic fever
D. Infective endocarditis
E. Pleural effusion

Answer and topic summary

The answer is D. Infective endocarditis

The patient has infective endocarditis (IE), which is an infection of the endocardial surface of the heart. Risk factors include pre-existing valvular or congenital heart disease, IVDU, indwelling cardiac devices, IV catheters, or recent dental/surgical procedures. The most common symptoms include fever (90%), new murmur (85%), and petechiae (20-50%). Other textbook findings include Janeway lesions (non-tender macules on palms/soles), Osler nodes (tender nodules on pads of fingers/toes), and Roth spots (hemorrhagic lesions of the retina). The best diagnostic test is a transesophageal echocardiogram. The modified Duke criteria can be used as a diagnostic guide but must be interpreted in light of pretest probability. At least 3 sets of blood cultures should be obtained. Treatment includes IV antibiotics and removal of any infected device.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Traumatic, infectious, and inflammatory heart conditions ⇒ Acute and subacute bacterial endocarditis

Also covered as part of the Emergency Medicine EOR, Internal Medicine EOR, and Family Medicine EOR topic list

10. Which of the following is not considered diagnostic for diabetes mellitus?

A. Random plasma glucose > 200 mg/dL with symptoms of hyperglycemia
B. A1c > 6.5
C. Fasting plasma glucose > 126 mg/dL on at least two separate occasions
D. Plasma glucose > 200 mg/dL measured after a glucose tolerance test
E. All of the above are diagnostic

Answer and topic summary

The answer is E. All of the above are diagnostic

Type 2 diabetes mellitus is a very prevalent, serious disease that impacts about 9% of adults in the United States. Risk factors include family history, obesity, sedentary lifestyle, smoking, and poor diet habits. Initial symptoms include polyuria, polydipsia, polyphagia, and blurred vision. Diagnosis is made by one of the following answer choices seen on the first slide. First-line therapies include metformin and lifestyle changes (i.e., weight loss + exercise). Early combination therapy can be considered at treatment initiation to extend the time to treatment failure. It is VERY important to reach tight glycemic control as soon as possible in diabetic patients. Complications of diabetes include microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (stroke, myocardial infarction).

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Endocrinology ⇒ Diabetes Mellitus ⇒ Diabetes Mellitus Type 2

Also covered as part of the Family Medicine EOR and Emergency Medicine EOR topic list

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