Artwork

İçerik The Physician Assistant Life | Smarty PANCE tarafından sağlanmıştır. Bölümler, grafikler ve podcast açıklamaları dahil tüm podcast içeriği doğrudan The Physician Assistant Life | Smarty PANCE veya podcast platform ortağı tarafından yüklenir ve sağlanır. Birinin telif hakkıyla korunan çalışmanızı izniniz olmadan kullandığını düşünüyorsanız burada https://tr.player.fm/legal özetlenen süreci takip edebilirsiniz.
Player FM - Podcast Uygulaması
Player FM uygulamasıyla çevrimdışı Player FM !

Podcast Episode 104: Ten PANCE, PANRE, and Rotation Review Questions

24:25
 
Paylaş
 

Manage episode 358473450 series 97199
İçerik The Physician Assistant Life | Smarty PANCE tarafından sağlanmıştır. Bölümler, grafikler ve podcast açıklamaları dahil tüm podcast içeriği doğrudan The Physician Assistant Life | Smarty PANCE veya podcast platform ortağı tarafından yüklenir ve sağlanır. Birinin telif hakkıyla korunan çalışmanızı izniniz olmadan kullandığını düşünüyorsanız burada https://tr.player.fm/legal özetlenen süreci takip edebilirsiniz.

Listen to Podcast Episode 104: Ten PANCE, PANRE, and Rotation Review Questions

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

Welcome to episode 104 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:

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.

Smarty PANCE is not sponsored or endorsed by, or affiliated with, the National Commission on Certification of Physician Assistants.

Interactive exam to complement today’s podcast

When is screening for gestational diabetes done?

A. 16 weeks
B. 22 weeks
C. 24 weeks
D. 32 weeks
E. 34 weeks

Answer and topic summary

The answer is C. 24 weeks

Prenatal care is extremely important. Screening for gestational diabetes is routinely done in pregnant patients at 24 weeks of gestation (typically until 28 weeks). Pregnancy is associated with insulin resistance, mostly because of the placenta’s secretion of human placental lactogen. There are bad consequences of gestational diabetes, so it is critical it is diagnosed and treated adequately.

The initial test is a one-hour 50-gram oral glucose tolerance test (GTT). A positive test >135 mg/dL. If a patient tests positive, they need to undergo the second test, which is a three-hour 100 mg oral GTT. The cut-offs are debated, but generally, the following are positive results: fasting > 95 mg/dL, 1 hour>180 mg/dL, 2 hours>155 mg/dL, 3 hours>140 mg/dL.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Reproductive SystemComplicated PregnancyGestational diabetes

Also covered as part of the Women’s Health EOR topic list

2. A 60-year-old male with a history of alcohol abuse and esophageal varices is brought to the ER with lethargy, delirium, weakness, and nausea. He is normotensive and afebrile. On physical exam, he is ill-appearing with jaundice, spider angiomas, a distended abdomen, and 3+ pretibial pitting edema. Based on his history and clinical presentation, which of the following electrolyte abnormalities would you expect to see in this patient?

A. Hyponatremia
B. Hypocalcemia
C. Hypercalcemia
D. Hyperphosphatemia
E. Hypermagnesemia

Answer and topic summary

The answer is A. Hyponatremia

The patient has hypervolemic hyponatremia secondary to cirrhosis. The causes of hypervolemic hyponatremia are cirrhosis, nephrotic syndrome, and CHF. Symptoms include nausea, headache, lethargy, and seizures. It’s important to have an approach to hyponatremia since it is the most common electrolyte abnormality in the hospital.

  • First, it’s important to rule out pseudohyponatremia due to proteins, glucose, or mannitol. Also, make sure it’s not a diuretic causing hyponatremia.
  • Next, consider the volume status – are they hypervolemic, hypovolemic, or euvolemic?
  • Hypovolemic causes are more obvious (emesis, hemorrhage, etc.); however, urinary sodium can help differentiate between hypovolemia and euvolemia. If uNA < 20, then this means the renin-angiotensin-aldosterone system is on and trying to maintain pressure/volume; therefore, it is likely the patient is hypovolemic.

Treatment of hyponatremia depends on the cause. It usually involves fluid restriction and possibly (and carefully) a hypertonic solution. Remember – rapid correction of hyponatremia can lead to central pontine myelinolysis.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Renal SystemFluid and Electrolyte DisordersHyponatremia

Also covered as part of the Internal Medicine EOR topic list

3. A 12-year-old male patient presents with a circular, expanding rash located where a tick had bitten him. He had recently been camping in the upper Midwest. He also complains of a headache and mild fever. Which of the following is a known cardiac complication of the patient’s most likely diagnosis?

A. Supraventricular tachycardia
B. Atrioventricular block
C. Wandering atrial pacemaker
D. Sinus bradycardia
E. None of the above

Answer and topic summary

The answer is B. Atrioventricular block

The patient most likely has Lyme disease, which is a tick-borne illness usually caused by Borrelia burgdorferi. It is more prevalent in the Northeast and upper Midwest. Erythema migrans, which is a circular, expanding rash that may look like a “bull’s eye” is seen about 20% of the time with Lyme disease. Clinical features in the early localized disease include fever, headaches, malaise, arthralgia, and lymphadenopathy. Treatment is doxycycline for non-pregnant adults and children. Amoxicillin is a second-line treatment. A well-known cardiac complication is an atrioventricular block.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Infectious DiseaseSpirochetal DiseaseLyme disease

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

4. Which of the following is not a manifestation of congenital rubella syndrome?

A. Deafness
B. Cataracts
C. Heart defects
D. Microcephaly
E. Fetal growth acceleration

Answer and topic summary

The answer is E. Fetal growth acceleration

Clinical features of a congenital rubella infection (CRI) include deafness, cataracts, and cardiac disease. Patients may also have CNS abnormalities, such as microcephaly. Typically, a congenital rubella infection will lead to fetal growth restriction, not fetal growth acceleration. A classic finding that you may see on exams is petechiae and purpura — some call these “blueberry muffin lesions.” In general, CRI should be considered in patients who have a suspected rubella infection during their pregnancy. Laboratory studies on the child (before the age of one) are done to help confirm the diagnosis. There is no treatment, and supportive care/surveillance is the main way to manage a congenital rubella infection.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Infectious DiseaseViral Infectious DiseaseRubella (German Measles)

Also covered as part of the Pediatric EOR topic list

5. Which of the following is the most common cause of cardiogenic shock?

A. Right ventricle failure
B. Tachydysrhythmias
C. Myocardial infarction
D. Coronary vasospasms
E. Papillary muscle rupture

Answer and topic summary

The answer is C. Myocardial Infarction

Cardiogenic shock is a type of shock that occurs due to cardiac pump failure; essentially, it is the most severe expression of heart failure. It is defined by systemic tissue hypoperfusion secondary to poor cardiac output despite adequate intravascular volume. The most common cause of cardiogenic shock is a myocardial infarction. Other causes include atrial/ventricular tachyarrhythmias, aortic or mitral valve insufficiency, septal defects, free wall rupture, etc. Therapy options vary but may include inotropic support (e.g., dobutamine), intra-aortic balloon pump, and percutaneous ventricular assist devices.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint CardiologyHypotensionCardiogenic shock

Also covered as part of the Emergency Medicine EOR topic list

6. A 20-year-old female with asthma presents to the clinic with “white stuff” in her mouth for the past few days. On physical exam, you notice a few white plaques on the buccal mucosa and tongue. The lesions are easily scraped off with a tongue depressor. Which of the following is the best initial treatment of choice for the most likely diagnosis?

A. Fluconazole
B. Amphotericin B
C. Lidocaine solution
D. Nystatin
E. Bactrim

Answer and topic summary

The answer is D. Nystatin

The patient has oropharyngeal candidiasis, which is a local infection in patients with certain risk factors (e.g., AIDs, dentures, radiation, inhaled glucocorticoids, etc.). This patient has asthma so the likely causative culprit is her inhaled glucocorticoids. The most common cause of oropharyngeal candidiasis is C. albicans. On a physical exam, you will see white plaques in the mouth (which can be scrapped). In smokers, the lesions may look more yellow/brown.

Diagnosis is usually clinical but can be confirmed by scraping the lesion. A KOH test can be performed on the scrapings — budding yeast with pseudohyphae are seen. The treatment of choice is nystatin swish and swallow or topical clotrimazole. If a patient has a severe disease or fails topical therapy, oral fluconazole can be given.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint DermatologyFungal InfectionsCandidiasis

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

7. A 51-year-old male presents to the clinic. His wife explains his symptoms: brief, involuntary movements of his limbs, depression, impaired thinking, and weight loss. Which of the following is the most likely diagnosis?

A. Parkinson disease
B. Multiple sclerosis
C. Alzheimer disease
D. Vascular dementia
E. Huntington’s disease

Answer and topic summary

The answer is E. Huntington’s disease

Huntington’s disease is an autosomal-dominant disorder characterized by progressive neurodegeneration. It is due to the expansion of the cytosine-adenine-guanine (CAG) trinucleotide in the HTT gene. The main clinical features include choreiform movements, dementia, cognitive impairment, and psychiatric problems. Patients typically present during mid-life. Diagnosis is confirmed by genetic testing. A brain MRI may reveal caudate atrophy. Treatment is generally supportive and symptomatic. There is no cure for Huntington’s disease.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint NeurologyMovement DisordersHuntington Disease

Also covered as part of the Internal Medicine EOR topic list

8. A 42-year-old male with a history of diabetes presents the ER with a “bad rash” on his left thigh. He said he had previously gotten a bug bite there. He is febrile (102.2F), tachycardic (110 bpm), and hypotensive (80/50 mmHg). On physical exam, you notice a 2-inch erythematous circular lesion that is warm to the touch. Which of the following is the best next step in the management of this patient?

A. Initiate IV antibiotics and fluids
B. Surgical consult for amputation
C. Outpatient dermatology referral
D. Order venous ultrasound of the leg
E. Send home on oral antibiotics

Answer and topic summary

The answer is A. Initiate IV antibiotics and fluids

This patient has a severe case of cellulitis and sepsis. The best next step is to initiate intravenous antibiotics and fluids. A broad-spectrum antibiotic (like cefepime) plus coverage for MRSA (vancomycin) would be appropriate.

The most common cause of cellulitis is Group A beta-hemolytic Streptococcus pyogenes. What differentiates cellulitis from erysipelas is that erysipelas is more well-defined. Antibiotic options for more mild cellulitis cases include Bactrim, clindamycin, and Keflex.

It’s important to keep in mind that events don’t happen in a vacuum — the bug bite led to cellulitis, and the patient’s body responded to the cutaneous infection in a complex and dysregulated way (i.e. sepsis), eventually leading to hypotension and instability.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint DermatologyDermatologic Infectious diseasesBacterial InfectionsCellulitis

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

9. An 8-year-old male is brought into the clinic by his mother, who is concerned about his behavior in school and at home for the past 7 months. In both settings, he lacks the ability to pay attention, does not follow directions or listen, is easily distracted, is reluctant to do tasks, and constantly loses his homework and pencils. Which of the following is a common side effect of the first-line treatment for this condition?

A. Cognitive fog
B. Appetite suppression
C. Constipation
D. Somnolence
E. Xerosis

Answer and topic summary

The answer is B. Appetite suppression

The patient has attention-deficit hyperactivity disorder (ADHD). There are two main patterns: inattentive or hyperactive-impulse (some may have a combined presentation). The DSM V has criteria for diagnosing ADHD and the various subtypes, but in general, symptoms should be seen in multiple settings, last for 6 months or more, and negatively impact social/academic activities. The first-line pharmacological treatment for ADHD, in most cases, is a stimulant (e.g., methylphenidate, dextroamphetamine, etc.). The most adverse effects of stimulants include moodiness and irritability, and appetite suppression. It’s important to monitor children’s growth and weight when they are taking a stimulant for this very reason.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint PsychiatryNeurodevelopmental disordersAttention-Deficit/Hyperactivity Disorder

Also covered as part of the Pediatric Rotation and Psychiatry EOR topic list

10. Which of the following patients should be screened for lung cancer, according to the USPSTF?

A. 82-year-old with 34 pack-years who quit 2 years ago
B. 51-year-old with 31 pack-years who quit 10 years ago
C. 70-year-old with 14 pack-years who quit 5 years ago
D. 40-year-old with 20 pack-years who quit 2 weeks ago

Answer and topic summary

The answer is B. 51-year-old with 31 pack-years who quit 10 years ago

The U.S. Preventive Services Task Force (USPSTF) recently changed the lung cancer screening guidelines in March 2021.

An annual low-dose chest CT scan (NOT chest x-ray) should be done for those who are 50 to 80 years old with at least a 20-pack-year history and who currently smoke or have quit within the past 15 years.

It is also important to note that these guidelines do not apply to those who have another illness that already severely limits their life expectancy.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint PulmonaryPulmonary NeoplasmsLung cancer

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

This podcast is available on every device!

You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and all podcasting apps.

Download Interactive Content Blueprint Checklists for the PANCE, PANRE, EOR, and PANRE-LA

Interactive Content Blueprints for the PANCE PANRE and PANRE-LA

Follow this link to download your FREE copy of the PANCE/PANRE/EOR Content Blueprint Checklists.

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.

The post Podcast Episode 104: Ten PANCE, PANRE, and Rotation Review Questions appeared first on The Audio PANCE and PANRE.

  continue reading

67 bölüm

Artwork
iconPaylaş
 
Manage episode 358473450 series 97199
İçerik The Physician Assistant Life | Smarty PANCE tarafından sağlanmıştır. Bölümler, grafikler ve podcast açıklamaları dahil tüm podcast içeriği doğrudan The Physician Assistant Life | Smarty PANCE veya podcast platform ortağı tarafından yüklenir ve sağlanır. Birinin telif hakkıyla korunan çalışmanızı izniniz olmadan kullandığını düşünüyorsanız burada https://tr.player.fm/legal özetlenen süreci takip edebilirsiniz.

Listen to Podcast Episode 104: Ten PANCE, PANRE, and Rotation Review Questions

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

Welcome to episode 104 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:

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.

Smarty PANCE is not sponsored or endorsed by, or affiliated with, the National Commission on Certification of Physician Assistants.

Interactive exam to complement today’s podcast

When is screening for gestational diabetes done?

A. 16 weeks
B. 22 weeks
C. 24 weeks
D. 32 weeks
E. 34 weeks

Answer and topic summary

The answer is C. 24 weeks

Prenatal care is extremely important. Screening for gestational diabetes is routinely done in pregnant patients at 24 weeks of gestation (typically until 28 weeks). Pregnancy is associated with insulin resistance, mostly because of the placenta’s secretion of human placental lactogen. There are bad consequences of gestational diabetes, so it is critical it is diagnosed and treated adequately.

The initial test is a one-hour 50-gram oral glucose tolerance test (GTT). A positive test >135 mg/dL. If a patient tests positive, they need to undergo the second test, which is a three-hour 100 mg oral GTT. The cut-offs are debated, but generally, the following are positive results: fasting > 95 mg/dL, 1 hour>180 mg/dL, 2 hours>155 mg/dL, 3 hours>140 mg/dL.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Reproductive SystemComplicated PregnancyGestational diabetes

Also covered as part of the Women’s Health EOR topic list

2. A 60-year-old male with a history of alcohol abuse and esophageal varices is brought to the ER with lethargy, delirium, weakness, and nausea. He is normotensive and afebrile. On physical exam, he is ill-appearing with jaundice, spider angiomas, a distended abdomen, and 3+ pretibial pitting edema. Based on his history and clinical presentation, which of the following electrolyte abnormalities would you expect to see in this patient?

A. Hyponatremia
B. Hypocalcemia
C. Hypercalcemia
D. Hyperphosphatemia
E. Hypermagnesemia

Answer and topic summary

The answer is A. Hyponatremia

The patient has hypervolemic hyponatremia secondary to cirrhosis. The causes of hypervolemic hyponatremia are cirrhosis, nephrotic syndrome, and CHF. Symptoms include nausea, headache, lethargy, and seizures. It’s important to have an approach to hyponatremia since it is the most common electrolyte abnormality in the hospital.

  • First, it’s important to rule out pseudohyponatremia due to proteins, glucose, or mannitol. Also, make sure it’s not a diuretic causing hyponatremia.
  • Next, consider the volume status – are they hypervolemic, hypovolemic, or euvolemic?
  • Hypovolemic causes are more obvious (emesis, hemorrhage, etc.); however, urinary sodium can help differentiate between hypovolemia and euvolemia. If uNA < 20, then this means the renin-angiotensin-aldosterone system is on and trying to maintain pressure/volume; therefore, it is likely the patient is hypovolemic.

Treatment of hyponatremia depends on the cause. It usually involves fluid restriction and possibly (and carefully) a hypertonic solution. Remember – rapid correction of hyponatremia can lead to central pontine myelinolysis.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Renal SystemFluid and Electrolyte DisordersHyponatremia

Also covered as part of the Internal Medicine EOR topic list

3. A 12-year-old male patient presents with a circular, expanding rash located where a tick had bitten him. He had recently been camping in the upper Midwest. He also complains of a headache and mild fever. Which of the following is a known cardiac complication of the patient’s most likely diagnosis?

A. Supraventricular tachycardia
B. Atrioventricular block
C. Wandering atrial pacemaker
D. Sinus bradycardia
E. None of the above

Answer and topic summary

The answer is B. Atrioventricular block

The patient most likely has Lyme disease, which is a tick-borne illness usually caused by Borrelia burgdorferi. It is more prevalent in the Northeast and upper Midwest. Erythema migrans, which is a circular, expanding rash that may look like a “bull’s eye” is seen about 20% of the time with Lyme disease. Clinical features in the early localized disease include fever, headaches, malaise, arthralgia, and lymphadenopathy. Treatment is doxycycline for non-pregnant adults and children. Amoxicillin is a second-line treatment. A well-known cardiac complication is an atrioventricular block.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Infectious DiseaseSpirochetal DiseaseLyme disease

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

4. Which of the following is not a manifestation of congenital rubella syndrome?

A. Deafness
B. Cataracts
C. Heart defects
D. Microcephaly
E. Fetal growth acceleration

Answer and topic summary

The answer is E. Fetal growth acceleration

Clinical features of a congenital rubella infection (CRI) include deafness, cataracts, and cardiac disease. Patients may also have CNS abnormalities, such as microcephaly. Typically, a congenital rubella infection will lead to fetal growth restriction, not fetal growth acceleration. A classic finding that you may see on exams is petechiae and purpura — some call these “blueberry muffin lesions.” In general, CRI should be considered in patients who have a suspected rubella infection during their pregnancy. Laboratory studies on the child (before the age of one) are done to help confirm the diagnosis. There is no treatment, and supportive care/surveillance is the main way to manage a congenital rubella infection.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Infectious DiseaseViral Infectious DiseaseRubella (German Measles)

Also covered as part of the Pediatric EOR topic list

5. Which of the following is the most common cause of cardiogenic shock?

A. Right ventricle failure
B. Tachydysrhythmias
C. Myocardial infarction
D. Coronary vasospasms
E. Papillary muscle rupture

Answer and topic summary

The answer is C. Myocardial Infarction

Cardiogenic shock is a type of shock that occurs due to cardiac pump failure; essentially, it is the most severe expression of heart failure. It is defined by systemic tissue hypoperfusion secondary to poor cardiac output despite adequate intravascular volume. The most common cause of cardiogenic shock is a myocardial infarction. Other causes include atrial/ventricular tachyarrhythmias, aortic or mitral valve insufficiency, septal defects, free wall rupture, etc. Therapy options vary but may include inotropic support (e.g., dobutamine), intra-aortic balloon pump, and percutaneous ventricular assist devices.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint CardiologyHypotensionCardiogenic shock

Also covered as part of the Emergency Medicine EOR topic list

6. A 20-year-old female with asthma presents to the clinic with “white stuff” in her mouth for the past few days. On physical exam, you notice a few white plaques on the buccal mucosa and tongue. The lesions are easily scraped off with a tongue depressor. Which of the following is the best initial treatment of choice for the most likely diagnosis?

A. Fluconazole
B. Amphotericin B
C. Lidocaine solution
D. Nystatin
E. Bactrim

Answer and topic summary

The answer is D. Nystatin

The patient has oropharyngeal candidiasis, which is a local infection in patients with certain risk factors (e.g., AIDs, dentures, radiation, inhaled glucocorticoids, etc.). This patient has asthma so the likely causative culprit is her inhaled glucocorticoids. The most common cause of oropharyngeal candidiasis is C. albicans. On a physical exam, you will see white plaques in the mouth (which can be scrapped). In smokers, the lesions may look more yellow/brown.

Diagnosis is usually clinical but can be confirmed by scraping the lesion. A KOH test can be performed on the scrapings — budding yeast with pseudohyphae are seen. The treatment of choice is nystatin swish and swallow or topical clotrimazole. If a patient has a severe disease or fails topical therapy, oral fluconazole can be given.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint DermatologyFungal InfectionsCandidiasis

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

7. A 51-year-old male presents to the clinic. His wife explains his symptoms: brief, involuntary movements of his limbs, depression, impaired thinking, and weight loss. Which of the following is the most likely diagnosis?

A. Parkinson disease
B. Multiple sclerosis
C. Alzheimer disease
D. Vascular dementia
E. Huntington’s disease

Answer and topic summary

The answer is E. Huntington’s disease

Huntington’s disease is an autosomal-dominant disorder characterized by progressive neurodegeneration. It is due to the expansion of the cytosine-adenine-guanine (CAG) trinucleotide in the HTT gene. The main clinical features include choreiform movements, dementia, cognitive impairment, and psychiatric problems. Patients typically present during mid-life. Diagnosis is confirmed by genetic testing. A brain MRI may reveal caudate atrophy. Treatment is generally supportive and symptomatic. There is no cure for Huntington’s disease.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint NeurologyMovement DisordersHuntington Disease

Also covered as part of the Internal Medicine EOR topic list

8. A 42-year-old male with a history of diabetes presents the ER with a “bad rash” on his left thigh. He said he had previously gotten a bug bite there. He is febrile (102.2F), tachycardic (110 bpm), and hypotensive (80/50 mmHg). On physical exam, you notice a 2-inch erythematous circular lesion that is warm to the touch. Which of the following is the best next step in the management of this patient?

A. Initiate IV antibiotics and fluids
B. Surgical consult for amputation
C. Outpatient dermatology referral
D. Order venous ultrasound of the leg
E. Send home on oral antibiotics

Answer and topic summary

The answer is A. Initiate IV antibiotics and fluids

This patient has a severe case of cellulitis and sepsis. The best next step is to initiate intravenous antibiotics and fluids. A broad-spectrum antibiotic (like cefepime) plus coverage for MRSA (vancomycin) would be appropriate.

The most common cause of cellulitis is Group A beta-hemolytic Streptococcus pyogenes. What differentiates cellulitis from erysipelas is that erysipelas is more well-defined. Antibiotic options for more mild cellulitis cases include Bactrim, clindamycin, and Keflex.

It’s important to keep in mind that events don’t happen in a vacuum — the bug bite led to cellulitis, and the patient’s body responded to the cutaneous infection in a complex and dysregulated way (i.e. sepsis), eventually leading to hypotension and instability.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint DermatologyDermatologic Infectious diseasesBacterial InfectionsCellulitis

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

9. An 8-year-old male is brought into the clinic by his mother, who is concerned about his behavior in school and at home for the past 7 months. In both settings, he lacks the ability to pay attention, does not follow directions or listen, is easily distracted, is reluctant to do tasks, and constantly loses his homework and pencils. Which of the following is a common side effect of the first-line treatment for this condition?

A. Cognitive fog
B. Appetite suppression
C. Constipation
D. Somnolence
E. Xerosis

Answer and topic summary

The answer is B. Appetite suppression

The patient has attention-deficit hyperactivity disorder (ADHD). There are two main patterns: inattentive or hyperactive-impulse (some may have a combined presentation). The DSM V has criteria for diagnosing ADHD and the various subtypes, but in general, symptoms should be seen in multiple settings, last for 6 months or more, and negatively impact social/academic activities. The first-line pharmacological treatment for ADHD, in most cases, is a stimulant (e.g., methylphenidate, dextroamphetamine, etc.). The most adverse effects of stimulants include moodiness and irritability, and appetite suppression. It’s important to monitor children’s growth and weight when they are taking a stimulant for this very reason.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint PsychiatryNeurodevelopmental disordersAttention-Deficit/Hyperactivity Disorder

Also covered as part of the Pediatric Rotation and Psychiatry EOR topic list

10. Which of the following patients should be screened for lung cancer, according to the USPSTF?

A. 82-year-old with 34 pack-years who quit 2 years ago
B. 51-year-old with 31 pack-years who quit 10 years ago
C. 70-year-old with 14 pack-years who quit 5 years ago
D. 40-year-old with 20 pack-years who quit 2 weeks ago

Answer and topic summary

The answer is B. 51-year-old with 31 pack-years who quit 10 years ago

The U.S. Preventive Services Task Force (USPSTF) recently changed the lung cancer screening guidelines in March 2021.

An annual low-dose chest CT scan (NOT chest x-ray) should be done for those who are 50 to 80 years old with at least a 20-pack-year history and who currently smoke or have quit within the past 15 years.

It is also important to note that these guidelines do not apply to those who have another illness that already severely limits their life expectancy.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint PulmonaryPulmonary NeoplasmsLung cancer

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

This podcast is available on every device!

You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and all podcasting apps.

Download Interactive Content Blueprint Checklists for the PANCE, PANRE, EOR, and PANRE-LA

Interactive Content Blueprints for the PANCE PANRE and PANRE-LA

Follow this link to download your FREE copy of the PANCE/PANRE/EOR Content Blueprint Checklists.

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.

The post Podcast Episode 104: Ten PANCE, PANRE, and Rotation Review Questions appeared first on The Audio PANCE and PANRE.

  continue reading

67 bölüm

Tüm bölümler

×
 
Loading …

Player FM'e Hoş Geldiniz!

Player FM şu anda sizin için internetteki yüksek kalitedeki podcast'leri arıyor. En iyi podcast uygulaması ve Android, iPhone ve internet üzerinde çalışıyor. Aboneliklerinizi cihazlar arasında eş zamanlamak için üye olun.

 

Hızlı referans rehberi