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
B. Increased tactile fremitus
C. Unilateral lag on chest expansion
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.
B. Increased tactile fremitus would be consistent with a consolidation.
D. The presence of egophony would be consistent with a consolidation.
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?
B. Cyclophosphamide (Cytoxan)
C. Methotrexate (Rheumatrex)
D. Azathioprine (Imuran)
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.
C. Methotrexate is a folate inhibitor used to treat rheumatoid arthritis, not polymyalgia rheumatica.
D. Azathioprine is an immunosuppressant that is used to treat rheumatic disease and inflammatory bowel disease, not polymyalgia rheumatica.
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)
B. Oral trimethoprim-sulfamethoxazole (Bactrim)
C. IV gentamicin (Garamycin)
D. IV ceftriaxone (Rocephin)
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.
B. The fluoroquinolones and trimethoprim-sulfamethoxazole are contraindicated in pregnancy.
C. Gentamicin is not indicated as first line therapy in the treatment of pyelonephritis in a pregnant patient.
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
B. Inpatient electroconvulsive therapy
C. Outpatient paroxetine (Paxil) therapy
D. Outpatient psychotherapy
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
B. CT scan of abdomen and pelvis
C. Serum haptoglobin
D. Urine myoglobin
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.
C. A decreased serum haptoglobin is seen in hemolysis and does not provide information on renal status.
D. A positive test for blood in the absence of red blood cells on urine examination suggests myoglobinuria, and should be confirmed by electrophoresis.
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)
B. Sucralfate (Carafate)
C. Metoclopramide (Reglan)
D. Misoprostol (Cytotec)
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.
C. Metoclopramide is indicated for the treatment of gastroparesis as a first-line agent and as a second-line agent in the treatment of refractory gastroesophageal reflux.
D. Misoprostol is indicated for the prevention of NSAID-induced gastritis.
7. Radioactive iodine (I131) is most successful in treating hyperthyroidism that results from
A. Grave’s disease.
B. subacute thyroiditis.
C. Hashimoto’s thyroiditis.
D. papillary thyroid carcinoma.
Watch this ReelDx Video of a 16-year-old with ADHD presents with chest pain and exophthalmos
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.
C. Radioiodine uptake is low in Hashimoto’s thyroiditis making radioactive therapy ineffective.
D. Papillary thyroid carcinoma is a common thyroid malignancy and should be treated by a thyroidectomy.
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
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.
B. Atrial septal defect causes a fixed split S2 rather than a continuous systolic heart murmur.
C. Congenital aortic stenosis causes a crescendo-decrescendo systolic murmur heard best in the second intercostal space.
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
B. Chest x-ray
C. Nuclear stress test
D. Cardiac catheterization
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.
B. Chest x-ray is not used as a diagnostic study to evaluate symptoms of angina or coronary heart disease.
D. Coronary angiography is indicated in patients with classic stable angina who are severely symptomatic despite medical therapy and are being considered for percutaneous intervention (PCI), patients with troublesome symptoms that are difficult to diagnose, angina symptoms in a patient who has survived sudden cardiac death event, patients with ischemia on noninvasive testings.
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)
C. Percutaneous coronary intervention (PCI)
D. Warfarin (Coumadin)
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.
B. Streptokinase is not commonly used for the treatment of acute myocardial infarction because it is ineffective at opening the occluded artery and reducing mortality. Streptokinase would be harmful because it would increase the risk of bleeding.
D. Warfarin is used to prevent thrombosis and not for acute treatment.
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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.
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