Welcome to episode 59 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.
Join me as I cover ten Emergency Medicine End of Rotation Exam (EOR) review questions from the SMARTYPANCE course content following the NCCPA and PAEA content blueprint (download the FREE cheat sheet).
This week we will be covering ten emergency medicine end of rotation exam 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. 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
B. Prolapse of orbital soft tissue
C. Hematoma of the orbit
D. Orbital emphysema
Answer: C. Hematoma of the orbit
Orbital hemorrhage into the space surrounding the globe following blunt trauma and rupture of the orbital vessels results in increased ocular pressure, proptosis, visual loss, and limitation of movement in all directions. CT reveals a hematoma.
A. Fracture of the medial orbital wall is associated with diplopia from medial rectus impingement, orbital emphysema, and epistaxis.
B. Prolapse of orbital soft tissue, including inferior rectus muscle, inferior oblique muscle, orbital fat, and connective tissue results in enophthalmos, ptosis, diplopia, anesthesia of the ipsilateral cheek and upper lip, and limitation of upward gaze and is seen with fractures of the orbital floor.
D. Orbital emphysema is seen with fractures of the medial orbital wall or floor of the orbit into the maxillary and ethmoid sinuses respectively. It will not lead to proptosis.
2. A 29-year-old male presents with a complaint of substernal chest pain for 12 hours. The patient states that the pain 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 for this patient?
C. Percutaneous coronary intervention
D. Indomethacin (Indocin)
Answer: D. Indomethacin
Indomethacin, a nonsteroidal anti-inflammatory medication, is the treatment of choice in a patient with acute pericarditis.
A. Pericardiocentesis is the treatment of choice in a patient with a pericardial effusion and cardiac tamponade, there is no evidence of either of these in this patient.
B. Nitroglycerin is indicated in the treatment of chest pain related to angina.
C. Percutaneous coronary intervention is the treatment of choice in a patient with an acute myocardial infarction.
3. 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
B. Hypersegmented neutrophils
C. Hypochromic red blood cells
Answer: A. Atypical lymphocytes
The hallmark of infectious mononucleosis is the presence of lymphocytosis with atypical large lymphocytes seen in the blood smear. These are larger than normal mature lymphocytes, stain more darkly, and frequently show vacuolated, foamy cytoplasm, and dark chromatin in the nucleus.
B. Hypersegmented neutrophils are seen in vitamin B12 deficiency.
C. Anemia, if seen in mononucleosis, is normocytic and normochromic.
D. Schistocytes are noted in hemolytic anemias.
4. A 30-year-old female complains of fatigue, weakness, diminished appetite, weight loss, and syncope. She denies fever, chest or abdominal pain, palpitations, changes in bowel patterns or sleep patterns. Physical examination reveals a thin female, BP 90/65 mmHg, and pulse 80 beats per minute. Pulmonary, cardiovascular, abdominal, and neurologic exam are without abnormalities. Areas of brown and bronze hyperpigmentation are noted on her elbows and the creases of her hands. Which of the following tests will be the most useful in making the diagnosis?
A. Drug screen
B. Urine dipstick
C. Complete blood count
D. Serum creatinine kinase
Answer: D. Serum creatinine kinase
Serum creatinine kinase is the most sensitive test to detect rhabdomyolysis, a serious complication of seizures and hyperthermia related to drug abuse.
A. Although a drug screen may identify specific drugs, the results will not alter the care of this patient.
B. Urine dipstick is not sensitive for myoglobinuria.
C. This patient is at risk for myoglobinuria, and a complete blood count will not alter the treatment.
5. A 15-year-old male was seen last week with complaints of a 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
B. mycoplasma pneumonia.
C. pneumococcal pneumonia.
D. staphylococcal pneumonia.
Answer: B. mycoplasma pneumonia.
The insidious onset of symptoms, the interstitial infiltrates on chest x-ray, and elevated cold hemagglutinin titer makes this diagnosis the most likely.
A. Most children with pulmonary tuberculosis are asymptomatic with few physical examination findings. The results of the diagnostic studies do not support tuberculosis as the most likely diagnosis.
C. The clinical presentation of bacterial pneumonia in children is variable, but usually involves fever of acute onset. The WBC count is also usually elevated, making this a less likely diagnosis.
Answer: A. Extreme vulvar irritation
Candida infection presents with pruritus, vulvovaginal erythema, and white, cheese-like (curd) discharge that may be malodorous.
B. A firm painless ulcer is seen in syphilis.
C. Tender lymphadenopathy is associated with bacterial infections and is not a feature of candidal vulvovaginitis.
D. Purulent discharge is noted in gonorrhea.
7. 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
B. Inferior wall myocardial infarction
C. Acute pericarditis
D. Pulmonary embolus
Answer: B. Inferior wall myocardial infarction
Myocardial infarction often presents with chest pressure and associated nausea and vomiting. ST-segment elevation in leads II, III, and AVF are classic findings seen in acute inferior wall myocardial infarction.
A. A patient with aortic dissection will complain of tearing, ripping pain. EKG is often normal but may reveal left ventricular strain pattern.
C. Acute pericarditis presents with atypical chest pain and diffuse ST-segment elevation.
D. Pulmonary embolism often presents with either no EKG changes or sinus tachycardia. Classically described, rarely seen findings include a large S wave in lead I, a Q wave with T wave inversion in lead III, ST-segment depression in lead II, T wave inversion in leads V1-V4 and a transient right bundle branch block.
Answer: C. Coxsackievirus
Coxsackievirus presents with small grayish vesicles and punched-out ulcers in the posterior pharynx.
A. Epstein-Barr virus presents with enlarged tonsils with exudates and petechiae of the palate.
B. Group C Streptococcus presents with a red pharynx and enlarged tonsils with a yellow, blood tinged exudates
D. Neisseria gonorrhea of the pharynx may be asymptomatic
9. Which of the following is the most appropriate management of acute psychosis in a patient with schizophrenia?
Answer: B. Risperidone (Risperdal)
There are numerous options used in the management of acute psychosis including benzodiazepines and antipsychotics such as haloperidol (first generation – typical -antipsychotic), risperidone or aripiprazole (second Generation – atypical – antipsychotics). Antidepressants and lithium have no benefit in the treatment of acute psychosis.
Schizophrenia is covered as part of the NCCPA psychiatry Content Blueprint which accounts for 6% of your exam.
10. A 25-year-old presents with pain in the proximal ulna after falling directly on the forearm. X-ray shows a 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
B. Monteggia fracture
C. Colles’ fracture
D. Smith fracture
Answer: B. Monteggia fracture
A Monteggia fracture is a fracture of the proximal ulna with anterior dislocation of the radial head.
A. A Galeazzi fracture is a fracture along the length of the radius with an injury to the distal radioulnar joint.
C. A Colles’ fracture is a fracture of the distal radius with dorsal displacement of the radial head.
D. A Smith fracture is a fracture of the distal radius with a ventral displacement of the radial head.
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