Episode 41: The Audio PANCE and PANRE Board Review Podcast

The Audio PANCE and PANRE Physician Assistant Board Review Podcast

Welcome to episode 41 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover 10 PANCE and PANRE board review questions from the Academy course content following the NCCPA content blueprint.

This week we will be taking a break from topic specific board review and covering 10 general board review questions.

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 genitourinary board review includes over 72 GU specific questions and is available to all members of the PANCE and PANRE Academy.

• You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
• You can listen to the latest episode, take an interactive quiz and download your results below.

Listen Carefully Then Take The Quiz

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Episode 41 PANCE and PANRE Podcast Quiz

1. A mother brings her 6-year-old boy for evaluation of school behavior problems. She says the teacher told her that the boy does not pay attention in class, that he gets up and runs around the room when the rest of the children are listening to a story, and that he seems to be easily distracted by events outside or in the hall. He refuses to remain in his seat during class, and occasionally sits under his desk or crawls around under a table. The teacher told the mother this behavior is interfering with the child’s ability to function in the classroom and to learn. The mother states that she has noticed some of these behaviors at home, including his inability to watch his favorite cartoon program all the way through. Which of the following is the most likely diagnosis?

1. Antisocial disorder
2. Dysthymic mood disorder
3. Obsessive-compulsive disorder
4. Attention deficit hyperactivity disorder

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Answer: D. Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder is characterized by inattention, including increased distractibility and difficulty sustaining attention; poor impulse control and decreased self-inhibitory capacity; and motor over activity and motor restlessness, which are pervasive and interfere with the individual’s ability to function under normal circumstances.

Explanations

• Antisocial behavior disorder is characterized by disregard for rights of others; a defect in the experience of compunction or remorse for harming others.
• Dysthymic mood disorder is characterized by chronic, sad mood occurring for at least 2 years in an adult (one year in a child). Behavioral problems are not part of this disorder.
• Obsessive-compulsive disorder is characterized by recurrent obsessions and compulsions that result in anxiety and disruptive behaviors related to those compulsions.

2. Which of the following is the treatment of choice for a torus (buckle) fracture involving the distal radius?

A. Open reduction and internal fixation
B. Ace wrap or anterior splinting
C. Closed reduction and casting
D. Corticosteroid injection followed by splinting

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Answer: B. Ace wrap or anterior splinting

A torus or buckle fracture occurs after a minor fall on the hand. These fractures are very stable and are not as painful as unstable fractures. They heal uneventfully in 3-4 weeks.

3. Which of the following can be used to treat chronic bacterial prostatitis?

A. Penicillin
B. Cephalexin (Keflex)
C. Nitrofurantoin (Macrobid)
D. Levofloxacin (Levaquin)

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Answer: D. Levofloxacin (Levaquin)

Chronic bacterial prostatitis (Type II prostatitis) can be difficult to treat and requires the use of fluoroquinolones or trimethoprim-sulfamethoxazole, both of which penetrate the prostate.

4. A 25 year-old male with history of syncope presents for evaluation. The patient admits to intermittent episodes of rapid heart beating that resolve spontaneously. 12 Lead EKG shows delta waves and a short PR interval. Which of the following is the treatment of choice in this patient?

A. Radiofrequency catheter ablation
B. Verapamil (Calan)
C. Percutaneous coronary intervention
D. Digoxin (Lanoxin)

Click here to see the answer

Answer: A. Radiofrequency catheter ablation

Radiofrequency catheter ablation is the treatment of choice on patients with accessory pathways, such as Wolff-Parkinson-White Syndrome.

Explanations

• Calcium channel blockers such as verapamil decrease refractoriness of the accessory pathway or increase that of the AV node leading to faster ventricular rates, therefore calcium channel blockers should be avoided in patients with WPW.
• Percutaneous coronary intervention is indicated in the treatment of coronary artery disease, not preexcitation syndromes.
• (Digoxin decreases refractoriness of the accessory pathway and increases that of the AV node leading to faster ventricular rates. It should therefore be avoided in patients with WPW.

5. Which of the following pathophysiological processes is associated with chronic bronchitis?

A. Destruction of the lung parenchyma
B. Mucous gland enlargement and goblet cell hyperplasia
C. Smooth muscle hypertrophy in the large airways
D. Increased mucus adhesion secondary to reduction in the salt and water content of the mucus

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Answer: B. Mucous gland enlargement and goblet cell hyperplasia

Chronic bronchitis results from the enlargement of mucous glands and goblet cell hypertrophy in the large airways.

Explanations

• Destruction of the gas-exchanging structures in the lung is characteristic of emphysema.
• There may be smooth muscle hypertrophy in chronic bronchitis but it is not to the extent as found in asthma and is not an underlying factor in the pathology of chronic bronchitis.
• Abnormal absorption of sodium and a reduced rate of chloride secretion in cystic fibrosis leads to thickening of the mucus and increase in adhesion of the mucus.

6. Which of the following dietary substances interact with monoamine oxidase-inhibitor antidepressant drugs?

A. Lysine
B. Glycine
C. Tyramine
D. Phenylalanine

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Answer: C. Tyramine

Monoamine oxidase inhibitors are associated with serious food/drug and drug/drug interactions. Patient must restrict intake of foods having a high tyramine content to avoid serious reactions. Tyramine is a precursor to norepinephrine.

Explanations

Lysine, glycine, and phenylalanine are not known to interact with MAO inhibitors.

7. Gallstones usually result in biliary symptoms by causing inflammation or obstruction following migration into the common bile duct or

A. cystic duct
B. pancreatic duct
C. duodenal ampulla
D. common hepatic duct

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Answer: A. cystic duct

Obstruction of the cystic duct by gallstones causes the typical symptom of biliary colic. Once obstructed the gallbladder distends and becomes edematous and inflamed. Gallstones can also migrate into the common bile duct through the cystic duct leading to a condition known as choledocholithiasis.

Explanations

• Obstruction of the pancreatic duct leads to development of acute pancreatitis.
• The duodenal ampulla is the area where the pancreatic duct and the common bile duct empty into the duodenum. Gallstones do not cause obstruction at this distal site.
• The common hepatic duct from the liver joins the cystic duct from the gallbladder to form the common bile duct. Stone migration occurs along the pathway of the cystic duct to the common bile duct, not along the common hepatic duct.

8. An elderly patient with poorly-controlled Type 2 diabetes and renal disease develops a fever of 102°F orally, productive cough, and dyspnea. Physical examination demonstrates a respiratory rate of 32/min, labored breathing, and rales at the left base. Pulse oximetry is 90%. Which of the following is the next appropriate step in the management of this patient?

A. Administer nebulized corticosteroids
B. Admit to the hospital
C. Oral antimicrobial therapy
D. Endotracheal intubation

Click here to see the answer

Answer: B. Admit to the hospital

Community acquired pneumonia is the most deadly infectious disease in the U.S. Important risk factors for increased morbidity and mortality include advanced age, alcoholism, comorbid medical conditions, altered mental status, respiratory rate greater than 30 breaths/min, hypotension, and a BUN greater than 30.

Explanations

• Inhaled corticosteroids are not utilized in the management of community-acquired pneumonia.
• Due to the age of the patient, comorbid diseases, and current signs of respiratory distress, intravenous not oral antimicrobial therapy is indicated.
• Endotracheal intubation is indicated for respiratory failure unresponsive to conservative management.

9. A 53 year-old female who is well known to the practice presents to the office complaining of increasing fatigue, constipation, and a weight gain of 10 lb (4.5 kg) over the past year. She also states others have noticed a recent hoarseness to her voice, and she is bothered by “charley horses” in her legs that wake her up at night. Her past medical history is unremarkable except for a history of hyperthyroidism treated by radioactive iodine 5 years ago. She is currently taking no medications and has no known drug allergies. Which of the following is the most likely cause of the patient’s symptoms?

A. Hypothyroidism
B. Hypoparathyroidism
C. Vocal cord paralysis
D. Radiation thyroiditis

Click here to see the answer

Answer: A. Hypothyroidism

The current symptoms, along with the past treatment of hyperthyroidism with radioactive iodine, would indicate hypothyroidism.

Explanations

• This is a possible later complication of subtotal thyroidectomy, not radioactive iodine therapy.
• This is an immediate complication of subtotal thyroidectomy or injury and does not occur with radioactive iodine therapy.
• Radiation thyroiditis may occur following radiation therapy but there is no history of the patient having previous external beam radiation therapy.

10. Which of the following is most frequently associated with bladder cancer?

A. Hematuria
B. Dysuria
C. Urgency
D. Frequency

Click here to see the answer

Answer: A. Hematuria

Significant persistent hematuria >3 RBC/HPF on three urinalyses, a single urinalysis with >100 RBC, or gross hematuria, identifies significant renal or urologic lesions. Bladder cancer usually presents with painless hematuria.

Explanations

Dysuria, urgency, and frequency are associated with irritative voiding symptoms associated with cystitis.

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