Welcome to episode 49 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover ten PANCE and PANRE board review questions from the Academy course content following the NCCPA™ content blueprint (download the FREE cheat sheet).

This week we will be covering 10 general board review questions based on the NCCPA PANCE and PANRE Content Blueprint.

Below you will find an interactive exam to complement the podcast.

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Episode 49 PANCE and PANRE Podcast Quiz

The following 10 questions are linked to NCCPA Content Blueprint lessons from the SmartyPANCE PANCE and PANRE board review website. If you are a member and login you will be able to view this content.

1. Which of the following clinical findings would be seen in a patient with food poisoning caused by Staphylococcus aureus?

A. Ingestion of mayonnaise-based salads 48 hours earlier

B. Bloody diarrhea with mucus for one week

C. Abdominal cramps and vomiting for 48 hours

D. High fever for 1 week

Staphylococcus aureus food poisoning is part of the NCCPA Content Blueprint GI and Nutrition which accounts for 10% of the exam

Click here to see the answer Answer: C. Abdominal cramps and vomiting for 48 hours Abdominal cramps, nausea, vomiting, and watery diarrhea typically last 1-2 days with staphylococcal food poisoning. A. A preformed toxin causes staphylococcal food poisoning; it has a short incubation period of 1-8 hours.

B. Because Staphylococcus aureus does not invade the mucus, blood and mucus are not seen with this noninflammatory cause of food poisoning.

D. Staphylococcal food poisoning may be associated with low-grade fever or subnormal temperature.

2. Which of the following diagnostic tests should be ordered initially to evaluate for suspected deep venous thrombosis

A. Venogram

B. Arteriogram

C. Duplex ultrasound

D. Impedance plethysmography

Venous thrombosis is part of the NCCPA Cardiology Content Blueprint and represents 16% of the exam

Click here to see the answer Answer: C. Duplex ultrasound Ultrasound is the technique of choice to detect deep venous thrombosis in the leg. A. Venogram has been replaced by noninvasive tests due to discomfort, cost, technical difficulties, and complications, such as phlebitis.

B. Thrombophlebitis is a venous problem, not an arterial one. Any unnecessary invasive procedure is potentially harmful.

D. Impedance plethysmography is equivalent to ultrasound in detecting thrombi of the femoral and popliteal veins, but it may miss early, nonocclusive thrombi.

3. A patient presents with signs and symptoms of Cushing's syndrome. Extensive diagnostic evaluation reveals an ACTH-secreting pituitary adenoma. First-line therapy should consist of

A. pituitary radiation

B. medical adrenalectomy

C. transsphenoidal resection of the tumor

D. amiloride (Midamor)

Cushings disease is part of the NCCPA Content Blueprint Endocrinology which represents 6% of your exam

Click here to see the answer Answer: C. transsphenoidal resection of the tumor

Transsphenoidal resection of the tumor cures about 80% of patients. The remainder can be given a combination of pituitary radiation and medical adrenalectomy with one or more drugs. If these procedures fail, the last option is bilateral adrenalectomy.

4. A 26-year-old man is stung by a bee, and shortly thereafter, a wheal develops at the site of the sting. He soon feels flushed and develops hives, rhinorrhea, and tightness in the chest. He is seen in the urgent care center. Immediate therapy should be to

A. transfer him to a local hospital emergency department

B. apply a cold compress to site of the sting

C. administer subcutaneous epinephrine

D. administer oral albuterol

Click here to see the answer Answer: C. administer subcutaneous epinephrine Epinephrine hydrochloride 1:1000, 0.2 to 0.5 mL subcutaneously is indicated for the initial treatment of this systemic reaction. Additional injections may be given every 20 to 30 minutes if needed. A. Systemic (anaphylactic) reactions can rapidly become life-threatening. Delay in treatment may cause death.

B. This is only supportive local therapy and does not address the need to treat the systemic reaction present.

D. Albuterol is indicated in the presence of bronchospasm (suggested by the presence of chest tightness) but would be delivered by an aerosol, not an oral, route.

5. An 18-year-old sexually active female was seen in the student health clinic 1 week ago for a sore throat. A streptococcal antigen test was positive, and she was given a prescription for oral penicillin. After 3 days, she stopped her medication because she felt better. She now presents with a severe sore throat. On physical examination, she has a temperature of 102.6° F (39.2° C), marked pharyngeal erythema, medial deviation of the soft palate on the left, tender left anterior cervical adenopathy, and a "hot potato" voice. The rest of her history and physical examination are unremarkable. Which of the following is the most likely diagnosis?

A. Recurrent streptococcal pharyngitis

B. Infectious mononucleosis

C. Gonococcal pharyngitis

D. Peritonsillar abscess

Peritonsillar abscess is covered as part of the NCCPA Content Blueprint EENT which accounts for 6% of your exam

View this ReelDx patient video case ~4d pain back of throat; swelling; difficulty swallowing

SmartyPANCE ReelDx + members can view this real-world case!

Click here to see the answer Answer: D. Peritonsillar abscess The soft palate deviation and a muffled voice are classic signs of peritonsillar abscess. A. This presentation suggests a complication of an incompletely treated streptococcal pharyngitis rather than recurrent disease

B. Infectious mononucleosis may present with a severe sore throat and cervical adenopathy in this age group, but would not cause deviation of the soft palate or the muffled voice

C. Gonococcal pharyngitis usually follows a more indolent course than this patient’s presentation

6. Which of the following would provide the most specific information regarding the functional cardiac status in a patient with chronic heart failure?

A. Electrocardiogram

B. Chest x-ray

C. Serum electrolytes

D. Echocardiogram

Heart Failure is covered as part of the NCCPA Content Blueprint Cardiology and accounts for 16% of the exam

View this SMARTYPANCE ReelDx patient video case: 45-year-old female with difficulty breathing; edema; 8/10 chest pain and whole-body pain

SmartyPANCE ReelDx + members can view this real-world case!

Click here to see the answer Answer: D. Echocardiogram An echocardiogram will estimate ejection fraction, which is an indicator of left ventricular function. A. Electrocardiogram offers no specific information of functional status but may provide clues about the cause.

B. A chest x-ray may show findings of chronic heart failure, such as cardiomegaly or pulmonary congestion, but does not reflect cardiac functional status.

C. Serum electrolytes may be abnormal, either as a result of heart failure, or as a contributing factor, but they do not indicate functional status.

7. A 33-year-old female presents for follow-up of her Pap smear that showed a low-grade squamous intraepithelial lesion. Reflex HPV testing is positive. Which of the following is the most appropriate diagnostic procedure?

A. Cone biopsy

B. Aspiration needle biopsy

C. Dilation and curettage

D. Colposcopy-directed biopsy

Cervical dysplasia and cervical cancer are covered as part of the NCCPA Content Blueprint Reproductive system and accounts for 8% of your exam

Click here to see the answer Answer: D. Colposcopy-directed biopsy A colposcopy-directed biopsy is the first diagnostic evaluation indicated for cervical dysplasia. A. A cervical cone biopsy may be indicated in further evaluation of this patient, but it is dependent on the results of the colposcopy.

B. An aspiration needle biopsy has no role in the evaluation of cervical dysplasia.

C. Dilatation and curettage has no role in either the diagnosis or treatment of isolated cervical dysplasia.



8. A decrease in the fetal heart rate (FHR) occurring late during contractions is noted. The FHR returns to the baseline slowly after the uterine contraction. The physician assistant should be alerted to the possibility of

A. pelvic dystocia

B. precipitous labor

C. fetal head compression

D. placental insufficiency

Fetal distress is covered as part of the NCCPA Content Blueprint Reproductive system and accounts for 8% of your exam

SmartyPANCE ReelDx + members can view this real-world case!

Click here to see the answer Answer: D. placental insufficiency Placental insufficiency is the probable cause of fetal distress resulting in late decelerations. A. Pelvic dystocia, particularly that due to small bony architecture, is the most common cause of passage abnormalities and is not directly associated with FHR decelerations.

B. This refers to the length of labor, not decelerations in FHR.

C. The drop in FHR is caused by an interference with uterine blood flow to the intervillous space causing an early, not late, deceleration.

9. A 36-year-old patient with cardiomyopathy secondary to viral myocarditis develops fatigue, increasing dyspnea, and lower extremity edema over the past 3 days. He denies fever. A chest x-ray shows no significant increase in heart size but reveals prominence of the superior pulmonary vessels. Based on these clinical findings, which of the following is the most likely diagnosis?



A. Heart failure

B. Subacute bacterial endocarditis

C. Pulmonary embolus

D. Pneumonia

Heart Failure is covered as part of the NCCPA Content Blueprint Cardiology and accounts for 16% of the exam

Click here to see the answer Answer: A. Heart failure

Given the presence of cardiomyopathy, the patient’s heart has decreased functional reserve. The symptoms and chest x-ray findings are typical of congestive heart failure. B. Endocarditis occurs as a result of an infection that primarily occurs in the blood stream. Endocarditis would present with signs of infection or seeding rather than signs of heart failure.

C. Pulmonary embolus usually presents with an acute onset of chest pain, severe dyspnea, and anxiety.

D. Pneumonia is less likely since there is no fever and edema is not usually associated with pneumonia.

10. Which of the following is the first-line treatment for symptomatic bradyarrhythmias due to sick sinus syndrome (SSS)?

A. Permanent pacemaker

B. Radiofrequency ablation

C. Antiarrhythmics

D. Anticoagulation therapy

Sick sinus syndrome is covered as part of the NCCPA Cardiology Content Blueprint which is 16% of your exam

Click here to see the answer Answer: A. Permanent pacemaker

Permanent pacemakers are the therapy of choice in patients with symptomatic bradyarrhythmias in sick sinus syndrome. B. Radiofrequency ablation is used for the treatment of accessory pathways in the heart.

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